Study Finds Female Genital Mutilation Can Increase Risk that Mothers or Their Babies Will Die In Childbirth By 50%

Scary.

The first large medical study of female genital cutting has found that the procedure has deadly consequences when the women give birth, raising by more than 50 percent the likelihood that the woman or her baby will die.

Rates of serious medical complications surrounding childbirth, such as bleeding, also rose substantially in women who had undergone genital cutting, according to new research being published today in The Lancet, a British medical journal.

“Reliable evidence about its harmful effects, especially on reproduction, should contribute to the abandonment of the practice,” wrote the study’s authors, all members of the World Health Organization Study Group on Female Genital Mutilation and Obstetrical Outcome.

And just so we’re clear on the what’s involved in the practice, the World Health Organization classifies the types of female genital mutilation thusly:

Type I – excision of the prepuce, with or without excision of part or all of the clitoris;
Type II – excision of the clitoris with partial or total excision of the labia minora;
Type III – excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation);
Type IV – pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue;
scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts);
introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it; and any other procedure that falls under the definition given above.

The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases; the most extreme form is infibulation, which constitutes about 15% of all procedures.

In short, this is in no way analogous to removal of the foreskin on males.* Excision of the clitoris would be analogous, perhaps, to the excision of the glans of the penis, or to the entire penis. Excision of the labia would be analogous to excision of the scrotal sac.

FGM survives and is defended because it is viewed as a cultural practice similar to scarification or male circumcision. But this study shows that the harm it does is so great that it should go the way of foot-binding:

While women’s groups and human rights organizations have long campaigned against genital cutting as a rights issue, the study provides the first conclusive medical evidence of long-term physical harm, moving the debate further into the public health arena.

“Finally we have data to prove what health workers have long known: that female genital mutilation is a health issue, a killer of women and children, as well as a human rights issue,” said Adrienne Germain, president of the International Women’s Health Coalition, in New York.

“This should greatly help advocates overcome arguments that genital mutilation is an untouchable cultural practice.”

Earlier, smaller, studies had been inconclusive or had conflicting results. This is the first large study of the effects of FGM on maternal and child health.

The study was conducted with the help of more than 28,000 women in six African nations from 2001 through 2003. The women were examined to document the degree of genital damage and were followed until after they had given birth.

The study found that the women who had undergone genital cutting of any degree of severity and their babies were more likely to die during childbirth. More extensive genital cutting produced the highest rates of maternal and infant death during childbirth, even many years later.

The lesser forms of cutting caused about a 20 percent increase in death rates, while extensive procedures caused increases of more than 50 percent.

By almost all measures studied by the World Health Organization, a history of genital cutting put both mother and baby at risk. Mothers who had had the procedure had longer hospital stays, experienced more blood loss, and were more likely to need a Caesarean section. Babies were nearly twice as likely to require resuscitation at birth.

The researchers noted that the study almost certainly underestimated the potential for death and damage, because it only tracked women who delivered their babies in hospitals.

Many women in the African nations where genital cutting is practiced deliver their babies at home, where typically it is not possible to treat medical complications like severe bleeding or to resuscitate an ailing newborn.

The scarring caused by genital mutilation likely makes it more difficult for babies to emerge, which is a factor in obstetric fistulas. Nicholas Kristoff has written pretty extensively about the Fistula Hospital, which repairs these fistulas, which generally occur in young girls giving birth for the first time, at home, who tear after many hours or days of labor due to narrow pelvises and genital scarring. Often, the child is born dead, and if the mother survives, she often has a fistula, which results in inability to control her bodily wastes and being cast out because of the smell.

Let’s hope that this study provides the impetus to outlaw this practice once and for all.
____

*Discussions of FGM always bring out trolls who want to derail the conversation to whine about how they were mutilated by being circumcised. Yes, Patriarchy Hurts Men, Too. However, this post is about Female Genital Mutilation and its role in maternal and child deaths. Unless you’re giving birth through your urethra, I don’t want to hear it. Any attempts to derail the discussion into issues of male circumcision will be summarily deleted.


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52 comments for “Study Finds Female Genital Mutilation Can Increase Risk that Mothers or Their Babies Will Die In Childbirth By 50%

  1. June 2, 2006 at 1:22 pm

    I saw a film from Senegal about FGM called Moolaadé directed by Sembene Ousmane. It’s narrative, not a documentary, but quite good nonetheless.

  2. Magis
    June 2, 2006 at 2:13 pm

    It is all based on nothing more than the idea that if a woman has no pleasure she will not cheat on her mate (owner). It is bestial, nothing less.

  3. June 2, 2006 at 2:36 pm

    First off, let me say that I disagree utterly with the idea of calling any widespread cultural practice “bestial” — these are people, damnit.

    That out of the way, this is an important study, one of the first significant studies *ever* performed on the health effects of FGC. But the headline is fairly misleading. Compare the claim that FGC increases the likelihood of death by 50% with the study’s findings:

    The excess deaths attributable to FGM ranged from 11 to 17 per 1000 deliveries…

    On the basis of the summary RR, about 22% (11–32) of perinatal deaths in infants born to women with FGM can be attributed to the FGM.

    What’s wrong with a headline that says “Study finds FGC increases risk of infant death by 1.4%”? Well, that hardly sells papers, and it hardly satisfies our need for righteousness porn: “Look at *those people* with their bestial ways! We’re so much superior to them!”

    As far as I can tell, the Lancet report doesn’t mention mother deaths.

    One concern I have is that the same group did a study in Sweden (among refugee women) a couple years ago that found no link at all between FGC and either infant or mother deaths, which suggests there may be some link between quality of health care and these higher rates of death — perhaps that better hospitals are better able to treat complications that arise from FGC, or perhaps that other factors than FGC are involved that the WHO group did not take into account. The second is unlikely, though — it looks like a pretty thorough and careful study.

    The Lancet article is at http://www.thelancet.com/journals/lancet/article/PIIS0140673606688053/fulltext (registration req’d).

  4. June 2, 2006 at 2:46 pm

    One more thing: the rate of mother death in the countries under examination ranges from 1 in 35 to 1 in 12; the baseline infant mortality rate ranges from 44/1000 to 88/1000. These are *insane* mortality rates — 1 in 12 births in Burkina Faso ends with the death of the mother?! However significant FGC might or might not be in these figures, the fact remains that the great human rights fiasco here is that the resources for even basic care are lacking for (some might say “withheld from”) the poorest women. I’d like ot see a movement with anything like the impact and power of the anti-FGC movement dealing with *that*!

  5. the15th
    June 2, 2006 at 2:54 pm

    What’s wrong with a headline that says “Study finds FGC increases risk of infant death by 1.4%”?

    What’s wrong with it? It implies that the risk of infant death with FGM is only 1.4% greater than that without FGM. That’s not the case. A headline like “Smoking raises lung cancer risk by 100%” doesn’t mean that you have a 100 percent chance of getting lung cancer if you smoke; it means that you have twice as high of a chance as someone who doesn’t. Sorry if a correct interpretation of the statistics seems like “righteousness porn” to you.

  6. June 2, 2006 at 3:02 pm

    Or, I meant to add, “Increases risk of death by 22%”, which is the number of excess deaths the authors determined were caused by FGC.

    How is 50% a “correct interpretation”? Nowhere does the study report a figure like that — where does it come from?

  7. June 2, 2006 at 3:05 pm

    When feminist bloggers post about sexism in the West, someone always pops up to say how trivial it is and why don’t you write about something more important like female genital mutilation.

    But no, that’s trivial too, it seems.

    To say “increases risk of death by 1.4%” would also be misleading: it would suggest a rise from, say, 10 per thousand to 10.14 per thousand.

  8. piny
    June 2, 2006 at 3:12 pm

    The lesser forms of cutting caused about a 20 percent increase in death rates, while extensive procedures caused increases of more than 50 percent.

    The “lesser forms” are much more common. While FGM overall has caused a 22-percent increase in death rates, severe FGM causes a fifty-percent increase.

    which suggests there may be some link between quality of health care and these higher rates of death

    If I get shot in an area that does afford access to health care, I have a much higher chance of survival than if I get shot far away from help. Does that mean that we should not condemn shooting people in general, or point out that gunshot wounds pose a pretty serious problem for people without health care?

  9. zuzu
    June 2, 2006 at 3:14 pm

    Dustin, that 1.4% you cite is for infant deaths only. The figures given of 20-50% increase in risk cited, depending on the type of FGM, are for maternal and child deaths together.

    And don’t start trying to derail the discussion with “Why aren’t you worried about this other thing?” We’re talking about this study. I’m sure the WHO is well aware that maternal and infant deaths are horrendous in Africa, HOWEVER, that does not mean that this study is not important as a weapon in the fight to end this damaging, mutilating practice. Given how much the risk of maternal or child death increases when a woman has been mutilated, don’t you think it’s a good idea to stop that practice? Stop FGM, and you lower the rate of deaths in childbirth.

  10. Dianne
    June 2, 2006 at 3:25 pm

    I agree that “bestial” is the wrong description: it’s an insult to beasts, none of whom, except for humans, practice FGM.

    Depending on the type of FGM, the relative risk of neonatal death in this study ranged from 1.15 (15% higher than for no FGM) for the least extensive form to 1.55 (55% higher) for the most extensive. So the headline might be considered a little sensationalistic in that the 50% quoted is true only for the worst form–women who had a relatively small amount of genital tissue cut have “only” a 15% higher than normal chance of having a stillbirh or neonatal death than women who had no FGM–but it is not entirely inaccurate. One other interesting thing to note from the study is that FGM did not increase the odds of a low birthweight baby. So it’s big, healthy, full term babies who die from FGM.

    Incidently, where are the pro-lifers? Shouldn’t they be outraged at this example of baby killing?

  11. nik
    June 2, 2006 at 3:44 pm

    Hope this isn’t derailment, since you touch on it above, but isn’t Type I FMG – without excision of the clitoris – exactly analgous to male circumcision? Until I read this post I didn’t even realise my clitoral hood *was* a prepuce, I though only men had them (prepuces, that is).

  12. June 2, 2006 at 4:00 pm

    Unless my math is fuzzy indeed, a 1.4% increase represents a shift of 14/1000, not 1.4/1000 — which is what the Lancet report says. Piny’s got it — the NYTimes chose to report the highest rate based on the smallest sub-group of the population studied. That’s what I’m questioning. Zuzu, fair enough — my second comment wasn’t meant to deflect attention from the topic under consideration, but to follow on the point of health care: if substandard health care makes FGC more dangerous, then that bears consideration.

    Dianne, the women who practice and undergo FGC are still people, and deserve a bit of respect. Period.

    As I said, this report is really important, because it’s the first wide-scale medical study that seems to be grounded in decent methodology. The Lancet report is pretty open and thorough about what could introduce errors, and I think they’ve been adequately accounted for. Maternal death isn’t mentioned, unless I’m missing something — that had to be introduced by the NYTimes, perhaps from outside material, but it’s not crucial to evaluating the WHO group’s findings.

    I’m not trying to present an apologia for FGC, which it really isn’t my place to do. I do not, however, think it’s very helpful to dismiss people as “beasts” and then argue that we’re the ones who really have their best interests at heart. I also think that the fascination with FGC does represent a kind of pornographic interest — after all, we’re sitting around talking about women’s genitals, and it makes a lot of people feel good about themselves to feel superior. I’m not denying that there’s a real concern among some — but I would like to see something a little more constructive than, say, our government’s response which has been to deny foreign aid — desperately needed aid — to people that practice FGC. And certainly more constructive than impugning the humanity of people who practice something, even something hurtful.

  13. Kristen from MA
    June 2, 2006 at 4:06 pm

    i think it’s important to note that women and their babies are dying as a result of FGM, and that many women develop fistulas; mabe this information will lead to the end or at leat a reduction in FGM.

    but i wish MSM would mention the fact that women who are mutilated in this manner cannot experience sexual pleasure. EVER. isn’t that important, too? (oh, right, nice girls aren’t interested in such things. it’s all about the BAYBEES.)

  14. zuzu
    June 2, 2006 at 4:11 pm

    Hope this isn’t derailment, since you touch on it above, but isn’t Type I FMG – without excision of the clitoris – exactly analgous to male circumcision? Until I read this post I didn’t even realise my clitoral hood *was* a prepuce, I though only men had them (prepuces, that is).

    It would be most analogous, but it’s pretty rare, according to the WHO figures. Type II accounts for 80% and Type III accounts for 15%.

  15. June 2, 2006 at 4:12 pm

    1.4% of ten in a thousand is 0.14 per thousand.
    If a risk is ten in a thousand, and that risk goes up by 1.4%, it goes up to 10.14 per thousand.

    You are making the same mistake that John Allen Paulos points out here with regard to Social Secuity (second paragraph):
    http://abcnews.go.com/Technology/WhosCounting/story?id=300038&page=1

  16. piny
    June 2, 2006 at 4:13 pm

    I’m not trying to present an apologia for FGC, which it really isn’t my place to do. I do not, however, think it’s very helpful to dismiss people as “beasts” and then argue that we’re the ones who really have their best interests at heart. I also think that the fascination with FGC does represent a kind of pornographic interest — after all, we’re sitting around talking about women’s genitals, and it makes a lot of people feel good about themselves to feel superior. I’m not denying that there’s a real concern among some — but I would like to see something a little more constructive than, say, our government’s response which has been to deny foreign aid — desperately needed aid — to people that practice FGC. And certainly more constructive than impugning the humanity of people who practice something, even something hurtful.

    You’re calling it “FGC,” aren’t you? A comparison to circumcision is apologist. And not to defend the term in general, but no one said that the women who had undergone it were “bestial.” There’s nothing pornographic about focusing on a problem of this magnitude, particularly one that doesn’t receive enough notice because gynecological and reproductive health is viewed as a dirty subject.

  17. nik
    June 2, 2006 at 4:19 pm

    Piny, I think the ‘C’ in FGC stands for cutting.

  18. June 2, 2006 at 4:27 pm

    FGC = Female Genital Cuttting, not circumcision. Circumcision is a specific type of cut — the removal of the prepuce — and doesn’t encompass all the procedures in question. Mutilation is a judgemental word that implies an aesthetic that, frankly, isn’t shared by cultures that practice FGC. Cutting is the best thing we have to avoid prejudgement and, in a field of discourse where there’s tons and tons of prejudgement, I feel that’s appropriate.

    Who’s bestial, then? In most societies (not all) where FGC is practiced, it is done by women to women — and the women doing it have all undergone it. So they’re bestial when they wield the knife, not when they’re under it?

    Miss Prism: I see the issue now. I wax talking about an increase overall, not an increase in risk. A 1.4% increase in infant deaths. From 100/1000 to 114/1000. But I see how I confused matters. Statistics aren’t my forte…

    Look, I can sympathise with the desire to end these practices. Less infant deaths is less infant deaths — a Good Thing. Less women’s suffering = less women’s suffering; also a Good Thing. But I don’t think it does anyone any good to a) exaggerate the facts, like the NYTimes article does (for sensationalistic reasons, I believe), or b) to refuse to address these practices as things that reasonable people do for understandable reasons. Women in these societies are marginalized in a thousand different ways — I don’t think that Westerners insisting we know what’s best for them is a way to *unmarginalize* them. Especially when we impose our assumptions about sexuality on them (as, e.g. the comment about not being able to experience sexual pleasure — how do we know that? It’s an assumption I see all the time, but I’ve never seen any evidence other than “it stands to reason”). I’m not about to insist that FGC is an unmitigated good, but it’s not a simple issue, and I think it belittles the women and men involved to depict it as if it were.

  19. zuzu
    June 2, 2006 at 4:40 pm

    Sorry, but how is cutting out a woman’s clitoris NOT mutilation?

  20. piny
    June 2, 2006 at 4:48 pm

    FGC = Female Genital Cuttting, not circumcision. Circumcision is a specific type of cut — the removal of the prepuce — and doesn’t encompass all the procedures in question. Mutilation is a judgemental word that implies an aesthetic that, frankly, isn’t shared by cultures that practice FGC. Cutting is the best thing we have to avoid prejudgement and, in a field of discourse where there’s tons and tons of prejudgement, I feel that’s appropriate.

    Mutilation is “irreparable damage.” Given the severe difficulty these women subsequently have in giving birth, why is it inappropriate? “Cutting” is a trivialization.

    (as, e.g. the comment about not being able to experience sexual pleasure — how do we know that? It’s an assumption I see all the time, but I’ve never seen any evidence other than “it stands to reason”).

    You’re kidding, right? Say you took a group of men and removed their scrotal sacs, along with the glans penis, and then stitched together whatever remained so that it would be more difficult for them to have intercourse. Would it be irrational to assume that a lot of them would be rendered anorgasmic or at least suffer huge complications during sex? FGM is characterized by trauma, clitoridectomy and a whole lot of scar tissue. Did you read the WHO report? They cite two studies.

  21. zuzu
    June 2, 2006 at 4:51 pm

    Dustin, the sole purpose of the clitoris is sexual pleasure. Remove it, and you remove most, if not all, of the ability to orgasm.

  22. Thomas
    June 2, 2006 at 4:52 pm

    Dustin, when you cut something off of a child’s body to limit his or her capacity in the future, it’s mutilation. It’s an amputation for social control. Aesthetics do not enter into it, and we are not talking about what a few adult radicals do to their own bodies.

    This i-can’t-judge-other-cultures shit is just nonsense. Your argument operates as sustained apologia for the practice, and refusing to engage ethical reasoning about other cultures is not a defensible position. If opposing a practice because it’s part of a culture that’s different than ours is wrong, than how can we challenge female infantacide, or sex trafficking in Southeast Asia, or the repressive policies of Saudi Arabia .. after all, it’s their culture, and who are we to judge? You know what? Fuck that. There are maybe a handful of philosophers that adopt pure cultural relativism, and none of them have ever left their libraries.

    Finally, the argument that removing the clitoris destroys some sexual function is not, “it stands to reason.” It’s an argument about biology, the same as an argument that if you lose your tongue, your olfactory sense will suffer. It’s tough to test empirically, because the people with the diminished capacity have no basis for comparison for their subjective experience. The only way to actually do the experiment is to find people who underwent the procedure late enough in life to make the comparison, and I’m not sure one could find that population.

  23. piny
    June 2, 2006 at 4:52 pm

    Dustin, the sole purpose of the clitoris is sexual pleasure. Remove it, and you remove most, if not all, of the ability to orgasm.

    Yup. Lest we be accused of insufficient cultural relativism–which is refreshing, if nothing else–I’ve got a post coming about some of the consequences of plastic surgery in this country.

  24. June 2, 2006 at 5:13 pm

    FGC removes the external part of the clitoris; the organ itself extends deep within a woman’s body. Removing the entire clitoris, especially under non-hospital conditions, would likely kill you.

    What is the effect of removing or cutting into the external part of the clitoris? Well, we can guess, but we do not know. The only relevant data that’s been collected (not the only relevant data that could be collected, however) shows that birth-rates are not significantly lower in communities that practice FGC than in those that do not. Which suggests that women in FGC-practicing communities are having the same amount of sex. Whether that sex is voluntary or not, I don’t know, though I doubt it’s *less* voluntary than the sex of their neighbors. The bottom line, though, is that we do not have data on most aspects of FGC, which means that nearly everything that is said about it is assumed — and I think we can agree on the dnager of that. Which is why the WHO study is interesting, for me — it’s actual data, and the trend it shows seems well-founded.

    The Free Dictionary gives these definitions for “mutilation”:

    1. To deprive of a limb or an essential part; cripple.2. To disfigure by damaging irreparably: mutilate a statue. 3. To make imperfect by excising or altering parts.

    To disfigure, to make imperfect, to cripple — these are all judgements. There are women who have undergone FGC who see themselves as mutilated; there are also women who have undergone FGC who see themselves as improved, finished. One common justification is that the male circumcision removes the last vestige of femininity from a man and the female procedure removes the last vestige of masculinity from a women. We may well question the patriarchal justifications behind this desire, but when we call it “mutilation”, we are judging it by a standard that we are imposing from our own worldview.

    With a bit of a double-standard, I might add. Women in our society choose surgical procedures to enhance (at least in their minds) the look and feel of their genitals quite frequently. Yes, this is chosen — but this is a choice that even an adult woman cannot make in Africa, under the current aid regime. Very few are willing to advocate making FGC itself safer and less likely to produce lasting damage — when Egypt (I think) proposed medicalizing the procedure and performing it on consenting adults in hospitals, they were threatened with the revocation of their foreign aid. What this suggests is that there is a concern that extends beyond the safety or medical implications of FGC (something akin to the debate around abortion in our society, where medical risks are highlighted but aren’t really the issue at all).

    I don’t thin it’s trivialization to insist that we take the experiences and desires of the women who live in FGC-practicing societies into account and that we resist the imposition of our understanding of their roles and of their sexualities. If people are dying because of these practices, then that makes it all the more important to understand them on their own terms. The history of Western intervention in native practices doesn’t have a lot to recommend itself by; I would like to think that there’s a way of dealing with human suffering that does not follow the same route.

  25. piny
    June 2, 2006 at 5:27 pm

    FGC removes the external part of the clitoris; the organ itself extends deep within a woman’s body. Removing the entire clitoris, especially under non-hospital conditions, would likely kill you.

    Most of the people you’re debating have one. We know that. The external part of the clitoris is what most women stimulate in order to get off; removing it makes it much more difficult for women to get off. According to the studies cited by the WHO, it can cause anorgasmia and does cause it at high rates. That data can’t be based on anything other than women from these cultures reporting their subjective experiences. The scar tissue that FGM leaves behind can also complicate any other kind of sexual activity, including stimulation of other clitoral nerves, particularly if the vaginal opening is stitched tighter. There are controls available; check out isna.org for more information, or do some research on potential complications for genital plastic surgery as practiced in the US.

    Finally, one of the stated rationales for FGM is rendering women chaste by controlling female desire. If clitoridectomy did not cause complications with regard to sexual pleasure, what utility would it have?

    To disfigure, to make imperfect, to cripple — these are all judgements. There are women who have undergone FGC who see themselves as mutilated; there are also women who have undergone FGC who see themselves as improved, finished. One common justification is that the male circumcision removes the last vestige of femininity from a man and the female procedure removes the last vestige of masculinity from a women. We may well question the patriarchal justifications behind this desire, but when we call it “mutilation”, we are judging it by a standard that we are imposing from our own worldview.

    The patriarchal justifications behind that rationale are a settled question. Yes, just as when we call it misogynistic for El Salvador to force women to undergo forensic gynecological exams to prove that they haven’t aborted recently. Evaluation involves judgment.

    With a bit of a double-standard, I might add. Women in our society choose surgical procedures to enhance (at least in their minds) the look and feel of their genitals quite frequently. Yes, this is chosen — but this is a choice that even an adult woman cannot make in Africa, under the current aid regime. Very few are willing to advocate making FGC itself safer and less likely to produce lasting damage — when Egypt (I think) proposed medicalizing the procedure and performing it on consenting adults in hospitals, they were threatened with the revocation of their foreign aid. What this suggests is that there is a concern that extends beyond the safety or medical implications of FGC (something akin to the debate around abortion in our society, where medical risks are highlighted but aren’t really the issue at all).

    Right, and no feminist has ever complained about Western genital “remodeling!” Why, we hadn’t even bothered to make ourselves aware of it until you brought it up here.

  26. piny
    June 2, 2006 at 5:30 pm

    The only relevant data that’s been collected (not the only relevant data that could be collected, however) shows that birth-rates are not significantly lower in communities that practice FGC than in those that do not. Which suggests that women in FGC-practicing communities are having the same amount of sex. Whether that sex is voluntary or not, I don’t know, though I doubt it’s *less* voluntary than the sex of their neighbors.

    And what does this finding have to do with a lack of sexual pleasure?

  27. Thomas
    June 2, 2006 at 5:42 pm

    Dustin, you have no basis for an assertion that sex in a culture where women’s clitorises are removed at puberty is not more frequently coerced that in other places. None.

    You said there was no empirical evidence of anorgasmia, which would not surprise me because of the problems in doing the research, but in fact there is; as Piny has pointed out. That destroys your assertion that we don’t know that FGM diminished sexual function.

    Apparently, you are completely invested in rubber-stamping anything that non-Western cultures do.

  28. June 2, 2006 at 5:44 pm

    Piny, I’m going to bow out of this discussion until I have the time to prepare an adequate response. I didn’t mean to hijack this thread to discuss the relative merits and demerits of FGC — as I’ve said, I think this is an important study, and I am very thankful that zuzu brought it to our attention. My main contention is that the reported experiences of many women who undergo FGC do not at all jibe with the way Westerners, feminist and non-feminist alike, respond to these practices, a point which I will develop on my own site so as not to detract from the discussion here.

  29. June 2, 2006 at 6:16 pm

    It is all based on nothing more than the idea that if a woman has no pleasure she will not cheat on her mate (owner).

    It’s more about making sure she’s a “good girl”, the FGM victims I’ve talked too say the idea of not having had it done scares them because then they wouldn’t be a “clean” women.

    It’s the equivalent to Hajib or not dressing slutty, it keeps women hating on other women (most FGM victims are mutilated by their own mothers for instance), it helps keep the abstinence (for women) only education in check, because then she won’t get “those urges” from the rubbing of a too tight pair of panties, and will be a bit less prone to experimentation if there’s damage done that makes sex physically painful.

    Patriarchy’s nastiest tools rarely have a single purpose, like the rape culture, flexibility is what keeps these specific practices hanging around for as long as they have after all.

  30. Dianne
    June 2, 2006 at 6:27 pm

    My main contention is that the reported experiences of many women who undergo FGC do not at all jibe with the way Westerners, feminist and non-feminist alike, respond to these practices, a point which I will develop on my own site so as not to detract from the discussion here.

    Have you ever seen the genitalia of a woman who has undergone FGM? Or talked to one about her experiences? I have and neither were pretty. I admit that I’ve only seen and talked to one woman who underwent FGM and her experiences may not be typical, but she did not view it positively–she described herself as having been forced to undergo the procedure–and I nearly threw up after examining the damage done to her genital area. Anecdote, of course, I suppose it’s possible in principle that 99% of women who undergo FGM are willing and never regret it, but somehow I don’t think that’s the case.

  31. Dianne
    June 2, 2006 at 7:26 pm

    This is interesting. Apparently, FGM hurts men too: men report problems including difficulty in penetration and penile wounds from sexual contact with women with FGM. Apparently also the majority of young men would prefer to marry a woman who had not undergone FGM. If it hurts both parties and neither desires it, why do it? Is tradition really that important?

  32. Mandolin
    June 2, 2006 at 7:32 pm

    FGS is a good term that avoids both ‘cutting’ and ‘mutilation’ – ‘surgeries’ imports some of the gravity, though, yes, this term is also limited in its usefulness.

    FGS are not done solely to make it less possible for women to cheat, although that is one of the reasons stated by some cultures.

    It’s very difficult to talk about infibulation and clitorodectomy in one breath. Doing so, and imputing the same motives to all the various cultures that practice FGS, is a form of racism in itself — they really aren’t a monolith.

    All types of FGS do not necessarily result in lack of orgasmic ability. Orgasmic ability varies. The work of anthropologist Carolyn Martin Shaw illuminates some of the ways that this variance occurs. One particular trend is that women who are taught how to orgasm before circumcision (as, I believe, in traditional Kikuyu ritual) are more likely to be able to find ways to orgasm after their genitals are altered.

    I believe it is much less likely for women to be able to experience sexual pleasure if they have undergone infibulation.

    There’s an overwhelmingly good reason to talk about FGS in terms of health instead of in terms of orgasm. Within the context of most of the cultures where FGS is practiced, female sexual pleasure is not a subject of conversation. For decades, white anthropologists went into Africa saying “Please, don’t circumcize; it’s barbaric and orgasms are affected.” The ultimate result of tihs was the formation, in many places, of an identity that involved self-righteous circumcision — people circumcized to show that their African-ness, to show that they were not like the Americans. Some cultures which never traditioanlly circumcized women have taken up the practice, to show the ways in which they are different from Westerners. Thus, circumcision has acquired another layer of meaning, and one that further talking about ‘sexual pleasure’ is likely to deepen.

    By contrast, talking about health has proven an effective way to lessen cultural attachment to FGS.

    To Dustin’s argument about the fact that western interference in other people’s cultures has rarely brought about laudable results – I agree. However, anthropologists and activists have found ways to argue against FGS which are effective. This involves thinking about the issue from the perspective of the women’s culture (for instance, realizing that health of babies is more likely to be of concern than sexual pleasure) and also thinking about the role of ritual in society. Successful programs have done things like substitute the giving of a bracelet or the ritual nicking of the clitoris for more drastic procedures.

    FGS is unlikely to go away soon. In addition to the new meanings that the practice has accumulated in regard to African (/non-western) identity, disastrous early attempts by colonial missionaries to outlaw the practice often resulted in FGS being disociated from its traditional contexts and being done to younger and younger subjects. It’s not uncommon for clitorodectomy procedures, for instance, which were once performed on teenage or adolescent women who were expected to have sexual practice – and which were once done as part of a ritual bonding experience – to be done to very young girls. These FGS procedures lose even their positive social benefits, and of course as already noted here, circumcizing younger girls is more likely to impare their ability to acheive sexual pleasure.

    By the by, I find comparing FGS to voluntary surgeries in the United States to be fallacious and silly. Not only are African women required to undergo the procedure as a norm – but – and this is important – in most FGS practicing cultures *women can not opt out*. This means they are undergoing dangerous, risky procedures even if they *and their families* disagree with the practices. Women who are not cut may not have any place in the society. They may be unable to marry and take on normal social roles. This is *not* like a boob job or American labioplasty in any sense at all.

    Incidentally, the fallacious comparison of FGS to boob jobs is something about half of the first year anthropology students make. The other half call FGS beastial.

  33. nik
    June 2, 2006 at 8:04 pm

    I think the reason behind the FGM to boob jobs comparison (at least as expressed by Dustin) is a bit more subtle than just claiming they’re the same sort of thing, and so equally valid. Campaigners have been campaigning for the total prohibition of FGM – including making performing the operation on consenting adults illegal. The criticism is that they’re being overzealous and is made from standard liberal grounds.

    Personally, I don’t buy it. Even if people consent to FGM, they do so because of an environment which is not conducive to their interests. Remedying that situation can only be done by stamping the practice out completely, for which I feel a total prohibition is justified.

    Having read the Lancet paper, they don’t actually demonstrate that Type I FGM has any of the negative effects they look for. I can see how that would make sense from the anatomy of the situation. Though I can’t say I blame them for blurring it all together and using the results as a stick with which to beat the whole practice.

  34. zuzu
    June 2, 2006 at 10:30 pm

    By the by, I find comparing FGS to voluntary surgeries in the United States to be fallacious and silly. Not only are African women required to undergo the procedure as a norm – but – and this is important – in most FGS practicing cultures *women can not opt out*. This means they are undergoing dangerous, risky procedures even if they *and their families* disagree with the practices. Women who are not cut may not have any place in the society. They may be unable to marry and take on normal social roles. This is *not* like a boob job or American labioplasty in any sense at all.

    So why would you use the term “surgeries” to refer to it?

    Having read the Lancet paper, they don’t actually demonstrate that Type I FGM has any of the negative effects they look for.

    And according to the WHO figures, Type I accounts for less than 5% of the FGM procedures, whereas the far more damaging Type II and Type III account for 95%.

  35. evil_fizz
    June 2, 2006 at 10:32 pm

    Orgasmic ability varies. The work of anthropologist Carolyn Martin Shaw illuminates some of the ways that this variance occurs. One particular trend is that women who are taught how to orgasm before circumcision (as, I believe, in traditional Kikuyu ritual) are more likely to be able to find ways to orgasm after their genitals are altered.

    And so what rationale is then offered for a clitoridectomy? Some sort of warped sense of asthetics?

    These FGS procedures lose even their positive social benefits, and of course as already noted here, circumcizing younger girls is more likely to impare their ability to acheive sexual pleasure.

    I’m sorry, but positive social benefits? A bonding ritual centered on sexual mutilation yielding positive social benefits? Like what?

  36. June 3, 2006 at 12:00 am

    And according to the WHO figures, Type I accounts for less than 5% of the FGM procedures, whereas the far more damaging Type II and Type III account for 95%.

    According to the Lancet study, each category accounted for about 25% of the total population, with the other 25% having had no form of FGC: http://www.thelancet.com/journals/lancet/article/PIIS0140673606688053/table?id=tbl1

    According to the table in the post above (2nd blockquote in the post), 80% of FGC’s are Type I:

    The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases; the most extreme form is infibulation, which constitutes about 15% of all procedures.

  37. June 3, 2006 at 12:03 am

    Sorry, I misread that — excision of the labia minora is Type II.

  38. jah
    June 3, 2006 at 1:31 am

    You know, it took me over a year to be able to have intercourse without intense pain after the (unasked for and unwanted) episiotomy I got with the birth of my first child.

    After that experience, I can’t imagine what iintercourse would be like after FGM — which is far, far more extensive than the small cut I was given — at an early (or really any) age.

    I think it’s kind of creepy that at least one of the apologists here for FGM is male.

  39. June 3, 2006 at 3:53 am

    I’m stunned that we’re actually debating the relative “merits” of FGM, and arguing that it’s ok “because it’s their culture.” I believe in respecting other cultures. I don’t believe that Western ideals are automatically superior to all others. I think that there are different ways to be feminist within varying cultural contexts.

    However, at some point a respect for human rights is going to clash with cultural practices, and we have to decide where we draw the line — where do we say that there’s a baseline of rights that every person deserves, regardless of where they happened to be born? I think that bodily autonomy is a pretty damn good place to start.

    FGM is rarely voluntary. It’s done to girls who are held down and mutilated. So let’s be clear here that we’re mostly talking about girls, not consenting adult women. And we’re talking about people — women and girls — who have very little power and personal autonomy. It’s a means of social control, and it deprives these girls of the basic ability to experience sexual pleasure. FGM has a high rate of infection, and as zuzu pointed out in her post is related to higher maternal mortality rates, and often leads to obstetric fistulas. It’s an abhorrent practice, and I’m absolutely sickened that people here would defend it.

    Feminism is about standing up for the basic human rights of women and girls. It reaches a point where it is incompatable with cultural relativism. This, clearly, is far past that point. And if you believe that “culture” trumps basic human rights, fine. But would you make the same arguments for cultures that supported slavery? How about the Western cultural practices that harm women — care to defend those by arguing that “it’s just our culture”?

  40. June 3, 2006 at 4:00 am

    I didn’t mean to hijack this thread to discuss the relative merits and demerits of FGC

    I’m disgusted that we’re even assuming that FGM has “merits” and making them credible by arguing about them.

    FGC removes the external part of the clitoris; the organ itself extends deep within a woman’s body. Removing the entire clitoris, especially under non-hospital conditions, would likely kill you.

    What is the effect of removing or cutting into the external part of the clitoris? Well, we can guess, but we do not know.

    The ability to enjoy sex is not correlated with how many children you have.

    And I’m missing your point about removing the whole clitoris. So only the outer part is removed, not all the internal clitoral tissue — this somehow makes FGM more acceptable?

    I hate to pull this card, but Dustin, do you have female sex organs? Because I can’t help but assume that you don’t. I’m not sure that anyone with a clitoris would argue that there are merits to being held down and having your external genitalia forcibly sliced off.

    If you have a penis, how would you feel about a cultural practice that cut your dick off — but after saving your sperm so that you could reproduce, of course. What if they did it to 8-year-old boys without anesthesia? Sickened? I’d hope so.

  41. Dianne
    June 3, 2006 at 5:27 am

    Having read the Lancet paper, they don’t actually demonstrate that Type I FGM has any of the negative effects they look for.

    Well, sort of. There was a trend towards worse outcomes in women who had type I FGM, but the 95% confidence interval included 1 in most cases (with the notable exception of neonatal mortality in primagravidas), meaning that the differences seen could be due to chance. Further study concentrating on countries where FGM type I is the common type might clarify the issue.

    The percentage of women who underwent each type of FGM as well as the percentage with none, varied from country to country. In the Sudan, nearly 3/4 of women undergo type III.

  42. nik
    June 3, 2006 at 12:44 pm

    “There was a trend towards worse outcomes in women who had Type I FGM, but the 95% confidence interval included 1 in most cases (with the notable exception of neonatal mortality in primagravidas), meaning that the differences seen could be due to chance.”

    I’m not even that confident about neonatal mortality in primagravidas. They carried out 12 tests in order to get that result. Even if there had been no difference between Type I FGM and no FGM, assuming the tests were independent, they’d have had a 46% (1-[0.95^12]) chance of seeing one or more positive results anyway. I’m not sure that’s not what happened.

    I’m also not sure about a trend towards worse outcomes either: in 5 of the measures the risk of complication was lower under Type I FGM, in 6 it was higher, and in 1 there was no difference.

    I’m not suggesting Type I FGM’s a good idea mind you.

    I think Zuzu’s data on FGM type prevalence is correct and the data in the lancet study can’t be relied upon. They constructed the study so that there’d be equal amounts of people in each of the 4 groups. So there’s no reason to suppose it accurately reflects proportions in the real world.

  43. Dianne
    June 3, 2006 at 2:45 pm

    nik: I think based on the data in the Lancet study, one would have to say that an increased risk in childbirth from type I FGM, paricularly for increased risk of neonatal death, is suspected but unproven. Another study looking exclusively at places where type I is used exclusively or nearly exclusively so that you could get larger numbers would be useful in sorting this out if anyone is interested. It’s clearly not as dangerous as types II or III, both of which unequivocally cause increased complications.

    It sounds to me like they invited all women giving birth to singleton babies at the study centers to particpate, so I don’t think they deliberately made each group equal, except insofar as they might have chosen their study sites to try to make the groups fairly equal. I don’t know why the prevalence is so different from the WHO’s figures, though. Between the two I would tend to trust the WHO’s figures.

  44. June 3, 2006 at 3:17 pm

    I think Western feminists and feminists in non Western countries should work together. Changing your culture seems much less threatening when the change comes from inside rather than being imposed on it. Here’s an example of local women fighting it. and I have heard other reports of local NGOs also opposing the practice.

  45. June 3, 2006 at 5:51 pm

    …a cultural practice that cut your dick off — but after saving your sperm so that you could reproduce…

    Wouldn’t have to save sperm, either. They can be tapped via needle aspiration, any time. Some people do that for assisted reproduction.

    Just sayin’.

  46. junk science
    June 3, 2006 at 5:57 pm

    What is the effect of removing or cutting into the external part of the clitoris? Well, we can guess, but we do not know.

    I can tell you with certainty the effect of having mine cut off, and it would involve a screwdriver through someone’s neck.

  47. Mandolin
    June 4, 2006 at 3:18 am

    Hey,

    I don’t know if people think I’m apologizing for FGS. I don’t personally think I am. I believe the practice should be eliminated, preferably by the people involved. People from the outside can provide tools that can help those people — such as education about sex and health, economic support, and moral encouragement.

    I also believe that stopping FGS will not be easy. Taking a hard line on this issue has repeatedly caused very bad outcomes. In order to stop FGS, people will have to work within the cultural framework to lessen cultural attachment to FGS. Otherwise, you get shit like the operations being done in incerasingly unsafe environments (when you ban it from hospitals), to increasingly younger girls (when you make it illegal, because very young children have less oversight), in less public arenas (when it’s illegal, to keep it out of sight), and by cultures who never did it before but who want to disidentify with westerners.

    We have to pick our methodology. Our methodology must be respectful. That doesn’t mean that FGS is okay. It isn’t.

    Shannon W.,
    Thanks for the link. I agree that western feminists working with local groups is the best way to go.

    To some of the questions that were directed to me:

    “So why would you use the term “surgeries” to refer to it?”

    I find the use of terminology in re: female genital surgeries to be uniformly problematic. Female circumcision illicits erroneous comparisons. I was using female genital mutilation this summer until an anthropologist friend of mine argued that this term is a barrier to conversation with African women, who as I’ve noted, really can’t be alienated from this discussion – after all, it involves their bodies! Female genital surgeries sounds like a good compromise to me at this time. It certainly isn’t perfect, and I may choose to use different terminology at another time.

    “And so what rationale is then offered for a clitoridectomy? Some sort of warped sense of asthetics?”

    Aesthetics are an issue to the people involved, but they aren’t what I was referring to. In the culture I was talking about, women and men are made, not born – a concept I imagine most of us can get down with. Ritual often deals with psychological symbol. In this case, clitorodectomy creates a woman by cutting out her male part. It’s a coming of age ritual. Men undergo a parallel one by being circumcised (which, of course, is a significantly less problematic procedure).

    This symbolic level is where some of the effective ways of changing the practice come from – the culture develops a new way of ‘making’ women that doesn’t involve cutting. That lessens cultural attachment to FGS by providing an alternative way of acheiving the goal.

    Obviously, this doesn’t work in the cultures where the overt goal is to eliminate sexual feeling or to make it impossible for women to have vaginal sex before marriage.

    “I’m sorry, but positive social benefits? A bonding ritual centered on sexual mutilation yielding positive social benefits? Like what? ”

    It’s not the sexual mutilation that yields the positive social benefit, but the rituals around it. This is why it’s a bad thing that these rituals have been mostly eliminated in many places.

    These are often coming of age rituals when done to adolescents, and coming of age rituals are useful and important for many peoples. They are also ways of creating group identity and marking, physically, who is in the group and who isn’t. These rituals are also useful and important for many peoples.

    Now, in places where the procedures are illegal, they are often done to very young girls who don’t understand their cultural significance. They are performed divorced from the rituals that impart that cultural significance. And they are surrounded by silence because no one wants to attract the wrong kind of attention.

    It was often the case that laws against FGS were passed by colonial states, supported by missionaries. When the colonial governments were overthrown, the rituals were often lost. So even though in many places FGS is no longer illegal, the procedures are still done the way they were done when FGS was illegal. Which means that simply making the practice illegal without making the attendant cultural changes yielded no net benefit and some net loss.

    The adolescent going through clitorodectomy used to suffer horrible consequences and come out as a clearly defined cultural woman who was marked as and bonded to her group. Now, she comes through just suffering horrible consequences.

  48. Mandolin
    June 4, 2006 at 3:25 am

    I misspoke (probably several times) but this is the one I wanted to address:

    (outsiders can help African women by providing) “moral encouragement”

    I didn’t mean like “we’re more moral than you, so we’re going to encourage you morally,” more like when your friend is breaking up with her boyfriend and one offers “moral support.” I do think it’s helpful for people – particularly physically present people – to support women in their choices. At least, my acquaintances who’ve worked in refugee camps in Africa seem to have found their presence and support helpful in enabling African women to act in ways that are not culturally sanctioned.

  49. joanna
    June 4, 2006 at 3:14 pm

    The Chinese ended the practice of footbinding which had been going on for hundreds of years, through a combination of internal and external pressure and enforcement. This included grass-roots efforts where individual families promised to only marry their sons to women with unbound feet, thus assuring families that their daughters would not remain unmarried and loose their place in society.

    There was a really interesting article in American Sociological Review 61 (6) 1996 by Gerry Mackie, illustrating the similar reasoning for footbinding and FGM, and how the succesful eradication of footbinding could be used as a template for ending FGM. Obviously ending a practice is not a matter of a Western nation sweeping down and dictating what is right or wrong, but at the same time just as no one would defend footbinding or try and mollify the physical and psychological effects that it had on women, it is ridiculous to defend FGM simply because it is a tradition.

  50. June 6, 2006 at 7:10 am

    If anyone’s still interested, I have posted a very long essay on FGC at my site: http://thinknaughty.com/2006/06/06/female-genital-cutting-sexuality-and-anti-fgc-advocacy/

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