A nuanced approach to Female Genital Mutilation/Cutting

A nuanced approach to Female Genital Mutilation/Cutting

By Abu Zahra

This topic, recently, sparked discourse, debate and disagreement in The Gambia as it had done in many, if not all, other countries that discussions around the topic is kindled. It quickly evolves into an “us” versus “them” debate, where one party is completely right and nothing can be accepted from the “opposition” party. Most often, the topic is seen from one viewpoint, which is regarded as the most important while the other bearings are ignored, assumed nonexistent or of little or no importance. Yet, the topic is much more nuanced than this simplistic approach to it. Sadly, any individual attempt to stay neutral is forcefully labelled into one of the two parties, as though a middle ground is, in fact, unrealizable.

I am convinced that some readers are already looking for a word or phrase to qualify this article into the anti- or pro-FGM law repeal group, even if unconsciously, hopefully, you don’t find any thus far. I am hoping to approach the topic from a more rational point of view, considering the religious, health and cultural aspects, rather than the mostly emotional approach plaguing the parley. I am aware of the fact that this can cause problems, as most of us are unwilling or have now become incapable of reading “non entertaining” material longer than half a page to water our intellectual seeds, yet we are more than ready to comment on any topic at all, regardless of our lack of knowledge, or not, of the topic.

I believe that any discussion or debate geared towards the formulation of a national policy or law, should be based on well-established facts or data, where those involved argue maturely and logically, ready to adjust, modify or change views based on authentic evidence available in the best interest of the nation while considering local factors specific to them and not as a win or lose situation.

Definition of terms

Definitions of terms to better understand the topic would be a good start: FGM is defined as the total or partial removal of the female external genitalia or other injuries to the female genitals for non-medical purposes, hence having no medical benefits and may be associated with some negative effects on the girls physical, mental and sexual health.

Classification of FGM according to the World Health Organization (WHO): Type I: (a) removal of the prepuce/clitoral hood (circumcision)

(b) removal of the clitoral glans with the prepuce (clitoridectomy)

Type II: (a) removal of the labia minora only
(b) partial or total removal of the clitoral glans and the labia minora (prepuce may be

affected)

(c) partial or total removal of the clitoral glans, the labia minora and the labia majora (prepuce may be affected)

Type III: Narrowing of the vaginal opening with the creation of a covering seal by cutting and appositioning the (a) labia minora or (b) labia majora with or without excision of the clitoral prepuce and glans (infibulation).

Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping and cauterization.

An understanding of these definitions is essential, as this would aid in comprehending the dialogue better, for then whatever class or type is mentioned, one can create a mental image and then try to link this to what is being said about it.

I would like to underscore at this point that the WHO recognizes ‘female circumcision’, which they classified as type 1a. In treating the topic, when this article mentions FGM, it refers to all types, while occasionally, when needed would specify ‘female circumcision’.

Refutation of claims

Having established the definition, lets clarify some statements that are not entirely the case:

1) FGM is not practiced in The Gambia: As much as it would have been preferred that this was the case, considering the consequences associated with some classes of the practice (which we would discuss later), this is not entirely true. The practice is in fact happening in The Gambia, and evidence has shown the practice of even the more severe forms. A study done in rural Gambia showed the prevalence of the more severe forms; type II and III than type I, and another showed the presence of the practice in urban areas too.

This statement is quite problematic, not only does it simply deny the existence of the practice but it also negates the fact that people might be suffering from the potential consequences of such practices. For if the practice is non-existent, then it’s not possible that any one at all is living with the potential complications. Hence, it does not only quickly obliterate any chance of recognizing the encounter of women who would classify their experience as traumatic but also any possibility of empathizing with such individuals and offering them the support they need. This is tantamount to emotional torture and forcing these women to relive the occurrence anew. This, coupled with the actual fact that they are living with these complications increases their chances of developing post-traumatic stress disorder.

These and such statements are utterly unacceptable and should be withdrawn from the dialogue. It is of essence that one takes it upon themselves to do some research, flip through a few pages on such sensitive topics, albeit any topic at all before weighing in on them. As there are always consequences, be that positive or negative. It is our collective responsibility to our mothers, aunties, sisters and daughters, to make them realize that we feel their pain, acknowledge that no

one should have undergone such, and would do all it takes or is needed to help them and would ensure no woman would ever have to go through such experiences ever again.

Let not these first few paragraphs sway you to a conclusion, as am sure that tendency is high. However, this article has yet a long way to go and requires a cruise to the end in order to make an informed conclusion.

2) Only weak ahadith justify the practice (female circumcision): The commonly mentioned hadith “…Do not cut severely as that is better for a woman and more desirable for a husband”. This hadith is classed as “weak” by Abu Dawood (he collected the hadith), for completeness, it should be noted that Sh. Albany classed the hadith as “sahih”.

It should be recognized that, there are authentic hadith from whose general meaning female “circumcision” can be inferred; “… Five practices are characteristics of the Fitra: circumcision, shaving the pubic hair, cutting the moustaches short, clipping the nails, and depilating the hair of the armpits or another from Sahih Muslim “… When anyone sits amidst four parts (of the woman) and the circumcised parts touch each other a bath becomes obligatory.

It is of essence to note that these are English translations of the Arabic text, and as always whenever a language as rich as Arabic is being translated to English, something is lost. Another noteworthy point is that “weak” hadith have actually been used and can be used to make Islamic rulings. This, however has conditions, which includes the reason the hadith is classified as “weak” among others, as a hadith can be “weak” for a number of different reasons.

It is quite concerning that individuals to whom the above paragraph may seem Aramaic are so vocal in the dialogue on the topic, specifically the religious aspect of it. If you’ve not completely understood these aspects of Islamic jurisprudence, how could you have made a well informed and constructive contribution? The recent exponential increase of 3 – 4 hadith quasi-scholars on this topic is mind boggling.

Islamic Jurisprudence (Fiqh) is a specialty, like medicine, law, economy etc., and as such needs specialists. Imams and scholars have spent a good number of years going through a structured program under this specialty and as a result are equipped with what it takes to rightly guide us in them. Attempts by other than them to state what is Islam or not can be measured up to a medical doctor trying to explain how to get The Gambia out of her current debt. How could he? His area of expertise is health and not finance. Though, the country is in dire need of a seasoned economist to save us from this ocean of debt, or at least get our heads above water. As we are only going deeper and deeper with no sight of the light above. At this rate, even if we fasted for three generations in order to save enough to pay up, we would probably still be in debt. Anyway, I digress.

A point of note is that, the four major schools of thought, upon which the vast majority of Muslims base their fiqh rulings on, have unanimously agreed on the fact that “female

circumcision” is Islamic, they only differ on the fact of it being (fard) obligatory or (sunnah) optional. The Maliki madhhab, upon which The Gambia mostly refers to, holds the position that the act is optional.

Complications and human rights concerns

The establishment of the above two facts sets the ground for a balanced look at the complications as well as the human rights violations associated with the practice.

This article will focus on the long-term obstetric and gynecological outcomes and a mention of the acute complications will be made.

A study showed that women subjected to FGM are at higher risk of the following than those without:

• Episiotomies
• Perineal tears
• cesarian sections
• postpartum hemorrhage
• extended maternal hospital stay
• resuscitation of the infant
• inpatient perinatal death

It is unfathomable that any humane person would advocate for any practice that has even the slightest potential to cause any of the above-mentioned complications on any one girl child talk less those of an entire country. That is, of course, assuming that one has an idea of what really these complications are. I would reiterate at this point, that it is of utmost importance, that one looks up such sensitive topics meticulously before commenting on such because the outcome, as in this case, can be fatal, literally.

These complications do not only threaten the life of the woman that was subjected to the practice but also that of their unborn child. Better put, the life of the woman + X, X being the number of children she intends to have. Hence if that is 5, then that is 6 lives at risk, the number is directly proportional to the value of X.

A WHO multi-center study conducted across several African countries concluded that there is a significant association between types II and III FGM and the complications listed above. The association with type I is however not significant.

On a more short-term basis, and more of a day to day difficulty, is the fact that they may not be able to attain sexual satisfaction, or even worse, pain with sexual intercourse. Right! The topic that would rather be shun, or simply tagged “unimportant”. A taboo, not to be discussed. Otherwise, there will be consequences, for instance, finding a solution to it. Perplexing! The clitoris is a very important sexual organ, endowed sufficiently with nerves, and contributes

significantly to the sexual act. Tampering with it in any form at all, hampers tremendously any chance at sexual satisfaction of the woman. Imagine being in a marriage in which one has no pleasure at all, the act is not sufficiently pleasurable or worse, pain during the act. This might eventually rid the woman of any desire to engage in the act, yet should she say no to her husband, she would make the headlines of the village women elders discussion board. The thought of it can make one cringe.

To complete the picture and lay down recommendations, a step into the human rights world as well as a brief look at the cultural arm of the practice is in order.

The WHO states that the practice violates a series of well-established human rights principles and of those cited are:

• principles of equality and non-discrimination based on sex.
• right to life
• right to freedom from torture or cruel, inhumane, or degrading treatment or punishment
• rights of the child.

To put some of these into perspective, some of the acute complications associated with the practice should be considered, which include; severe pain and injury to tissues, hemorrhage (severe hemorrhage can lead to anemia), hemorrhagic shock, infection and septicemia, genital tissue swelling and acute urine retention.

Taking these acute complications into account as well as the gynecological complications mentioned earlier, the basis of these claims can be understood. Keeping in mind, as well, the classifications as noted above then the reasoning behind these statements become even more evident. For instance, if the procedure were to lead to death, the pain associated, more so, with the more severe forms etc. These are genuine points which need to be and should be considered in the discussion of this topic to put all pieces of the puzzle together.

A quick perusal through the human rights act quickly leads to the conclusion that it is a noble cause. An act to ensure everyone is treated equally, regardless of race, culture, religion, or financial status. It is obvious that most often the strong, majority, and influential are not usually the ones in need of someone standing for them. Then advocacy for these rights is equivalent to standing up for those who cannot for themselves, being the voice of the voiceless. There can’t be any questions about the nobility of such cause.

I, however, respect anyone who is consistent in the application of their principles, regardless of who it is for or against. I do not necessarily have to agree with your principles, but the “consistency” here is the key word, once you lose that my respect for you becomes shaky. The advocacy of human rights though seems a little selective or better still a lot selective. Consider the following examples for more insight.

France put a ban on headscarves in public schools, this was later followed, more recently, by a ban on the ‘abaya’, out in the public space there is also a ban on covering the face. Under the article on freedom of religion in the human rights act, there are limitations of this right as provided by law when such “… are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others”. So surely the banning is justified because these acts are potentially fatal to someone, or maybe just to their desires. Probably, it takes from their freedom of pleasing their eyes. Sigh! Adding insult to injury, last Ramadan, Muslims on their national team are not allowed to fast. All this in the name of “laïcité” or secularism. No wonder we don’t want that term in our constitution.

More examples include the Swiss denial of citizenship to applicants due to their refusal to shake hands on religious basis claiming that refusal to shake hands threatens equal treatment of men and women, or the barring of Palestinian Christians from visiting the Jerusalem’s Old City at Easter. Apparently, the right to religious freedom should only be considered if it does not disagree with anything else or simply qualified as unimportant. If you’re wondering, “what is all this?” or you’re hearing these for the first time, then that’s exactly my point. The world is going bananas and you’re oblivious of it.

Assuming the explanations given were plausible, though that’s barely the case, how about the current war on Gazza? With the death toll being over 30,000, including over 10,000 children and over 8,000 women, the human right activists, as well as the feminists, are expected to be all over this. As this war is not potentially fatal, it is actually quite deadly brutal. The right of the child, women’s right, or all that put aside, right to life! Alas, for some reasons, they didn’t meet the criteria.

This is not in any way insinuating that because these rights are being violated by others that it’s now okay for us to do the same, or that because there seems to be selective activism, though more is expected from them, that we should suddenly disregard everything they have to say. Rather, that we are equipped with what it takes to critically analyze whatever is presented to us, investigate, and choose best practices based on grounded evidence. As such, that we are a people capable of thinking for ourselves and not passive assimilators. This approach is what I would implore us to employ when it comes to our culture.

Cultural arm of the practice          

Our culture is who we are, an identity, it gives us a sense of belonging, it ties us to our roots, tells us our history, something to fall back to for guidance should we lose our way. We should be proud of our culture, in fact, we should be trying to sell our culture to the world, from the dress codes to the food, the hair styles, the discipline, of all the many ethnic groups, so rich a culture. I find it interesting that we believe it’s okay that we should get rid of a practice simply because “it’s only cultural.”

Don’t get me wrong, should we find a certain cultural practice harmful, and there is reason to believe without an iota of doubt that this is the case, then by all means. However, what makes anyone think they have the right to come tell us what of our culture is ‘barbaric’, as though we don’t have the capacity to sensibly appraise our practices and make informed decisions, that we need saving. How dare you? Who told you we agree with all that is in your culture?

Is there a cultural aspect to FGM, as there is a religious bearing? Absolutely! If anyone is familiar with “ngansing baa” and its proceedings, the setting, the ritual rites, to the ceremony marking the end of the rites, it becomes apparent that those rites have nothing to do with Islam. Does this exclude a religious component? No! It cannot be claimed that the whole of Africa has the same culture such that the countries in which the WHO collaborative study was done all had only culture in common. If that claim was made, then how would female circumcision in Indonesia be explained? Or the very much argued point, the presence of the practice in Saudi Arabia?

Discussion

Ok, point made, there is a religious and cultural bearing, is that a green light to continue? How do we reconcile all of this?

Well, as much as the beauty of our culture is recognized and the importance of our cultural heritage acknowledged, blind following of our cultural believes is discouraged. Whenever unbiased evidence regarding the harmful nature of any of our cultural practices is made apparent, the right path is to abandon such practices. Therefore, considering the evidence presented above from the acute to long term complications as well as the impact on a woman’s sexual life, anything from FGM type Ib through to type III, should be discouraged, abandoned, and condemned without reservations.

From the Islamic perspective, the subtypes mentioned in the previous paragraph should be done away with. It is a basic principle of fiqh to do no harm, in fact, that is the principle of the prohibitions of Islam. Most, if not all, the prohibitions have the potential of causing harm. Thence, these practices not only having the potential of causing harm but also being potentially fatal, have no place in Islam. Furthermore, if the Hadith describing the practice is to be adhered to, then these practices do not qualify and may even be considered as going beyond the limits of the recommendations of the hadith?

Considering these types and contrasting it against the claim by the WHO that it violates human rights, one would agree with the claim that these practices are in fact in violation of these rights. As such, in the best interest of the girl child, in the spirit of justice, regardless of who it is for and based on authentic evidence, these practiced cannot be condoned, they should be vehemently condemned and an absolute stop put to them.

Note: I intentionally left out type IV as it has various other subtypes included, while most of the studies cited above mostly focused on type I to III. If you’ve however also noticed that type Ia is not included, good, you’ve been keenly following.

Peculiarities of type Ia

Shifting gears now to type Ia, which the WHO described as circumcision. We can now elucidate the differences between this type and the types described in my previous paragraphs.

As would be seen, almost as a pattern in the studies quoted above with regard to the complications of FGM, the types are grouped together, the subtypes are not separated, and the complications are generalized without distinction. The same applies to the study cited above with regard to the long-term gynecological complications. Despite the authors of the study concluding that the association of the complications with types II and III is quite significant, they however clumped together the subtypes of type I and the complications assumed to be for all subtypes. Not only is the association with type I less or not significant, I’d argue, none of the complications mentioned can be explained by type Ia.

Once the description of type Ia is really understood, then it becomes evident that there cannot be any sensible explanation for how type Ia can lead to any of complications. Certainly, the WHO has put a lot of work into FGM, and for a long time. Surely, a body as such with so much financial muscle and access to the expertise would have, by now, noted the need to identify, if there were, any complications associated with this subtype so as to discourage the practice in totality or if this is not the case, then clarify that the subtype does not fit into the definition of FGM as it does not meet the criteria. This, however, will only happen if there is any interest in bringing such information to light.

Regarding the sexual satisfaction of the woman, research has shown that women with type Ia have the same sexual scores as the non-circumcised. In fact, if one were to consider an analog of type Ia, hoodectomy, which by the way is a medical procedure performed by plastic surgeons mainly in the west, is found to be associated with increased sexual pleasure. There is also reported decreased yeast infection in those women that benefitted from hoodectomy.

As for the violations of human rights as stated above, I don’t see any of the rights being violated in this type. For instance, “principles of equality and non-discrimination on the basis of sex”, males are also circumcised, “right of the child”, male circumcision is done in childhood, “right to freedom from torture or cruel, inhuman or degrading treatment or punishment”, knowledge of type Ia refutes this claim and finally “right to life”, well I have not heard such claims made with respect to male circumcision yet what is taken of the prepuce in males is much more.

Allow me to drift off a little and explore the topic as a whole before concluding. Why is the practice termed “mutilation”? I am not naïve, neither am I unaware of the usage of language as a tool for propaganda. I am not oblivious of the fact that mutilation or cutting carries a negative connotation. To make this apparent, consider the following questions: “Will you mutilate/cut your daughter?” Against “will you circumcise her?”. Let’s take it a step further.

Is it based on the degree of tampering with the female genitalia? If this is the case, then genital reassignment surgeries come to mind, certainly this tampers way more with the female genitalia, as it does not only stop at the external genitalia but extends to the internal female reproductive organs in some cases. Not to mention the pre and post procedure hormonal bombardment. Yet this practice, genital reassignment surgeries, is recognized by the WHO and surgeons are making millions of dollars off of it.

Maybe then it depends on who carries out the procedure, given that these genital reassignment surgeries are carried out by surgeons, that disqualifies it for a mutilation. Should this be the case, then the advocacy should have been to have doctors carry out the procedure. This could have solved some of the complications mentioned earlier. However, this is not the case neither as the WHO insists that medicalization is never acceptable. Is it then? Race dependent? Religion dependent? Or the benefit that certain people will get off of it? The inconsistencies are alarming! Anyway, I digress.

Reccomendations and conclusion

Returning to making informed decisions based on available information and not being swayed by any inconsistent body, or something in the line of “anything west is best”, but rather by critically appraising information using our intellect that we’ve been endowed with, which is by no means inferior in anyway or form, there by coming to conclusions by adopting best practices.

Considering the plight of the advocates who genuinely have the best for the girl child at heart, ardently advocating against the practice that has consequences on the physical, mental and sexual health of the girl child, which by the way we should all be doing, those of the religious leaders not flinching in their advocacy for their right to conduct a religious rite, as well as those that would not have anyone take their culture for granted, is there any possibility that we can come to a conclusion where all parties will be flexible without any having to let go of the principles they stand for? I would recommend the following:

• Based on the evidence provided above, it would be realized that anything from type Ib to type III has both short and long-term complications, some of these complications potentially fatal. As a result, these practices should be done away with and the laws banning these remain as they are.
• However, as for type Ia, it cannot be associated with any of the complications mentioned and is reported to have some benefits, thence, should be removed from the definition of FGM as it does not fit the criteria. There are no concerns with regards to the health of the child and who ever wishes to practice it should be allowed to.
• The chances that those currently conducting the procedure have no knowledge of anatomy is quite high. Hence, the practice should be regulated such that it is carried out only in health facilities by experienced health personnel, where the procedure can be made safe and painless for the girl child.

Note: the whole of the prepuce need not to be removed to qualify as female circumcision is the Islamic sense, removal of a small portion of the prepuce suffices.

After ensuring the safety of the girl child, am certain there is not much reservations with regards to the rest of the religious and cultural rites. In fact, I will argue, some people look forward to some of those.

I really do hope that the recommendations put above can be applied and that we get past this topic and hopefully lessons learnt from this debate is applied to other pressing issues in the country. Those ones that the authorities would rather have us not digging into as it would start showing that which they prefer remains hidden. Like for instance, how, with the vast land and water bodies, we are not feeding ourselves? Or why we are drowning further in debt? Or why some allowances alone are enough to serve them the whole year while the entire salary of others is finished before they even receive it? Or why do the youth see “back way”, as horrible as it is, as the only solution or the other major deficiencies in the health care delivery system. I could keep going but I guess you get the point. Until I have to write again, peace be on you.