Global Health Issue: FGM

By Nathalie S

It has been estimated that up to 125 million girls and women alive today have undergone procedures known as Female Genital Mutilation (FGM). Furthermore, it has been assessed that up to three million girls are at risk of the procedure every year. As it yields no medical benefits, it has been strongly condemned by international organisations and many national governments. Yet, with the staggering numbers of people affected, it is clear that the issue still constitutes a serious global health problem. Advocacy to end FGM has increased in the past decade, resulting in the issue gaining momentum on the international policy agenda. This article will provide an overview of the topic.


An Overview

FGM is an umbrella term referring to all procedures causing damage to the external female genitalia for non-medical reasons. The damage caused ranges from injuries to the tissue to total or partial removal. In its most severe form – also called infibulation – the external genitalia is completely removed and the vaginal opening closed surgically, only to be opened after marriage and at childbirth.

There are no known medical benefits of FGM. In fact, it’s downright harmful. The procedure often causes severe physical and psychological trauma, which those that have undergone it have to endure for the rest of their lives.

A majority of FGM is performed by traditional practitioners, who usually hold respected and central positions in their communities. The conditions where the cutting is performed do usually not meet modern standards of hygiene and sterility, increasing the already-high risks involved in the procedure. Although the number of cases has decreased in recent years, an alarming trend of medicalisation has emerged. Out of all the procedures taking place, an increasing number is performed by professional health workers.

Some of the immediate consequences of FGM include severe hemorrhage, infection, and urine retention (the inability to empty the bladder). The severe pain and shock involved also renders cutting as a traumatic, horrifying experience. This is especially so as many girls are cut after infancy, when they are more capable of understanding the reality of the procedure and form a lasting memory of it. Severe bleeding and infections also result in mortality, although the exact figures are not known. Some estimates from Sudan suggest that up to one third of those undergoing the procedure die. This is, however, a rate that is increased by antibiotics not being readily available.

The long-term consequences are in many ways even more severe, and make living with FGM so unbearable for many women. At worst, having undergone it causes reoccurring cysts, bladder and urine tract infections, and infertility. It has also been linked to an increased risk of neonatal mortality and difficulties during birth. Another consequence is also that those who have undergone FGM usually find intercourse and menstruation extremely painful, which can severely decrease the general quality of life and wellbeing of the individual. In many cases significant improvement could be achieved through reconstructive surgery, although they are inaccessible to many women due to the lack of economic resources, and local social norms.

FGM is mainly practiced in the western, eastern and north-eastern Africa and in some countries the Middle-East and Asia. Migrants from these areas have also brought the practice to areas where it wouldn’t otherwise occur, such as many developed western nations with significant immigrant populations from these regions.

The highest percentages of girls and women affected by FGM occur in Sub-Saharan countries, such as Guinea, Djibouti, Eritrea and Sudan, where rates range from 88-96%. Perhaps surprisingly, the rate in Egypt is also high, at 91%. Thus, the adverse health effects of FGM disproportionately affect many of the world’s poorest countries, which are simultaneously struggling with many other development issues, such as weak health systems, lack of resources, corruption and high prevalences of many challenging diseases, such as Malaria and HIV/AIDS, that place a heavy strain on local health systems.

From a human rights perspective, FGM violates the right to health, physical integrity and freedom from discrimination, violence, torture and cruel, inhuman or degrading treatment. When causing mortality, it also violated the right to life.

 Causes of FGM

It can be said that FGM is deeply rooted in social, cultural and religious norms and understandings of female sexuality. Dating back to at least the fifth century B.C., it has established a position of a social convention in many communities. Many see it as way to control the female libido, and consequently as a reassurance against unwanted sexual activity taking place outside of marriage. In many places having undergone the procedure is understood as the removal of unwanted, impure body parts and considered the proper way to raise girls.

Rally in Kenya against FGM: Say NO - UNiTE
Rally in Kenya against FGM: Say NO – UNiTE

In some communities in Kenya, for example, FGM is performed to ensure that the girls in the family can get married and that a proper bride-price can be agreed on from the groom’s family. It’s also the only livelihood of some practitioners, some earning up to 30 USD per girl. This is an aspect that is often overlooked by the responses combatting FGM, which tend to be focused on educational and attitude change campaigns.

The supporters of FGM use arguments of tradition and religion to argue for the continuation of the practice. However, no religious text is known to actually describe the practice.

It’s known that FGM is facilitated by the wide acceptance it has in some communities both within the families of girls and among men, who demand it from their brides-to-be. As marriage is a key economic event in many communities, FGM essentially becomes a bargaining chip and an investment in the future economic welfare of the family. Considering this, international organisations and local movements advocating against FGM could benefit greatly from including strategies that help families and practitioners economically, instead of focusing only on educational campaigns.

Thank you for reading

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