By Jennifer Dias
As social animals, humans often coordinate their lives around cultural norms, formally sanctioned rules that prescribe or proscribe certain behavior. Typically, when a large majority of people are dissatisfied with an existing norm or an existing norm poses a threat to a group, it seems obvious they’d change it, but this isn’t always the case— in fact, there is substantial evidence of norms that cause harm those who comply. Examples of this include foot-binding in China and female circumcision in Africa.
In an effort to rally the international community to prioritize the end of female circumcision (also known as female genital mutilation), the United Nations Population Fund (UNFPA) again recognized the annual International Day of Zero Tolerance for Female Genital Mutilation (FGM) on Saturday, February 6. The global health and human rights community has long condemned this practice, but it was not mentioned in the Millennium Development Goals (MDGs), which governed global health and human rights priorities in the early 21st century. Now, eliminating FGM by 2030 is a distinct target in the 17 new Sustainable Development Goals (SDGs), focusing on human rights and gender equality.
Of the SDGs, the International Day of Zero Tolerance for FGM focuses on Goals 3, 4, and 5, which seek to ensure healthy lives well-being for all at all ages, ensure inclusive, equitable and quality education and promote lifelong learning, and achieve gender equality to empower all women and girls, respectively.
About female genital mutilation
Female circumcision, also known as female genital mutilation and female genital cutting, is recognized internationally as a violation of the human rights of girls and women, and continues to stand as a public health challenge in the international community. Female genital mutilation is a common traditional practice in countries such as Ethiopia, Gambia, Mauritania, in which there is a partial or total removal of the clitoris for non-medical reasons. The practice is primarily performed in Africa where more than 28 countries and more than three million girls are at risk of experiencing FGM.
Although, FGM has long been perceived as a problem reserved to Africa and the Middle East, it has been recently documented that this practice is also widespread in Colombia, and Indonesia, where nearly half the women are estimated to have undergone the procedure, and other places. In fact, as of 2016 there are an estimated 200 million women and girls alive today who have undergone FGM.
Types of FGM
The World Health Organization (WHO) classifies four types of FGM: Type I, clitoridectomy, involving partial or total removal of the clitoris and/or prepuce; Type II, excision, involving partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora; Type III, infibulation, involving narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris; and Type IV, other, involving all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, and cauterization.
All of these pose complex and serious long-term health risks for women and girls, and in some cases can lead to complications or death. FGM threatens the health and wellbeing of many women, and in severe cases can cause hemorrhage, infection, prolonged labor, pain during sexual intercourse, gynecological and urogynecological problems.
FGM has varying sociocultural meanings, degrees of practice and support for its continuation or discontinuation. The practice of FGM is maintained by social, cultural, and religious tradition and the meaning passed on from generation to generation, in which, oftentimes, mothers and grandmothers who have experienced FGM themselves perform the practice
But recently there has been a shift in attitudes toward this traditional practice. Specifically in Ethiopia, the government has shown high levels of political commitment to end FGM, implementing various interventions to discourage these practices. These efforts should encourage dialogue and the empowerment of communities to act collectively to end the practice, while also addressing the sexual and reproductive health needs of women and girls who suffer from this practice. Currently, the UNFPA, jointly with UNICEF, leads the large global campaign to accelerate the eradication of FGM, focusing specifically on 17 African countries where the practices is highly prevalent.
Factors associated with Female Genital Mutilation
In a paper published earlier this year in PLOS ONE, Setegn and colleagues analyzed the geographic variation and factors associated with FGM among women of reproductive age in Ethiopia. Prior to this study, there had been little evidence of factors associated with FGM, which poses challenges for designing geographic and population interventions for the areas with highest FGM prevalence.
This study was based on the 2000 and 2005 Ethiopian Demographic and Health Surveys (EDHS) to determine potential social and FGM indicator variables, and later merged this with demographic and geographic data using statistical analyses. There were three outcome variables, which were measured as “Yes” or “No” for determining the prevalence of women having experienced FGM, daughters having experienced FGM, and women in support of FGM continuation. Independent factors presumed to affect the practice or support for FGM for women and their daughters were included in the analysis; these factors included exposure to mass media, wealth status, occupation, religion, age, women and men educational status, and geographic regions.
The results of the EDHS survey results study showed that the prevalence of FGM among women was a staggering 79.9% in 2000 and later 74.3% in 2005, and was widespread across the majority of regions and ethnic groups, where the prevalence is estimated to be highest in Afar, Somali, and Dire Dawa regions. Interestingly, women’s support for the continuation of FGM showed significant decrease from 65% in 2000 to 31.4% in 2005. The study also showed that women in the richer wealth index categories have higher odds of having experienced FGM as compared to women in the poorest category. Muslim women were three times more likely to have experienced FGM as compared to Christian women. Daughters of richer women, Muslim mothers and mothers over 25 years had higher odds of having experienced FGM, showing similar trends as their mothers. Also, higher levels of maternal education were associated with 80% lower odds of FGM experience for daughters.
In this analysis, being a rural resident and Muslim were factors positively associated with women’s support of FGM. Rural women were twice as likely to support FGM continuation as compared with urban women. It is important to note that although wealthier women were less likely to support the continuation of FGM, being wealthy is associated with FGM practice. This discrepancy may be associated with the decision-making power of wealthy women. Similarly, Muslim women were twice as likely to support FGM continuation as compared with Christian women. A higher level of paternal education was not statistically associated with FGM support, however, all levels of women’s formal education was associated with lower odds of supporting FGM continuation.
Looking specifically at the geographic variation in FGM, the relationship between the Muslim religion and FGM practice and support are clustered in regions majorly populated by Muslims, in which the Muslim community perceives FGM as a religious tradition and coming of age process for women. This indicates a need to develop faith-based interventions involving Muslim religious leaders and to change social expectations and perceived religious requirements in order to reduce FGM. Similarly, the majority of women in high FGM prevalence clusters are rural residents with less formal education who are often illiterate. This highlights primary prevention targets for FGM reduction in rural areas by increasing the number of girls and women enrolled in school. Therefore, women’s education is a development priority necessary to foster behavioral and cultural changes to eradicate FGM.