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The fight against FGM
Published in Al-Ahram Weekly on 01 - 09 - 2015

Clerics have debated it, doctors are divided about it, and parents are wary of it but some of them just follow tradition. Female genital mutilation (FGM), the practice of female circumcision, has been blamed for a wide range of health problems among women, ranging from death to the loss of libido. Although the procedure is formally illegal, enforcement of the law is still rare and girls in Egypt are still being circumcised in their thousands.
Mona, not her real name, was only 15 when her mother took her and her younger sister, then 14, to a doctor at a health clinic. The girls weren't told what to expect. Now 35, Mona still recalls the experience with horror.
“If I gave birth to a daughter I would not have her circumcised. I would not subject her to the physical pain I still feel. The procedure is misguided and survives solely because of ignorance and a lack of awareness,” she said.
“When I got married and gave birth to my first son, the woman doctor who supervised the birth informed me that my circumcision had been badly done,” Mona added. “They say that the moral uprightness of girls depends on this procedure. But this is nonsense. Morality is about upbringing, not surgery.”
Another woman, whom I will call Tahani, had her older daughter circumcised. “We circumcise our daughters because it is a sunna [a religious custom],” she said. “Female circumcision also differentiates between Muslims and Christians,” she added.
Now 47 years of age, Tahani said that her daughter has not suffered psychologically or physically from the procedure, which she underwent five years ago. Soon, she said, it will be time to circumcise her younger daughter.
“We go to the doctor at the [government] medical unit who performs the circumcision procedure. Other people go to midwives,” she said. When I asked Tahani what her reaction would be if her daughter refused to undergo circumcision, she replied, “Her father wouldn't hear of it.”
A third woman, whom I will call Soad, admitted that she knew very little about the procedure before undergoing it. “I was 14 at the time and was simply mortified. But I didn't feel anything because the woman doctor gave me anaesthesia, although I didn't fully understand the point of circumcision,” she said.
Soad, who is now 27, is not taking sides on the issue. “Some people say the procedure is good for girls. But affluent people claim it is harmful. I haven't seen any impact, negative or positive, of the procedure, either psychologically, or physically, or sexually. Still, I don't think I will have the procedure done on my daughter unless there is a medical need.”
The World Health Organisation (WHO) defines FGM as the ritual removal of some or all of the external female genitalia. The procedure has been known in Egypt since pharaonic times. Some say it was introduced to the country by the Kushite Kingdom in the seventh century BCE. Others say that it goes back to the 23rd century BCE.
The practice to be deeply rooted in Africa, where it remains common in 28 African countries, some of them with a Christian majority. Although Muslim tradition is always cited as the reason for the survival of this custom in Egypt, the evidence points to the contrary. Other Arab countries have no such practice, with the exception of Yemen, and the custom may have been imported from Africa.
As more Africans and Arabs emigrate to the West, the custom has brought widespread controversy to the US and Europe. In April 2015, the London-based newspaper The Guardian said that the number of girls suffering from FGM-related complications was on the rise.
Nearly 600 girls in the UK were undergoing treatment related to such complications in March 2015, the newspaper reported. But social groups in the UK say the real number is much higher. Nearly 4,000 cases of post-FGM complications have been reported since September 2014, when data collection started.
The issue of FGM has topped the political agenda in Britain since 2014, with civil society groups trying to put a stop to the procedure. For the first time ever, a British doctor was put on trial for allegedly performing FGM on a patient.
The doctor, Dhanuson Dharmasena, was acquitted in February 2015. He was reported to have “re-stitched” the genitalia of a Somali woman who had undergone FGM as a child, after he had helped her give birth.
Dharmasena, who didn't know that the woman was circumcised until he was in the operating theatre, told reporters that he considered FGM an “abhorrent practice.”
A 2014 study said that some 60,000 women in Britain were at risk of undergoing FGM because of the customs of their countries of origin. FGM has been outlawed in Britain since 1985, and a UK law passed in 2003 punishes any person responsible for arranging for children to travel out of the UK to undergo the procedure abroad. The punishment is up to 14 years in prison.
In the US, the federal government banned FGM in 1996 and then passed a law in 2012 that criminalised sending girls outside the country to undergo the procedure. However, it is thought that only 24 states enforce the federal ban. Human rights groups in the US have been demanding a stricter ban on the practice.
Aware of the risks associated with FGM, the UN has designated 6 February as International Day of Zero Tolerance of Female Genital Mutilation, during which events are held worldwide to raise awareness of the risks. On 18 December 2014, the UN General Assembly passed a resolution calling on member states to formulate comprehensive plans to combat the practice.
EGYPTIAN LAW: Egyptian authorities have fought against FGM for decades. Back in 1928, Ali Pasha Ibrahim, then dean of the Qasr Al-Aini Medical School, made it clear that FGM had no medical merits and that it would not be taught in Egypt.
In 1959, the Health Ministry banned doctors from performing FGM. In 2008, Egyptian law (Article 242-ii of the penal code) banned FGM, noting that any person engaged in the practice could be punishable by three months to two years in prison plus a fine.
The Health Ministry's Decision 271 of 2007 also prohibits “doctors and members of the nursing staff from cutting, straightening or altering any natural part of the female reproductive organs.”
In February 2013, Egypt's Supreme Constitutional Court threw out a case filed by Sheikh Youssef Al-Badri and Hamed Siddiq against the Health Ministry. In this case, the two men claimed that the Health Ministry's ban on FGM was unconstitutional.
However, Nehad Abul-Qomsan, a lawyer and the head of the Egyptian Centre for Women's Rights (ECMR), an NGO, blames sharia-thumping for the survival of FGM.
“The real challenge to implementing the legislative amendment to the Children's Law of 2007 is that there are people who say that circumcision is a part of the sharia, a claim that others contest,” she told me.
“The legal text is clear. FGM is a crime according to the law of 2008. However, punishments can still be insignificant compared to what the penal code says. Nevertheless, it has reduced the incidence of female circumcision by about 30 per cent” since 2007, she said.
“The law is not only a tool of punishment, but also a tool for raising awareness,” Abul Qomsan said.
The rise of conservative Islam, even before the Muslim Brotherhood took power in Egypt after the 25 January Revolution, has boosted l0ogn discredited claims that the noncircumcision of girls is a Western custom that must be abandoned as it deprives girls of a level of chastity that only FGM can ensure, she pointed out.
“A conflict of interest has developed, leading to the spread of the phenomenon over the past two years, with the direct support of the Political Islam current. That has been a terrible development. The other problem has been that law enforcers have been busy with other issues,” Abul Qomsan said.
Mona Amin, coordinator of the National Programme for the Combat of Female Circumcision and Family Empowerment at the Ministry of Population, is aware that unless public opinion turns against the practice, the law will remain comparatively powerless.
“The laws are solid. But the problem has to do with encouraging people to report FGM. Unless it is reported, the law cannot spring into action,” Amin said. “We need people to report circumcisions when they take place. In the meantime, we need to keep sending out the message that circumcision is a crime punishable by law.”
Amin admits that FGM is still practiced to this day, “but those who do it today cannot brag about it as they used to 15 years ago. They work in the dark, like drug-traffickers and criminals,” she commented.
As part of the bid to eradicate FGM, the government in May 2015 released its 2016-2020 strategy for fighting FGM. The strategy aims to cut FGM rates by ten to 15 per cent among females aged ten to 19 nationwide. The strategy calls for collecting more data on the practice, for stricter enforcement of the law, for enhancing awareness of women rights and for more women empowerment programmes.
A survey of Egypt in 2014 conducted by the Ministry of Population showed a clear reduction among the new generations of incidents of FGM. According to the survey, the rate of married women aged 15-49 who had undergone FGM was just over 90 per cent. But in the age group of 15-17, the number of girls who had undergone FGM was only 61.1 per cent, down from 74.4 per cent in 2008.
According to Mona Amin, this is a good sign for it shows that some women “who underwent circumcision decided not to circumcise their own daughters.” Amin said that the government was also becoming more proactive. “The Ministry of Justice (MOJ) is now handling the dossier in a manner different from that seen back in 2004 through 2006. Now the MOJ runs training courses for judges about the law,” she said.
The FGM dossier, she noted, used to be handled by the National Council for Motherhood and Childhood, but since 2011 the Ministry of Population (MOP) has been in charge. Amin was also pleased with an announcement made by the health minister in June 2015 that said the Ministry of Health (MOH) would periodically “inspect medical institutions to combat female circumcision.” The MOH has also included FGM in its training programmes.
The mere fact that the government has updated its FGM statistics is encouraging, as it denotes a willingness to face the facts. “There are other countries in which the real percentage of circumcision is unknown,” Amin said, adding, “Female circumcision is an act of violence against women.”
Randa Fakhr Al-Din, director of the NGO Coalition against FGM/C, concurs with this view. “Circumcision is only one of many problems in society. If we change people's attitudes, a lot of things will change, including violence against women, FGM and sexual harassment,” she said.
“We must put pressure on the government to enforce the law and to make the public understand that circumcision has nothing to do with religion or women's morality.
“When people submit a report on FGM, they should receive the full attention of the police and not be dismissed as something trivial. The life of a girl could be at stake. FGM is not a misdemeanour. It is a felony,” she remarked.
She was thrilled to see that the percentage of FGM was dropping, as the population survey of 2014 had illustrated. “Such results are a sign that our work is paying off,” she added.
Dalia Abdel-Hamid, who handles gender issues at the Egyptian Initiative for Personal Rights (EIPR), an NGO, was also pleased to see that the government is taking an interest in women's productive health. In her view, legal bans are fine but social customs cannot be changed by laws alone.
“What use is the law if society itself doesn't see the point of it?” she asked. “We need societal disapproval to stop FGM. We need to work at the social level, launch awareness campaigns and open a real dialogue with the people to change their ideas,” Abdel-Hamid said.
“The law was passed in 2007, but the first lawsuit against FGM practitioners was filed in 2012. This is not deterrence, but failure. The FGM procedure takes place through collusion between the girl's family and the doctor concerned. If no complications happen, it goes unreported,” she explained.
“The government keeps saying that circumcision is bad for the health of girls. But this only prompts people to go to doctors to perform the procedure, instead of midwives. So we have ended up with a lot of doctors who think that circumcision is normal.”
MOH Decree 271 of 2007 banned doctors and nurses from carrying out circumcision. According to the health survey of 2014, however, doctors are now conducting 74 per cent of the circumcision procedures on girls up to the age of 19.
“We must face the real reasons parents circumcise their girls, which include the desire to control their sexuality, something the government doesn't like to address, deeming it too sensitive. The government doesn't have enough courage to deal with such things.
“But this issue must be addressed as part of a campaign to protect the rights of women and girls, as well as their right to keep their bodies intact and the fact that they are entitled to their sexuality,” Abdel-Hamid added.
She noted that the recent government strategy doesn't state clearly that women have the right to a sexual life. “Only in one paragraph does the strategy note that efforts will be made to have clerics spread the word that women have sexual rights,” she said.
Circumcision is not going to change by campaigns or the training of doctors alone, Abdel-Hamid remarked. “Such things may have some impact. But for the younger generations, you have to change the way they think by introducing sexual teaching in schools, for example,” he said.
VICTIMS OF CIRCUMCISION: Several girls are known to have died because of botched circumcisions. One was Soheir Al-Bati', who died in June 2013 in the governorate of Daqahliya after a procedure carried out by a doctor named Raslan Halawa.
Halawa, 57, was then the first doctor in Egypt ever to be convicted for carrying out FGM. He was sentenced to two years in prison and fined LE500. The girl's father, Al-Bati' Mohamed Al-Bati', was sentenced to a three months suspended sentence as an accomplice to the crime.
Another girl, Iman, died in 2003 in the governorate of Menoufiya during a circumcision carried out by a medical doctor. Bodour Ahmad Shakir was 12 when she died in 2007 in Maghagha, in the governorate of Minya, during a circumcision performed by a female doctor. Amira Al-Basyuoni from Kafr Al-Tawila near Talkha, bled for five days before dying after she was circumcised in a medical clinic.
Omniya Abdel-Hamid Abul-Ela, 14, died of low blood pressure after a circumcision carried out by a male doctor in Kom Ethnein near Qalyub. Karima Rahim Masoud died while undergoing FGM in a medical clinic in Basyoun in the governorate of Gharbiya.
Nermine Al-Haddad bled to death in the governorate of Menoufiya in 2010 while undergoing FGM performed by a woman doctor.
The official Muslim and Christian religious authorities in Egypt are opposed to FGM. Egypt's mufti passed a fatwa, or religious ruling, in 2006 banning female circumcision. The Coptic Church has also repeatedly expressed its opposition to FGM.
Sayyed Zayed, director-general of the Al-Diri Islamic Complex in Beni Suef, a religious centre, says that female circumcision is a custom and not a religious rite. “In the jahiliya [pre-Islamic times], people used to believe that girls were bad luck and could bring poverty and shame to their parents.
“That's why they used to bury newly born girls alive. Later, they abandoned this habit and started removing part of the clitoris instead, in the belief that this would make girls ‘more clean,'” he said.
“But FGM is not about cleanliness, but rather the opposite. Doctors say that if a girl is circumcised, she becomes prone to vaginal infections, for example,” he added. According to Zayed, the Prophet Mohamed had four daughters, none of whom were circumcised. “In Saudi Arabia, where the Qur'an was revealed, there are no circumcised women,” he added.
A medical necessity for the surgical alteration of a woman's genitalia is conceivable, but is very rare, said Amr Abbasi, a gynaecologist and obstetrician. “Contrary to common belief, such cases in which circumcision is advised for medical reasons are rare,” Abbasi explained.
“This happens when the clitoris is oversized, which is very rare. Women with an oversized clitoris may have problems with excessive friction, which can be irritating.” Abbasi, said that he had only ever come across one such case in his entire career.
Abbasi noted the risks of infection during FGM. “Carrying out circumcision with unsterilised instruments in an unsterilised place can lead to intense inflammation, blood poisoning and perhaps even death,” he said.
The procedure can also damage crucial nerves, leading to the inflammation of the nerves connected to the clitoris. “It can lead to injury and the inappropriate healing of the area. It can also lead to a loss of libido, for the clitoris is responsible for arousal.”
As for the psychological consequences of the procedure, Mohamed Al-Mahdi, a professor of psychology at Al-Azhar University in Cairo, believes that it is scary enough to leave a mental trauma.
“When one is faced with any surgical procedure, one is afraid. And in the case of the circumcision of girls, the anxiety is heightened by the privacy of this particular body part, one that has always been associated with taboos and moral warnings. Therefore, the whole thing can be very frightening,” Al-Mahdi said.
The mental trauma of FGM differs from case to case, he added. “If the social context in which the girl lives attributes a positive value to circumcision, and if the event is thought of as one of celebration and if gifts are exchanged, the fear is lessened,” Al-Mahdi said.
“But if the societal context perceives circumcision as an assault on the girl's body, the fear is heightened.” But in all cases, “there is a psychological damage.”
According to Al-Mahdi, religious customs have helped keep the practice alive. “The religious upbringing of men can play a big role. There are some men who equate circumcision with chastity,” and these men may only agree to marry a woman who has undergone the procedure, he said.
According to the 2014 population survey, doctors now perform about 74 per cent of all FGM procedures, while nurses perform 7.9 per cent of cases. The rest are performed by nonmedical staff.
Rashwan Sha'ban, assistant secretary-general of the Doctors' Syndicate, said that the syndicate refers doctors who carry out this procedure to disciplinary action that may lead to their suspension and/or a financial penalty. “It all depends on the nature of the crime, for not all cases are similar,” Sha'ban said.
The syndicate is informed of violations when something goes wrong and relatives alert it, or when a case goes to court. “Some cases have been referred to us by the Ministry of Health,” he said, underlining that FGM is considered a crime, and the syndicate's board has issued decisions to this effect.

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