Female genital mutilation (“FGM”) is a procedure in which the female genitalia are deliberately cut, injured or altered without any medical reason. It is also termed female circumcision, female genital cutting and by other local terms.
FGM is usually performed on young girls between the infancy and adolescence, most often before puberty.
The United Nations Children’s Fund (“Unicef”) estimate that at least 200 million girls and women have been maimed by FGM.
FGM is practised in Africa, some countries in the Middle East and South America, and parts of India, Pakistan, Sri Lanka, Indonesia and Malaysia.
Unicef states: “Numerous factors contribute to the prevalence of the practice. Yet in every society in which it occurs, FGM is a manifestation of entrenched gender inequality. Some communities endorse it as a means of controlling girls’ sexuality or safeguarding their chastity. Others force girls to undergo FGM as a prerequisite for marriage or inheritance.
“Where the practice is most prevalent, societies often see it as a rite of passage for girls. FGM is not endorsed by Islam or Christianity, but religious narratives are commonly deployed to justify it.”
The United Nations (“UN”) has designated 6 February as the International Day of Zero Tolerance for FGM, with the UN Secretary General stating: “On the International Day of Zero Tolerance for Female Genital Mutilation, join us in calling to accelerate investment to end female genital mutilation and uphold the human rights of all women and girls”. The UN’s target is to end FGM by 2030.
Types Of FGM
The World Health Organization (“WHO”) has classified FGM into four types i.e:
- Type 1 (clitoridectomy) – Partial or total removal of the clitoris and/or the prepuce
- Type 2 (excision) – Partial or total removal of the clitoris and the lips at the vaginal opening (labia minora), with or without excision of the larger outer lips (labia majora)
- Type 3 (infibulation) – Narrowing of the vaginal opening with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris
- Type 4 – All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, cutting, scraping and burning (cauterisation)
Harms Of FGM
There are no health benefits of FGM.
It can cause serious harms which include constant pain; painful and difficult sexual intercourse; repeated infections which can lead to infertility; bleeding; cysts; abscesses; problems passing urine and holding urine (incontinence); problems in labour and childbirth which can be life threatening; depression; anxiety; sleep problems; and even death from blood loss or infection.
Medicalisation Of FGM
Unicef estimates that about a quarter of FGM globally “are performed by health personnel pointing to an alarming trend in the medicalization of female genital mutilation”.
There is limited data on FGM in Malaysia. However, a study by Rashid A, Iguchi Y and Afiqah SN provide some insight with the researchers using the term female genital cutting (“FGC”) synonymously with FGM. The study involved 366 doctors in two medical associations with large numbers of Muslim members and in-depth interviews of 24 doctors.
The authors reported: “Most of the respondents were women, had medical degrees from Malaysia, and had a postgraduate degree in Family Medicine. The median age was 42. Most were working with the Ministry of Health (MoH) Malaysia, and in a clinic located in an urban location. The prevalence of Muslim doctors practising FGC was 20.5 per cent.
“The main reason cited for practising FGC was religious obligation. Qualitative findings too showed that religion was a strong motivating factor for the practice and its continuation, besides culture and harm reduction. Although most Muslim doctors performed type IV FGC, there were a substantial number performing type I. Respondents who were women, who owned a clinic or jointly owned a clinic, who thought that FGC was legal in Malaysia, and who were encouraged in religion and thought that FGC should continue were more likely to practise FGC.”
The authors concluded: “In this study, we found that many of the Muslim doctors were unaware of the legal and international stand against FGC, and many wanted the practice to continue. It is a concern that type IV FGC carried out by traditional midwives may be supplanted and exacerbated by type I FGC performed by doctors, calling for strong and urgent action by the Malaysian medical authorities.”
Say No to FGM
There are media reports of Malaysian women who are opposed to the practice of FGM.
Malaysia acceded to the UN Convention on the Elimination of All Forms of Discriminations Against Women (“CEDAW”) and Convention on the Rights of the Child (“CRC”) with both treaties prohibiting FGM. Malaysia was criticised in the CEDAW report in 2018 with even the Organization of Islamic Cooperation (“OIC”) countries urging Malaysia to eliminate FGM.
Malaysia is currently a member of the UN Human Rights Council and the Executive Board of WHO.
The WHO has described FGM as violation of rights with no medical justification. Its position is “FGM has no health benefits. It can lead to not only immediate health risks, but also to long-term complications to women’s physical, mental and sexual health and well-being.
“The practice is recognised internationally as a violation of human rights of girls and women and as an extreme form of gender discrimination, reflecting deep-rooted inequality between the sexes. As it is practised on young girls without consent, it is a violation of the rights of children.
“FGM also violates a person’s 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. As part of the Sustainable Development Goals, the global community has set a target to abandon the practice of female genital mutilation by the year 2030.”
Will the Malaysian authorities respond to international exhortations? Does Primum non nocere (First do no harm) matter? Shall Malaysia say no to FGM?
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.