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Female genital cutting (FGC; also known as "female circumcision" or "female genital mutilation") has sparked enormous debate because the issue lies at the crux of many other critical issues: globalization, sovereignty, women's and children's rights, democracy, and modernity. The precise origins of the practice, which dates back to antiquity, are unclear. FGC is deeply embedded in the culture of a number of eastern and central African nations and can be found in other parts of the world as well. The practice continues primarily because it is a tradition. At the turn of the millennium, female genital mutilation was practiced widely in 25 countries. The World Health Organization (WHO) has estimated that more than 130 million women and girls have undergone some form of genital cutting worldwide. Since the 1970s, eradication efforts have been particularly intense.

FGC is typically delineated into categories that vary by type of procedure. "Sunna" is most comparable to male circumcision. It involves the removal of the prepuce, or hood, of the clitoris. "Genital excision" or "clitoridectomy" is the removal of the entire clitoris and the labia minora, leaving the labia majora intact. "Infibulation," the most extreme form of female genital mutilation, is the excision of the clitoris, labia minora and labia majora, followed by the sewing together of the raw edges of the vulva so that only a small hole remains through which urine and menstrual fluid may pass. Mothers have typically taken responsibility for having their daughters circumcised. A traditional midwife often performs the circumcisions, but in some places, health professionals are circumcisers.

FGC creates a number of short- and long-term health consequences. Severe bleeding is the most common immediate complication. Many other complications, such as urine retention or keloids, can lead to discomfort and disfigurement but are typically not life-threatening. Nearly all forms of female genital mutilation interfere with women's sexual response. However, they do not necessarily eliminate the possibility of sexual pleasure or climax. Infibulated women are especially vulnerable to more serious health consequences. Much of the literature on FGC exaggerates such harmful or negative health consequences because it often assumes that all circumcised women are infibulated. In fact, estimates suggest that this extreme form of FGC occurs among only 15 to 20 percent of circumcised women. Further, the incidence of infibulation has decreased in recent years. In some parts of the world, increased medicalization has reduced the incidence of negative health complications.

Three different cultural frameworks for female genital mutilation exist. Frequently, the practice is promoted to ensure the virginity of women upon marriage. The idea is that a clitoridectomy will help women keep their sexual desires in check; in some societies, infibulation is an added precaution because it makes intercourse uncomfortable and difficult. In communities where virginity is of paramount importance, girls are often circumcised in a private ceremony. The second cultural framework treats FGC as a rite of passage into adulthood. In this case, entire cohorts of girls are circumcised at the same time at a certain age. A cohort of boys is also often circumcised at the same time. When female genital mutilation is a rite of passage, a period of seclusion often follows, in which elders educate girls about community requirements. Under either of these cultural frameworks, FGC is usually a requisite for finding a marriage partner. A much less common cultural framework for FGC is the fad. Young women in a number of countries (including the United States and Chad) are undergoing the procedure to be fashionably different. This type of FGC is the least prevalent and tends not to have a lasting impact on the communities in which it occurs.

Western feminists and women's international organizations were critically important in the 1970s in raising international interest in female genital mutilation. African opponents of the practice had been present for some time but had been unsuccessful in getting the attention of international organizations. The Western women who initially took up the issue argued that FGC was a tool of patriarchy and a symbol of women's subordination. Although some African women were part of this early mobilization, many African women objected to this framing of FGC. For example, at the international women's conference in Copenhagen in 1980, African women boycotted a session featuring Western feminist Fran Hosken, calling her perspective ethnocentric and insensitive to African women. As a consequence, international organizations eschewed the feminist rhetoric in their eradication efforts. Instead, they couched their interventions in a purportedly more neutral medical discourse.

Eventually, in the late 1980s and early 1990s, activists returned to the women's rights discourse. A relationship between gender equality and human rights had been developing, and gender equality was becoming an appropriate basis for international action. Feminist arguments that the state was responsible for protecting women and children from abuses suffered in the private sphere had been rejected or downplayed earlier, but now these arguments became the overriding ideology of international organizations. By the mid-1990s, a women's rights frame was dominating the anti-FGC discourse.

In a dramatic policy reversal, a joint statement of WHO, UNICEF, UNFPA (UN Population Fund), and UNDP (UN Development Programme) in 1995 even labeled the medical basis for anti-FGC policies a "mistake." The reasoning of the joint statement suggested that much of the medical discourse--at least as it was applied locally--was exaggerated and consequently counterproductive. The second problem with the medical reasoning was more surprising. Essentially, medicalization had been too effective. By making FGC safer, the international community had undermined the urgency that originally motivated the eradication of the practice. The organizations attempted to recapture some of that urgency in their repackaged message: female genital mutilation had negative health consequences, but--more important--it was a violation of women's rights.

The popular media in the West were particularly amenable to this message and to dramatizing FGC. In 1994 Cable News Network (CNN) broadcast live the circumcision of a 12-year-old girl in Cairo. The footage prompted promises of action from the Egyptian government. It also launched a global media frenzy. In the United States, female genital mutilation was suddenly featured on many popular television talk shows, such the Oprah Winfrey Show, and in popular magazines, such as Cosmopolitan. These popular media stories were grossly ethnocentric, often involving stories of U.S. women "saving" the women of Africa from FGC.

In 1996 the United States made female genital mutilation illegal. In addition to forbidding FGC in the United States, the law also made loans and aid to other countries contingent on the development of eradication policies. Soon all of the countries where FGC occurred (except those which had no government) had policies opposing the practice. These policies were often very controversial and frequently had to be implemented without formal parliamentary approval. For example, in Egypt, where mid-1990s estimates suggested that 97 percent of women had been circumcised, the Egyptian parliament was unwilling to pass a law criminalizing FGC. Ultimately, the anti-FGC policy in Egypt took the form of a "Health Ministry Decree." Although some women were able to use the laws as leverage to forgo circumcision, a lack of popular support undercut their effectiveness in many countries.

In fact, the media hype, combined with the coercive measures of countries like the United States, created a backlash against intervention in some parts of the world. Leading African proponents of eradication began to call for more local solutions. A number of scholars began to argue that FGC was not an issue that should concern individuals outside the societies where it occurs. These scholars have been at the forefront of exploring FGC within a cultural context and of calling for more culturally sensitive anti-FGC interventions.

One widespread impact of international intervention has been to increase the medicalization of FGC. In other words, chances have increased that parents will go to a health professional to have their daughters circumcised, and even traditional midwives now frequently use antiseptics and other medical aids.

In terms of raw rates of circumcision, the overall effect of eradication efforts has been uneven. For example, a recent study conducted in Egypt indicated that the percentage of circumcised Coptic Christian girls had decreased, but the percentage of circumcised Muslim girls had remained relatively stable. The same study also found that education only led to a decrease in daughters' circumcisions among Christians. This suggests that for some groups FGC has become an important cultural marker to distinguish "us" from "them." In other countries, such as Uganda, eradication efforts appear to be very effective. The most recent demographic health surveys coming from countries where female genital mutilation is practiced tend to show no change or slight decreases in the prevalence of the practice (from 2 to 6 percent) at the aggregate national level. Overall, interventions that are narrowly tailored and culturally sensitive to empower women appear to be the most effective at eradicating FGC.

Bibliography:

1) Boyle, Elizabeth Heger. 2005. Female Genital Cutting: Cultural Conflict in the Global Community. Baltimore: Johns Hopkins University Press.

2) Gruenbaum, Ellen. 2001. The Female Circumcision Controversy. Philadelphia: University of Pennsylvania Press.

3) Shell-Duncan, Bettina and Ylva Hernlund. 2000. Female "Circumcision" in Africa. Boulder, CO: Lynne Reinner.

4) U.S. Agency for International Development. 2006. "FGC Data from DHS Surveys, 1990-2004."

5) Yount, Kathryn M. 2004. "Symbolic Gender Politics, Religious Group Identity, and the Decline in Female Genital Cutting in Minya, Egypt." Social Forces 82:1063-90.

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