Public Health Magazine: Winter 1995, Vol.5, No.1
Women's health takes center stage
Female Genital Mutilation: At the Crossroads of women's Health & Human Rights

Ask most people if they see women's reproductive freedom as a human rights issue and they would probably scratch their heads and think about it for awhile. But bring up female genital mutilation and there won't be any question.

Although it is not a population concern, per se, female genital mutilation (FGM) is probably today's clearest intersection of women's reproductive health and human rights. Because it is only tangentially related to population issues, FGM was somewhat of a side issue at the International Conference on Population and Development (ICPD). But it was, nevertheless, a very important issue, moted CSPH Dean Allan Rosenfield, M.D., and received much media attention.

Sometimes referred to as "female circumcision," FGM describes a variety of practices that involve cutting and removing the female external genitalia. Presently, FGM is reportedly practiced in at least 26 African countries, including Sudan, Somalia, Djibouti, Mali, Ethiopia, Eritrea, Gambia and Egypt. It affects more than two million women and girls each year, reports Nahid Toubia, M.D., a physician from Sudan and assistant clinical professor in CSPH's Center for Population and Family Health. The practice also occurs among a few groups in Asia and among some African immigrants in North and South America, Australia and Europe. "Female circumcision is the physical marking of the marriageability of women, because it symbolizes social control of their sexual pleasure-- clitoridectomy--and their reproduction--infibulation," said Toubia. Infibulation is the removal of the labia.

FGM may cause numerous physical complications, including hemorrhage and severe pain, which can cause shock, even death. It may lead to prolonged bleeding and severe anemia, especially in poorly nourished children. It also may produce local and systemic infections, abscesses, ulcers, delayed healing, septicemia, tetanus, and gangrene. Finally, FGM may create long-term complications resulting from scarring and interference with the drainage of urine and menstrual blood, such as chronic pelvic infections, which may cause pelvic and back pain, dysmenorrhea, infertility, chronic urinary tract infections, urinary stones, or kidney damage

As far as Toubia is concerned, female circumcision raises numerous human rights issues, including reproductive rights, the protection from violence, women's rights, and especially children's rights since most circumcisions take place on girls who are four to ten years of age. But she also stresses that FGM, which has no theological basis, will not be eradicated until the deep cultural traditions that support it are understood. Her organization, RAINB(female symbol), is very concerned that if international human rights organizations become involved, some fundamentalist Muslim groups could exploit that involvement as another example of Western anti-Muslim activity.

Professor Stephen Isaacs, J.D., agreed, pointing to the difference between principles vs. application. "Human rights transcend cultural relativism by definition," said Isaacs, who specializes in human rights issues. "But the cultural-religious argument has to be taken into consideration for implementation of policy."

Toubia maintains, however, that the goal of ending FGM must never be compromised. "No ethical defense can be made for preserving a cultural practice that damages women's health and interferes with their sexuality," she reminded. "It is only a matter of time before all forms of female circumcision in children will be made illegal in Western countries and, eventually, in Africa."

The Cairo conference's Programme For Action took a step in that direction, calling female genital mutilation "a violation of basic rights." The international community agrees. Several countries, including Sweden, Britain, The Netherlands and Belgium have declared the practice illegal. In the United States, a bill drafted by the Congressional Women's Caucus would make female circumcision illegal and has been presented to Congress. In addition, the practice has been condemned by the International Federation of Gynecology and Obstetrics and the World Health Organization. Further, the Vienna Declaration of the World Conference on Human Rights has called female circumcision a violation of human rights.