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OVERVIEW

NADER NABEH

SOC 438 Final Project

The topic I chose to explore for my Tumblr Final Research Project is Female Genital Mutilation/Cutting (FGM/C) because of its prevalence in the world, negative health consequences, and potential to be eliminated in the twenty-first century. It is imperative that we understand FGM/C and the cultures that practice it so we can work toward ending this tradition on a global scale. 

I was born in Egypt, a country where the FGM/C rate is 87%, and can be as high as 98% in some governates. A common misconception is that FGM/C is only executed by Muslims, but this is not the case. The Christian populations of Egypt, Ethiopia, Sudan, and other countries also have young girls and women undergo FGM/C. Many women and girls escape their husbands, families, and communities to avoid this harmful practice, or are ostracized for refusing the procedure.  

ACRONYMS

FGM/C =  Female Genital Mutilation/Cutting

FGM =  Female Genital Mutilation

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INTRODUCTION

It has been estimated that more than 200 million girls and women have suffered through FGM/C, half of which live in Indonesia, Egypt, and Ethiopia (UNICEF, 2016). The WHO (2008) defines FGM/C as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.” This practice has no health benefits for women; in fact, it can result in immense pain, bleeding, trouble while urinating, increased risk of infection, danger during childbirth, anxiety, PTSD, and many more negative consequences (World Health Organization, 2008). There are four types of FGM: (1) clitoridectomy, (2) excision, (3) infibulation, and (4) other procedures, such as burning or piercing. I wanted to explore the socio-cultural circumstances that allow and encourage the practice of FGM/C, as well as how women’s health is impacted after undergoing FGM/C. This project reviewed the factors that perpetuate the existence of FGM/C, which include education, attitudes toward the procedure, and social norms.

NOTE: The acronyms FGM and FGM/C in this project are used interchangeable. There is debate on which terminology is most appropriate for the procedures. Some view “mutilation” as a problematic or controversial term because some women survivors do not feel as though they have been mutilated, while others do. Others have argued that “cutting” is a more neutral term, but trivializes the procedure and makes it seem as less than a human rights violation.

Sources:

UNICEF. 2016. “Female Genital Mutilation/Cutting: A Global Concern.”

World Health Organization, Department of Reproductive Health and Research. 2008. “Eliminating female genital mutilation. An interagency statement.”

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Female Genital Mutilation: Health Consequences and Complications—A Short Literature Review

The article Female Genital Mutilation: Health Consequences and Complications—A Short Literature Review reports the findings of dozens of articles and studies on FGM. Klein et al. (2018) discuss the prevalence, ramifications, implications, and societal and cultural importance of FGM. The authors explained that parents feel pressure to perform FGM on their daughters as a way to prepare them for marriage. FGM is often done ceremonially by community leaders and is accompanied by gifts and food. The unsanitary conditions can lead to major life-long health problems that cost thousands of dollars to fix or reverse.

The authors used PRISMA as a measure to systematically review existing literature to assess the harms of FGM. Databases including PubMed, MEDLINE, Google Scholar, Web of Science, and EBSCOhost were used to find a wide range of studies, reports, and reviews on FGM. The article mostly drew on conflict theory because it described how FGM has no medical benefits, but is used as a tool to violate women’s rights, maintain gender inequality, and uphold men’s social dominance over women.

This study compared literature from all available time periods that reported on the harmful outcomes of FGM while exploring the social and cultural dynamics of FGM. The article also sought to answer the questions of which factors may help to perpetuate the practice, and what ways exist to eradicate it.

The review found that the rate of FGM is estimated to be nearly 99% in countries within the Horn of Africa (Djibouti, Eritrea, Ethiopia, and Somalia), and exceeds 90% in some regions within mainland Asia and its surrounding islands. FGM has short- and long-term physical and psychological consequences for the victims. Those who undergo the procedure have a higher risk of contracting infections and thus are also at risk of mortality due to living in poverty and limited health care. Another common long-term physiological complication is “the development of keloid scar tissue over the area that has been cut,” which can lead to severe shame and pain during sexual intercourse.  

This article was discussed the multilayered consequences of FGM, which is relevant to learning how it impacts the health of women in societies that follow this practice. FGM almost always lowers the quality of life and the health outcomes of women who had the procedure, and in some cases are life-threatening and cause death.

“Primary infections include staphylococcus infections, urinary tract infections, excessive and uncontrollable pain, and hemorrhaging. Infections such as human immunodeficiency virus (HIV), Chlamydia trachomatis, Clostridium tetani, herpes simplex virus (HSV) 2 are significantly more common among women who underwent Type 3 mutilation... it is estimated that 1 in every 500 circumcisions results in death.”

Source:

Klein, Elliot, Elizabeth Helzner, Michelle Shayowitz, Stephan Kohlhoff, and Tamar A. Smith-Norowitz. 2018. “Female Genital Mutilation: Health Consequences and Complications—A Short Literature Review.” Obstetrics and Gynecology International 2018:1–7.

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Health sector involvement in the management of female genital mutilation/cutting in 30 countries

National and international organizations have emphasized the importance of using a multisector approach to eradicate female genital mutilation.  Johansen et al. (2018) aimed to evaluate the involvement of the health sector and its efforts in reducing FGM/C rates. The monitoring and evaluation of the procedure needs involvement in multiple nations, but a lot of progress has been made by the health industry in treating and preventing FGM/C. Most countries in the study (24 out of 30) had a FGM/C policy in national or professional guidelines, and 20 countries had partially or fully implemented these guidelines. 13 countries offered psychological and counseling services to survivors of FGM/C, and 27 countries had clinics that offered deinfibulation services, which reverse type 3 FGM/C, which is the excision of the clitoris. Johansen et al., (2018) found that “substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C.”

“Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries.”

Source:

Johansen, R.E.B., Ziyada, M.M., Shell-Duncan, B. et al. 2018. “Health sector involvement in the management of female genital mutilation/cutting in 30 countries.” BMC Health Serv Res 18(240). https://doi.org/10.1186/s12913-018-3033-x

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Ritual Genital Cutting of Female Minors

Immigrants from regions with high FGM/C rates can request the procedure to be performed by medical doctors in the United States. Because FGM/C has no health benefits and is decidedly harmful, the American Academy of Pediatrics opposes all FGM/C procedures and advises members to avoid competing this procedure as it poses physical, psychological, and sexual risks for the sufferer.

“Efforts should be made to use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter. For circumstances in which an infant, child, or adolescent seems to be at risk of FGC, the American Academy of Pediatrics recommends that its members educate and counsel the family about the detrimental health effects of FGC. Parents should be reminded that performing FGC is illegal and constitutes child abuse in the United States.”

Source:

Committee on Bioethics. 2010. "Ritual Genital Cutting Of Female Minors." PEDIATRICS 125(5):1088-1093. Retrieved (https://doi.org/10.1542/peds.2010-0187). 

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Can young men act as allies in social change programs?

The 2014 Girl Summit declared intentions to increase efforts to end Female Genital Mutilation (FGM), and 24 countries with high FGM rates have implemented laws that criminalize the practice. Men can be important allies in the local and global effort to eradicate FGM because they play a role in the demand of FGM as husbands, fathers, and community and religious leaders (Brown, Mwangi-Powell, Jerotich and le May, 2016). This study took place in West Pokot, Kenya, and twelve PEER researchers were recruited to conduct a total of 72 narrative interviews with their friends. 

Brown et al. (2016) used Participatory Ethnographic Evaluation Research (PEER) to understand young men’s perceptions of FGM, their demand for a wife who experienced FGM, and perceptions of efforts to end the practice. This research gained insight into how members of a specific community view the world by training members of the target population to become PEER researchers and conduct exhaustive qualitative interviews with peers in the same social network (Brown et al., 2016). The authors drew from critical gender theory to describe the participants’ views on FGM.

This study aimed to discover how young men perceived FGM and understand their role in perpetuating or potentially eliminating FGM. According to Brown and colleagues (2016), the purpose of this study was to understand how FGM demand influenced marriage decisions in young men of pre-marital age (18-25 years).

The results showed signs of both hopeful and concerning trends. The interviewed young men believed that marrying a woman with FGM was necessary as it ensured the accumulation of wealth and ancestral blessings. On the other hand, marrying a woman without FGM might result in curses like crop failure, and health setbacks, marital dissatisfaction, and ultimately divorce. The interviewees also reported feeling external social pressure to marry women with FGM. Alternatively, many male peers expressed the desire to marry women with higher education who were less likely to have and/or support FGM.

“The young men in this PEER study saw themselves as valuable allies for young women in a social movement to end FGM...Men – especially younger men – disapprove of the practice because they recognize the harms that it inflicts on women and themselves. Men’s potential as strategic allies against FGM has been widely recognized: husbands’ opposition to FGM is a protective factor against the practice.”

This article relates to my final project topic because I had aimed to understand and report on the consequences of ending FGM on societies where it is common. This research article provides evidence that shows ending FGM is becoming increasingly popular among younger generations, and will impact all players (not just women) positively. The article also reveals shifting cultural attitudes toward FGM in traditional societies, which is necessary for comprehending how the efforts to end FGM can be sustained and accelerated. 

Source:

Brown, E., Mwangi-Powell, F., Jerotich, M. and le May, V., 2016. “Female Genital Mutilation in Kenya: are young men allies in social change programmes?.” Reproductive Health Matters, 24(47):118-125.

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Daughters at Risk of Female Genital Mutilation: Examining the Determinants of Mothers’ Intentions to Allow Their Daughters to Undergo Female Genital Mutilation

The authors of this study aimed to investigate the factors that influence Iranian mothers to have their daughters undergo FGM. Factors included mothers’ attitudes (e.g. FGM enhances health), subjective norms (e.g. family members expect mutilation of daughter), and perceived behavioral control (e.g. I can prevent my daughter from undergoing FGM despite obstacles). The researchers found that a mother’s attitude toward FGM, subjective norms, and her age are the strongest predictors of allowing a daughter to experience mutilation.

Pashaei et al. (2016) utilized the theory of planned behavior, which proposes that an individual’s attitude, subjective norms, and perceived behavioral control can collectively predict behavior, as a framework to evaluate mothers’ willingness to allow the mutilation of their daughters. Workers in health centers of rural and urban Ravansar, Iran, helped authors identify subjects by reviewing mothers’ medical records. More than half of women in the region experience FGM before the age of seven, so eligible mothers were required to (1) have experienced FGM, (2) have a daughter younger than seven years old, and (3) have no daughters above the age of seven. Three hundred and twenty-three women were eligible to take the survey, and 97, almost a third of the women, agreed to complete the survey. The authors used structural equation modeling through Mplus 6 to scrutinize the relationships between the variables.

The main research question was of the study is: what determinants are associated with FGM behavior among Iranian mothers and their daughters? Consistent with most studies that have investigated the relationship between educational level and FGM, the authors found that mothers with less education tend to perceive FGM more favorably (Pashaei et al., 2016). This finding suggests that more educated mothers viewed FGM more negatively and were not as likely to be influenced by social pressure as less educated mothers. Pashaei et al. (2016) also discovered that subjective norms of mothers were also strongly associated with their intention to mutilate their daughters, while perceived behavioral control had no relationship with mothers’ intention. Women lack empowerment and autonomy in Iran, so they are more likely to succumb to social pressure and judgment from family and friends.

My project’s topic includes exploring the social and cultural factors that encourage the practice of FGM, which include attitude toward FGM, subjective norms, education level, and the mother’s age. This article is extremely relevant to the project topic because it discusses the determinants of mothers’ decisions to have their daughters undergo an FGM procedure, which is integral to understanding and eradicating the cycle of FGM. Although the sample was limited to mothers in Ravansar, Iran, the factors that influence their decisions likely exist and prevail in other regions and countries around the world. It is critical to research the determinants of FGM behavior in more cultures to formulate plans for permanently erasing the practice.

“Evidence has shown that education and health promotion can encourage mothers to stop performing FGM. Therefore, a significant change in factors such as economic development, literacy, education, health promotion and social development might cause a gradual decline in FGM behavior.“

Source:

Pashaei, T., Ponnet, K., Moeeni, M., Khazaee-pool, M. and Majlessi, F., 2016. “Daughters at Risk of Female Genital Mutilation: Examining the Determinants of Mothers’ Intentions to Allow Their Daughters to Undergo Female Genital Mutilation.” PLOS ONE, 11(3):e0151630. https://doi.org/10.1371/journal.pone.0151630