Female Genital Mutilation

The following report is excerpted from Report (No. 47) of the Minority Rights Group (36 Craven Street, London WC2N 5NG, England) entitled 'Female Circumcision, Excision and Infibulation: the facts and proposals for change'. Edited by Scilla Mclean with contributions from Marie Assaad, Eddah Gachukia Scilla Mclean, Esther Ogunmodede, Awatif Osman, Isabelle Tevoedjre and Awa Thiam. Price Z7.20. First Published 1980. Here we present a shortened version of Part I of the report, and the Conclusions drawn. Part II entitled 'Programmes and practical proposals for change', covers experiences of a few African women with regard to genital mutilation, situation, in different countries affected by this practise, and Proposals and Programmes for change. A very useful source of information on the subject.

Copies of the Report in English and Arabic are available from the Minority Rights Group (address above); in Italian from GiselleMarziale, MRG Italia, via Vechiarelli 37, Roma 00186, Italy; in French from Elena Borghese, OECD, 2 rue Andre- Pascal, 75775 Paris Cedex 16, France.

 

 

 

 

INTRODUCTION

In Africa today, women's voices are being raised for the first time against genital mutilations still practised on babies, little girls, and women. These voices belong to a f ew women, who, from Egypt to Mali, from the Sudan and Somalia to Senegal, remain closely attached to their identity and heritage, but are prepared to call it in question when traditional practices endanger their lives and their health. They are beginning the delicate task of helping women free themselves from customs which have no advantage and many risks for their physical and psychological well-being, without at the same time destroying
the supportive and beneficial threads of their cultural fabric.

Sexuality remains for many of us an obscure area, mined with cultural taboos, loaded with anxiety and fear. This is one of the reasons why the subject of genital mutilations provokes violent emotive reactions, both from those in the West who are shocked and indignant, and from those in Africa and the Middle East who are wounded when these facts are mentioned, and prefer to minimise the quantitative importance of the practice. The total number of women affected is in any case unknown, but with out any doubt involves several tens of millions of women. Medically unnecessary, painful, and extremely dangerous operations are being carried out every day, at the present time.

THE FACTS ABOUT FEMALE GENITAL MUTILATION

Types of Mutilations

i) Circumcision, or cutting of the prepuce or hood of the clitoris, known in Muslim countries as 'Sunna' ( tradition). This, the mildest type, affects only a small proportion of the millions of women concerned. It is the only type of mutilation which can correctly be called circumcision, whereas there has been a tendency to group all kinds of mutilations under the misleading term, 'female circumcision'.

ii) Excision, meaning the cutting of the clitoris and of all or part of the labia minora.

iii) Infibulation, the cutting of the clitoris, labia minor a and at least the anterior two-thirds and often the whole of the medial part of the labia majora. The two sides of the vulva are then pinned together by silk or catgut sutures, or with thorns, thus obliterating the vaginal introitus except for a very small opening, preserved by the insertion of at tiny piece of wood or a reed for the passage of urine or menstrual blood. These operations are done with special knives (in Mali, a sawtoothed knife) ", with razor blades ( in Sudan, a special razor known as Moos el Shurfa), or with pieces of glass. The girl's legs are then bound together from hip to ankle and she is kept immobile for up to forty days to permit the formation of scar tissue.

iv) Intermediate, meaning the removal of the clitoris and some parts of the labia minora or the whole of it. Sometimes slices of the labia majora are removed and stitched. It has various degrees, done according to the demands of the girl's relatives.

Operators: Most frequently, the operations are performed by an old woman of the village (known as 'Gedda' in Somalia), or traditional birth attendant (known as 'Daya' in Egypt and the Sudan). In Northern Nigeria and in Egypt village barbers also carry out the task, but usually it is done by a woman: rarely, it seems, by the mother. In Mali and Senegal it is traditionally carried out by a woman of the blacksmith's caste gifted with knowledge of the occult. Studies in Egypt, the Sudan and Somalia have reported excisions and infibulations being done by qualified nurses and doctors, but in small numbers. More recently, in some countries, mutilations are also being carried out in hospitals in urban areas; for example, female children one month old are excised in Bamako Hospital in Mali. Any accompanying ceremonies obviously disappear in a hospital setting, but they are disappearing equally in rural areas where traditional birth attendants do the operations. Except in hospital, anaesthetics are never used, the child being held down either by a woman lying underneath her who pins her arms and legs with her own, or by several village women. Men are very rarely present at operations. Herb mixtures, earth or ashes are rubbed on the wound to stop bleeding.

The age at which the mutilations are carried out varies from area to area, and according to whether legislation against the practice is foreseen or not. It varies from a few days old (for example, the Jewish Falashas in Ethiopia, and the nomads of the Sudan), to about seven years old (as in Egypt and many countries of central africa), to adolescence (among the I bo of Nigeria, for instance, where excision takes place shortly before marriage, but only before the first child among the Aboh in midwestern Nigeria). Most experts are agreed, however, that the age of mutilation is becoming younger, and has less and less to do with initiation into adulthood."

Physical Consequences

Health risks and complications depend upon the gravity of the mutilation, hygienic conditions, the skill and eyesight of the operator, and the struggles of the child. Whether immediate or long-term, they are grave.*

Immediate complications: Haemorrhage from section of the internal pudental artery or of the dorsal artery of the clitoris; post-operative shock (death can only be prevented if blood transfusion and emergency resuscitation are possible). Bad eyesight of the operator or the resistance of the child causes cuts in other organs: the urethra, the bladder (resulting in urine retention and bladder infection), the anal sphincter, vaginal walls or Bartholin glands. As the instruments used have rarely been sterilized, tetanus (frequently fatal), and septicaemia often result.

It is impossible to estimate the number of deaths, since the nature of the operation requires that unsuccessful attempts be concealed from strangers and health authorities, and a very small proportion of cases of immediate complication reach hospital. Nevertheless, hospital staff in all the areas concerned are very familiar with last minute and often hopeless attempts to save bleeding, terrified little girls. Operators are not held responsible by parents if death or infection result from the operation.

Long-term complications: Chronic infections of the uterus and vagina are frequent, the vagina having become, in the case of infibulation, a semi-sealed organ.

The most excruciating result of excision, rendering the whole genital area permanently and unbearably sensitive to touch, is the development of neuroma at the point of section of the dorsal nerve of the clitoris. Vulval abscesses can also develop. Mutilated women, it goes without saying, feel severe pain during intercourse (known as dyspareunia), and they sometimes become sterile due to infections which ascend into the reproductive organs.

Further complications during childbirth are unavoidable for infibulated women. Splitting of the scar is always needed to let the baby out. The tough obliterated vulva has lost its elasticity, and if it is not re-opened in time, may fatally hold up the second stage of labour. The head of the baby may be pushed through the perineum which tears more easily than the infibulation scar, so causing a high incidence of perineal tears. There is unnecessary blood loss, and the pain produced may result in uterine inertia. The long and obstructed labour can lead to intrauterine foetal death, or brain damage to the baby. If a cut is made (bilateral or anterior episiotomy), other structures
may be injured: the vagina or the cervix of the mother, or the scalp or any other part of the baby, especially if the operator is working in a hurry. Again, there is the danger of infection. Custom demands that a woman be re-infibulated, or sewn up again, after each delivery, and this may be done twelve times or more.

Sexual Problems

In all types of mutilation, even the most 'mild' clitoridectomy (excision of the clitoris), a part of a woman's body containing nerves of vital importance to sexual enjoyment is amputated. The glans clitoridis with its specific sensory apparatus is a primary erogenic zone. When it has been reduced to an area of scar tissue, no orgasm can be released by its manipulation. The well-known work of William Masters and Virginia Johnson, and many others*, has conclusively proved that all orgasms in women originate in the clitoris, although they may be felt elsewhere.

The earlier a woman is mutilated, the greater is the damage, since infantile and adolescent masturbation teaches the organism and the consciousness the proper function of the sexual reaction. There is no surgical technique capable of repairing a clitoridectomy, nor of restoring erogenous sensitivity of the amputated apparatus.

Very little research has been done on the sexual experiences of mutilated women. Dr. A.A. Shandall found that some of the women he interviewed in the Sudan had no idea at all of the existence of orgasm.'

There is great difficulty in obtaining accurate research data on the sexual experiences of mutilated women, because the majority of them are reluctant to speak on the subject at all until the third or fourth visit to a clinic, and are generally ambivalent on questions of sex enjoyment. A great deal more research is needed (and not only in countries where female genitals are mutilated) on subjects such as the relationship between male excitation and the presence of pain in the female, male concepts
of female sexual pleasure, and the dichotomy between total possession (i.e., a man taking extreme measures to assure himself of his wife's fidelity) and sexual enjoyment. Westerners discussing sexual practices in cultures other than their own must be wary of moral judgements, for although Western women may not be physically mutilated, they do to this day suffer sexually inflicted pain and degradation.

Psychological Consequences

Even less research has been done to date on the psychological aspects of these traditions. As a result of his work with Egyptian and Sudanese female patients. Dr. T.A. Ba'asher, World Health Organization Regional Adviser for the Eastern Mediterranean on Mental Health, reports:

'It is quite obvious that the mere notion of surgical interference in the highly sensitive genital organs constitutes a serious threat to the child and that the painful operation is a source of major physical as well as psychological trauma.'"

Many personal accounts and research findings contain repeated references to anxiety prior to the operation, terror at the moment of being seized by an aunt or village matron, unbearable pain; a sense of humiliation follows, and of being betrayed by parents, especially the mother." On the other hand, there are references to special clothes and good food associated with the event, to the pride felt in being like everyone else, in being 'made clean', in having suffered without screaming. Clearly, if
in a community sufficient pressure is put on a child to believe that her clitoris or genitals are dirty, dangerous or a source of irresistible temptation, she will feel relieved psychologically to be made like everyone else. To be different produces anxiety and mental conflict. An unexcised, non-infibulated girl is despised and made the target of ridicule, and no one in her community will marry her. Thus what is clearly understood to be her life's work, namely marriage and childbearing, is denied her. So, in tight-knit village societies where mutilation is the rule, it will be the exception who will suffer psychologically, unless she has another very strong identity to substitute for
the community identity which she has lost.'

There is no doubt that genital mutilation would have overwhelming psychological effects on an unmotivated girl, unsupported by her family, village, peers and community.

These remarks concern the social-psychological aspects rather than the central question, namely, what effects do these traumatic operations have on little girls at the moment of the operation, and as they grow up? There are references to a child dreaming of a preying mantis while under threat of operation, which disappeared once the threat of operation was removed. There are references to infibulated women being docile, incapacitated, inert. But the fact is that in psychiatric or psycho-analytic terms, we simply do not know. We do not know what it means to a girl or woman when her central organ of sensory pleasure is cut off, when her life-giving canal is stitched up amid blood and fear and secrecy, while she is forcibly held down, and told that if she screams she will cause the death of her mother, or bring shame on her family.

 

 

 

 

The Countries Concerned

The countries concerned number more than twenty in Africa, from the Atlantic to the Red Sea, the Indian Ocean and the Eastern Mediterranean. Outside Africa, excision is also practised in Oman, South Yemen and in the United Arab Emirates. Circumcision is practised by the Moslem populations of Indonesia and Malaysia. On the map of Africa, an uninterrupted belt is formed across the centre of the continent, which then expands up the length of the Nile. This belt, with the exception of the Egyptian buckle, corresponds strikingly with the pattern of countries which have the highest child mortality rates (more than 30 percent for children from one to four years of age)'^. These levels reflect deficiencies of medical care, of clean drinking water, of sanitary infrastructure and of adequate nutrition in most of the countries.

 

The gravity of the mutilations varies from country to country. Infibulation is reported to affect nearly all the female population of Somalia, Djibouti and the Sudan (except the non-Moslem population of Southern Sudan), Southern Egypt, the Red Sea coast of Ethiopia, Northern Kenya, Northern Nigeria and many parts of Mali. The most recent estimate of women mutilated is 74 million .' " Ethnic groups closely situated geographically are by no means affected in the same way: for example, in Kenya, the Kikuyu practise excision and the Luodo not; in Nigeria, the Yoruba, the Ibo and the Hausa do, but not the Nupes or the Fulanis; in Senegal, the Woloff have nothing to do with mutilation, and soon.

As the subject begins to be eligible at least for discussion, reports of genital operations on non-consenting females are appearing from many unexpected parts of the world : women In Sweden have recently been shocked by accounts of mutilations performed in Swedish hospitals on daughters of immigrants (Sweden and Norway have pending legislation forbid ding the operations); in France, women from Mali and Senegal are reported to bring an 'exciseuse' to France once year to operate on their daughters in their appartments.'

 

 

 

 

Legislation

Only one country to our knowledge has adopted formal legislation forbidding genital mutilation, or more precisely infibulation, and that is the Sudan. A law first enacted in 1946 allows for a term of imprisonment up to five years and/or a fine. However, it is not an offence (under Article 284 of the Sudan Penal Code for 1974) 'merely to remove the free and projecting part of the clitoris '.

History

Female sexuality has been repressed in a variety of ways in all parts of the world throughout history and up to the present time. Female slaves in ancient Rome had one or more rings put through their labia majora to prevent their becoming pregnant. Chastity belts were brought to Europe by the Crusaders during the twelfth century. Until very recently, clitoridectomy was performed as a surgical remedy against masturbation in Europe and in the US, and unnecessary genital surgery continues until this day.

The customs which we are discussing here, however, are so widespread and so tenacious, that we need to know a great deal more than we do know about their origins, it is not possible to conclude whether there was one origin or several independent origins. Marie Assaad feels that there is sufficient evidence to assume that infibulation was practised in ancient Egypt, and that it was perhaps there that the custom originated.' * Or it could have been an old African puberty rite that came to Egypt by diffusion ( infibulation is known in the Sudan as 'Pharaonic circumcision ' and in Egypt it is referred to as 'Sudanese circumcision'). Certainly, the practice was widespread in the pre-lslamic era, in Egypt, Arabia and the Red Sea coasts .' ' We need to know why the custom has taken hold and survived in some communities, and not in others.

Motives for and Functions of the Custom

What are the forces which motivate a mother to subject her daughters to such drastic operations, undertaking such risks?

At first glance the number of different reasons given are bewildering, often conflicting, and always at odds with biological fact. They are worth examining in some detail, firstly simply because they are believed in, and with such tenacity. Thereafter, we will attempt to answer the question as to why they are believed in.

Generally, the reasons given, as they appear in research papers, interviews, and testimonials, fall into four main groups: psychosexual, religious, sociological and hygienic.

i) Psychosexual. There is frequent mention (Mali, Kenya, Sudan, Nigeria) of the clitoris being believed to be an aggressive organ, threatening the male organ and even endangering the baby during delivery. In some areas, notably Ethiopia, people believe that if the female genitals are not excised they will dangle between the legs like a man's.

Very frequently, the reason offered by both women and men is ' the attenuation of sexual desire'. Since the focus of this desire is clearly recognised to be the clitoris, excision is believed to protect a woman against her over-sexed nature, saving her from temptation, suspicion and disgrace, whilst preserving her chastity. These beliefs must be understood in context of societies where virginity (for a woman) is an absolute prerequisite for marriage, and where an extra-marital relationship provokes
the most severe penalties. So strong is the association of mutilation with pre-marital chastity that in many areas a non-excised girl (in Somalia, a non-infibulated girl) is ridiculed and often forced to leave her community, and regardless of her virginity will stand little or no chance of marriage. In societies where a man has several wives, it is said that since it is physically impossible for him to satisfy them all, it helps if they are not too demanding.

ii) Religious. Excision and infibulation are practised by Moslems, Catholics, Protestants, Copts, Animists, and non-believers in the various countries concerned. The custom has, however, frequently been carried out in the genuine but erroneous belief that it was demanded by the Islamic faith, or perpetrated as a required Islamic custom. Dr. Taha Ba'asher, Regional Adviser on Mental Health for the World Health Organization for the Western Mediterranean, clarifies the position:

'Among Moslem communities in Egypt and the Sudan, for example, it is not uncommon to find that female circumcision has been traditionally practised under the pretext of adherence to religious principles. It is remarkable that this custom is no longer observed in leading Arab countries such as Saudi Arabia, the cradle of Islam and the centre of the Holy Lands.

 

 

 

 

There is clearly no basis whatsoever in any religion for the practice of infibulation. In many countries the Moslem population continues to believe that the non-excised woman is impure in a religious sense: the words used bear witness.

iii) Sociological. Some authors explain the practice in terms of initiation rites, of development into adulthood. In many areas (Northern Sudan,  Kikuyu in Kenya, Tagouana in the Ivory Coast, Bambara in Mali) an elaborate ceremony surrounded, and in some cases still surrounds, the event — with special songs, dances and chants intended t o teach the young girl her duties and desirable characteristics as a wife and mother, with ritual rich in symbolism; with special convalescent huts for the girls attended only by the instructress and cut off from the rest of society until their emergence, healed, as marriageable women; or simply with special clothes and food. However, it seems that today in many of these societies the ceremonial has fallen away; both excision and infibulation are performed at a much younger age that cannot be construed as having anything to do with entry into adulthood or marriage, and the child's role in society does not change at all after the mutilation.

iv) Hygiene and aesthetics. In countries toward the Eastern part of the belt on the map, the external female genitals are considered dirty. In Egypt, for instance, the uncircumcised girl is called 'Nigsa' (unclean) and bodily hairs are removed in efforts to attain a smooth, and therefore clean, body. The same sentiment appears in Somalia and the Sudan where the aim of infibulation is to produce a smooth skin surface, and women questioned insist that it makes them cleaner.

Infibulation clearly has the effect opposite to that of promoting hygiene; urine and menstrual blood which cannot escape naturally, secrete and result in discomfort, odour and infection . Individuals interviewed in Katiola in Mali maintained that the clitoris is ugly.' However, the idea of female and male genitals being dirty or ugly is not confined to those who cut them off.

Now we have to ask ourselves why the central core of the cust om has persisted when many of the given reasons for it have either disappeared or are clearly seen through , and a significant percentage of respondents in every survey cannot think of any reason at all why they do it, apart from the fact that it is done. There are a number of possible explanations, but there is probably no single explanation:

a) Women have been persuaded, over centuries, to see their sexual impulses in terms of what suits men. This suggestion must be considered in context of the total economic and social structure of the societies concerned, where marriage is the only secure future for a woman.

b) It is an irreplaceable source of revenue for operators — mostly older women — who can bring to bear the influence of other older female relatives of the child to have it done.

c) Perhaps the reason why it is women themselves who perpetrate the practice with such zeal, lies in their own suffering:' if I submitted to this and bore it, then so shall those who follow '. (Indeed Dr. Shandall, in his interviews of older Sudanese women, found that 35 out of 100 admitted that they had insisted on infibulation for their children and grandchildren, out of spite.)

d) Since mutilations are less visible than, for instance, would be the amputation of children's noses, health education campaigns have not been directed towards them. In Esther Ogunmodede's words, describing the situation in Nigeria:

'since there are no data or records of the distress and dangers caused by the operations, it is difficult to convince people as to the urgency of dealing with it. '

e) Western efforts to eliminate the practice, on the part of missionaries or colonial administrators, have simply served to confirm in people's minds that colonial destruction of traditional customs weakens their societies and exposes th em to the ill-effects of Western influence.

f ) No forceful replacement, in terms of community identity, has been put forward to convince people to dispense with the custom (except in rare cases like Eritrea). On the contrary, Jomo Kenyatta made resistance to the elimination of excision one of the cornerstones of his national liberation campaign. This makes the subject particularly difficult to discuss or research in Kenya.

Attitudes of Doctors and Nurses

Medical experts can find no advantage whatsoever in circumcision, excision, or infibulation for ordinary healthy women. The harmful consequences have been enumerated by doctors, gynaecologists, obstetricians, and pediatricians in Egypt, Somalia, Sudan, Kenya, Djibouti, Mali, Nigeria, Upper Volta, Ghana, and Ivory Coast. Dr. Gisim Badri of Ahfad University College for Women, reports on the views of 43 Sudanese gynaecologists (in a paper entitled The Views of Sudanese Gynaecologists, MIdwives and College Students on Female Circumcision). All agreed that any form of mutilation is bound to create many complications. Every respondent believed that it is a harmful and unnecessary practice and that an effort should be made to put an end to it, unanimous that a wide campaign of publicity is needed, showing not only the dangers of mutilations, but also the erroneous belief that it is required by religion. However, Dr. Badri reports:

'this belief is not shared by another important group of health personnel, namely the midwives. In a questionnaire answered by forty midwives in Khartoum and Port Sudan, 10 percent of them expressed the view that female circumcision of the 'sunna' type should be continued... Since the midwives are the persons who actually perform the operations, a great effort sould be made to educate them and point out to them the errors of their assumptions.'

A study carried out recently in Alexandria by Eleanor Smith, Professor of Maternal and Child Health Nursing, Project Hope, Egypt, found that 63 percent of 135 nurses interviewed did not know about the possible types of the operations, and 32 percent refused to answer the question about who usually performs the operations. An amazing 83 percent believed there were no disadvantages, and 29 percent said they would excise their own daughters, mostly for aesthetic reasons.

There appears therefore to be a wide spectrum of opinion and belief even among trained medical personnel. A clearly worded and illustrated teaching guide has now been prepared on the risks and complications of mutilations, and might usefully be included in the curricula of Midwives and Nurses Training Programmes in the countries concerned, with local adaptations. It is available from the Health Action Network of Womens International Network, 187 Grant St, Lexington, Mass 02173, USA

Action:

Campaigns against mutilation are most advanced in the Sudan. The matter can be more freely discussed than in other countries, the College of Nursing and Midwifery educates against the practice, an educational booklet in Arabic has been developed, and concrete programmes have been started in rural areas with financial assistance from an organization in Sweden. Kenya is also starting a similar project, financed from the same source. The Working Group on Female Circumcision in Geneva,
co-ordinated by Isabelle Tevoedjre from Benin, have done much to further contact between African women, and to enable member organizations of their group to act in a positive but discreet way to support work being done in Africa. Edna Adan Ismail from Somalia, where over 90 percent of female children are infibulated, described the ways in which the support of her government had been obtained for research and programmes for education towards eradication.

 

 

 

 

CONCLUSION

Mutilation of female genitals remains a widely practised custom. For a normally healthy woman there is no medical advantage whatsoever in any type of operation; on the contrary, grave (and frequently fatal) complications may ensue immediately, or may last throughout a woman's life. In many areas the practice has lost its traditional ceremonial significance, yet is perpetuated with tenacity.

Two conclusions emerge most clearly from our report. First, our contributors are agreed that in order to have any hope of success, the issue must be treated as a health issue, and then with the greatest sensitivity, according to the conditions in each country. The tendency to link the subject with sexual liberation of women will be disastrous on a local level. However, there is one great danger in treating the issue purely as a health one. And that is the tendency to 'clean up' the gory aspects of the operations by either offering to perform them in hospitals, or by providing midwives and other operators with anaesthetics and penicillin. Indeed, thousands of health kits issued
by international health organizations have been used for just this purpose — 'sanitizing' the custom, and thus effectively removing some of the health-based objections. As the women participants at Khartoum insisted, the temptation to reduce pain and death by offering to do the operations in hospitals 'in the meantime' must be refused. As step one, all governments concerned might be encouraged to ban the operations in their hospitals. Efforts to eradicate mutilation must clearly approach
it via the whole subject of reproduction, female genital organs and sexuality, and not just deal with the health risks and pain aspects.

Secondly, practical steps towards eradication can and must be taken on a local and community level, by women in the countries concerned. Other women can, however, contribute in a practical way. Many Western women read about these practices with a feeling of outrage. It is not unnatural that they identify very strongly with these African women, possibly sensing these mutilations as an extreme example of the suffering of women the world over. African women reply that alarmism and righteous indignation will not help. On a practical level, research is urgently needed, country by country, into the extent and distribution of different forms of genital mutilation, into the psychological motivation and damage caused, into ways of communicating knowledge of the physical and psychological damage to ardent promoters of the tradition,
and into the deeper reasons why mutilation continues. Funds are needed for the research, and those wishing to assist may enter directly into contact with the authors cited her.

Since all of the health ministries concerned have a long list of priority claims on their budgets, and given the reluctance even to discuss the subject in many countries, genital mutilation is far from the top of the list of priorities. Therefore, concrete assistance from outside for the development and implementation of health education campaigns will be acceptable in certain cases. This should be channelled through non-governmental organizations with competence in the field, who may be
contacted as follows.

The Working Group on Female Circumcision Co-ordinator: Ms Isabelle Tevoedjre 17 Chemin des Ramiers 1245 Collonge-Bellerive Geneva, Switzerland

The National Council of Women of Kenya Chairperson: Ms Wangari iVI. IVIaathai P.O. Box 43741 Nairobi, Kenya

The Cairo Family Planning Association Chairperson: Ms Aziza Hussein 50 Goumhouria St Cairo, Egypt

Babiker Badri Scientific Association for Women's Studies P.O. Box 167 Omdurman, Sudan

The Assistant General Secretary to the Middle East Council of Churches c/o The Women's Programme The Coptic Orthodox Church
P.O. Box 35, Nasr City Cairo, Egypt

NOTES

1 Assitan Diallo, 'L'Excision en Milieu Bambara'; unpublished thesis for the Ecole Normale Superieure, in Bamako, Mali. p. 20.

2 See Fran Hosken, 'The Hosken Report — Genital and Sexual Mutilation of Females' (second enlarged/revised edition Autumn 1979 published by Womens International Network News, 187 Grant St, Lexington, Mass 02173, USA). This is the most detailed and comprehensive collection of information available.

6 The consequences of sexual mutilations on the health of women have been studied by Dr. Ahmed Abu-el-Futuh Shandall, Lecturer, Dept. of Obstetrics and Gynaecology, Fad. of Medicine, University of Khartoum, in a paper entitled, 'Circumcision and Infibulation of Females' published in the Sudanese Medical Journal 1967 Vol 5 No. 4; and by Dr. J.A. Verzin, in an article entitled 'The Sequelae of Female Circumcision', published in Tropical Doctor, October 1975. A bibliography on the subject has been prepared by Dr. R. Cook for the World Health Organization.

8 See Masters and Johnson, 'Human Sexual Response' (Boston: Little, Brown and Co, 1966); the Boston Women's Health Collective Inc, 'Our Bodies, Ourselves' (Penguin 1978); Mary Jane Sherfey, 'The Nature and Evolution of Female Sexuality' (New York: Vintage Books, 1973); Helen Kaplan, 'The New Sex Therapy' (New York:
Brunner/Mazel 1974).

9 Dr. Shandall cit. p. 188.

11 Dr. Taha Ba'asher, 'Psychosocial Aspects of Female Circumcision' paper presented to the Symposium on the Changing Status of Sudanese Women' 23 Feb-1 st Mar 1979.

12 These feelings of rejection are clearly articulated by Kenyan girls in 'The Silence over Female Circumcision in Kenya' in Viva Magazine, August 1978. (Box 46319, Nairobi).

13 See map of Childhood Mortality in the World, 1977; Health Sector Policy Paper, World Bank, Washington, 1980.

14 See Fran Hosken cit. for details and estimates of ethnic groups involved.

15 'F Magazine' No. 4 , Mar 1979 and No. 31, Oct 1980.

18 Marie Assaad cit.

19 Dr. Asma El Dareer, in the report of her current research in the Sudan,84 percent of respondents were infibulated.

29 Aminata D. Traore, Ministere de la Condition Feminine, B.P.V. 200, Abidjan, Ivory Coast, 'Elements pour une autre methode d'approche au probleme de I'excision' presented to the above symposium in Yaounde.

30 Esther ogunmodede, in a background paper prepared for this report, entitled 'Female Circumcision in Nigeria' available from CompanionFeatures, 48 Winnock Road, Yiewsley, West Drayton, Middx, U.K.

The map is a compilation of the latest information available from the International Planned Parenthood Federation, from WIN News, and from individual researchers.

Additional Reading

The Hosken Report: Genital and Sexual Mutilation of Females Fran Hosken WIN News 187 Grant Street Lexington, M A 02173 USA.

A 368-page study on genital mutilation of females. It is well documented with case histories from several countries of Africa and Asia. The report includes the medical facts, the history and the effect of this mutilation on the health and lives of women. Strong recommendations for the abolition of this mutilation are also given. I ncluded is a report of the World Health Organization Seminar held in Khartoum, Sudan, in February 1979, a good part of which was devoted to this issue, with the recommendations which came out of that seminar. There is a lengthy bibliography on the subject. Fran Hosken and WIN News have a very complete collection of information on the subject of genital mutilation, and as such should be considered a primary source of information.

L'Excision en Afrique Belkis Wolde Giorgis African Women's Centre for Research and Training (of the United Nations) and Association of African Women for Research on Development Addis Ababa Ethiopia. 1981.

This document tries "to analyse excision from a more global point of view", with the notion that "the practice of excision cannot be understood, or eradicated without changing the situation which created it in the first place." The text starts with a historical analysis of the origins of excision, its relationship to Islam, and goes on to describe the different kinds of operation and the medical complications. It ends with an elaboration of the various campaigns against excision and actions taken by international organisations.

As an appendix the AAWARD (Association of African Women for Research on Development) declaration on genital mutilation
dated November 1979 is included.

Also included is an extensive annotated bibliography on the subject of genital mutilation.