Article

Disappearance of Female Genital Mutilation from the Bedouin Population of Southern Israel

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Recently, clinicians in Southern Israel perceived that the practice of female genital mutilation had disappeared entirely in the Bedouin population. We previously studied the prevalence of this practice in 1995. We decided to survey again the Bedouin population focusing on those tribes previously reported to perform this practice. Eighty percent of the interviews were done by an Arabic-speaking psychiatrist and 20% were done by an Arabic speaking nurse in the gynecologic clinic of a large Bedouin township or the gynecologic clinic of a smaller Bedouin township. Women were asked if they would be willing to answer a few questions about their past and if they were willing to have the gynecologist, with no additional procedure, note whether any operation had been performed on their genitalia. Physical examination by gynecologist and an oral questionnaire. One hundred and thirty two women were examined. No cases of any scarring of the kind reported in the previous study were found on physical examination. FGM has apparently disappeared over 15 years in a population in which it was once prevalent.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... In the last few years, clinicians in southern Israel have had the impression that the practice has disappeared entirely in the Bedouin population. erefore we decided to survey again the Bedouin population with an emphasis on those tribes previously reported to perform this practice (9). Moreover, we limited our survey to women under age 30, who would have been expected to have had this procedure in the last two decades, rather than older women who might have scars from FGM performed 40-50 years ago. ...
... Six women reported that they had heard that FGM is still going on but only by word of mouth, and we could not identify a single case that we could be referred to. e present study (9), in combination with the study (3) published in 1995, represents an almost unique anthropological follow-up study. Few studies of this kind have been reported. ...
Article
Full-text available
Female genital mutilation (FGM) is practiced in many areas of the world, including the Middle East, Africa and Australia. Although it is most common in Muslim populations it is not a dictate of Islam. In the 1980s this practice was reported among Bedouin tribes, originally nomadic, in the southern area of Israel. Almost all of the women interviewed in the first study intended to continue the practice by performing FGM on their daughters including educated women who were teachers, dental assistants or university students. A second study was therefore done based in the obstetrical clinic where only women from tribes reporting to undergo FGM were examined for signs of FGM by an experienced gynecologist, in the presence of an Arabic-speaking female nurse and translator, as part of a gynecologic examination that was indicated for other reasons. In no cases was clitoridectomy or any damage to the labia found. All women had a small scar from a 1cm. incision somewhere on the labia or prepuce of the clitoris. this study concluded that the importance of the ritual in this population was unrelated to its severity. the ritual had apparently become over time a small symbolic scar, even though this population continued to believe in its importance. By contrast, a group of Ethiopian Jews who had immigrated to Israel was interviewed by an Amharic translator, and examined during routine gynecological examination in the same manner as the Bedouin group above. In Ethiopia, FGM is universal among Christian, Muslim and Jewish groups. All women interviewed reported that FGM was universal in Ethiopia, but none intended to continue this practice with their daughters. All stated that this was a practice that would be left behind in their country of origin. On physical examination many of the women had amputation of the clitoris. The conclusion of this study was that the severity of the operation performed had no relation to the social and cultural adherence to the operation, since the Ethiopian Jews who practiced a more severe form of the operation intended to abandon this practice while the Muslim Bedouin who had a much milder form intended to continue it. A follow-up study in 2009 of the Bedouin population of southern Israel has found that FGM had disappeared, both by self-report of women under the age of 30, and by physical examination of women under the age of 30 in an obstetrical clinic. These results suggest an optimistic approach toward cultural change involving unhealthy cultural practices and emphasize the importance of cognitive approaches to cultural change.
... In the last few years, clinicians in southern Israel have had the impression that the practice has disappeared entirely in the Bedouin population. Therefore we decided to survey again the Bedouin population with an emphasis on those tribes previously reported to perform this practice (9). Moreover, we limited our survey to women under age 30, who would have been expected to have had this procedure in the last two decades, rather than older women who might have scars from FGM performed 40-50 years ago. ...
... The present study (9), in combination with the study (3) published in 1995, represents an almost unique anthropological follow-up study. Few studies of this kind have been reported. ...
Article
Female genital mutilation (FGM) is practiced in many areas of the world, including the Middle East, Africa and Australia. Although it is most common in Muslim populations it is not a dictate of Islam. In the 1980s this practice was reported among Bedouin tribes, originally nomadic, in the southern area of Israel. Almost all of the women interviewed in the first study intended to continue the practice by performing FGM on their daughters including educated women who were teachers, dental assistants or university students. A second study was therefore done based in the obstetrical clinic where only women from tribes reporting to undergo FGM were examined for signs of FGM by an experienced gynecologist, in the presence of an Arabic-speaking female nurse and translator, as part of a gynecologic examination that was indicated for other reasons. In no cases was clitoridectomy or any damage to the labia found. All women had a small scar from a 1cm. incision somewhere on the labia or prepuce of the clitoris. this study concluded that the importance of the ritual in this population was unrelated to its severity. the ritual had apparently become over time a small symbolic scar, even though this population continued to believe in its importance. By contrast, a group of Ethiopian Jews who had immigrated to Israel was interviewed by an Amharic translator, and examined during routine gynecological examination in the same manner as the Bedouin group above. In Ethiopia, FGM is universal among Christian, Muslim and Jewish groups. All women interviewed reported that FGM was universal in Ethiopia, but none intended to continue this practice with their daughters. All stated that this was a practice that would be left behind in their country of origin. on physical examination many of the women had amputation of the clitoris. the conclusion of this study was that the severity of the operation performed had no relation to the social and cultural adherence to the operation, since the Ethiopian Jews who practiced a more severe form of the operation intended to abandon this practice while the Muslim Bedouin who had a much milder form intended to continue it. A follow-up study in 2009 of the Bedouin population of southern Israel has found that FGM had disappeared, both by self-report of women under the age of 30, and by physical examination of women under the age of 30 in an obstetrical clinic. these results suggest an optimistic approach toward cultural change involving unhealthy cultural practices and emphasize the importance of cognitive approaches to cultural change.
... In Kuwait, Chibber et al. (2011), using a non-probability sample of clinical examinations of 4800 pregnant women from 2001 to 2004, estimated the prevalence of FGM to be 38%. FGM has also been reported amongst the Bedouin population in Israel (WHO, 2008); however, recent studies show that the practice has disappeared over the last decade (Halila, Belmaker, Rabia, Froimovici, & Applebaum, 2009;Belmaker, 2012). The presence of FGM has been reported in the United Arab Emirates (Kvello & Sayed, (2008) Unspecified Note for "anecdotal": FGM has been reported as occurring in the past but there is no evidence of the presence of the practice in recent years. ...
Article
While Female Genital Mutilation (FGM) has been in existence for centuries, the rigorous and systematic documentation of the extent of the practice is a recent undertaking. This paper discusses data availability related to the practice of FGM and reviews the methods used to generate prevalence estimates. The aim is to illustrate strengths and limitations of the available data. The review is organised around two main categories of countries: FGM countries of origin, where representative prevalence data exist, and countries of migration for women and girls who have undergone FGM, for which representative prevalence data are lacking. This second category also includes countries across the world where FGM is only found among small autochthonous populations.
... Some culture-specifi c practices, such as female circumcision, create less doubt in the minds of professional as to whether or not they constitute abuse, because these practices clearly contravene child protection and civil laws in many countries (Hassan et al., 2011 ;Pottie et al., 2011 ). Yet these practices have important cultural meanings that must be considered in determining how to intervene effectively (Grisaru, Lezer, & Belmaker, 1997 ;Halila, Belmaker, Abu Rabia, Froimovici, & Applebaum, 2009 ;Shweder, 2002 ). The trainer aims to help professionals learn to distinguish between parental practices that are illegal, legal but unusual or dysnormative practices and practices that may be legal or illegal but are clearly dysfunctional practices. ...
Chapter
Services that are designed by, and for, the host society majority group may be inadequate or inappropriate for ethnic minority or immigrant families. These issues are relevant to cultural consultants who are asked to provide advice to a variety of social service and institutional settings, including youth protection as well as legal and family services. Those who work within these agencies must be assisted to understand the difficulties encountered by migrant families during the process of resettlement, including separation and reunification, cultural variations in discipline and physical punishment, and the important roles of identity and intergenerational conflicts as well as distinguishing between situations of dysnormativity and dysfunctionality. Given that intimate partner violence is one of the challenges that institutional agencies face when assisting families, it is imperative that staff members be provided with the training necessary to adequately assist families confronted by these difficulties. The enormous power vested in these institutions and their representatives must also be considered when creating training strategies to assist workers. Finally, special attention must also be given to the challenges of migration and resettlement which can result in the destabilization of families, interrupt the transmission of traditional values from parents to children, diminish parental authority, and lead to the break-down of family structures which could result in the inappropriate removal of children from the parental home. Case vignettes and examples training programmes are used to demonstrate how cultural consultants can assist in the development of culturally safe spaces for families interacting with societal institutions.
... The Falasha community, who used to practice FC when they were in Ethiopia, abandoned the practice when they resettled in Israel, where the practice is unknown. 28 The rationale is that when people resettle to a new environment "they weigh their available choices, and they always move to the highest possible value among their available choices". 29 Accordingly, in populations where every girl is circumcised, neither those who oppose the practice nor those who do not (acting alone) have an option valued more highly than to circumcise their daughters, since neither of the two groups has an incentive to choose otherwise. ...
Article
Full-text available
Female genital mutilation or female circumcision (FC) is increasingly visible on the global health and development agenda - both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway's approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants' support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence permit is granted. This study adds to the knowledge of the process of the abandonment of FC among immigrants in Western countries.
... The change in Bedouin society sometimes includes the revision of venerable traditions. For example, female genital mutilation, highly prevalent 20 years ago, is no longer practiced at all (Halila, Belmaker, Abu Rabia, Froimovici, & Applebaum, 2009). Conversely, consumption of alcohol, once uncommon among young Bedouin due to the injunction in Islam, has become common in recent years (Diamond et al., 2008). ...
Article
Little is known about the attitudes of Negev Bedouin toward attention-deficit/hyperactivity disorder (ADHD) and its pharmacological treatment. This study examines the perspectives of Negev Bedouin teachers on pharmacological treatment. Thirty-six teachers are asked to consider how their views influence the way they relate to pupils’ parents. A grounded-theory analysis of semistructured interviews illuminates ambivalence in teachers’ attitudes. Teachers, like the rest of their community, when asked about the implications of an ADHD evaluation for their children, respond that ADHD and its pharmacological treatment cause dishonor. When asked what ADHD means when it is their pupils who are diagnosed and treated, however, teachers, like the education establishment, accept the need for medication. However, they fail to communicate this need to parents because their attempts to do so show parents that they consider their children “flawed”—causing parents to oppose treatment even more lest they succumb to social stigma.
... In a follow-up study in 2009 in which women under the age of 30 from tribes previously reported to perform this practice were interviewed and examined by gynecologists, there was no evidence of the procedure. These findings indicate the cultural change that the Bedouin society has undergone in relation to this cultural custom [8]. ...
Article
In this paper we describe health and morbidity characteristics of Bedouin women in southern Israel, based on papers published over the past 20 years. This is a unique population whose customs, tradition, singular circumstances as a population "in transit", and underprivileged socio-economic status are reflected in mental illness, pregnancy course, perinatal morbidity and mortality rates, and acute and chronic disease. Recognition of these characteristics can help the medical team treat various health problems in this population as well as other populations with similar characteristics.
Article
This study aimed to gather information from service users of an African Women's Clinic for the purposes of planning service improvement and estimating research feasibility. The report is based on 17 interviews with Somali speaking women who had experienced female genital cutting in childhood. With language barriers removed, a high percentage of clinic attendees responded positively to the invitation to participate in research. They willingly discussed their experiences of FGM and expressed their negative viewpoints about the practice of FGM, suggesting that psychosocial and psychosexual research may be feasibly carried out in specialist contexts. The results also point to the need for psychological and educational input for service improvement.
Article
Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reasons. Aim of this study was to determine sexual function before and after defibulation using a CO(2) laser in migrant women who had undergone FGM in the past. Female Sexual Function Index (FSFI) before and 6 months after defibulation. Patients were asked to fill the FSFI before surgery and at 6 months follow-up. Defibulation took place under general anesthetic using a CO(2) laser. Eighteen patients underwent defibulation in a standardized manner and filled in the FSFI completely. Female sexual function improves after surgical defibulation in the domains desire, arousal, satisfaction, and pain whereas lubrification and orgasm remained unchanged. Defibulation using CO(2) laser may improve some aspects of sexual function in patients who undergo defibulation but not all.
Article
Introduction: The existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual function as defined by performance on the following domains: desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Other studies however indicated that sexual function of genitally cut women is adversely altered. Aim: The aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women. Methods: This is a cross-sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women and 317 uncut women). Participants were requested to complete the Arabic Female Sexual Function Index (ArFSFI) and were then subjected to clinical examination where the cutting status was confirmed. Main outcome measures: The total score of the ArFSFI and its individual domains. Results: The mean age of cutting was 8.59 (±1.07) years. Of the cut participants, 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area, and education level, uncut participants had significantly higher ArFSFI total score (23.99±2.21) compared with cut participants (26.81±2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02±0.78, 4.86±0.72, 4.86±0.75, 4.86±0.68, 5.04±0.71, respectively) compared with those of the cut participants (3.37±0.89, 4.13±0.71, 4.16±0.84, 4.50±0.79, 4.69±0.92, respectively). No significant difference between the two groups was found regarding the sexual pain domain. Conclusion: In Egyptian women, FGC is associated with reduced scores of ArFSFI on all domain scores except the sexual pain domain.
Article
Full-text available
Introduction: Female genital mutilation (FGM) is a serious problem occurring very commonly in the developing world and it has serious health implications. The purpose of this study was to determine the practice of FGM among the Malays living in a rural region of north Malaysia. Methods: The study is a descriptive survey supplemented by qualitative information conducted in five villages in north Malaysia comprising entirely of Muslim Malays. Results: 597 women who experienced FGM were interviewed and they cited religion as the main reason for the practice. It was commonly performed by a traditional practitioner of the art called 'Mak Bidan', but the more recent FGM were done in clinics by doctors (P=0.000). All female adults interviewed wanted the practice to go on (P=0.05). Comparatively the FGM practiced in these villages was less traumatic than that practiced in most other countries. In contrast with studies conducted elsewhere, the responders in this study believed that FGM actually helps to increase the female libido. Conclusion: The public and especially the 'Mak Bidan's' need to be educated on the dangers of female circumcision and the true requirements of circumcision in religion using an advocacy and social movement approach. This is best done by those from the state religious authority and it should be multisectoral, sustained and community led.
Article
IntroductionFemale genital cutting (FGC) is a ritual involving cutting part or all of the female external genitalia, performed primarily in Africa. Understanding the motivation behind FGC whether religious or otherwise is important for formulating the anti-FGC messages in prevention and awareness campaigns. AimThe study aims to provide an investigation of opinion over FGC, the root motive/s behind it, in addition to the current prevalence of FGC among Internet users in the Middle East. Methods The Global Online Sexuality Survey was undertaken in the Middle East via paid advertising on Facebook (R), comprising 146 questions. Main Outcome MeasuresThe main outcomes are the prevalence of and public opinion on FGC among Internet users. Results31.6% of 992 participants experienced FGC at an average age of 9.63.5 years, mostly in Egypt (50.2%). FGC was performed among both Muslims (36.9%) and Christians (18.8%), more in rural areas (78.7%) than urban (47.4%), and was performed primarily by doctors (54.7%) and nurses (9.5%). Whether or not it is necessary for female chastity, FGC was reported as highly necessary (22.5%), and necessary (21.6%). This was more among males, particularly among those with rural origin, with no difference as per educational level. This is in contrast to only 3.7% regarding FGC as a mandate of Islam. Religious opinion among Muslims was: 55.4% anti-FGC and 44.6% pro-FGC. Conclusion An important motivation driving FGC seems to be males seeking female chastity rather than religion, especially with FGC not being an Islamic mandate, not to undermine the importance of religion among other motives. School and university education were void of an effective anti-FGC message, which should be addressed. There is a shift toward doctors and nurses for performing FGC, which is both a threat and an opportunity. We propose that the primary message against FGC should be delivered by medical and paramedical personnel who can deliver a balanced and confidential message. Shaeer O and Shaeer E. The Global Online Sexuality Survey: Public perception of female genital cutting among Internet users in the Middle East. J Sex Med 2013;10:2904-2911.
Article
Full-text available
Objective: Ritual female genital surgery (RFGS), or female circumcision, is common among certain ethnic groups in Asia and Africa and describes a range of practices involving complete or partial removal of the female external genitalia for nonmedical reasons. Several studies in African populations, in which more severe forms of RFGS are performed, reported an increased prevalence of posttraumatic stress disorder and other psychiatric syndromes among circumcised women than among uncircumcised controls. Among the Bedouin population in southern Israel, RFGS has become a symbolic operation without major mutilation. However, in a study performed in 1999, Bedouin women after RFGS reported difficulties in motherdaughter relationships and trust. This pilot study assessed the mental health of Bedouin women from southern Israel after RFGS compared to age-matched controls without RFGS. Method: The psychological impact of RFGS was assessed in 19 circumcised Bedouin women compared to 18 age-matched controls. The Post Traumatic Stress Disorder Scale, Symptom Checklist, Impact of Event Scale, and a demographics and background questionnaire were used to assess traumatization and psychiatric illnesses. The study was conducted from March to July 2007. Results: No statistically significant differences were found between the 2 groups. Conclusions: The prevailing procedure of RFGS among the Bedouin population of southern Israel had no apparent effect on mental health.
Chapter
This chapter covers the broader population policies that were designed and implemented in developing countries during the period from 1974 until today. The heyday of these more comprehensive policies was in the 1980s and 1990s.
Article
Full-text available
Ritual female genital surgery (RFGS), or female circumcision, is common among certain ethnic groups in Asia and Africa and describes a range of practices involving complete or partial removal of the female external genitalia for nonmedical reasons. Several studies in African populations, in which more severe forms of RFGS are performed, reported an increased prevalence of posttraumatic stress disorder and other psychiatric syndromes among circumcised women than among uncircumcised controls. Among the Bedouin population in southern Israel, RFGS has become a symbolic operation without major mutilation. However, in a study performed in 1999, Bedouin women after RFGS reported difficulties in mother-daughter relationships and trust. This pilot study assessed the mental health of Bedouin women from southern Israel after RFGS compared to age-matched controls without RFGS. The psychological impact of RFGS was assessed in 19 circumcised Bedouin women compared to 18 age-matched controls. The Post Traumatic Stress Disorder Scale, Symptom Checklist, Impact of Event Scale, and a demographics and background questionnaire were used to assess traumatization and psychiatric illnesses. The study was conducted from March to July 2007. No statistically significant differences were found between the 2 groups. The prevailing procedure of RFGS among the Bedouin population of southern Israel had no apparent effect on mental health.
Article
Full-text available
Ritual female genital operations are common in many parts of the world, with varying degrees of mutilation from clitoridectomy and removal of the labia to removal of the clitoral prepuce. Interviews of 21 Bedouin women in southern Israel revealed the practice to be normative in several tribes. However, physical examination of 37 young women from those tribes at a gynecological clinic revealed only small scars on the labia in each woman. Bedouin in southern Israel may offer a model of evolution of female circumcision into a nonmutilative ritual incision. PIP Interviews conducted in 1992 with 21 Bedouin women living in southern Israel suggested that female circumcision may be evolving into a symbolic operation without the major mutilation associated with this procedure in much of Africa. Respondents ranged in age from 16 to 45 years. The reasons most frequently cited for ritual female genital surgery were pressures to maintain tradition and the belief that food prepared by uncircumcised women is neither tasty nor clean. Only two of the women interviewed--the youngest (16 and 18 years old) and most educated in the group--stated they would not permit their daughters to undergo the ritual. Physical examination of 37 additional Bedouin women 17-36 years of age revealed that all had small scars on the prepuce of the clitoris or the upper 1 cm of the labia minora near the clitoral prepuce. None had undergone clitoridectomy or removal of the labia minora or majora. Although all of the examined women reported pain on intercourse in the months after marriage, they approved of the practice and intended to continue the tradition. Recommended, both to protect the health of young women and uphold cultural norms, is the training and licensing of health-religious functionaries in the performance of a symbolic version of female genital surgery under sterile conditions.
Article
Full-text available
Female Genital Mutilation (FGM) which involves alteration of the female genitalia for non-medical grounds is prevalent in Sub-Saharan Africa, associated with long-term genitourinary complications, and possible HIV transmission. This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure. We performed an electronic search using Medline for articles published between 1966 to 2006 for evidence of FGM practice, its complications, and the nexus between this procedure and HIV sero-positivity. The results indicate ongoing FGM practice, albeit prevalence reduction, due probably to the increasing knowledge of the consequences of FGM as a result of non-sterile techniques. Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies in order to assess the association between FGM and HIV transmission.
Article
Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.
Article
In a study conducted over a 5-year period, the author interviewed over 300 Sudanese women and 100 Sudanese men on the sexual experience of circumcised and infibulated women. Sudanese circumcision involves excision of the clitoris, the labia minora and the inner layers of the labia majora, and infusion or infibulation of the bilateral wound. The findings of this study indicate that sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their also being culturally bound to hide these experiences. These findings also seriously question the importance of the clitoris as an organ that must be stimulated in order to produce female orgasm, as is often maintained in Western sexological literature.
Article
During the past 2 years, substantial progress has been made in changing attitudes towards female genital mutilation in countries such as Guinea, Egypt, Tanzania, Kenya, and Senegal. But the practice remains widespread across Africa. Wairagala Wakabi reports.
Article
Genital mutilation has been hidden for centuries and the damage done by it has rarely been evaluated. This concealment has permitted genital mutilation to be spread all over Africa in the absence of facts and open discussion. The present extent of genital mutilation is such that it should be treated as a public health problem and recognized as an impediment to development that can be prevented and eradicated much like any disease. The prevention of man-made damage to female children should become part and parcel of all health education, maternal and child health, family planning, and preventive care programmes in Africa. Genital mutilation blights the lives and destroys the health of millions of children and women: once abandoned it will never come back again.
Article
Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects. PIP Ritualistic sexual mutilation of females dates back to the 5th century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle East, concern has recently been expressed that female genital mutilation is also being practiced in the US, Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition; outlines the associated medical, psychological, and sexual problems; and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.
Article
In Kenya, a new ceremony known as "Ntanira Na Mugambo," or "circumcision through words," is being offered in some rural communities as an alternative to the harmful practice of female genital mutilation. This new ceremony includes a week-long program of counseling, training, and provision of information to young women ending with a "coming of age" celebration that involves music, dancing, presents, and feasting. Since its initiation in August 1996, about 300 young women have accepted this alternative rite. Kenya is among the countries where the practice of female genital mutilation is slowly diminishing, but the mutilation is still common in at least 26 African countries and among immigrants in some developed countries. The new Kenyan rite has the advantage of requiring the cooperation and support of the communities where it is practiced. It was developed as a cooperative effort of the Kenyan Maendeleo Ya Wanawake Organization and the Program for Appropriate Technology in Health after years of research. An important aspect of Ntanira Na Mugambo is the flexibility that arises from the ability to stress various components in response to community characteristics. Its success is also linked to the fact that it involves the entire family and community and has a male motivation component. It is hoped that this nonjudgmental rite will become a widely successful strategy to eliminate female genital mutilation and improve women's health throughout the world.
Article
Female genital mutilation (FGM) has been practiced worldwide, clothed under the tradocultural term "circumcision." Indications for its practice include ensuring virginity, securing fertility, securing the economic and social future of daughters, preventing the clitoris from growing long like the penis, and purely as a "tradition." Outlawed only in the United Kingdom, Sweden, and Belgium, no law forbids it in most other countries. Classified into four identified types, the current perpetrators are mainly quacks, but trained medical personnel still connive at and encourage FGM. Early complications include hemorrhage, urinary tract infection, septicemia, and tetanus. Late complications include infertility, apareunia, clitoral neuromas, and vesicovaginal fistula. Reasons for the ritual persisting include fear that legislation would force it underground and it will be performed in unsterile conditions, belief that it is racist to speak out against FGM, "tolerance" by health professionals, continued use of the term "female circumcision," lack of awareness of the culture of immigrants by the physicians in areas where FGM is not culturally practiced, and sporadic or uncommitted eradication efforts. We believe there is no reason for the continued practice of FGM. It should incur global abolition, the same way slave trade or Victorian chastity belts have done. We advocate that in medical communications the term "female genital mutilation" be used in place of "female circumcision." World leaders should include unacceptable cultural practices such as FGM in the "world summit" agenda. The year 1999 should be declared the year for global eradication of FGM.
Article
Female circumcision, more accurately known as female genital mutilation, is still a common practice in parts of Africa. This ritual genital operation can involve partial or complete excision of the clitoris and labia minora as well as infibulation (labial fusion). The case reported here involves a 16-year-old African girl with a complication of this mutilating procedure.
Article
The purpose of this review is to provide an up to date account of recent papers and attitude on female genital mutilation in the past year. It is aimed at all professionals caring and supporting women/girls with female genital mutilation, and to identify gaps. Given the multidisciplinary complexity of the practice of female genital mutilation, it is surprising how little empirical research (both quantitative and qualitative) exists. There is a paucity of rigorous research into its prevalence, its health consequences for those girls/women experiencing the practice, the understanding of professionals who have to address the issue, the implementation of existing legislation and the impact of programme interventions intended to change people's attitudes to, and the practice of, female genital mutilation. The overwhelming majority of literature focuses on the same topics, often drawing upon the same less-than-rigorous research data. Worldwide, there are approximately 13 million refugees and asylum seekers, and human rights violations are seen as contributing factors to people fleeing their homeland. In the United States, those seeking asylum or refugee status are asked about their life experiences. African women are asked about ritual genital surgery, as it may be an indicator of their gynaecological, obstetric and sexual health. Health and social care professionals in host countries, in Europe, Australia, Canada, the USA and the UK, for example, are increasingly encountering this vulnerable client group in their practice and are finding that they are ill-prepared to deal with presenting complex health needs and challenges.
Article
The Bedouin Arab population of southern Israel is in transition from a semi-nomadic lifestyle to permanent settlement, with many characteristics of a third-world population. A major outbreak of measles in the winter of 1990-91, with an incidence of 415.6 per 100,000 and a case fatality rate of 2.2 % among the Bedouin, led to the establishment of a national committee, which recommended an intervention programme. We report on the effect of the programme implementation on the reduction of vaccine-preventable communicable diseases in a Bedouin Arab population. We compared immunisation coverage and incidence of reportable vaccine-preventable communicable diseases before and after implementation of the intervention programme. Implementation of the intervention programme was associated with a marked increase in immunisation coverage, from 53% for first measles immunisation among those born in 1988, and reaching 2 years of age in 1990 at the start of the outbreak, to 90% at age 2 years among those born in 2001. We noted a decrease in all vaccine-preventable communicable diseases, except for pertussis, during this period. The implementation of a targeted programme to improve immunisation coverage, and other concomitant changes in health-care delivery, was temporally associated with reduction of vaccine-preventable communicable diseases in a population of Bedouin Arabs in Israel who are living in semi-nomadic conditions. The success of the programme could be applicable to semi-nomadic populations living in other areas of the middle east.
Article
Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
Article
Female genital mutilation (FGM) is performed in many countries where it is an accepted and expected custom. This is not the case in the UK but more and more women who have had FGM performed are presenting to healthcare professionals. It is therefore important that we increase our awareness of FGM and the particular problems associated with this procedure. There is no religious basis for FGM but it is perpetuated by tradition in societies. The complications are vast, and women who are coming to this country who have had FGM are often keen to have it reversed. Although the vaginal introitus can be made adequate, if the clitoris has been removed, clearly this cannot be replaced.It is illegal to perform FGM in this country after the Prohibition of Female Circumcision Act 1985. However, it is important that we are sensitive and supportive to women who have had FGM.
Article
Sexual health is an assumed right for every individual, but we know little regarding customs, culture, or tradition and the role they play on the sexual experiences for a woman. A woman's sexuality must be considered in the context of the environment in which she and her partner live. Culture, social customs of the community, and religion often determine the acceptance and achievement of sexual health for both men and women. This is a review of the available literature on the impact of culture on a woman's sexual satisfaction, with emphasis placed on information from cultures practicing female genital circumcision (FGC). FGC provides a spectrum of surgical excisions and outcomes. The spectrum of FGC surgical excisions can alter well-being, obstetrical outcomes, and sexual responses. The psychologic aspects of a painful procedure in a young child may also impact her future sexual responsiveness. There is a paucity of information on which to base conclusions and the effect of culture on a woman's sexual satisfaction. Preliminary data suggest the need for further research using markers specific to the culture and her satisfaction.
Article
Female genital cutting (FGC) and HIV/AIDS are both highly prevalent in sub-Saharan Africa, and researchers have speculated that the association may be more than coincidental. Data from 3167 women aged 15-49 who participated in the 2003 Kenya Demographic and Health Survey (KDHS) are used to test the direct and indirect associations of FGC with HIV. Our adjusted models suggest that FGC is not associated directly with HIV, but is associated indirectly through several pathways. Cut women are 1.72 times more likely than uncut women to have older partners, and women with older partners are 2.65 times more likely than women with younger partners to test positive for HIV Cut women have 1.94 times higher odds than uncut women of initiating sexual intercourse before they are 20, and women who experience their sexual debut before age 20 have 1.73 times higher odds than those whose sexual debut comes later of testing positive for HIV. Cut women have 27 percent lower odds of having at least one extra-union partner, and women with an extra-union partner have 2.63 times higher odds of testing positive for HIV. Therefore, in Kenya, FGC may be an early life-course event that indirectly alters women's odds of becoming infected with HIV through protective and harmful practices in adulthood.
Article
This study aimed to establish Egyptian women's attitudes and beliefs about female genital cutting (FGC) or mutilation by applying a questionnaire module about violence to a subsample of 5,249 married women from a total of 19,474 women who participated in the 2005 Egypt Demographic Health Survey. Women were interviewed to determine if they had been exposed to marital violence in the year prior to the survey, their attitudes and beliefs about FGC, and if they physically abused their children. The association of beliefs about FGC with maternal physical abuse was examined, adjusting for exposure to marital violence and other socio-demographic variables. Of the women surveyed 16.4% and 3.4% had been exposed to physical and sexual violence, respectively, during the year prior to the survey. Around 76% of the women surveyed intended to continue the FGC practice, and 69.8% had slapped or hit their children during the year prior to the survey. Holding positive beliefs about the practice of FGC or intending to continue it was associated with maternal physical abuse and this has significant implications for health and welfare workers in Egypt and for society in general.
Article
Female genital mutilation/cutting (FGM/C) violates human rights. FGM/C women's sexuality is not well known and often it is neglected by gynecologists, urologists, and sexologists. In mutilated/cut women, some fundamental structures for orgasm have not been excised. The aim of this report is to describe and analyze the results of four investigations on sexual functioning in different groups of cut women. Instruments: semistructured interviews and the Female Sexual Function Index (FSFI). Sample: 137 adult women affected by different types of FGM/C; 58 young FGM/C ladies living in the West; 57 infibulated women; 15 infibulated women after the operation of defibulation. The group of 137 women, affected by different types of FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after defibulation 14 out of 15 infibulated women reported orgasm; the group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an equivalent group of control in desire, arousal, orgasm, and satisfaction with mean scores higher in the group of mutilated women. No significant differences were observed between the two groups in lubrication and pain. Embryology, anatomy, and physiology of female erectile organs are neglected in specialist textbooks. In infibulated women, some erectile structures fundamental for orgasm have not been excised. Cultural influence can change the perception of pleasure, as well as social acceptance. Every woman has the right to have sexual health and to feel sexual pleasure for full psychophysical well-being of the person. In accordance with other research, the present study reports that FGM/C women can also have the possibility of reaching an orgasm. Therefore, FGM/C women with sexual dysfunctions can and must be cured; they have the right to have an appropriate sexual therapy.
Article
Female genital mutilation is a deeply rooted cultural tradition observed primarily in Africa and among certain communities in the Middle East and Asia. It has considerable health consequences. Women from the practising communities are increasingly seen within healthcare settings but few healthcare professionals are trained to treat their specific healthcare needs.
Article
The objective of this study was to evaluate the prevalence of female genital cutting (FGC) in Upper Egypt, after 6 years of putting prohibition law into action. A total number of 3730 girls between the ages of 10-14 years were recruited to participate in this study. They were mainly preparatory school students (three urban and three rural areas). Social workers interviewed them as to whether they had undergone circumcision within the last 6 years or not. Subsequently, a questionnaire was sent to parents of girls who were positive for circumcision as to the circumstances surrounding the procedure. The prohibition law of FGC seems not to have altered the prevalence of this procedure. The majority of girls (84.9%) had had circumcision within the last 6 years with high prevalence in rural areas (92.5%). Circumcision was done for a combination of reasons, according to parents, with high rates of non-medical personnel participation (64.15%). This study's results indicate that the practice of FGC in Upper Egypt remains high despite enforcement of law. Extensive efforts are needed both to revise public awareness and to change attitudes regarding FGC.