1. Female Genital Mutilation
(By Jonathon Dedecker, Jenelle Swenberger, Sonam Dekyi, Jena Frenzel, Dominique Deziel, Ciera Lamb, Jessica Bernier, Sonda Sauers, Lindsey Berger, and Anna Mueller
Social Problems (SC210) Fall Semester 2010
Dr. Lee Garth Vigilant

2. Disclaimer
There are images and videos in our presentation that are graphic, please feel free to turn away or leave the room.

3. The World Health Organization (WHO) defines female genital mutilation (FGM) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”
The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. Increasingly, however, FGM is being performed by health providers.

5. Type I
Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

6. Type II
Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina).

7. Type III
Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

8. Unclassified: includes
Type IV
Unclassified: includes
pricking, piercing or incising of the clitoris and/or labia
stretching of the clitoris and/or labia
cauterization by burning of the clitoris and surrounding tissue
scraping of tissue surrounding the vaginal orifice or cutting of the vagina
introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it
and any other procedure which falls under the definition of female genital mutilation given above.

10. Pain (lack of anesthesia)
Injury to adjacent tissue
Severe bleeding (hemorrhage, a potentially life threatening complication)
Shock
Acute urine retention
Fractures or dislocations (when a struggling girl is restrained)
Infection (depending on the cleanliness of the instruments, the substances applied to wounds, and the bindings used on the legs or cut surfaces)
Fever and septicemia
Potential HIV infection or other blood born virus
Failure to heal

11. Delay in wound healing due to infection, malnutrition and anemia.
Anemia due to profuse bleeding.
Pelvic infection: infection of the uterus and vagina ascending from the genital wound, and necrotizing fasciitis.
Irregular bleeding and vaginal discharge.
Dysmenorrheal due to pelvic infection, or due to the obstruction of the vaginal orifice.
Damage to the Bartholin's duct can also lead to cysts and abscesses.
Formation of a keloid scar because of slow and incomplete healing of the wound.
and infection after the operation leading to production of excess connective tissuein the scar.
Dyspareunia due to the tight vaginal opening, to pelvic infection or to vaginismus.
Vulvar dermoid cysts and abscesses

12. Difficulty in passing urine
Recurring urinary tract infections
Pelvic infections
Infertility (from deep infections) scarring
Difficulties in menstruation, fistulae (holes or tunnels between the vagina and the bladder or rectum)
Painful intercourse
Sexual dysfunction
Problems in pregnancy and childbirth (the need to cut the vagina to allow delivery and the trauma that results, often compounded by re- stitching)

14. Maternal Obstetrical Complications FGM/C substantially increases the risk of maternal death
Prolongation of the second stage of labor
Perinea laceration
Perinea infections and postpartum sepsis
Hemorrhage
Vesico-vaginal or recto- vaginal fistula
Difficulties in performing pelvic examination
Difficulty with urinary catheterization
Unnecessary caesarean sections

15. Acronyms WHO (World Health Organization)
FGM/C (Female Genital Mutilation/Cutting)
UNICEF (United Nations Children’s Fund)

16. Child Obstetrical Complications
According to the WHO, Female Genital Mutilation/Cutting (FGM/C) increases the risk of stillbirth three to four times.
Prolonged, obstructed labor and lack of oxygen during the second phase of labor can result in stillbirths or children with cerebral palsy.

17. Five African Countries their Similarities and Differences: Reasoning, Practice, and Age
Senegal: FGM/C is said to protect morality, chastity, fidelity, and marriagability
FGM/C undergone before age 10, some between 10 and 14
In 2005, 28% of women had underwent FGM/C but, rates vary among regions and ethnicities
Egypt: FGM/C (tahara (purification)) is associated with good hygiene, cleanliness, chastity, marriagability, controlled sexual desire, and protection against adultery
Undergone before 13th birthday, median age 10
91% of women had underwent FGM/C
Ethiopia: FGM/C is said to safeguard chastity and fidelity
Undergone largely before the girls first birthday
In 2005, 74% of women had underwent FGM/C

18. Five African Countries their Similarities and Differences: Reasoning, Practice, and Age
Kenya: FGM/C varies in form and frequency; and some ethnic groups do not practice FGM/C
FGM/C signifies a coming of age and preparation for marriage
Ages vary but, most undergo FGM/C between 12 and 18 some being cut between the ages of 7 and 12
27% of girls and women have underwent FGM/C but, prevalence is extremely varied among provinces (e.g., 98% in the North Eastern Province to 1% in the Western Province); and is more prevalent among certain ethnic groups (common among Somali and Kisii and uncommon among the Lu and Luhya)
Sudan: FGM/C is associated with modesty, morality, marriagability, and family honor
Girls undergo between 5 and 11 years, they are usually infibulated
89% had underwent FGM/C

19. Social Dynamics of the Abandonment of FGM/C
In communities where FGM/C is practiced it is believed to be essential to raise and protect a girl and often to make her eligible for marriage; it is an act of love.
Marriage if frequently necessary to ensure a girl’s economic and social security.
FGM/C is believed to be the best choice in ensuring their daughter’s future.

20. Medicalization of the Practice of FGM/C
Solely focusing on the medical issues associated with FGM/C has been unsuccessful in the effort to abandon the practice.
Families seek the aid of medical personnel to perform FGM/C on their daughters so, that they can be assured that the medical issues are minimized or alleviated.
The medicalization of the practice leads to legitimization which is undesirable in the effort to abandon the practice.

21. Criminalization of the Practice of FGM/C
Practice of FGM/C may continue underground.
Those who abide simply do so in fear of legal consequences not because of attitudinal change.

22. Social Dynamics of the Abandonment of FGM/C
Again, FGM/C is a social convention: a social rule of behavior that members of a community follow based on the expectation that others will follow suit, compliance is in an individuals best interest.
Social convention theory explains that FGM/C is held in place by reciprocal expectations within a reference group.
Game theory: The study of decision-making as an interdependent process: A Choice made by one player in the game depends on the choice made by another player, whose choice, in turn, depends on that made by the first. In a larger group, the choice of each depends on the choice of all.

23. Social Dynamics of the Abandonment of FGM/C
FGM/C is a social norm: a social rule of behavior that members of a community follow in the belief that others expect them to follow suit. Compliance with a social rule is motivated by expectations of social rewards for adherence for adherence to the rule and social sanctions for non-adherence.
Conformity is rewarded with approval, respect and admiration while the individual and family maintains social status.
Nonconformity is met with sanctions that include: moral judgments, ostracism, social exclusion, rebuke or even violence, and effects on marriageability.
Girls may want to be cut to ensure marriageable.

24. Abandonment of FGM/C
Abandonment of FGM/C is described as the situation whereby communities reach a collective, coordinated decision to stop practicing female genital mutilation/cutting (FGM/C).
The same factors that motivate a parent to have their daughter cut can motivate efforts to abandon the practice.
Social rewards and sanctions that maintain the practice of FGM/C can also aid in the abandonment of the practice.
Moral Norm: a behavioral rule motivated by personal values of right and wrong.
Moral norms sustain FGM/C but, they can also promote abandonment once an alternative to FGM/C is feasible.

25. Social Dynamics of the Abandonment of FGM/C
Human rights framework: FGM/C is a violation of the rights of women and girls. FGM/C is a harmful (traditional) practice: a practice that has some cultural legitimacy but is harmful to girls and women.
FGM/C violates rights to health, security, and physical integrity; the right to be free from torture and cruel, inhuman or degrading treatment; and the right to life when the procedure results in death.
Even if violence is not intended, FGM/C is de facto violent.
FGM/C is upheld by social norms that are manifested in gender inequalities.
A human rights framework promotes communal reflection which facilitates modifications of social conventions and norms.

26. Social Dynamics of the Abandonment of FGM/C a multifaceted approach
Taking part in human rights deliberation regarding FGM/C brings about assessment of communal values, the formation of objectives, and evaluation of barriers that may counter goals.
Proactive action and reflection is encouraged; and by acting in concert, they can bring about change.
Once rights are realized people make efforts to secure and protect them.
Communal discussion, decision, and commitment are necessary in working toward successful abandonment of FGM/C.
Involve family, kinship ties, trade, religion, and local resources, respected community members, including religious and local leaders, representatives of local women’s and youth associations, media, and others.
Local and national engagement

27. Social Dynamics of the Abandonment of FGM/C a multifaceted approach
Critical mass: a number of people that is large enough to launch an ongoing process of group change. In the process of abandonment of FGM/C, the critical mass is motivated to persuade and show others in the group the comparative benefits of not practicing FGM/C and to recruit others to the cause of eventual abandonment.
Public declaration/statement: an explicit affirmation and public manifestation of collective will and commitment to abandon a practice.

28. Social Dynamics of the Abandonment of FGM/C a multifaceted approach
Social networks are vital in spreading knowledge about the masses intent – ‘organized diffusion.’
Until social expectations change families will not be motivated to stop cutting their daughters.
Tipping point: point at which the greater part of a community is persuaded to abandon FGM/C. At this point, the community abandonment would be stable because it would permanently change social expectations. Community members would now be expected to not cut their daughters and would be socially rewarded or sanctioned accordingly.
Viable alternatives to cutting include the employment of a positive term to recognize uncut girls.
In Sudan, the Arabic word saleema, meaning whole, undamaged, unharmed, complete, was implemented. ‘Every girl is born saleema. Let her grow saleema.’
The hope is that being uncut will engender a sense of pride.

29. Why it Exists

30. Pressure to conform to a social norm
A cultural tradition
Necessary part of raising a girl properly
FGM removes the ‘unclean’ and ‘male’ parts of the girl resulting in a ‘clean’ and ‘beautiful’ woman
Meant to stem any sexual desires
Assurance that the girl is a virgin when married

31. Girl is found unfit and unclean
Not permitted to handle water and food
Girl not considered eligible for marriage
If a clitoris touches a mans penis, he will die
If a clitoris touches a baby’s head, it will die
Without the procedure, the breast milk could be poisonous
Prevents vaginal cancer
Keeps the woman’s face beautiful

32. FGM has been around for over 2000 years
It predates Islam, however most Muslims do not practice it
Muslims who do practice FGM justify it religiously using records from their prophet Mohammed
However, their justification contradicts passages in the Qur'an

33. “Female circumcision is the physical marking of the marriage ability of women, because it symbolizes social control of their sexual pleasure– clitoridectomy– and their reproduction—infibulation.”

34. It has been in practice for 2 thousand to 5 thousand years.
The first historical reference to FGM can be found in the writings of Herodotus, who reported its existence in ancient Egypt in the 5th century B.C. 

35. Some believe that female circumcision was rooted in the Pharaonic belief in the bisexuality of the gods.
every individual possessed both a male and a female soul. The feminine soul of the man was located in the prepuce of the penis; the masculine soul of the woman was located in the clitoris.
For healthy gender development, the female soul had to be excised from the man and the male soul from the woman. Circumcision was thus essential for boys to become men and girls to become women.

36. Egyptians once raided territories to the south for slaves, and Sudanic slaves were exported to areas along the Persian Gulf. Reports from the 15th and 16th centuries suggest that female slaves were sold at a higher price if they were ''sewn up" in a way that made them unable to give birth.

37. FGM is a pre-requisite to marriage and marriage is vital to a woman's social and economic survival. It is believed by some African women that if their daughters are not circumcised they will not get a husband.
Women tenaciously adhere to the practice, even in those countries where they are now forbidden by law, such as Sudan, Egypt, and Kenya.

38. “Federal Prohibition of Female Genital Mutilation Act of 1995” 
The law provides for prison sentences of up to 5 years for anyone who "circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18.”

39. US representatives to the World Bank and similar financial institutions are required to oppose loans to countries where FGM is prevalent and in which there are no anti-FGM educational programs.
FGM has also been criminalized on the state level in 17 states.

40. The locations in which FGM is most commonly practiced include western, eastern, and north-eastern regions of Africa, some countries in Asia and the Middle East, and among some immigrant communities in North America and Europe.

42. TYPE PERFORMED Guinea 98.6 I, II, III, IV Egypt 97.3 I, II, III
COUNTRY PREVALENCE(%)
TYPE PERFORMED
Guinea 98.6
Egypt 97.3
Mali 91.3
Djibouti 90-98
Somalia 90-98
Sudan 90
Eritrea 88.7
Ethiopia 79.9
Gambia 60-90
I, II, III, IV
I, II, III
I, III
I, II, III,

43. “Only 40 percent of circumcised women with secondary education plan to circumcise their daughters, while 63 percent of women with no education plan to circumcise their daughters.”
•“Practical arrangements for a daughter’s circumcision are usually made by mothers. However, husbands and other family members, especially mothers-in-law, can exert pressure on women to make these arrangements. If fathers, mothers, and grandparents have different opinions on the genital cutting, family power structures will influence the relationship between individual attitudes toward circumcision and the practice of cutting. Thus, family dynamics are relevant to … gathering…support that… is necessary to end female genital cutting.”
•“The more education a woman has, and the more she is exposed to modern media sources, the less likely her daughter is to be circumcised.” •
Hayford, Sarah R “Conformity and Change: Community Effects on Female Genital Cutting in Kenya.” American Sociological Association 46(Jun.): pp
Theoretical Support

44. Hayford, Sarah R. 2005. “Conformity and Change: Community Effects on
Hayford, Sarah R “Conformity and Change: Community Effects on Female Genital Cutting in Kenya.” American Sociological Association 46(Jun.): pp

45. The Cut
Click to play

46. Ideal State
Where educated women choose whether or not to have the procedure.
If they do decide to have it done then the operation will be performed with sterile tools in a clean environment.
Hope that someday through education and support we will eventually be able to abolish the practice.

47. Procedure of Treatment
The United Nations has already put forth an effort on this issue.
UNIFEM- UN development fund for women
UNICEF- Child protection
Partner with UN to elaborate education plans.

48. Procedure of Treatment
Education:
Teens and Adults
Women
Men

49. All Teens and Adults Educate on complications that can occur
Short and Long Term
Emphasize that FGM is a cultural practice

50. Just For Women Not just about you but about daughters.
Extra Emphasis on Health Risks
Other cultural practices
Clean, sterile environments
Would not have to endure sex-- you can enjoy it.

51. Just For Men
Emphasis on infant mortality and death of mother during childbirth.
Spouse may experience pain during intercourse.

52. For the Young Female genital mutilation is a cultural practice.
There is no medical or religious requirement for this.

53. If FGM is still chosen... Sanitary regulations need to be met.
Sterile environment and tools
If the necessary tools are provided and properly sterilized, many of the risks discussed later will be greatly reduced.
Educated practitioners should perform the procedure.
Anesthetic should be required.

54. What “sterile equipment” means?
Instruments are free of blood or organic material.
Instruments have been thoroughly cleaned with detergent, rinsed, and disinfected to reduce bacteria, fungi, and other microorganisms

55. Other health concerns:
Establish organizations that allow for a safe and healthy facility to perform these procedures
Poor conditions can lead to infections and infertility

56. Range of Application:
All those living in the areas of the world where female genital mutilation is practiced.
Everyone affected should be educated.

57. Unintended Outcomes
If a young woman chooses not to have procedure done:
She may be stigmatized or cast out of society or family.
Could be unable to marry because men in the area would not want to marry a woman who is uncircumcised.
People in such societies could defend practice by saying that education is an attempt to take over and/or change the culture.
Surgeons who perform the procedures could end up with private profiteering problems.

58. Success or failure depends upon:
Possible rejection of education by people who participate in the practice
Limited funding for a project of this size
Limited man power for education and proper practice
If successful, reduce harm caused to women by preventing complications
Prevalence decreased where women are educated and higher exposure to media
Raise awareness of other options

59. a UNICEF Innocenti documentary
Click to play.

60. Created BY:
Jonathon Dedecker
Jenelle Swenberger
Sonam Dekyi
Jena Frenzel
Dominique Deziel
Ciera Lamb
Jessica Bernier
Sonda Sauers
Lindsey Berger
Anna Mueller

61. Health effects of female genital Cutting/female genital mutilation
Health effects of female genital Cutting/female genital mutilation. (1999). Retrieved from FemalGenitalCuttingFemaleGenitalMutilation/file
Female genital mutilation. (2010, February). Retrieved from

62. Dietrich, H. L. (2010, September). FGC around the world
Dietrich, H. L. . (2010, September). FGC around the world. Retrieved from
Female genital mutilation. (2010, February). Retrieved from

63. References
United Nations Children’s Fund (UNICEF), The UNICEF Innocenti Research Centre. (2010). The dynamics of social change toward the abandonment of female genital mutilation/cutting ( ). Florence, Italy: Nuova Grafica Fiorentina srl. Retrieved from irc.org/publications/pdf/fgm_insight_eng.pdf
World Health Organization, Sexuality Education Resource Centre. (1999). Health effects of female genital cutting/female genital mutilation New York, NY: RAINBO. Retrieved from GenitalCuttingFemaleGenitalMutilation/file