Health and Cultural Impacts of Female Genital Mutilation or Cutting (FGM/C)

Female Genital Mutilation (FGM) is a cultural process that involves the cutting of the female genitalia. Although it is widely known as FGM, in the field prefer to address it as "cutting," so that the stigma of mutilation is not endowed upon women who have undergone this rite.

FGM is mainly practiced in parts of Africa, the Middle East, and Asia. Its presence has been historically documented over thousands of years and it transcends religious affiliations. Until recently, many people in the West attributed to a practice of tribal communities. However, this is not always the case, because tradition seems to prevail regardless of social status. In the increasingly global community in which we live, the custom of FGM is often brought over with migrants who move to Europe or the United States. Young girls of immigrants may be sent back home on holiday to undergo the rite or a cutter, the person who performs the rite, may be in the community.

The awareness of FGM in the West has posed new problems both around cultural understanding and health management toward these female immigrants. In the West, FGM is generally viewed as a barbaric, cruel, and unnecessary procedure for women and girls. This view is valid and the World Health Organization (WHO) has also put weight behind eradication of the procedure. However, many people fail to acknowledge that communities practicing FGM do so out of custom. It is not seen as an act of punishment. This may be difficult to digest, but communities who do this to their daughters do so to preserve their honor in marriage. The cutting, and sometimes sewing, is what a man expects when he marries to ensure his wife’s honor has been preserved. Without this seal of approval a woman can be rejected and in parts of the world where a woman’s livelihood depends on her allegiance to a man, not having undergone this violation can result in a life spent in solitude.

Tears are wiped from the face of a 9-month old following her circumcision
Copyright: Stephanie Sinclair, New York Times

From a health perspective, the complications resulting from FGM are often not openly discussed in communities due to respectful discretion. Yet, the complications are often severe and can be lifelong. Cutting any of the vulva tissues causes intense pain; women can die from hemorrhage; and shock from the procedure is common. Then, there is the risk of infection. Most FGM is not practiced in sterile conditions, a blade may be used on a number of girls. Some cutters employ the alternative of sharp stones or broken glass. There is also the psychological trauma that these girls suffer and may continue to be affected by as women. Finally, there is the possibility of long-term complications. These can range from painful or blocked menses, difficulty in passing urine, urinary tract infections, infertility, increased risk of fistula and, finally, increased risk of maternal and child morbidity due to obstructed labor.

Women Gather for a Cutting Ceremony
Copyright: IRIN - Integrated Regional Information Networks

In traditional settings, herbal remedies and rest would be used to alleviate the symptoms. In the West, women may try health clinics to access treatment. This poses another problem: immigrant women often face a multitude of barriers preventing them adequate access to healthcare to begin with. Many women who have tried to access treatment express the cultural incompetency of health professionals who often judge the practice and express visible horror at the sight of their genitalia. Health professionals in the West have often not seen genitals that have been cut, and some minority women may feel too timid to even see a doctor. Furthermore, health professionals may not have an understanding about what the consequences of FGM are or how to effectively deal with the problems resulting from the procedure. Education on the topic among health professionals remains a highly specialized field and enough information has not trickled down to more generalized health professionals

On the upside, clinics have been formed in communities of immigrants to specially address health problems from FGM. On an international level, work from UNICEF, WHO, and other global health agencies as well as celebrity campaigns such as Waris Darie through the Desert Flower Foundation have helped reduce -- and sometimes eradicate --FGM from communities where it is practiced.

Through appropriate dialogue and education, communities can continue to make progress in this area as should the medical community.