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Stronger campaign needed to end female genital mutilation

BMJ 2000; 320 doi: (Published 22 April 2000) Cite this as: BMJ 2000;320:1153
  1. Pascal Abboud, obstetricians and gynaecologists,
  2. Christian Quereux, obstetricians and gynaecologists,
  3. Georgette Mansour, obstetrician and gynaecologist,
  4. Fadila Allag, midwives,
  5. Michele Zanardi, midwives
  1. University Hospital of Reims, France
  2. Hospital of Soissons, France
  3. University Hospital of Reims, France

    Female genital mutilation is considered to be the most dangerous ritual custom still practised. It is performed in 26 countries, and more than 100 million women have been mutilated, with two million girls subjected to the ordeal each year. The procedure is carried out in Western countries among immigrants from African countries, and it is estimated that the number of girls at risk or who have already been mutilated is 168 000 in the United States, 42 000 in France, and 10 000 in Britain.

    We interviewed 14 African women who had undergone the procedure and were living in France. They were all members of African cultural associations unrelated to the campaign to abolish female genital mutilation. Thirteen had undergone clitoridectomy and one had been infibulated. Ten were Muslims and four were Christians. Only one woman favoured the practice, although her 2 year old daughter had not yet been mutilated. Two were uncertain, although one out of their four daughters had had the procedure performed on them. Religion and social pressure were the arguments justifying mutilation.

    Among the 11 women who opposed the procedure, eight of their 11 daughters had already had it, but they bitterly regretted the fact.

    Mutilation is illegal in Europe and the United States, and for this reason international medical authorities have rejected the idea of doctors performing the procedure to prevent physical complications. Some immigrants send their daughters to Africa for holidays, where the mutilation is carried out. Education about the dangers of the practice has increased in Africa, but it is insufficient.

    We believe that only by changing the social and political position of the women at risk will they become aware of their sexual oppression, so the education programme needs to be more targeted and ambitious. Although the Koran does not prescribe female genital mutilation it is almost exclusively practised in countries with a high Muslim population. It does not exist in Islamic countries, such as Saudi Arabia and Iran. The procedure would decline if it was condemned by religious authorities and the media.

    Social pressure is another obstacle. Mothers consider the procedure to be a criterion for marriage, so any education campaign must also be addressed to men who must be persuaded not to require their future wives to have had the procedure. Some people have proposed an alternative ritual, and in Kenya girls have been sent away for a week in isolation and taught anatomy and physiology, with the idea of developing self esteem. But is this really necessary? It would be better to prohibit the procedure without substituting anything else.

    Embedded Image

    A 6 year old Somali girl has her legs tied together after her mutilation and eats only sticky rice to prevent her from urinating


    The women we interviewed considered their daughters' mutilation and their sons' circumcision to be similar. Male circumcision is also a form of genital mutilation since it involves removing a healthy part of an organ. How can we convince mothers that they should not mutilate their daughters while they could continue to have their sons circumcised? The dilemma is that male circumcision is widely spread, has a religious significance, has a low morbidity in developed countries, and is practised even in countries where female genital mutilation is unknown. Because of the fear of compromising the eradication of female genital mutilation, male circumcision is tolerated as doing less harm.


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