2.1 The practice of FGM
In 1991, the term "Female Genital Mutilation" was adopted at the Inter-African Committee Regional Conference on Traditional Practices Affecting the Health of Women and Children held in Burkina-Faso.[2] Female genital mutilation (FGM) is the collective term given to several different procedures that involve the cutting of female genitalia and permanently mutilating the sexual organs of young females for non-medical reasons. For the purpose of this paper, FGM refers to the ritualistic or traditional practices involving the cutting and removal of the female sexual organs.
Over centuries, FGM has been conducted as a ritual intended to prepare a girl for womanhood. Most commonly, girls are subjected to FGM between the ages of four and eight.
The practice is common in certain traditional Islamic communities although some religious experts note that there is no religious basis in the Quran for the practice.[3] While it is true that the practice has its roots in some countries in Africa, the Arabian Peninsula, Asia and South America, global migration patterns have brought the practice to Canada.
Women and girls who undergo FGM routinely experience pain, physical and emotional trauma and health complications as a result of infection to their genitalia and other reproductive organs. In some cases, severe bleeding and infection result in chronic disability or even death.[4] Substantial psychological effects on the self-image and sexual lives of women are also a documented consequence of the practice. The most severe form of FGM, infibulation, which involves removal of the clitoris, results in trauma that is repeated after each childbirth.
Since the sole function of the clitoris is sexual stimulation, the main purpose of the practice is to control female sexuality, ensure chastity until marriage and to render young women more desirable for marriage purposes. Background information for this document, derived from the OHRC’s participation on the Ontario Female Genital Mutilation Prevention Task Force, lists a number of reasons for the practice, including: (a) preservation of virginity; (b) control over women's sexuality; (c) cosmetic reasons; (d) class distinction; and (e) cultural identity. Hygienic reasons have also been cited for continuing the practice.
In 1996, the World Health Organization estimated that between 100 and 132 million girls and women have been mutilated, and approximately 2 million girls and young women are at risk globally.[5] Because of the nature of FGM, reliable statistics on the incidence of the practice here in Canada are not available. However, there is sufficient information obtained through discussions with members of at-risk communities to indicate that there is a significant population of women in Ontario and other provinces in Canada who have been subjected to the practice, and whose girl children may be at risk. Although the practice is often referred to as ”female circumcision,” the term belies the severity of what is actually involved.
2.2 Degrees of FGM
FGM includes any or all of the following: the removal of the hood of the clitoris; the complete removal of the clitoris along with labia minora excisions; the complete removal of the clitoris and surrounding tissues, and suturing of the vaginal opening (infibulation). An opening as small as 3 – 4 millimetres or as large as 1.8 centimetres is maintained to permit urination, menstruation and intercourse. The instruments that are often used include scissors, shards of glass, razor blades, cactus spines or other rigid plant materials. In most instances it is performed outside of proper health care facilities and without anaesthesia.[6]
FGM can be broadly classified into the following two categories:
Clitoridectomy (sometimes known as Sunna circumcision[7]): In this set of operations, one or more parts of the external genitals are removed. The prepuce, or hood of the clitoris, is cut and there is partial or complete removal of the clitoris. Approximately 85% of all women who undergo FGM have clitoridectomies.
Infibulation (Pharaonic mutilation): This is the most severe FGM procedure and it is practised widely in countries in the Horn of Africa. The clitoris is removed, some or all of the labia minora are cut off and incisions are made in the labia majora to create raw surfaces. The raw surfaces are either stitched together, or kept in contact by pressure until they heal as a "hood of skin" which covers the urethra and most of the vagina, leaving only a very small opening. This obstruction may lead to urinary and menstrual flow retention, dysmenorrhoea, and infections of the reproductive and urinary systems. An estimated 15% of all women who experience FGM have been infibulated. In some countries, however, 80 – 90% of all FGM cases involve infibulation.[8]
2.3 FGM and male circumcision
FGM is often referred to as female circumcision. This term implies a comparable practice to male circumcision. However, the degree of excision and trauma involved in FGM is generally much more extensive, including the actual removal of genital organs.
Male circumcision involves excision of the foreskin from the tip of the penis. The Canadian Paediatric Society conducted a literature review and concluded that “the overall evidence of the benefits and harms of male circumcision is so evenly balanced,” that “the benefits have not been shown to clearly outweigh the risks and costs” and that male “circumcision for newborns should not be routinely performed.”[9] The Canadian Paediatric Society advises that when parents are making a decision about circumcision, they should be informed with respect to the present state of medical knowledge about its reported benefits and risks.
[2] UN Doc. E/CN.4/Sub.2/1991/48 para. 136 (5)(1001).
[3] See, Gloria Jacobs, Female Genital Mutilation: A Call for Global Action (New York: Women, Ink., 1993) at 5.
[4] The physical effects on women and children include immediate complications such as haemorrhaging, acute infections, bleeding of adjacent organs, violent pain, and may sometimes lead to death. Later complications include so-called vicious or keloid scars which considerably shrink the genital apertures with attendant consequences; chronic infections which can lead to infertility; haematic complications (inability of menstrual blood to exit) and obstetric complications. Cutting and restitching performed on infibulated women can result in subsequent health risks. As well, psychological complications often develop, including functional psychiatric manifestations.
[5] Female Genital Mutilation: PREVALENCE AND DISTRIBUTION, World Health Organization, August 1996, www.who.int/frhwhd/FGM/infopack/English/fgm_infopack.htm#PREVALENCE AND DISTRIBUTION (8 December 2000).
[6] See further Working Group on Traditional Practices Affecting the Health of Women and Children, Report of the UN Economic and Social Council, Commission on Human Rights, First Session, March 18 – 22, 1985; Female Genital Mutilation: Information Kit, Division of Family Health World Health Organization, Geneva, July 31, 1994; Human Rights are Women's Rights (London: Amnesty International), 1995.
[7] "Sunna" refers to any practice required of Muslims. Yet, there are no direct references to FGM in the Quran and religious leaders generally remain silent on the practice. See further note 32.
[8] Nahid Toubia, Female Genital Mutilation in Julie Peters and Andrea Wolper, eds., Women's Rights Human Rights (New York: Routledge, 1995) at 227.
[9] Neonatal Circumcision Revisited. Fetus and Newborn Committee, Canadian Paediatric Society (CPS). Approved by the CPS Board of Directors in 1996, Canadian Medical Association Journal 1996; 154(6): 769-780. Reference No. FN96-01.