United Nations, international and human rights organizations are calling for an end to female genital mutilation and appealing for tougher legislation to halt the practice on the Ninth International Day of Zero Tolerance to Female Genital Mutilation (FGM).
FGM, a practice which dates back thousands of years, persists despite widespread recognition of its harmful physical and psychological effects on girls and women.
Involving partial or total removal of the external female genitalia, FGM's immediate health complications include severe pain, shock and hemorrhage, and longer-term consequences such as cyst formation, infertility, increased risk of childbirth complications, and newborn deaths.
Elise Johansen, a Medical Anthropologist for the World Health Organization (WHO), says that although traditional circumcisers remain the primary practitioners of FGM, doctors, nurses and other health-care providers are increasingly conducting the procedure, perpetuating the so-called medicalization of FGM.
"By allowing health care providers to perform FGM, it signals that this is an okay practice, that maybe it is healthy or harmless," she says, explaining that the WHO strongly opposes the practice. "So it actually contributes to make sure that the practice continues, I think."
According to WHO statistics, up to 140 million girls and women worldwide currently live with consequences of FGM, which is most common in Africa, but also occurs in parts of Asia and the Middle East.
WHO reports that an estimated 92 million girls age 10 and up have undergone FGM in Africa alone, with about three million more subjected to the procedure on other continents each year.
While the number of female genital mutilations is declining in most countries, Johansen says, the practice is not in rapid decline. Getting communities to change such a deeply ingrained cultural tradition, she says, can be extremely difficult.
"Most people do it because everybody else does it and that is how it has always been done, and they have not really thought of what can be the alternative," says Johansen. "Many women ... say they are against the practice ... and there are many men as well, often more men than women who would like the practice to stop. But still, if you ask 'do you intend to have FGM on your daughter?' they say yes. Although they are convinced that it is not a good thing, they feel social pressure and [that] it is necessary to be accepted in the community."
WHO data from 28 African countries show huge variation in the extent to which FGM is currently practiced. Studies show the practice has almost disappeared in Togo, for example, but remains widespread in Somalia, Djibouti, Sudan, Gambia and Mali.
Various cultural, religious and social factors contribute to FGM. Among the most common reasons cited: belief the procedure will reduce a woman’s desire for sex and thus reduce chances of extra-marital sex. FGM is also associated with cultural ideals of femininity, modesty and fertility, and practitioners often believe the practice is based on religious doctrine, though no scriptures support it.
Research indicates FGM is more widely practiced in Muslim than in Christian communities, and that Ethiopia and Kenya have significantly reduced its prevalence.
Female genital mutilation is increasing in Western countries among migrants who come from places where it is practiced. Many European countries, along with Canada, the United States, Australia and New Zealand have enacted legislation outlawing the practice.
Health and human rights organizations see the adoption of such laws as an important first step, but note that laws must be fully implemented for them to work. These groups are calling for more comprehensive human rights based legislation and greater preventive efforts to end the scourge of female genital mutilation.