FEMALE GENITAL CUTTING By Prof. Ezzeldin Osman Hassan

TERMINOLOGY Different terms to describe a procedure aiming essentially towards assault to the clitoris 1. Female circumcision Has to be changed because of confusion with male circumcision 2. Female genital mutilation Also has to be changed because it offends circumcised women who do not consider themselves mutilated

TERMINOLOGY (cont.) 3. Female genital surgery Is inaccurate because it is not done for therapeutic purposes and is not included in medical curricula or training programs 4. Female genital cutting An attempt to find a neutral language that describe the procedure

THE PROCEDURE Almost always done before puberty Done by : Traditional birth attendants Midwives Physicians

HISTORY AND BACKGROUND FOR CLITORIDECTOMY IN THE WEST : Alleged medical grounds To cure nymphomania To prevent masturbation IN THE EAST : Complex and include socially constructed concepts of Gender and sexuality

REASONS FOR CONTINUATION IN THE EAST Cultural tradition and do what others do Preparation for adulthood and marriage Lead to what is believed to be proper sexual behavior (do not demand or enjoy sex and do not masturbate and to emphasize a passive gender role) Reduce libido (chastity before and fidelity after marriage) Cultural ideas about feminity (clitoris grow and simulate the penis) Girl become clean ? External genital organs become more beautiful ? Belief that the practice has Islamic religion support

CLASSIFICATION Type 1: Partial or total excision of the clitoris Type 2: Excision of the clitoris and labiae minorae (most common type practiced in Egypt) Type 3: (infibulation) Excision of the clitoris and labiae minorie and excision and suture of labiae majorae Type 4: (unclassified) pricking, piercing, incision, scraping, cauterization

COMPLICATIONS IMMEDIATE: Bleeding, shock, death Infection, tetanus Injuries to adjacent tissues REMOTE: Recurrent bladder and urinary tract infections Infertility Dermoid cysts Risks during childbirth (tears) Complications to the newly born Need for further surgery Psychosexual

MEDICAL ASPECTS Has no therapeutic purposes Categories are not distinct on actual grounds Medical complications can be reduced if done by professionals but this cannot prevent remote psychosexual sequelae

ETHICAL ASPECTS Many countries issued laws that prohibit FGC Ethical explanations reinforce inhibitory legislations Ethical choices operate in the absence of legislations Some ethical principles may be in conflict Maleficence prohibit doing harm But also require to minimize risk by performing symbolic cuts in an equipped setting otherwise the procedure will be done by unqualified cutters

LEGAL ASPECTS Physicians must not be involved in acts that result in unrelieved harm as FGC in the same way that they should not be implicated in torture and excusion of such judicial sentences as amputation and death General criminal laws contain articles that prohibit unjustified bodily assault ( FGC is not included in Egyptian medical curricula or training program and is not considered as a recognized surgical procedure) The Egyptian criminal law (articles 231 and 242) penalize a physician who perform FGC by imprisonment for a period of three months to two years and by a fine between 1000 to 5000 EL

LEGAL ASPECTS(cont.) Parental request or consent does not relieve physician’s liability as parents can only consent to medical interventions on their dependant children and FGM is not considered a medical procedure and The Highest Administrative Court ruled that “female circumcision” is not an individual right that emanates from the Shareaa or the Quraan.

HUMAN RIGHTS ASPECTS In 1994, FIGO General Assembly unanimously adopted a resolution considering FGC a violation of Human Rights FGC cannot be justified irrespective of its medical complications because it violates many Human Rights : - The right to autonomy in future life being enforced by parents on a child that cannot give an autonomous informed consent - The right to health - The right to life - The right not to be subjected to inhuman and degrading treatment - The right not to be subjected to any form of discrimination - Children’s right not to be harmed by those on whom the child depend for protection and physical integrity

HUMAN RIGHTS ASPECTS (cont.) Parents right for religious freedom can be applied to support male circumcision in the Islamic and Jewish religions believed to have health benefits, not for FGC with its known health risks Parents claim that they reinforce their daughters prospects for marriage can be rejected by allowing girls to make their own decisions after becoming free from family and cultural constrains

ERADICATING FGC Physicians should not : - comply with mothers request - Succumb to fears that a more harmful procedure be done by unqualified cutters - Their refusal satisfies ethical, legal, and human rights responsibilities Physicians should inform parents about harmful medical and possibly legal consequences * They can follow different strategies and approaches to eradicate the procedure

THE HEALTH APPROACH Stresses the complications and side effects If not supplemented by other approaches can result in : - Disbelief among excised women who did not encounter such complications - Medicalization

THE CULTURAL APPROACH Enforce harmful local traditions Support other forms of expressions that cerebrate women’s sexuality in a positive way eg. Songs etc.

THE DEVELOPMENT/GENDER APPROACH Seek positive role for adolescent girls (education, sports and training to provide sources of income) Enhance women empowerment Find alternative source of income and status for traditional excisors Need community involvement

THE ETHICAL/HUMAN RIGHTS APPROACH Ethical, legal and human rights legitimize efforts to say “ THIS PROCEDURE IS WRONG” The challenge is for local activists to use a language that provide arguments based on local constitutions, local laws and ethical norms and not on International Human Rights Conventions

CONCLUSION Given the strengths and weaknesses of all those approaches, a particular approach may be more useful in one context than the other Moreover, the approaches overlap and are not mutually exclusive and can be implemented by different means