Female genital mutilation | Wikipedia audio article

Female genital mutilation (FGM), also known
as female genital cutting and female circumcision, is the ritual cutting or removal of some or
all of the external female genitalia. The practice is found in Africa, Asia and the
Middle East, and within communities from countries in which FGM is common. UNICEF estimated in
2016 that 200 million women living today in 30 countries—27 African countries, Indonesia,
Iraqi Kurdistan and Yemen—have undergone the procedures.Typically carried out by a
traditional circumciser using a blade, FGM is conducted from days after birth to puberty
and beyond. In half the countries for which national figures are available, most girls
are cut before the age of five. Procedures differ according to the country or ethnic
group. They include removal of the clitoral hood and clitoral glans; removal of the inner
labia; and removal of the inner and outer labia and closure of the vulva. In this last
procedure, known as infibulation, a small hole is left for the passage of urine and
menstrual fluid; the vagina is opened for intercourse and opened further for childbirth.The
practice is rooted in gender inequality, attempts to control women’s sexuality, and ideas about
purity, modesty and beauty. It is usually initiated and carried out by women, who see
it as a source of honour and fear that failing to have their daughters and granddaughters
cut will expose the girls to social exclusion. Adverse health effects depend on the type
of procedure; they can include recurrent infections, difficulty urinating and passing menstrual
flow, chronic pain, the development of cysts, an inability to get pregnant, complications
during childbirth, and fatal bleeding. There are no known health benefits.There have been
international efforts since the 1970s to persuade practitioners to abandon FGM, and it has been
outlawed or restricted in most of the countries in which it occurs, although the laws are
poorly enforced. Since 2010 the United Nations has called upon healthcare providers to stop
performing all forms of the procedure, including reinfibulation after childbirth and symbolic
“nicking” of the clitoral hood. The opposition to the practice is not without its critics,
particularly among anthropologists, who have raised difficult questions about cultural
relativism and the universality of human rights.==Terminology==Until the 1980s FGM was widely known in English
as female circumcision, implying an equivalence in severity with male circumcision. From 1929
the Kenya Missionary Council referred to it as the sexual mutilation of women, following
the lead of Marion Scott Stevenson, a Church of Scotland missionary. References to the
practice as mutilation increased throughout the 1970s. In 1975 Rose Oldfield Hayes, an
American anthropologist, used the term female genital mutilation in the title of a paper
in American Ethnologist, and four years later Fran Hosken, an Austrian-American feminist
writer, called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation
of Females. The Inter-African Committee on Traditional Practices Affecting the Health
of Women and Children began referring to it as female genital mutilation in 1990, and
the World Health Organization (WHO) followed suit in 1991. Other English terms include
female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those
who work with practitioners.In countries where FGM is common, the practice’s many variants
are reflected in dozens of terms, often alluding to purification. In the Bambara language,
spoken mostly in Mali, it is known as bolokoli (“washing your hands”) and in the Igbo language
in eastern Nigeria as isa aru or iwu aru (“having your bath”). Other terms include khifad, tahoor,
quodiin, irua, bondo, kuruna, negekorsigin, and kene-kene. A common Arabic term for purification
has the root t-h-r, used for male and female circumcision (tahur and tahara). It is also
known in Arabic as khafḍ or khifaḍ. Communities may refer to FGM as “pharaonic” for infibulation
and “sunna” circumcision for everything else. Sunna means “path or way” in Arabic and refers
to the tradition of Muhammad, although none of the procedures are required within Islam.
The term infibulation derives from fibula, Latin for clasp; the Ancient Romans reportedly
fastened clasps through the foreskins or labia of slaves to prevent sexual intercourse. The
surgical infibulation of women came to be known as pharaonic circumcision in Sudan,
and as Sudanese circumcision in Egypt. In Somalia it is known simply as qodob (“to sew
up”).==Methods==The procedures are generally performed by
a traditional circumciser (cutter or exciseuse) in the girls’ homes, with or without anaesthesia.
The cutter is usually an older woman, but in communities where the male barber has assumed
the role of health worker he will also perform FGM. When traditional cutters are involved,
non-sterile devices are likely to be used, including knives, razors, scissors, glass,
sharpened rocks and fingernails. According to a nurse in Uganda, quoted in 2007 in The
Lancet, a cutter would use one knife on up to 30 girls at a time. Health professionals
are often involved in Egypt, Kenya, Indonesia and Sudan; in Egypt 77 percent of FGM procedures,
and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016.
Women in Egypt reported in 1995 that a local anaesthetic had been used on their daughters
in 60 percent of cases, a general anaesthetic in 13 percent, and neither in 25 percent (two
percent were missing/don’t know).==Classification=====
Variation===The WHO, UNICEF and UNFPA issued a joint statement
in 1997 defining FGM as “all procedures involving partial or total removal of the external female
genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic
reasons”. The procedures vary according to ethnicity and individual practitioners; during
a 1998 survey in Niger, women responded with over 50 terms when asked what was done to
them. Translation problems are compounded by the women’s confusion over which type of
FGM they experienced, or even whether they experienced it. Studies have suggested that
survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said
they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the
other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that
73 percent had undergone it. In Sudan in 2006, a significant percentage of infibulated women
and girls reported a less severe type.===Types===Standard questionnaires from United Nations
bodies ask women whether they or their daughters have undergone the following: (1) cut, no
flesh removed (symbolic nicking); (2) cut, some flesh removed; (3) sewn closed; or (4)
type not determined/unsure/doesn’t know. The most common procedures fall within the “cut,
some flesh removed” category and involve complete or partial removal of the clitoral glans.
The World Health Organization (a UN agency) created a more detailed typology in 1997:
Types I–II vary in how much tissue is removed; Type III is equivalent to the UNICEF category
“sewn closed”; and Type IV describes miscellaneous procedures, including symbolic nicking.====Type I====
Type I is “partial or total removal of the clitoris and/or the prepuce”. Type Ia involves
removal of the clitoral hood only. This is rarely performed alone. The more common procedure
is Type Ib (clitoridectomy), the complete or partial removal of the clitoral glans (the
visible tip of the clitoris) and clitoral hood. The circumciser pulls the clitoral glans
with her thumb and index finger and cuts it off.====Type II====
Type II (excision) is the complete or partial removal of the inner labia, with or without
removal of the clitoral glans and outer labia. Type IIa is removal of the inner labia; Type
IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral
glans, inner and outer labia. Excision in French can refer to any form of FGM.====Type III====Type III (infibulation or pharaonic circumcision),
the “sewn closed” category, is the removal of the external genitalia and fusion of the
wound. The inner and/or outer labia are cut away, with or without removal of the clitoral
glans. Type III is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia,
Somalia, and Sudan (although not in South Sudan). According to one 2008 estimate, over
eight million women in Africa are living with Type III FGM. According to UNFPA in 2010,
20 percent of women with FGM have been infibulated. In Somalia, according to Edna Adan Ismail,
the child squats on a stool or mat while adults pull her legs open; a local anaesthetic is
applied if available: The element of speed and surprise is vital
and the circumciser immediately grabs the clitoris by pinching it between her nails
aiming to amputate it with a slash. The organ is then shown to the senior female relatives
of the child who will decide whether the amount that has been removed is satisfactory or whether
more is to be cut off. After the clitoris has been satisfactorily
amputated … the circumciser can proceed with the total removal of the labia minora
and the paring of the inner walls of the labia majora. Since the entire skin on the inner
walls of the labia majora has to be removed all the way down to the perineum, this becomes
a messy business. By now, the child is screaming, struggling, and bleeding profusely, which
makes it difficult for the circumciser to hold with bare fingers and nails the slippery
skin and parts that are to be cut or sutured together. … Having ensured that sufficient tissue has
been removed to allow the desired fusion of the skin, the circumciser pulls together the
opposite sides of the labia majora, ensuring that the raw edges where the skin has been
removed are well approximated. The wound is now ready to be stitched or for thorns to
be applied. If a needle and thread are being used, close tight sutures will be placed to
ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum,
and which, after the wound heals, will form a bridge of scar tissue that will totally
occlude the vaginal introitus. The amputated parts might be placed in a pouch
for the girl to wear. A single hole of 2–3 mm is left for the passage of urine and menstrual
fluid. The vulva is closed with surgical thread, or agave or acacia thorns, and might be covered
with a poultice of raw egg, herbs and sugar. To help the tissue bond, the girl’s legs are
tied together, often from hip to ankle; the bindings are usually loosened after a week
and removed after two to six weeks. If the remaining hole is too large in the view of
the girl’s family, the procedure is repeated.The vagina is opened for sexual intercourse, for
the first time either by a midwife with a knife or by the woman’s husband with his penis.
In some areas, including Somaliland, female relatives of the bride and groom might watch
the opening of the vagina to check that the girl is a virgin. The woman is opened further
for childbirth (defibulation or deinfibulation), and closed again afterwards (reinfibulation).
Reinfibulation can involve cutting the vagina again to restore the pinhole size of the first
infibulation. This might be performed before marriage, and after childbirth, divorce and
widowhood. Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the
1980s about sexual intercourse with Type III: The penetration of the bride’s infibulation
takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their
wives at all (in my study over 15%), and the task is often accomplished by a midwife under
conditions of great secrecy, since this reflects negatively on the man’s potency. Some who
are unable to penetrate their wives manage to get them pregnant in spite of the infibulation,
and the woman’s vaginal passage is then cut open to allow birth to take place. … Those
men who do manage to penetrate their wives do so often, or perhaps always, with the help
of the “little knife”. This creates a tear which they gradually rip more and more until
the opening is sufficient to admit the penis.====Type IV====
Type IV is “[a]ll other harmful procedures to the female genitalia for non-medical purposes”,
including pricking, piercing, incising, scraping and cauterization. It includes nicking of
the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing
substances into the vagina to tighten it. Labia stretching is also categorized as Type
IV. Common in southern and eastern Africa, the practice is supposed to enhance sexual
pleasure for the man and add to the sense of a woman as a closed space. From the age
of eight, girls are encouraged to stretch their inner labia using sticks and massage.
Girls in Uganda are told they may have difficulty giving birth without stretched labia.A definition
of FGM from the WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria
and Niger. These were removed from the WHO’s 2008 definition because of insufficient information
about prevalence and consequences. Angurya cutting is excision of the hymen, usually
performed seven days after birth. Gishiri cutting involves cutting the vagina’s front
or back wall with a blade or penknife, performed in response to infertility, obstructed labour
and other conditions. In a study by Nigerian physician Mairo Usman Mandara, over 30 percent
of women with gishiri cuts were found to have vesicovaginal fistulae (holes that allow urine
to seep into the vagina).==Complications=====
Short-term and late===FGM harms women’s physical and emotional health
throughout their lives. It has no known health benefits. The short-term and late complications
depend on the type of FGM, whether the practitioner has had medical training, and whether they
used antibiotics and sterilized or single-use surgical instruments. In the case of Type
III, other factors include how small a hole was left for the passage of urine and menstrual
blood, whether surgical thread was used instead of agave or acacia thorns, and whether the
procedure was performed more than once (for example, to close an opening regarded as too
wide or re-open one too small). Common short-term complications include swelling,
excessive bleeding, pain, urine retention, and healing problems/wound infection. A 2014
systematic review of 56 studies suggested that over one in ten girls and women undergoing
any form of FGM, including symbolic nicking of the clitoris (Type IV), experience immediate
complications, although the risks increased with Type III. The review also suggested that
there was under-reporting. Other short-term complications include fatal bleeding, anaemia,
urinary infection, septicaemia, tetanus, gangrene, necrotizing fasciitis (flesh-eating disease),
and endometritis. It is not known how many girls and women die as a result of the practice,
because complications may not be recognized or reported. The practitioners’ use of shared
instruments is thought to aid the transmission of hepatitis B, hepatitis C and HIV, although
no epidemiological studies have shown this.Late complications vary depending on the type of
FGM. They include the formation of scars and keloids that lead to strictures and obstruction,
epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue)
involving nerves that supplied the clitoris. An infibulated girl may be left with an opening
as small as 2–3 mm, which can cause prolonged, drop-by-drop urination, pain while urinating,
and a feeling of needing to urinate all the time. Urine may collect underneath the scar,
leaving the area under the skin constantly wet, which can lead to infection and the formation
of small stones. The opening is larger in women who are sexually active or have given
birth by vaginal delivery, but the urethra opening may still be obstructed by scar tissue.
Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces
to seep into the vagina). This and other damage to the urethra and bladder can lead to infections
and incontinence, pain during sexual intercourse and infertility. Painful periods are common
because of the obstruction to the menstrual flow, and blood can stagnate in the vagina
and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra
(where the vagina and uterus fill with menstrual blood). The swelling of the abdomen and lack
of menstruation can resemble pregnancy; Asma El Dareer, a Sudanese physician, reported
in 1979 that a girl in Sudan with this condition was killed by her family.===Pregnancy, childbirth===FGM may place women at higher risk of problems
during pregnancy and childbirth, which are more common with the more extensive FGM procedures.
Infibulated women may try to make childbirth easier by eating less during pregnancy to
reduce the baby’s size. In women with vesicovaginal or rectovaginal fistulae, it is difficult
to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such
as pre-eclampsia harder. Cervical evaluation during labour may be impeded and labour prolonged
or obstructed. Third-degree laceration (tears), anal-sphincter damage and emergency caesarean
section are more common in infibulated women.Neonatal mortality is increased. The WHO estimated
in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM.
The estimate was based on a study conducted on 28,393 women attending delivery wards at
28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. In those
settings all types of FGM were found to pose an increased risk of death to the baby: 15
percent higher for Type I, 32 percent for Type II, and 55 percent for Type III. The
reasons for this were unclear, but may be connected to genital and urinary tract infections
and the presence of scar tissue. According to the study, FGM was associated with an increased
risk to the mother of damage to the perineum and excessive blood loss, as well as a need
to resuscitate the baby, and stillbirth, perhaps because of a long second stage of labour.===Psychological effects, sexual function
===According to a 2015 systematic review there
is little high-quality information available on the psychological effects of FGM. Several
small studies have concluded that women with FGM suffer from anxiety, depression and post-traumatic
stress disorder. Feelings of shame and betrayal can develop when women leave the culture that
practises FGM and learn that their condition is not the norm, but within the practising
culture they may view their FGM with pride, because for them it signifies beauty, respect
for tradition, chastity and hygiene. Studies on sexual function have also been small. A
2013 meta-analysis of 15 studies involving 12,671 women from seven countries concluded
that women with FGM were twice as likely to report no sexual desire and 52 percent more
likely to report dyspareunia (painful sexual intercourse). One third reported reduced sexual
feelings.==Distribution=====Household surveys===Aid agencies define the prevalence of FGM
as the percentage of the 15–49 age group that has experienced it. These figures are
based on nationally representative household surveys known as Demographic and Health Surveys
(DHS), developed by Macro International and funded mainly by the United States Agency
for International Development (USAID); and Multiple Indicator Cluster Surveys (MICS)
conducted with financial and technical help from UNICEF. These surveys have been carried
out in Africa, Asia, Latin America and elsewhere roughly every five years, since 1984 and 1995
respectively. The first to ask about FGM was the 1989–1990 DHS in northern Sudan. The
first publication to estimate FGM prevalence based on DHS data (in seven countries) was
written by Dara Carr of Macro International in 1997.===Type of FGM===
Questions the women are asked during the surveys include: “Was the genital area just nicked/cut
without removing any flesh? Was any flesh (or something) removed from the genital area?
Was your genital area sewn?” Most women report “cut, some flesh removed” (Types I and II).Type
I is the most common form in Egypt, and in the southern parts of Nigeria. Type III (infibulation)
is concentrated in northeastern Africa, particularly Djibouti, Eritrea, Somalia and Sudan. In surveys
in 2002–2006, 30 percent of cut girls in Djibouti, 38 percent in Eritrea, and 63 percent
in Somalia had experienced Type III. There is also a high prevalence of infibulation
among girls in Niger and Senegal, and in 2013 it was estimated that in Nigeria three percent
of the 0–14 age group had been infibulated. The type of procedure is often linked to ethnicity.
In Eritrea, for example, a survey in 2002 found that all Hedareb girls had been infibulated,
compared with two percent of the Tigrinya, most of whom fell into the “cut, no flesh
removed” category.===Prevalence===FGM is mostly found in what Gerry Mackie called
an “intriguingly contiguous” zone in Africa—east to west from Somalia to Senegal, and north
to south from Egypt to Tanzania. Nationally representative figures are available for 27
countries in Africa, as well as Indonesia, Iraqi Kurdistan and Yemen. Over 200 million
women and girls are thought to be living with FGM in those 30 countries.The highest concentrations
among the 15–49 age group are in Somalia (98 percent), Guinea (97 percent), Djibouti
(93 percent), Egypt (91 percent) and Sierra Leone (90 percent). As of 2013, 27.2 million
women had undergone FGM in Egypt, 23.8 million in Ethiopia, and 19.9 million in Nigeria.
There is a high concentration in Indonesia, where according to UNICEF Type I (clitoridectomy)
and Type IV (symbolic nicking) are practised; the Indonesian Ministry of Health and Indonesian
Ulema Council both say the clitoris should not be cut. The prevalence rate for the 0–11
group in Indonesia is 49 percent (13.4 million). Smaller studies or anecdotal reports suggest
that FGM is also practised in Colombia, Jordan, Oman, Saudi Arabia and parts of Malaysia;
in the United Arab Emirates; and in India by the Dawoodi Bohra. It is found within immigrant
communities around the world.Prevalence figures for the 15–19 age group and younger show
a downward trend. For example, Burkina Faso fell from 89 percent (1980) to 58 percent
(2010); Egypt from 97 percent (1985) to 70 percent (2015); and Kenya from 41 percent
(1984) to 11 percent (2014). Beginning in 2010, household surveys asked women about
the FGM status of all their living daughters. The highest concentrations among girls aged
0–14 were in Gambia (56 percent), Mauritania (54 percent), Indonesia (49 percent for 0–11)
and Guinea (46 percent). The figures suggest that a girl was one third less likely in 2014
to undergo FGM than she was 30 years ago. According to a 2018 study published in BMJ
Global Health, the prevalence within the 0–14 year old group fell in East Africa from 71.4
percent in 1995 to 8 percent in 2016; in North Africa from 57.7 percent in 1990 to 14.1 percent
in 2015; and in West Africa from 73.6 percent in 1996 to 25.4 percent in 2017. If the current
rate of decline continues, the number of girls cut will nevertheless continue to rise because
of population growth, according to UNICEF in 2014; they estimate that the figure will
increase from 3.6 million a year in 2013 to 4.1 million in 2050.===Rural areas, wealth, education===
Surveys have found FGM to be more common in rural areas, less common in most countries
among girls from the wealthiest homes, and (except in Sudan and Somalia) less common
in girls whose mothers had access to primary or secondary/higher education. In Somalia
and Sudan the situation was reversed: in Somalia the mothers’ access to secondary/higher education
was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan access
to any education was accompanied by a rise.===Age, ethnicity===
FGM is not invariably a rite of passage between childhood and adulthood, but is often performed
on much younger children. Girls are most commonly cut shortly after birth to age 15. In half
the countries for which national figures were available in 2000–2010, most girls had been
cut by age five. Over 80 percent (of those cut) are cut before the age of five in Nigeria,
Mali, Eritrea, Ghana and Mauritania. The 1997 Demographic and Health Survey in Yemen found
that 76 percent of girls had been cut within two weeks of birth. The percentage is reversed
in Somalia, Egypt, Chad and the Central African Republic, where over 80 percent (of those
cut) are cut between five and 14. Just as the type of FGM is often linked to ethnicity,
so is the mean age. In Kenya, for example, the Kisi cut around age 10 and the Kamba at
16.A country’s national prevalence often reflects a high sub-national prevalence among certain
ethnicities, rather than a widespread practice. In Iraq, for example, FGM is found mostly
among the Kurds in Erbil (58 percent prevalence within age group 15–49, as of 2011), Sulaymaniyah
(54 percent) and Kirkuk (20 percent), giving the country a national prevalence of eight
percent. The practice is sometimes an ethnic marker, but it may differ along national lines.
For example, in the northeastern regions of Ethiopia and Kenya, which share a border with
Somalia, the Somali people practise FGM at around the same rate as they do in Somalia.
But in Guinea all Fulani women responding to a survey in 2012 said they had experienced
FGM, against 12 percent of the Fulani in Chad, while in Nigeria the Fulani are the only large
ethnic group in the country not to practise it.==Reasons=====Support from women===Dahabo Musa, a Somali woman, described infibulation
in a 1988 poem as the “three feminine sorrows”: the procedure itself, the wedding night when
the woman is cut open, then childbirth when she is cut again. Despite the evident suffering,
it is women who organize all forms of FGM. Anthropologist Rose Oldfield Hayes wrote in
1975 that educated Sudanese men who did not want their daughters to be infibulated (preferring
clitoridectomy) would find the girls had been sewn up after the grandmothers arranged a
visit to relatives. Gerry Mackie has compared the practice to footbinding. Like FGM, footbinding
was carried out on young girls, nearly universal where practised, tied to ideas about honour,
chastity and appropriate marriage, and “supported and transmitted” by women. FGM practitioners see the procedures as marking
not only ethnic boundaries but also gender difference. According to this view, male circumcision
defeminizes men while FGM demasculinizes women. Fuambai Ahmadu, an anthropologist and member
of the Kono people of Sierra Leone, who in 1992 underwent clitoridectomy as an adult
during a Sande society initiation, argued in 2000 that it is a male-centred assumption
that the clitoris is important to female sexuality. African female symbolism revolves instead
around the concept of the womb. Infibulation draws on that idea of enclosure and fertility.
“[G]enital cutting completes the social definition of a child’s sex by eliminating external traces
of androgyny,” Janice Boddy wrote in 2007. “The female body is then covered, closed,
and its productive blood bound within; the male body is unveiled, opened and exposed.”In
communities where infibulation is common, there is a preference for women’s genitals
to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive.
Some men seem to enjoy the effort of penetrating an infibulation. The local preference for
dry sex causes women to introduce substances into the vagina to reduce lubrication, including
leaves, tree bark, toothpaste and Vicks menthol rub. The WHO includes this practice within
Type IV FGM, because the added friction during intercourse can cause lacerations and increase
the risk of infection. Because of the smooth appearance of an infibulated vulva, there
is also a belief that infibulation increases hygiene.Common reasons for FGM cited by women
in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability
and enhancement of male sexual pleasure. In a study in northern Sudan, published in 1983,
only 17.4 percent of women opposed FGM (558 out of 3,210), and most preferred excision
and infibulation over clitoridectomy. Attitudes are changing slowly. In Sudan in 2010, 42
percent of women who had heard of FGM said the practice should continue. In several surveys
since 2006, over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, Gambia, and
Egypt supported FGM’s continuance, while elsewhere in Africa, Iraq, and Yemen most said it should
end, although in several countries only by a narrow margin.===Social obligation, poor access to information
===Against the argument that women willingly
choose FGM for their daughters, UNICEF calls the practice a “self-enforcing social convention”
to which families feel they must conform to avoid uncut daughters facing social exclusion.
Ellen Gruenbaum reported that, in Sudan in the 1970s, cut girls from an Arab ethnic group
would mock uncut Zabarma girls with Ya, Ghalfa! (“Hey, unclean!”). The Zabarma girls would
respond Ya, mutmura! (A mutmara was a storage pit for grain that was continually opened
and closed, like an infibulated woman.) But despite throwing the insult back, the Zabarma
girls would ask their mothers, “What’s the matter? Don’t we have razor blades like the
Arabs?”Because of poor access to information, and because circumcisers downplay the causal
connection, women may not associate the health consequences with the procedure. Lala Baldé,
president of a women’s association in Medina Cherif, a village in Senegal, told Mackie
in 1998 that when girls fell ill or died, it was attributed to evil spirits. When informed
of the causal relationship between FGM and ill health, Mackie wrote, the women broke
down and wept. He argued that surveys taken before and after this sharing of information
would show very different levels of support for FGM. The American non-profit group Tostan,
founded by Molly Melching in 1991, introduced community-empowerment programs in several
countries that focus on local democracy, literacy, and education about healthcare, giving women
the tools to make their own decisions. In 1997, using the Tostan program, Malicounda
Bambara in Senegal became the first village to abandon FGM. By August 2019, 8,800 communities
in eight countries had pledged to abandon FGM and child marriage.===Religion===Surveys have shown a widespread belief, particularly
in Mali, Mauritania, Guinea and Egypt, that FGM is a religious requirement. Gruenbaum
has argued that practitioners may not distinguish between religion, tradition, and chastity,
making it difficult to interpret the data. FGM’s origins in northeastern Africa are pre-Islamic,
but the practice became associated with Islam because of that religion’s focus on female
chastity and seclusion. According to a 2013 UNICEF report, in 18 African countries at
least 10 percent of Muslim females had experienced FGM, and in 13 of those countries, the figure
rose to 50–99 percent. There is no mention of the practice in the Quran. It is praised
in a few daʻīf (weak) hadith (sayings attributed to Muhammad) as noble but not required, although
it is regarded as obligatory by the Shafi’i version of Sunni Islam. In 2007 the Al-Azhar
Supreme Council of Islamic Research in Cairo ruled that FGM had “no basis in core Islamic
law or any of its partial provisions”.There is no mention of FGM in the Bible. Christian
missionaries in Africa were among the first to object to FGM, but Christian communities
in Africa do practise it. In 2013 UNICEF identified 19 African countries in which at least 10
percent of Christian women and girls aged 15 to 49 had undergone FGM; in Niger, 55 percent
of Christian women and girls had experienced it, compared with two percent of their Muslim
counterparts. The only Jewish group known to have practised it are the Beta Israel of
Ethiopia. Judaism requires male circumcision but does not allow FGM. FGM is also practised
by animist groups, particularly in Guinea and Mali.==History=====
Antiquity===The practice’s origins are unknown. Gerry
Mackie has suggested that, because FGM’s east-west, north-south distribution in Africa meets in
Sudan, infibulation may have begun there with the Meroite civilization (c. 800 BCE – c.
350 CE), before the rise of Islam, to increase confidence in paternity. According to historian
Mary Knight, Spell 1117 (c. 1991–1786 BCE) of the Ancient Egyptian Coffin Texts may refer
in hieroglyphs to an uncircumcised girl (‘m’t): The spell was found on the sarcophagus of
Sit-hedjhotep, now in the Egyptian Museum, and dates to Egypt’s Middle Kingdom. (Paul
F. O’Rourke argues that ‘m’t probably refers instead to a menstruating woman.) The proposed
circumcision of an Egyptian girl, Tathemis, is also mentioned on a Greek papyrus, from
163 BCE, in the British Museum: “Sometime after this, Nephoris [Tathemis’s mother] defrauded
me, being anxious that it was time for Tathemis to be circumcised, as is the custom among
the Egyptians.”The examination of mummies has shown no evidence of FGM. Citing the Australian
pathologist Grafton Elliot Smith, who examined hundreds of mummies in the early 20th century,
Knight writes that the genital area may resemble Type III because during mummification the
skin of the outer labia was pulled toward the anus to cover the pudendal cleft, possibly
to prevent sexual violation. It was similarly not possible to determine whether Types I
or II had been performed, because soft tissues had deteriorated or been removed by the embalmers.The
Greek geographer Strabo (c. 64 BCE – c. 23 CE) wrote about FGM after visiting Egypt
around 25 BCE: “This is one of the customs most zealously pursued by them [the Egyptians]:
to raise every child that is born and to circumcise [peritemnein] the males and excise [ektemnein]
the females …” Philo of Alexandria (c. 20 BCE – 50 CE) also made reference to it:
“the Egyptians by the custom of their country circumcise the marriageable youth and maid
in the fourteenth (year) of their age, when the male begins to get seed, and the female
to have a menstrual flow.” It is mentioned briefly in a work attributed to the Greek
physician Galen (129 – c. 200 CE): “When [the clitoris] sticks out to a great extent
in their young women, Egyptians consider it appropriate to cut it out.” Another Greek
physician, Aëtius of Amida (mid-5th to mid-6th century CE), offered more detail in book 16
of his Sixteen Books on Medicine, citing the physician Philomenes. The procedure was performed
in case the clitoris, or nymphê, grew too large or triggered sexual desire when rubbing
against clothing. “On this account, it seemed proper to the Egyptians to remove it before
it became greatly enlarged,” Aëtius wrote, “especially at that time when the girls were
about to be married”: The surgery is performed in this way: Have
the girl sit on a chair while a muscled young man standing behind her places his arms below
the girl’s thighs. Have him separate and steady her legs and whole body. Standing in front
and taking hold of the clitoris with a broad-mouthed forceps in his left hand, the surgeon stretches
it outward, while with the right hand, he cuts it off at the point next to the pincers
of the forceps. It is proper to let a length remain from that cut off, about the size of
the membrane that’s between the nostrils, so as to take away the excess material only;
as I have said, the part to be removed is at that point just above the pincers of the
forceps. Because the clitoris is a skinlike structure and stretches out excessively, do
not cut off too much, as a urinary fistula may result from cutting such large growths
too deeply. The genital area was then cleaned with a sponge,
frankincense powder and wine or cold water, and wrapped in linen bandages dipped in vinegar,
until the seventh day when calamine, rose petals, date pits, or a “genital powder made
from baked clay” might be applied.Whatever the practice’s origins, infibulation became
linked to slavery. Mackie cites the Portuguese missionary João dos Santos, who in 1609 wrote
of a group near Mogadishu who had a “custome to sew up their Females, especially their
slaves being young to make them unable for conception, which makes these slaves sell
dearer, both for their chastitie, and for better confidence which their Masters put
in them”. Thus, Mackie argues, a “practice associated with shameful female slavery came
to stand for honor”.===Europe and the United States===Gynaecologists in 19th-century Europe and
the United States removed the clitoris to treat insanity and masturbation. A British
doctor, Robert Thomas, suggested clitoridectomy as a cure for nymphomania in 1813. In 1825
The Lancet described a clitoridectomy performed in 1822 in Berlin by Karl Ferdinand von Graefe
on a 15-year-old girl who was masturbating excessively.Isaac Baker Brown, an English
gynaecologist, president of the Medical Society of London and co-founder in 1845 of St. Mary’s
Hospital, believed that masturbation, or “unnatural irritation” of the clitoris, caused hysteria,
spinal irritation, fits, idiocy, mania and death. He therefore “set to work to remove
the clitoris whenever he had the opportunity of doing so”, according to his obituary. Brown
performed several clitoridectomies between 1859 and 1866. In the United States, J. Marion
Sims followed Brown’s work and in 1862 slit the neck of a woman’s uterus and amputated
her clitoris, “for the relief of the nervous or hysterical condition as recommended by
Baker Brown”. When Brown published his views in On the Curability of Certain Forms of Insanity,
Epilepsy, Catalepsy, and Hysteria in Females (1866), doctors in London accused him of quackery
and expelled him from the Obstetrical Society.Later in the 19th century, A. J. Bloch, a surgeon
in New Orleans, removed the clitoris of a two-year-old girl who was reportedly masturbating.
According to a 1985 paper in the Obstetrical & Gynecological Survey, clitoridectomy was
performed in the United States into the 1960s to treat hysteria, erotomania and lesbianism.
From the mid-1950s, James C. Burt, a gynaecologist in Dayton, Ohio, performed non-standard repairs
of episiotomies after childbirth, adding more stitches to make the vaginal opening smaller.
From 1966 until 1989, he performed “love surgery” by cutting women’s pubococcygeus muscle, repositioning
the vagina and urethra, and removing the clitoral hood, thereby making their genital area more
appropriate, in his view, for intercourse in the missionary position. “Women are structurally
inadequate for intercourse,” he wrote; he said he would turn them into “horny little
mice”. In the 1960s and 1970s he performed these procedures without consent while repairing
episiotomies and performing hysterectomies and other surgery; he said he had performed
a variation of them on 4,000 women by 1975. Following complaints, he was required in 1989
to stop practicing medicine in the United States.==Opposition=====
Colonial opposition in Kenya===Protestant missionaries in British East Africa
(present-day Kenya) began campaigning against FGM in the early 20th century, when Dr. John
Arthur joined the Church of Scotland Mission (CSM) in Kikuyu. An important ethnic marker,
the practice was known by the Kikuyu, the country’s main ethnic group, as irua for both
girls and boys. It involved excision (Type II) for girls and removal of the foreskin
for boys. Unexcised Kikuyu women (irugu) were outcasts.Jomo Kenyatta, general secretary
of the Kikuyu Central Association and later Kenya’s first prime minister, wrote in 1938
that, for the Kikuyu, the institution of FGM was the “conditio sine qua non of the whole
teaching of tribal law, religion and morality”. No proper Kikuyu man or woman would marry
or have sexual relations with someone who was not circumcised, he wrote. A woman’s responsibilities
toward the tribe began with her initiation. Her age and place within tribal history was
traced to that day, and the group of girls with whom she was cut was named according
to current events, an oral tradition that allowed the Kikuyu to track people and events
going back hundreds of years. Beginning with the CSM in 1925, several missionary
churches declared that FGM was prohibited for African Christians; the CSM announced
that Africans practising it would be excommunicated, which resulted in hundreds leaving or being
expelled. In 1929 the Kenya Missionary Council began referring to FGM as the “sexual mutilation
of women”, and a person’s stance toward the practice became a test of loyalty, either
to the Christian churches or to the Kikuyu Central Association. The stand-off turned
FGM into a focal point of the Kenyan independence movement; the 1929–1931 period is known
in the country’s historiography as the female circumcision controversy. When Hulda Stumpf,
an American missionary who opposed FGM in the girls’ school she helped to run, was murdered
in 1930, Edward Grigg, the governor of Kenya, told the British Colonial Office that the
killer had tried to circumcise her.There was some opposition from Kenyan women themselves.
At the mission in Tumutumu, Karatina, where Marion Scott Stevenson worked, a group calling
themselves Ngo ya Tuiritu (“Shield of Young Girls”), the membership of which included
Raheli Warigia (mother of Gakaara wa Wanjaũ), wrote to the Local Native Council of South
Nyeri on 25 December 1931: “[W]e of the Ngo ya Tuiritu heard that there are men who talk
of female circumcision, and we get astonished because they (men) do not give birth and feel
the pain and even some die and even others become infertile, and the main cause is circumcision.
Because of that the issue of circumcision should not be forced. People are caught like
sheep; one should be allowed to cut her own way of either agreeing to be circumcised or
not without being dictated on one’s own body.”Elsewhere, support for the practice from women was strong.
In 1956 in Meru, eastern Kenya, when the council of male elders (the Njuri Nchecke) announced
a ban on FGM in 1956, thousands of girls cut each other’s genitals with razor blades over
the next three years as a symbol of defiance. The movement came to be known as Ngaitana
(“I will circumcise myself”), because to avoid naming their friends the girls said they had
cut themselves. Historian Lynn Thomas described the episode as significant in the history
of FGM because it made clear that its victims were also its perpetrators. FGM was eventually
outlawed in Kenya in 2001, although the practice continued, reportedly driven by older women.===Growth of opposition===
One of the earliest campaigns against FGM began in Egypt in the 1920s, when the Egyptian
Doctors’ Society called for a ban. There was a parallel campaign in Sudan, run by religious
leaders and British women. Infibulation was banned there in 1946, but the law was unpopular
and barely enforced. The Egyptian government banned infibulation in state-run hospitals
in 1959, but allowed partial clitoridectomy if parents requested it. (Egypt banned FGM
entirely in 2007.) In 1959, the UN asked the WHO to investigate
FGM, but the latter responded that it was not a medical matter. Feminists took up the
issue throughout the 1970s. The Egyptian physician and feminist Nawal El Saadawi criticized FGM
in her book Women and Sex (1972); the book was banned in Egypt and El Saadawi lost her
job as director general of public health. She followed up with a chapter, “The Circumcision
of Girls”, in her book The Hidden Face of Eve: Women in the Arab World (1980), which
described her own clitoridectomy when she was six years old: I did not know what they had cut off from
my body, and I did not try to find out. I just wept, and called out to my mother for
help. But the worst shock of all was when I looked around and found her standing by
my side. Yes, it was her, I could not be mistaken, in flesh and blood, right in the midst of
these strangers, talking to them and smiling at them, as though they had not participated
in slaughtering her daughter just a few moments ago. In 1975, Rose Oldfield Hayes, an American
social scientist, became the first female academic to publish a detailed account of
FGM, aided by her ability to discuss it directly with women in Sudan. Her article in American
Ethnologist called it “female genital mutilation”, rather than female circumcision, and brought
it to wider academic attention. Edna Adan Ismail, who worked at the time for the Somalia
Ministry of Health, discussed the health consequences of FGM in 1977 with the Somali Women’s Democratic
Organization. Two years later Fran Hosken, an Austria-American feminist, published The
Hosken Report: Genital and Sexual Mutilation of Females (1979), the first to offer global
figures. She estimated that 110,529,000 women in 20 African countries had experienced FGM.
The figures were speculative but consistent with later surveys. Describing FGM as a “training
ground for male violence”, Hosken accused female practitioners of “participating in
the destruction of their own kind”. The language caused a rift between Western and African
feminists; African women boycotted a session featuring Hosken during the UN’s Mid-Decade
Conference on Women in Copenhagen in July 1980.In 1979, the WHO held a seminar, “Traditional
Practices Affecting the Health of Women and Children”, in Khartoum, Sudan, and in 1981,
also in Khartoum, 150 academics and activists signed a pledge to fight FGM after a workshop
held by the Babiker Badri Scientific Association for Women’s Studies (BBSAWS), “Female Circumcision
Mutilates and Endangers Women – Combat it!” Another BBSAWS workshop in 1984 invited the
international community to write a joint statement for the United Nations. It recommended that
the “goal of all African women” should be the eradication of FGM and that, to sever
the link between FGM and religion, clitoridectomy should no longer be referred to as sunna.The
Inter-African Committee on Traditional Practices Affecting the Health of Women and Children,
founded in 1984 in Dakar, Senegal, called for an end to the practice, as did the UN’s
World Conference on Human Rights in Vienna in 1993. The conference listed FGM as a form
of violence against women, marking it as a human-rights violation, rather than a medical
issue. Throughout the 1990s and 2000s governments in Africa and the Middle East passed legislation
banning or restricting FGM. In 2003 the African Union ratified the Maputo Protocol on the
rights of women, which supported the elimination of FGM. By 2015 laws restricting FGM had been
passed in at least 23 of the 27 African countries in which it is concentrated, although several
fell short of a ban.===United Nations===
In December 1993, the United Nations General Assembly included FGM in resolution 48/104,
the Declaration on the Elimination of Violence Against Women, and from 2003 sponsored International
Day of Zero Tolerance for Female Genital Mutilation, held every 6 February. UNICEF began in 2003
to promote an evidence-based social norms approach, using ideas from game theory about
how communities reach decisions about FGM, and building on the work of Gerry Mackie on
the demise of footbinding in China. In 2005 the UNICEF Innocenti Research Centre in Florence
published its first report on FGM. UNFPA and UNICEF launched a joint program in Africa
in 2007 to reduce FGM by 40 percent within the 0–15 age group and eliminate it from
at least one country by 2012, goals that were not met and which they later described as
unrealistic. In 2008 several UN bodies recognized FGM as a human-rights violation, and in 2010
the UN called upon healthcare providers to stop carrying out the procedures, including
reinfibulation after childbirth and symbolic nicking. In 2012 the General Assembly passed
resolution 67/146, “Intensifying global efforts for the elimination of female genital mutilations”.===Non-practising countries=======
Overview====Immigration spread the practice to Australia,
New Zealand, Europe and North America, all of which outlawed it entirely or restricted
it to consenting adults. Sweden outlawed FGM in 1982 with the Act Prohibiting the Genital
Mutilation of Women, the first Western country to do so. Several former colonial powers,
including Belgium, Britain, France and the Netherlands, introduced new laws or made clear
that it was covered by existing legislation. As of 2013 legislation banning FGM had been
passed in 33 countries outside Africa and the Middle East.====North America====In the United States an estimated 513,000
women and girls had experienced FGM or were at risk as of 2012. A Nigerian woman successfully
contested deportation in March 1994 on the grounds that her daughters might be cut, and
in 1996 Fauziya Kasinga from Togo became the first to be granted asylum to escape FGM.
In 1996 the Federal Prohibition of Female Genital Mutilation Act made it illegal to
perform FGM on minors for non-medical reasons, and in 2013 the Transport for Female Genital
Mutilation Act prohibited transporting a minor out of the country for the purpose of FGM.
The first FGM conviction in the US was in 2006, when Khalid Adem, who had emigrated
from Ethiopia, was sentenced to ten years for aggravated battery and cruelty to children
after severing his two-year-old daughter’s clitoris with a pair of scissors. A federal
judge ruled in 2018 that the 1996 Act was unconstitutional, arguing that FGM is a “local
criminal activity” that should be regulated by states, not by Congress; he made his ruling
during a case against members of the Dawoodi Bohra community in Michigan accused of carrying
out FGM. Twenty-four states had legislation banning FGM as of 2016. The American Academy
of Pediatrics opposes all forms of the practice, including pricking the clitoral skin.Canada
recognized FGM as a form of persecution in July 1994, when it granted refugee status
to Khadra Hassan Farah, who had fled Somalia to avoid her daughter being cut. In 1997 section
268 of its Criminal Code was amended to ban FGM, except where “the person is at least
eighteen years of age and there is no resulting bodily harm”. As of July 2017 there had been
no prosecutions. Canadian officials have expressed concern that a few thousand Canadian girls
are at risk of “vacation cutting”, whereby girls are taken overseas to undergo the procedure,
but as of 2017 there were no firm figures.====Europe====According to the European Parliament, 500,000
women in Europe had undergone FGM as of March 2009. France is known for its tough stance
against FGM. Up to 30,000 women there were thought to have experienced it as of 1995.
According to Colette Gallard, a family-planning counsellor, when FGM was first encountered
in France, the reaction was that Westerners ought not to intervene. It took the deaths
of two girls in 1982, one of them three months old, for that attitude to change. In 1991
a French court ruled that the Convention Relating to the Status of Refugees offered protection
to FGM victims; the decision followed an asylum application from Aminata Diop, who fled an
FGM procedure in Mali. The practice is outlawed by several provisions of France’s penal code
that address bodily harm causing permanent mutilation or torture. All children under
six who were born in France undergo medical examinations that include inspection of the
genitals, and doctors are obliged to report FGM. The first civil suit was in 1982, and
the first criminal prosecution in 1993. In 1999 a woman was given an eight-year sentence
for having performed FGM on 48 girls. By 2014 over 100 parents and two practitioners had
been prosecuted in over 40 criminal cases.Around 137,000 women and girls living in England
and Wales were born in countries where FGM is practised, as of 2011. Performing FGM on
children or adults was outlawed under the Prohibition of Female Circumcision Act 1985.
This was replaced by the Female Genital Mutilation Act 2003 and Prohibition of Female Genital
Mutilation (Scotland) Act 2005, which added a prohibition on arranging FGM outside the
country for British citizens or permanent residents. The United Nations Committee on
the Elimination of Discrimination against Women (CEDAW) asked the government in July
2013 to “ensure the full implementation of its legislation on FGM”. The first charges
were brought in 2014 against a physician and another man; the physician had stitched an
infibulated woman after opening her for childbirth. Both men were acquitted in 2015.==Criticism of opposition=====Tolerance versus human rights===Anthropologists have accused FGM eradicationists
of cultural colonialism, and have been criticized in turn for their moral relativism and failure
to defend the idea of universal human rights. According to critics of the eradicationist
position, the biological reductionism of the opposition to FGM, and the failure to appreciate
FGM’s cultural context, serves to “other” practitioners and undermine their agency—in
particular when parents are referred to as “mutilators”.Africans who object to the tone
of FGM opposition risk appearing to defend the practice. The feminist theorist Obioma
Nnaemeka, herself strongly opposed to FGM, argued in 2005 that renaming the practice
female genital mutilation had introduced “a subtext of barbaric African and Muslim cultures
and the West’s relevance (even indispensability) in purging [it]”. According to Ugandan law
professor Sylvia Tamale, the early Western opposition to FGM stemmed from a Judeo-Christian
judgment that African sexual and family practices, including not only FGM but also dry sex, polygyny,
bride price and levirate marriage, required correction. African feminists “take strong
exception to the imperialist, racist and dehumanising infantilization of African women”, she wrote
in 2011. Commentators highlight the voyeurism in the treatment of women’s bodies as exhibits.
Examples include images of women’s vulvas after FGM or girls undergoing the procedure.
The 1996 Pulitzer-prize-winning photographs of a 16-year-old Kenyan girl experiencing
FGM were published by 12 American newspapers, without her consent either to be photographed
or to have the images published.The debate has highlighted a tension between anthropology
and feminism, with the former’s focus on tolerance and the latter’s on equal rights for women.
According to the anthropologist Christine Walley, a common position in anti-FGM literature
has been to present African women as victims of false consciousness participating in their
own oppression, a position promoted by feminists in the 1970s and 1980s, including Fran Hosken,
Mary Daly and Hanny Lightfoot-Klein. It prompted the French Association of Anthropologists
to issue a statement in 1981, at the height of the early debates, that “a certain feminism
resuscitates (today) the moralistic arrogance of yesterday’s colonialism”.===Comparison with other procedures=======
Cosmetic procedures====Nnaemeka argues that the crucial question,
broader than FGM, is why the female body is subjected to so much “abuse and indignity”,
including in the West. Several authors have drawn a parallel between FGM and cosmetic
procedures. Ronán Conroy of the Royal College of Surgeons in Ireland wrote in 2006 that
cosmetic genital procedures were “driving the advance” of FGM by encouraging women to
see natural variations as defects. Anthropologist Fadwa El Guindi compared FGM to breast enhancement,
in which the maternal function of the breast becomes secondary to men’s sexual pleasure.
Benoîte Groult, the French feminist, made a similar point in 1975, citing FGM and cosmetic
surgery as sexist and patriarchal. Against this, the medical anthropologist Carla Obermeyer
argued in 1999 that FGM may be conducive to a subject’s social well-being in the same
way that rhinoplasty and male circumcision are. Despite the 2007 ban in Egypt, Egyptian
women wanting FGM for their daughters seek amalyet tajmeel (cosmetic surgery) to remove
what they see as excess genital tissue. Cosmetic procedures such as labiaplasty and
clitoral hood reduction do fall within the WHO’s definition of FGM, which aims to avoid
loopholes, but the WHO notes that these elective practices are generally not regarded as FGM.
Some legislation banning FGM, such as in Canada and the US, covers minors only, but several
countries, including Sweden and the UK, have banned it regardless of consent. Sweden, for
example, has banned operations “on the outer female sexual organs with a view to mutilating
them or bringing about some other permanent change in them, regardless of whether or not
consent has been given for the operation”. Gynaecologist Birgitta Essén and anthropologist
Sara Johnsdotter argue that the law seems to distinguish between Western and African
genitals, and deems only African women (such as those seeking reinfibulation after childbirth)
unfit to make their own decisions.The philosopher Martha Nussbaum argues that a key concern
with FGM is that it is mostly conducted on children using physical force. The distinction
between social pressure and physical force is morally and legally salient, comparable
to the distinction between seduction and rape. She argues further that the literacy of women
in practising countries is generally poorer than in developed nations, which reduces their
ability to make informed choices.====Intersex children, male circumcision
====Several commentators maintain that children’s
rights are violated not only by FGM but also by the genital alteration of intersex children,
who are born with anomalies that physicians choose to correct. Arguments have been made
that non-therapeutic male circumcision, practised by Muslims, Jews and some Christian groups,
also violates children’s rights. Globally about 30 percent of males over 15 are circumcised;
of these, about two-thirds are Muslim. An American Academy of Pediatrics circumcision
task force issued a policy statement in 2012 that the health benefits of male circumcision
outweigh the risks; they recommended that it be carried out, if it is performed, by
“trained and competent practitioners … using sterile techniques and effective pain management”.
The statement met with protests from a group of 38 doctors in Europe, who accused the task
force of “cultural bias”. At least half the male population of the United States is circumcised,
while most men in Europe are not.==See also==
Child marriage==

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