Fig. 12.1
Classification of female genital mutilation
- 1.
Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce.
- 2.
Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.
- 3.
Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner or outer labia, with or without removal of the clitoris.
- 4.
Other: all other harmful procedures to the female genitalia for nonmedical purposes, e.g., pricking, piercing, incising, scraping, and cauterizing the genital area.
12.5 Sociological Aspects
12.5.1 Why Is Female Genital Mutilation a Violation Against Human Rights?
Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for nonmedical reasons (WHO) [2]. The procedure has no health benefits for girls and women.
These procedures can cause severe bleeding and problems urinating and later cysts, infections, and infertility as well as complications in childbirth and increased risk of perinatal or newborn deaths. More than 125 million girls and women alive today underwent FGM in the 29 countries in Africa and the Middle East where FGM is concentrated. FGM is mostly carried out on young girls somewhere between infancy and age 15 [2].
FGM is a violation of the following articles in the United Nations Universal Declaration of Human Rights [3]:
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Article 3: Everyone has the right to life, liberty and security of person.
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Article 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
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Article 25: Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
12.5.2 What Is the Effect of Migration on the Women Who Underwent Female Genital Mutilation?
12.5.2.1 Migration and FGM in Western Europe: In the Context of African Women
Most West-European countries are multicultural societies, but FGM was an unknown phenomenon in these countries until the late 1980s. In the past 3 decades, immigrants, refugees, and asylum seekers entering Europe brought this practice with them. Healthcare providers were shocked to learn of this practice, primarily taking notice of it from African women refugees. On the other hand, these newly arrived African women were ashamed and concerned about how their European doctors might react.
The Somali community is one of the largest communities in Western Europe that practices this harmful tradition, mostly in the form of infibulation (FGM type III). Most of the Eritreans are Tigrigna, orthodox Christians. They mainly perform clitoridectomy and this is done while the child is still a baby. Sudan is one of the countries where FGM is widely practiced as a very strong, deeply rooted tradition, which has been carried out for centuries. Most of the Sudanese women migrants have been circumcised in Sudan. Besides that, in Europe after delivery, re-stitching is not allowed, but there are some Sudanese women who are traveling back to their country in order to become re-infibulated. In West Africa, FGM is also widely practiced but the type of FGM is usually less mutilating. Apart from in Africa, FGM is also practiced in some places in Latin America, the Middle East (i.e., Yemen and Iraq), Indonesia, and other Asian countries.
Several African women commented that as a result of migration, the situation within their families changed compared to the situation at home, where the practice of FGM was self-evident. They now know “that it is not allowed” in Europe and that you end up in prison if you have your daughter cut genitally. Despite these measurements, some of them said that for their family members back home, FGM in young girls is still important and relevant because it is deep-rooted and a significant African custom.
12.5.2.2 Fighting Against FGM in the African Context
On 6 February 2003, the Inter-African Committee (IAC) held an international conference in Addis Ababa, Ethiopia [4]. Delegates from 30 African countries discussed the tradition of FGM. The members were unanimous; this tradition in Africa and the rest of the world must come to an end. Therefore, the IAC proposed a common agenda on worldwide policy between 2003 and 2015.
The first lady of Nigeria, the late Mrs. Stella Obasanjo, officially declared 6th of February as “Zero Tolerance Day to FGM.” In her statement, Mrs. Obasanjo praised the work that had been done since the early 1970s at the local, regional, and international levels. She added, “IAC has come to a stage where a paradigm shift would move the gains we have made so far by having a common agenda which will provide a common framework to intensify and collaborate our activities at the different levels while respecting our diversities”[4].
12.5.2.3 Fighting Against FGM in the European Context
The European Parliament adopted its first resolution on female genital mutilation in 2001(2001/2035[INI]) [7]. In this resolution, the European Parliament strongly condemned FGM as a violation of fundamental human rights for the first time. After that, the European Parliament has repeatedly called for action in the field of FGM. From 2002 to 2007, several resolutions and a regulation were adopted by the European Parliament dealing with sexual and reproductive health, the situation of women from minority groups, population and development, violence against women, and the rights of the child, each including FGM in their body of work.
In 2008, the European Parliament adopted the resolution toward an EU strategy on the rights of the child (2007/2093[INI0]) [8]. In this resolution, the European Parliament called for community legislation that prohibits all forms of violence and harmful tradition practices, including FGM. The European Parliament also called member states “either to implement specific legal provisions on female genital mutilation or to adopt laws under which any person who carries out genital mutilation may be prosecuted” and drew attention to the role of education on FGM.
In March 2009, the European Parliament adopted the resolution on combating FGM in the EU (2008/2071[INI]) [9]. This was the second resolution at the EU level that specifically dealt with FGM. A number of issues that were dealt with in the first resolution of 2001 were reiterated; however, the second resolution marked the first time that the European Parliament addressed asylum as it pertains to FGM.
The most recent resolution on FGM—the European Parliament of June 14, 2012 on ending female genital mutilation—can be considered a further landmark in the fight against FGM. It clearly stipulates that “any form of FGM is a harmful traditional practice that cannot be considered part of a religion, but is an act of violence against women and girls which constitutes a violation of their fundamental rights” [10]. In this resolution, the European Parliament also called on the member states to take firm action to combat this illegal practice.
To respond to the resolutions from the European Parliament, some of the member states took actions against FGM based on mainly the four Ps approach: prevention, protection, prosecution, and provision of services.
12.6 Prevention
12.6.1 How Can Female Genital Mutilation Be Prevented?
The UN Secretary General’s report on ending female genital mutilation highlights that “prevention is a core component of any strategy to end FGM and it needs to complement legislation and other measures in order to effectively eliminate the practice” [5]. In general, any prevention measures against FGM should aim at the transformation of social beliefs and behavior. The prevention activities are mainly awareness raising for communities from practicing countries, training key figures from migrant groups, and training professionals in different fields. Civil society organizations (CSOs) with key figures are the main actors working on FGM prevention programs.
12.6.2 The Netherlands: The Dutch Chain Approach
In the early 1990s in the Netherlands, prevention programs were started, and the Dutch Obstetrical and Gynecological Society issued a moratorium on re-infibulation in 1993 [11].
The chain approach is a method of working together among a number of key actors dealing with FGM in order to spread responsibility over different institutions. The members of the different chain approaches include youth health care, medical professionals (midwives, general practitioners [GPs], gynecologists, and pediatricians), child protection institutions, advice and reporting points on child abuse, and key persons from FGM-practicing communities and community-based organizations. The collaboration between actors from different sectors is indispensable in order to provide adequate prevention, protection, prosecution, and provision of services. The chain approach is further characterized by the use of protocols for each sector as well as other instruments to guide the work of actors involved. The first lines in the chain approach are the key individuals from the communities at the grass roots level who are committed to fight all forms of FGM. Their main role is to provide relevant FGM information to their communities through information sessions, home visits, and living room conversations. In addition to that, they function as a liaison between these communities and professionals.
12.6.3 Belgium: Multidisciplinary Guidelines for Professionals
The Belgium Ministry of Health published guidelines (2011) developed by CSOs targeting all professionals working with practicing communities [12]. This includes health professionals, psychosocial workers, teachers, lawyers, and police. The main objectives of the guidelines are to help professionals to better understand the issue of FGM (prevalence, geographic distribution, and medical and psychological consequences) and social-cultural aspects.
12.6.4 Cyprus, Portugal, Italy, Ireland: United to End FGM (UEFGM)
In March 2013, END FGM European campaign and partner organizations from the aforementioned countries launched an e-learning tool, offering information and practical advice on FGM in Europe [13]. The training is supported and endorsed by the Office of the United Nations High Commissioner for Refugees (UNHCR).
The e-learning course aims to raise awareness and enhance skills of health professionals, asylum officers, and social welfare officers supporting women and girls affected by FGM. More information is available at www.uefgm.org.
12.7 Protection
The aim of protection is to prevent FGM in girls at risk of being subjected to FGM, focusing on the safety of girls and addressing specific needs of this target group. Protection within the EU is firstly achieved by recognizing the transnational nature of FGM and that it mainly occurs outside of the EU. There are two types of protection most relevant to FGM: (1) child protection and (2) international or asylum protection. Regarding international protection, special attention is given to the recognition of gender-based violence, and in particular FGM, as a form of persecution and serious harm requiring protection. The following are a number of interventions in different countries, which are given to illustrate how FGM may be prevented and prosecuted:
12.7.1 The Netherlands: Document “Statement Opposing FGM”
In 2011 the Dutch Ministry of Health, Welfare, and Sport and Ministry of Justice and Security have developed a document called “Statement Opposing Female Circumcision” [14]. This document is signed by various Dutch Civil Institutions and Medical Societies and some immigrant organizations, and also provides a space for the parents’ signatures. The aim of the document is to help parents resist family pressure related to FGM when visiting their families back home.
12.7.2 United Kingdom (UK): Asylum Policy Instruction
In 2004, the Home Office in the UK launched “The Asylum Policy Instruction: Gender Issues in the Asylum Claim” [17]. This instruction was revised and updated in 2006 and in 2010. The Asylum Policy Instruction is the UK government policy on asylum and is followed by asylum caseworkers within the UK Border Agency (UKBA). The aim of the instruction is to ensure that all caseworkers are aware of gender-specific issues related to women seeking asylum, including gender-based violence and FGM, which is specifically mentioned numerous times within the instruction. The instruction also contains guidance on how caseworkers should deal with asylum applications by women and the need to utilize gender-sensitive procedures.
12.8 Prosecution
Prosecution involves not only the legal proceedings against those suspected of having subjected a girl or woman to FGM but also includes judicial proceedings and court cases. In related investigation and prosecution, the Council of Europe Convention on preventing and combating violence against women (also known as the “Istanbul Convention”) said, “Where suspicions arise that a girl or a woman is at risk or is affected by violence against women, including FGM, protection systems that help with identification, reporting, referral and support are required to trigger a coordinated action that would prevent violence from taking place and protect the girl or women in question (Articles 18, 49, 50, 51 and 53)” [18].
12.8.1 Belgium: Female Genital Mutilation Prevention Kit, Decision Tree
In 2014, Belgian CSOs developed a decision tree as part of an “FGM prevention kit” [19] to guide professionals in detecting FGM and supporting girls affected by or at risk of the practice. The decision tree is a protocol describing the protection measures that professionals need to adopt when confronted with a risk or an act of FGM. The decision tree is supplemented by risk assessment indicators and a risk scale, which professionals are advised to consider before reporting. Risk indicators aim to help professionals in making an objective assessment of the situation and have been designed to be culturally and child sensitive. Protection measures as described in the decision tree are then determined according to the level of risk identified by the professionals.
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