“Clitoridectomy and female circumcision, practices often labeled as female genital mutilations, are not just controversial cultural rites performed in foreign countries…

“…medical historian reports that American physicians treated women and girls for masturbation by removing the clitoris from the mid-19th century through the mid-20th century. And physicians continue to perform female circumcision (removal of the clitoral hood) to enable women to reach orgasm, although the procedure is controversial and can result in lasting problems such as painful intercourse for some women…

“‘The medical view was to change the female body to treat a girl or woman’s ‘faulty’ sexual behavior, such as masturbation or difficulty having an orgasm, rather than questioning the narrowness of what counted as culturally appropriate behavior,’ said Rodriguez, who also is a lecturer in global health studies at Northwestern’s Weinberg College of Arts and Sciences. ‘This practice is still alive and well in the United States as part of the trend in female cosmetic genital surgery…’” (Marla Paul, “Clitoridectomy and Female Circumcision in America: Centuries-old Procedures Reflect Views of ‘Appropriate’ Female Sexuality,” December 1, 2014).

Introduction

The issue of female genital mutilation, a practice encompassing a partial or complete removal of the clitoris, has been a tricky and contentious subject for many people across diverse religious, political, and ideological persuasions.

According to the World Health Organization, “An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM…In Africa, about three million girls are at risk for FGM annually…It is mostly carried out on girls sometime between infancy and age 15 years.”

Therefore, given these staggering statistics, the World Health Organization should monitor countries identified with the practice of female genital mutilation by educating their populace on the dangers to which infant girls and young women are inevitably subjected to and the need to minimize or eliminate them.

Then also Ghana News Agency (GNA), in 2013, reported an increase in cases of the practice in spite of a ban imposed on it. According to the GNA, a UNICEF multiple Indicator Cluster (MICS) puts “FGM at 3.8 per cent for women between 15 to 49 years and four per cent for the most recent survey of 2011” (See also Article 39 of the Constitution; and the so-called Maputo Protocol (2007). We should also remember that Ghana abolished the practice as far back as 1994, under the administration of Rawlings).

This report further mentioned the three northern regions (the Northern Region, the Upper East Region, the Upper West Region), the Brong Ahafo Region, and Zongo communities in certain urban centers of the country, Ghana, where the practice still goes on. (see Rogaia M. Abusharaf’s edited volume “Female Circumcision: Multicultural Perspectives” for a much broader discussion of the subject matter across Africa).

Perhaps Adelaide Abankwah’s disgraceful case has not completely died yet. Adelaide, whose real name was Regina Norman Danson, from Biriwa in the Central Region of Ghana, used the female-genital-mutilation excuse to apply for political asylum in the US only to be found out, a case that unleashed a chain reaction of outright lies on the part of the asylee and embroiled Ghana in an international ignominy of sorts. How sad that Hillary Clinton and Julia Roberts publicly defended her. This author met in person with a Somali-American City College professor of African and African-American history who appeared on Gil Noble’s “Like It Is” to defend the fraud.

Finally, we should also want to make it clear that female genital mutilation was and still is practiced among whites, and in the white world at large, in the West (see Sarah Rodriguez’s book “Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment.” Dr. Rodriguez teaches in the Feinberg School of Medicine, Northwestern University, USA; Readers may also want to take a look at Isaac B. Brown’s book “On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females” for more information on clitoridectomy in 19-century Europe, Britain to be precise).

Well, this two-part article takes a general look at the practice as it is done across Africa.

Need for change

The dilemma here is that proponents advance their arguments without evidently paying sufficient attention to what the practice actually is and to the enduring health hazards and psychological disequilibrium to which these female infants and young women are constantly exposed.

Indeed, some of these arguments are subtly constructed to further complicate the subject; for instance, the case is often made that male circumcision is no different from the female version, yet nowhere is it mentioned that the consequential long-lasting medical and psychological hazards resulting from the latter far outweigh those from the former (PalMD, 2008).

The following arguments therefore provide the requisite grounds for the active monitorial presence and educational intervention of the World Health Organization in countries known to tolerate the practice.

The first issue is the four major classification groups subsumed under female genital mutilation. These four groups are very important for the debate because they provide us with a vivid picture describing in some detail the various forms under which mutilation of the female genitalia is generally conducted.

In most of these cases the same excision instrument is used on several persons without the benefit of sanitizing. In this regard, representatives from the World Health Organization should team up with the clergy, traditional rulers, lawyers, politicians, local scientists, and the like to collect and collate data in order to objectify the health hazards of the practice, as could be deduced from the following four broad categories defined by The Center for Reproductive Rights:

• Type I (also referred to as “clitoridectomy”): the excision of the prepuce with or without excision of the clitoris.

• Type II (also known as “excision”): the excision of the prepuce and clitoris together with partial or total excision of the labia minora.

• Type 111 (otherwise termed “infibulation”): the excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening.

• Type IV: all other procedures involving partial or total removal of the female external genitalia for cultural or any other non-therapeutic reasons.

The second pertinent controversy commonly encountered in the heated debates associated with female genital mutilation concerns the serious nature and permanency of the psychological perturbations many of these women inescapably inherit from the largely anesthesia-free surgeries, as well as from the multifariously severe medical consequences.

For the most part, these victims are surprisingly left to fend off these deleterious effects without the timely medical and legislative interventions required of the medical establishment and lawmakers, respectively, and the lack of political action or will on the part of politicians to reverse age-old cultural norms that have long provided the necessary ideological leverage for the practice.

In fact, supporters of the practice are quick to cite a plethora of reasons including custom and traditions, among others, as viable justifications for its incessant observation.

Here, for instance, the World Health Organization can wreck the cultural foundation of female genital mutilation by the sheer invocation of statistics exposing the cultural vacuity of the practice.

This suggestion is strongly supported by facts presented in the article “Female Genital Mutilation—The Facts,” a piece authored by Laura Reymond, Asha Mohamed, and Nancy Ali. They write:

• Intense pain and/or hemorrhage that can lead to shock during and after the procedure: A 1985 Sierra Leon study found that nearly 97 percent of the 269 women interviews experienced intense pain during and after FGM, and more than 13 percent went into shock.

• Hemorrhage can also lead to anemia.

• Wound infection, including tetanus: A survey in a clinic outside of Freetown (Sierra Leone) showed that of the 100 girls who had FGM, 1 died and 12 required hospitalization. Of the 12 hospitalized, 10 suffered from bleeding and 5 from tetanus. Tetanus is fatal in 50 to 60 percent of all cases.

• Damage to adjoining organs from the use of blunt instruments by unskilled operators: According to a 1993 nationwide study in the Sudan, this occurs approximately 0.3 percent of the time.

• Urine retention from swelling and/or blockage of the urethra.

Third, statistical validation from the medical profession establishing the causal relationship between female genital mutilation and the psychological health of victims is not extensive enough to merit considerable quotation here for purposes of serious analysis, since such data from the medical literature are shockingly lacking.

However, some evidence does seem to suggest that the causal relationship is there, but has not been thoroughly studied.

Therefore, there is the need for more research resources to be made available to those with the expertise to study the correlation between these two variables.

For this reason, the World Health Organization can provide much-needed technical assistance in this area. Despite this constraint, the Center for Reproductive Rights has this to say:

“There have been few studies on the psychological effects of FGM. Some women, however, have reported a number of problems, such as disturbances in sleep and mood.”

Furthermore, Reymond, et al., relate this causal relationship to their readers:

“Some researchers describe the psychological effects of FGM as ranging from anxiety to sever depression and psychosomatic illnesses. Many children exhibit behavioral changes after FGM, but problems may not be evident until the child reaches adulthood.”

Fourth, what is more, a constellation of problems of infertility, death, increased risks of maternal and child morbidity and mortality resulting from obstructed labor, painful or blocked menses, post-coital bleeding, tissue damage, urine retention, urinary infection, and difficult penetration during sexual intercourse have all been identified with FGM (Reymond at el.).

The practice also reeks of sexism and violation of girls’ and women’s rights (WHO). Also, in some of the areas where the practice is still deeply entrenched, for instance, in Somalia, the level of sexually transmitted diseases, including HIV/AIDS, have increased because of the failure of traditional circumcisers to sterilize excision tools between surgeries.

The gravity of this claim demands the undivided attention of the World Health Organization and FGM-prone national governments in addressing this complex issue, especially as it relates to the curtailment of disease transmission. It is reported in the piece, “Somali-Somaliland—Excision—AIDS: Female Genital Mutilation: Cause of Increased HIV/AIDS in Somalia: Doctors,” that:

“Objects used for the excision are not sterilized and at the same could again be used to mutilate more women, who could already be HIV-positive.”

Additionally, Margaret Brady, a nurse practitioner, with a master’s in nursing and extensive experience in her field of expertise, concurs in her masterfully written expose, “Female Genital Mutilation: Complications and Risk of HIV Transmission”:

“It has been postulated that FGM may play a role in the transmission of HIV. One recent article which, was presented at the International Conference on AIDS 1998, was a study performed on 7350 young girls less than 16 years old in Dar-es-Salaam. In addition to other aspects of the research, it was revealed that 97% of the time, the same equipment could be used on 15-20 girls. The conclusion of the study was that the use of the same equipment facilitated HIV/AIDS/STD transmission.”

As a final point, the UNFPA also reports:

“A recent study that surveyed the status of FGM/C in 28 obstetric centers in six African countries—Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan—found that women who had undergone FGM/C were significantly more likely than others to have adverse obstetric outcomes such as Caesarean sections, post-partum hemorrhaging, prolonged labour, resuscitation of the infant and low birth weight and in-patient prenatal deaths. The inquiry also discovered that the risks seemed to increase among women who had undergone more extensive forms of FGM/C.”

Fifth, why does female genital mutilation continue to exist despite widespread backlash against it? Part of the answer relates to the ideological, cultural, and psychological manipulation of the citizenry.

The other part lies with the immense power vested with traditional practitioners to carry out the mutilations, in addition to the attractive financial incentive and coveted social prestige they stand to gain.

Accordingly, any fruitful attempt designed to ameliorate female genital mutilation’s harmful consequences or to extirpate the practice from the unfathomable recesses of man’s consciousness must ultimately come from a frank and profound familiarity with the realistic interplay of these socio-cultural and economic elements.

Therefore, a defensive maneuver calculated to enervate proponents’ viewpoints and to divest them of their flimsy ideological clothes must surely connect well with these noble objectives. This is also why the following reasons presented by the World Health Organization should be challenged:

• It endows a girl with cultural identity as a woman.

• It imparts on a girl a sense of pride, a coming of age and admission to the community.

• Not undergoing the operation brands a girl as a social outcast and reduces her prospects of finding a husband.

• It is part of a mother’s duties in raising a girl “properly” and preparing her for adulthood and marriage.

• It is believed to preserve a girl’s virginity, widely regarded as a prerequisite for marriage, and helps to preserve her morality and fidelity.

Not unsurprisingly, however, these misguided claims are made without any concrete allusion to scientific verification or approbation, even though they may possess some measure of anthropological verity.

Yet the harsh realities on the ground do not impute substantial health benefits to anthropological claims of the practice, let alone be used to justify it.

Thus, the preceding analyses can provide the World Health Organization with indubitable moral and political impetus, at least from the perspective of this essay, to monitor and educate countries associated with the practice and the masses populating them.

Moreover, the challenge now is to formulate a corrective framework within which the World Health Organization should operate in order to bring about the needed changes. This concern is expressed below.