What is Female Genital Mutilation (FGM)?

by the Women's Bar Association of Massachusetts


FGM is a defined by the World Health Organization ("WHO") as the partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. There are various types and degrees of FGM. WHO has defined four degrees of FGM:

    1. Clitoridectomy – the partial or total removal of the clitoris, along with the prepuce.

    2. Excision – the partial or total removal of the clitoris and inner labia, with or without removal of the outer labia.

    3. Infibulation – the removal of all external genitalia (the inner and outer labia are cut away; with or without the excision of the clitoris) and the fusing of the wound, leaving a small hole (2–3 mm) for the passage of urine and menstrual blood.

    4. Other – All other harmful procedures to female genitalia for non-medical purposes from nicking (called "ritual circumcision"), pricking, piercing, incising, scraping, and cauterization of the clitoris to labia stretching, hymenotomy (the removal of a hymen regarded as too thick), gishiri cutting (cutting the vagina's front wall to enlarge it), angurya cutting (scraping tissue away from around the vagina), burning or scarring the genitals, and introducing substances into the vagina to tighten it.

The timing of FGM can range from shortly after birth to a woman's first pregnancy, though victims are commonly between four and ten years old, and in half the countries for which figures were available in 2013, most girls were cut before the age of five. It is typically carried out, with or without anesthesia, by a traditional circumciser using a knife or razor.

FGM predominantly occurs in 27 countries in sub-Saharan and Northeast Africa, and to a lesser extent in Asia and the Middle East, but the threat of FGM is a reality for a significant number of girls in the U.S. as well.

According to the report "Eliminating Female Genital Mutilation: An interagency Statement" by various international agencies in 2008 (the "Interagency Report"), in every society where it is practiced, FGM is a manifestation of gender inequality and a violation of human rights.


Prevalence of FGM in the U.S. and in Massachusetts

In 1997, the Centers for Disease Control estimated that as many as 150,000 to 200,000 girls in the U.S. were at risk of being forced to undergo FGM or had undergone FGM, and, in 2000, the African Women's Health Center of the Brigham and Women's Hospital found that approximately 228,000 women and girls in the U.S. either underwent FGM or were at risk.

Some of the FGM takes place in the U.S. itself, and sometimes girls living in the U.S. are taken overseas to their parents' home countries, usually during school vacations, and forced to undergo FGM there. The latter practice is known as "vacation cutting." In some cases, girls are taken from their parents or parents are tricked into sending their girls away, unaware that they will undergo FGM.

According to a study performed in 2000 by the African Women's Health Center of the Brigham and Women's Hospital, approximately 5,231 women and girls in Massachusetts are at risk of undergoing FGM.


Legislation and Enforcement Actions

The U.S. Congress enacted legislation in 1996 criminalizing the performance of FGM in the U.S. on anyone under the age of 18. The penalty is a fine or imprisonment up to 5 years. In January 2013, the U.S. enacted the "Transport for Female Genital Mutilation" amendment to address "vacation cutting." It carries the same penalty. In addition, twenty one states have laws specifically criminalizing FGM. Unfortunately, Massachusetts is not currently one of them.

Despite federal laws prohibiting and criminalizing FGM and the fact that FGM occurs in the U.S., there have been no prosecutions under federal law.

Last year, the UN unanimously passed a resolution seeking the worldwide eradication of the practice of FGM; all of the African-block nations voted to support the resolution. Both the UN resolution and the report of Sanctuary for Families call for robust and consistently applied laws that prohibit FGM locally and extraterritorially.


The Physical and Psychological Effects of FGM

FGM varies among the populations in which it occurs. In a majority of cases, FGM is performed by an individual with no medical training and outside of a medical facility. Depending on the type of FGM, the immediate health consequences can range from severe pain, hemorrhaging, infections, to death. If the girls survive the procedure, long-term consequences include chronic pain, ulcers, abscesses, excessive scarring, infections, slow and painful menstruation and urination, and a greater risk of transmitting HIV.

FGM can also cause severe sexual and reproductive consequences. Women who have undergone FGM often have severe pain during sexual intercourse and a reduction or elimination of sexual sensation, arousal, or fulfillment. FGM also increases the risk of childbirth complications where labor is prolonged or obstructed and even leads to death of the mother. Not only is the mother at risk during childbirth, but death rates for infants of mothers who have undergone FGM increase anywhere from 15-55% depending on the type of FGM.

Many girls and women who have undergone FGM describe suffering from severe psychological and emotional effects including depression, anxiety, multiple phobias, memory loss, and post-traumatic stress disorder. In some cases, the families of these girls and women tricked them into undergoing FGM causing them to feel betrayed and isolated. In addition, the procedure itself can be very painful, shocking, and violent leading to severe psychological consequences.


What are the motivations underlying the practice?

Those who continue to perform and support FGM provide a variety of reasons for continuing the practice. Some view it as an initiation of a girl into womanhood. Some claim that FGM cleanses or purifies girls or FGM physically differentiates women from men, claiming the clitoris and labia are male-like body parts. Some communities require FGM prior to marriage as it will ensure premarital virginity and marital fidelity.

Another oft-cited reason is that FGM is required by religion, and in particular Islam. No support has been found for the requirement of FGM by any religion. In fact, FGM predates Islam, and a majority of Muslims worldwide do not practice FGM.

Parents in the United States who require their daughters to undergo FGM may see FGM as a way to maintain their child's identity and reinforce the culture of her nation of origin. Some parents feel immense pressure from family or their community to continue the traditions of their homeland.