1. Ahoua Koné, MPH, JD Attorney at Law Seattle Immigration & Family Law Group

2. FGC or FGM: what is it? Moral outrage? Legitimate exercise of one’s tradition? Violation of rights? Gender discrimination? Health issue?

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4. FGC by Country and Age Prevalence Among Younger and Older Women Percent Source: DHS STATcompiler: accessed online at www.measuredhs.com/statcompiler on July 21, 2004.www.measuredhs.com/statcompiler

5. Classification (by outsiders) (Types 0-III or types I-IV) Type 0: Symbolic act Type I (Sunna) : Clitoridectomy - Partial or complete removal of clitoris Type II (Excision): Removal of clitoris + inner labia Type III (Infibulation): Removal of clitoris + both inner & outer labia + stitching

6. FGC by type by country

7. Reasons for practicing FGC? Religious/Cultural rite? Preservation of Female Virginity? Controlling/Enhancing Sexuality? Esthetic/Cosmetic reasons? Cleanliness? Unknown?

8. Frequency of reasons for Practicing FGC

9. Health Risks: Short Term consequences. Long Term consequences.

10. Short term health consequences: (percentages from DHS surveys in West Africa, 1999-2001) –Shock / Physical pain –Hemorrhage (11-31%) –Infection (7-32%) –Slow healing (10-23%) –Death

11. Long term health consequences Obstetric (Ivory Coast study, 1997) –Increased vaginal tearing & episiotomy (only first birth, 3 rd type - infibulation) –No significant difference in obstructed labor, hemorrhage, infections (all types of circumcision) Urinary tract and genital infections (no data on relative frequency) Reduced sexual pleasure?

12. How to address it? Medicalization? Criminalization? Health Education? Advocacy? General Female Education? Eradication? Policy development? Cross-Cultural Interventions?

13. Percent of women who want to stop FGC

14. Women vs Men wanting FGC

15. FGC Trends over Three Generations Pre 1950s1960s1990s Age10–15 years8-12 years2-12 months LocationSacred place in forest/wood At a homeAt the family home # Participants 10-15 girls from same generation 2-4 girls from several families 1 infant from a single family Duration2-4 weeks7-10 daysOne day FestivitiesCommunity level Family levelNone CuttingYes