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The practice of female circumcision has elicited intense international reaction and scrutiny from human rights organization, feminists organization, health practitioners, legislators and the news media. As such, it has little parallel in its capacity to arouse emotional response. Even though opposition to this practice has been coordinated throughout the twentieth century beginning with the missionaries and colonial administrators, the resurgence of indignation in the last decade was sparked off in part by activists at conferences held in honor of the United Nations Decade for Women. The practice was initially challenged as an indication of moral decay. Today, it is seen as posing a major threat to the rights, health and dignity of women. The practice has thus been reclassified. Initially considered as a local concern, the practice is today seen as a global concern. It has been renamed to female genital mutilation from what it used to be called-female circumcision. Having been seen in the past as a traditional practice, it is today been considered a violation of human rights.
The issue of female circumcision, under the watch of the international community, has come to include a site for numerous emotionally charged debates concerning cultural relativism, western imperialism, racism, international human rights, medicalization, patriarchal oppression of women and sexuality, leading to an upsurge of discussions and writings on the issue. However, controversy, misunderstanding and confusion over the complicated dimensions of the topic have not been resolved. The body of literature concerning the issue of female circumcision is dispersed and desperate, falling into many and various fields such as law, social work, public health policy, epidemiology, anthropology, demography, history, political science and women’s studies. The aim of this paper is to narrow these conceptual boundaries by taking a multi dimensional approach of the subject from various disciplines, geography and ideological backgrounds. It thus highlights the emerging issues and related dimensions of the current analysis and debates.
Both academic and non-academic observers are forced to confront a wide ethical and philosophical issues by the practice of female circumcision. Many critics have argued that there is much biasness inn the discussion of the topic especially by the Westerners. Their discussions have been seen as paternalistic, excessive and essentializing (Nnaemeka, 2005). Both African and Western scholars have sharply criticized the intervention of Westerners in this field. The common argument has been that the affected Africans should be given a chance to argue it out for themselves. However, one thing that cannot be denied is that many people in Africa are conscious of the fact that their traditions have come under intense scrutiny. The debate over female circumcision in Africa is inevitable and is there is no indication that it will fade away. Instead, it will intensify further. With the knowledge that their traditions have fallen under attack, many Africans are increasingly becoming aware that the practice will raise a global attention and hence are eager to have their conception and perception of the issue to be known. This paper looks at these conceptions and perceptions with the aim of revealing the multifaceted and complex processes that involve the practice and its impact on the victims.
Increasing pressure has been mounted on African governments, communities and individuals to stop what has come to be seen as a “dangerous tradition”. In many African nations, various local initiatives that are against the practice have been developed. Most of these initiatives are linked with international projects. The practice have been seen to impact negatively on women, being associated with certain health risks and human rights abuses. The common notion is that the practice is forced upon women by the communities that practice it, a claim that cannot entirely be confirmed. The practice is in most cases embedded in the culture of the groups and as such, many communities embrace it as an acceptable practice, oblivious of the dangers and risks that accompany it. However, like any aspect of tradition and culture, it is not an easy task neither is it justified, mounting an international campaign to convince majority of adult African women to abandon their traditions. Any effort to stop the practice, even in situations where it is deemed risky, should begin with the women and communities among whom the practice is carried out. This however does not mean that the practice has no health consequences to the women whose communities are involved with the practice.
The practice of female circumcision is presently going through rapid and dramatic changes on the level of discourse and action. This change cannot be reversed. On the level of practice, there still remains a receding amount of choice for individuals and communities whose traditions have been the focus of much contention. On the level of discourse, silence has ceased to be an option and the choice remains between informed and non-informed discussion.
Definition of the practice
Female circumcision encompasses a variety of practices which involve partial or complete removal or alteration of the external genitalia for reasons that are not medical. This practice is present in a variety of African cultural context and other populations. There exists heterogeneity in this practice. Some groups may perform it at infancy, before puberty, at puberty, marriage, after birth of the first child or during the seventh month of pregnancy. The practice is normally associated with a number of assumptions. Among these are that it is a deeply entrenched practice, it symbolizes initiation and is associated with Islam and patriarchy.
The term “female circumcision” is a loose description of what is actually a number of procedures for altering the female genitalia. Many terms have been used to define a broad range of procedures. Although this diversity encompass a continuum rather than bounded categories that are discreet, there are generally four major types that are being recognized. The least extensive type which is seen to resemble male circumcision is commonly referred to as ‘sunna’, an Arabic term that means tradition or duty. It involves the cutting of the prepuce of the clitoris. There are however some claims that medical reports does not document the existence of this procedure. In the majority of cases that are classified as sunna, all or a section of the clitoris is taken out, along with the clitoral prepuce (Gollaher, 2001)). An example is given from Sudan by Lightfoot-Klein which involves the cutting of half or top of the clitoris (Lightfoot-Klein 1989: 33).the medical literature refers to the procedure which involves the removal of a section of the clitoris or the entire clitoris as cliteridectomy. This type is classified by the World Health Organization as type I. The second type, commonly known as excision, involves the partial or complete removal o the clitoris together with a section or all of labia minora. The World Health Organization refers to this type as type II. It is however difficult to draw a sharp distinction between clitoridectomy and excision since one grades into the other. Again, the attempts to distinguish them in survey research has also proved difficult. Hence, the two are often integrated into a single category.
Pharaonic circumcision or infibulation is the most radical form of female circumcision. Infibulation is a Latin term and refer to the ancient practice in Rome which involved fastening a fibula through the labia majora to bar women from being unfaithful. Pharaonic circumcision on the other hand refer to the possible origins of the practice in the ancient Egypt even though it has often been suggested that infibulation is called Sudanese circumcision in Egypt. The procedure involves a complete removal of labia minora and the clitoris together with most or the entire labia majora. The cut ages are then stitched together so that the vaginal opening and the urethra can be covered. Only a small opening is left for the passage of urine and menstrual blood. For the opening to be maintained, a small stick is normally inserted with the girl’s leg being bound together to promote healing. In regions where there is some level of medicalization of the practice, anesthesia and antibiotics may be used. A catgut or silk may be used to join the opening rather than with thorns. The part that has not been joined following this procedure is left open for intercourse and childbirth. This procedure is referred to as de-infibulation. After every birth, re-infibulation follows. This is also done when a woman is divorced or widowed.
There exist a variation in Sudan which is normally referred to as intermediate circumcision. This is a modified form of infibulation. It involves the same amount of cutting but only two thirds of the anterior parts of the outer labia is stitched together, leaving a larger posterior opening. The procedure is held to have come as a result of circumcisers’ compromise following the ban of infibulation in Sudan in nineteen forty six. A survey carried out in 2003 show that less than two percent of Sudanese women reported to have gone under intermediate circumcision (Abusharaf, 1995). The World Health Organization classify both infibulation and pharaonic circumcision as type III. In West Africa, another form of infibulation known as sealing is practiced even though not with the same frequency as with the other types. The procedure involves excision and the subsequent sealing of the vagina. This sealing is not done by stitching but rather, the blood is allowed to coagulate so a to form what amounts to artificial hymen.
Beside these four main types of genital mutilation, little known variations have been reported. These have been collectively referred to as type IV by the World Health Organization. Among these is the procedure which involves the cutting of the internal genitalia. They include hyminectomy, zur-zur cuts of the cervix which are meant to remedy obstructed labor and gishiri cuts which involves the cutting of the walls of the vagina. The latter procedure is meant to enhance sexual penetration in communities where child marriage is widely practiced (quoted in Harvard Law Review 1993: 1947). There are also reports of symbolic circumcision which involves nicking the clitoris with a sharp instrument. This is intended to cause bleeding even though there is no permanent change of the external genitalia. This procedure is said to occur mainly in Malaysia and Indonesia even though there are references to this in Africa but with no specific examples.
Symbolic cutting has been proposed in a few cases in the West as part of an effort to stop more extensive cutting. As an alternative to infibulation among Somali immigrant women, an anesthetized pricking of the clitoris was proposed at some point to be carried out by health care providers in the Netherlands. Because this proposal provoked strong protests, it was never implemented. In nineteen ninety six, a United States hospital considered carrying out a symbolic procedure which was requested by members of a Somali immigrant community who offered to allow such a transitional measure to replace infibulation. Although this procedure would have involved no removal of tissue and would have been carried out under anesthesia, intense lobbying by anti-Female Genital Mutilation and negative public opinion blocked this plan (Paulson, 1996). It was argued that the new federal anti-Female Genital Mutilation legislation rendered the practice unlawful.
Terminological choice in describing these practices is marred with political land mines. The general term, “female circumcision”, is always employed in collectively referring to all these procedures. Objections to this term has however grown following the spread of feminist consciousness and the establishment of international women’s health movements. This is because the term deemphasizes the severity of the many forms of the practice by equating it with male circumcision. Female genital mutilation has been advanced as the most appropriate term.
Female Circumcision and religion
Female circumcision is in most cases associated with religion even though there are some individuals who are of the position that it is suctioned by Islam. However, the type I is often referred to as sunna procedure which means following the Prophet’s tradition. This is often used as as an evidence to this contention. The practice is often found among both Christian and Muslim population and it is a cultural practice that dates before the two religions. Infibulation which is normally referred to as the pharaonic procedure in Sudan and Ethiopia is likely to have been practiced in ancient Egypt.
There is however no direct link between religion and female circumcision in all the major religions. One apparent fact is that the practice is embedded in deeper cultural and traditional practices that predates religion. Many communities in Africa practice female circumcision as a result of tradition even after embracing the new religions. As such, it cannot be claimed that there is any direct relationship between female circumcision and religion. It can however be claimed that it is an attempt to regulate women’s sexual desires so as to reduce the onset of adultery and promiscuity within the society. There is nowhere within the sacred books that mention the circumcision of women as a spiritual entity.
Impact of Female Circumcision on Health
It is a widely held belief that female circumcision has devastating and harmful consequences throughout the life of the woman. This is largely because the communities that are locked in the practice do not have access to modern health facilities due to poverty. The result has been that there have been cases of medical emergencies arising from female circumcision which often result in death. However, it is not easy to determine the exact number of women who die from this practice owing to its protected nature. The systems for keeping medical records are also rarely configured to record female circumcision and related complications as causes of death. The health complications that a victim can experience are largely dependent upon three factors. This includes the severity of the procedure, sanitary conditions upon which the procedure has been carried and the health of the victim.
There is a likelihood of women who undergo type II and type III procedures to experience more serious health complications even though health consequences for type I have also been recorded. These complications associated with type I are evident during childbirth owing to reduced elasticity of the vagina resulting from the scar tissue formed during the circumcision. The vagina tears down to compensate for reduced elasticity during childbirth. These tears are often too tiny to stitch which leads to more scar tissue forming thereby compromising the elasticity of the vagina even further. With each subsequent birth, labor becomes more painful and longer. These tears expose the woman to infection while her ability to be satisfied sexuality is undermined as the vagina become lose due to tearing.
The competence of the person and the sanitary condition where the procedure is being carried out is also a major factor that determines the health of the woman. Many circumcisers are experienced professionals but the sanitary condition and tools that they use are often rudimentary. Their basic surgical instruments are often razor blades and knife like implements that are in most cases not well sterilized. Adherence to traditions does not allow for innovation or the adoption of new and more suitable instruments as it dictates the type of instrument that is suitable. The circumcision ceremonies often take place once a year and all the girls that qualify to be circumcised are normally cut on the same day using the same instrument. There is normally no sterilization between the procedures which increases the chances of infection and the risk of exposure.
The health of the girl undergoing the procedure also dictates her health condition after the procedure. The ability of the girl’s immunity to resist infections that could be passed during the procedure and her ability to heal are also factors that must betaken into consideration. If one has a poor immune system, the chances of being infected become great. The secret nature of the practice poses inherent danger to the health of girls that undergo the practice. The practice is highly confidential and no one is allowed to have any contact with the girls during the period of circumcision or after the ceremony. This means that most of them often do not have access to medical professionals should they be in need of one during or after the ceremony. The period of isolation often associated with type III means that a woman may succumb to infection before she gets the chance to access proper health care. Even if female circumcision is done by a qualified medical personnel under good sanitary conditions, the long term consequences cannot be ignored.
Among the physical problems that results from female circumcision are bleeding, post operative shock, damage to other organs, infections and urine retention which come as a result of swelling and inflammation. The longer consequences include chronic infections of the vagina and the bladder, extremely painful menstruation, excessive scars, childbirth obstruction and risk of HIV infection.
The psychological impacts of female circumcision seem to be Pavlovian in nature and effect. The women who have undergone the practice are often traumatized that they often associate their genitals with pain and possible death during childbirth (Agugua and Egwuatu. 1982). They also do not conceive of sexual intercourse as a pleasurable activity.