FGM or Female Genital Mutilation

Prevalence of FGM in Africa

With the increase in immigration from Africa and the Middle East, Australia is seeing far more cases of the hideous practice of FGM or Female Genital Mutilation. Royal Melbourne Hospital alone is seeing 600 to 700 cases of FGM a year.

What is FGM? 

FGM or Female Genital Mutilation is defined as "all procedures involving the partial or total removal of the female external genitalia, for non-medical purposes." Often called 'female circumcision' or 'cutting'.

There are basically four types of FGM. Sometimes carried out with a local anaesthetic or under a  general anaesthetic, but commonly without any anaesthetic at all. In Egypt 25% of FGM operations use no anaesthetic.

Type 1 - Partial or total removal of the clitoris and/or the pupace.

Type 2 - As for type 1 but with the removal of the labia minora, with or without the excision of the labia majora.

Type 3 - Narrowing of the vaginal orifice by cutting and bringing together of the labia minora and/or majora, with or without the excision of the clitoris. The edges are normally sewn together which is called 'infibulation'. The sewing can be done with thread, or, in some parts of Africa, with,acacia thorns. A small orifice is left for urine and menstrual fluid to escape. As part of the 'cutting' process, this orifice may at first be kept open with a twig, or rock salt which also acts as a cauteriser.

Type 4 - Various other methods.

Where does FGM occur?

FGM is banned in many countries and extensive education is carried out to reduce FGM, but it is still a common practice.

FGM  is particularly prevalent in Africa, but also in Yemen and parts of NE Iraq. It is estimated that today over 125 million girls and women in Africa and the Middle East are 'circumcised'/'cut'. Although FGM predates Islam, the majority of (but not all) women who have undergone FGM are Muslims.

Statistics vary greatly from country to country, and among ethnic groupings within a country.

The highest number of women affected are Egyptian - 27 million, that is  91% of females in Egypt. The next highest number comes from Ethiopia, with 23.8 million, which is 74% of Ethiopian females. Then Nigeria with 20 million, or 27% of Nigerian females.

The highest percentage occurs in Somalia, where 98% (6.5 million) of females have undergone FGM, followed by Sudan where 88% (12.1 million) of females have been 'cut'. In addition, 63% of those women and girls in Somalia are infibulated, that is type 3 FGM .

How is it carried out?

In Egypt, most FGM operations (77%) are carried out by medical professionals, often at the girl's home, and a razor blade is the most commonly used instrument. In other countries, the operation is often done by backyard circumcisers using a variety of implements, ranging from scissors to a piece of glass. In Australia and the western world, FGM is done secretly because it is illegal in all western countries. Alternatively, a girl returns to her family's country of origin for the operation.

Most girls who undergo FGM are under the age of 5 years, and the rest are usually 'cut' before they are 10 years old.

Why is it done?

The most common reasons for the practice are social and cultural, and women's status. Other reasons include belief that FGM is required by religion. For example, in Egypt more than 50% of women believe their faith requires FGM. They believe there is a need to prove female virginity and therefore marriageability which reflects on the all important family honour. FGM is believed to relate to health and cleanliness which is linked to religion. Very few men or women believe that a man enjoys increased sexual pleasure with a woman who has been 'cut'.

As would be expected if a girl's mother underwent FGM, then it is more likely that her daughter will be 'cut'. While statistics vary considerably between countries, less educated people are more likely to follow the practice of FGM while wealthier, better educated people are less likely to follow the practice. However, education has more influence than wealth in reducing FGM.

Despite education from NGOs, and laws forbidding FGM, the practice is slow to decline. For example, in Egypt FGM has declined only by 2% in 10 years. However, in Kenya the practice has declined much faster. In many African countries women think FGM should continue:  82% of women in Gambia, 70% in Mali, 63% in Somalia, 55% in Egypt, down to 22% in Nigeria, 10% in Kenya and 9% in Uganda. Men's views are similar to women's views on the subject.

The health effects of FGM

The negative health effects of FGM are very significant. The figures for deaths either due to the operation or after the operation are unknown, but must be noticeable. Deaths of the mother during, or as a result of child birth are not known. The World Health Organisation estimates 10 to 20 babies per thousand die from the effects of FGM. This estimate does not mention women's pain and psychological stress when complications occur.

Problems created during the FGM procedure include haemorrhaging, septicaemia, urinary tract infections and the spread of hepatitis and HIV.

After the FGM operation the common problems are: incontinence, vaginal infections, pain during sex and menstruation, recto-vaginal fistula, the collection of blood in the uterus and infertility. With women who have undergone type 3 FGM, surgery is often required before they can have sexual intercourse. In Australia, 30 % of infibulated women require surgery before sex and childbirth, in other countries less sophisticated surgery is carried out before sexual intercourse can occur.

In Australia the effects of FGM (such as scar tissue around the vulva and reduced size of the birth canal) have led to a necessary increase in the number of caesarean births. Scarring varies from fairly minor to severe in women who have undergone type 3 FGM. An Australian gynaecologist-obstetrician observed a particularly hideous case of scarring in a woman who had undergone FGM as a child by having rock salt strapped to her vulva.