Article

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

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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.

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... 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. ...
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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.
... Thus, it is possible that isolated incidents may have occurred but the systematic cultural rite had disappeared. 133 The researchers explained that Bedouins have become more westernized. 134 I would say that the Bedouin have re-evaluated their position and altered their customs. ...
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... 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. ...
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... 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). ...
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... 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. ...
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... 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. ...
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... 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]. ...
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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.
Female circumcision in Africa
  • Shell-Duncan