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The Ethical Quandary: Female Circumcision in Cultural Crossroads

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Professor Salmon's Staunch Advocacy for Abolition

Professor skinner's cultural relativism.

Exploring the Cultural Landscape through Ethnography

A critical stance: beyond cultural relativism, conclusion: navigating the complex terrain.

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The Ethical Quandary: Female Circumcision in Cultural Crossroads essay

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The New York Times

Tierneylab | a new debate on female circumcision, a new debate on female circumcision.

Should African women be allowed to engage in the practice sometimes called female circumcision? Are critics of this practice, who call it female genital mutilation, justified in trying to outlaw it, or are they guilty of ignorance and cultural imperialism?

Those questions will be debated Saturday morning in Washington at the American Anthropological Association’s annual meeting . Representatives of international groups opposed to this procedure will be debating anthropologists with somewhat different views, including African anthropologists who have undergone the procedure themselves. As the organizers of the AAA panel note:

The panel includes for the first time, the critical “third wave” or multicultural feminist perspectives of circumcised African women scholars Wairimu Njambi, a Kenyan, and Fuambai Ahmadu, a Sierra Leonean. Both women hail from cultures where female and male initiation rituals are the norm and have written about their largely positive and contextualized experiences, creating an emergent discursive space for a hitherto “muted group” in global debates about FGC [female genital cutting].

Dr. Ahmadu, a post-doctoral fellow at the University of Chicago, was raised in America and then went back to Sierra Leone as an adult to undergo the procedure along with fellow members of the Kono ethnic group. She has argued that the critics of the procedure exaggerate the medical dangers, misunderstand the effect on sexual pleasure, and mistakenly view the removal of parts of the clitoris as a practice that oppresses women. She has lamented that her Westernized “feminist sisters insist on denying us this critical aspect of becoming a woman in accordance with our unique and powerful cultural heritage.” In another essay, she writes:

It is difficult for me — considering the number of ceremonies I have observed, including my own — to accept that what appears to be expressions of joy and ecstatic celebrations of womanhood in actuality disguise hidden experiences of coercion and subjugation. Indeed, I offer that the bulk of Kono women who uphold these rituals do so because they want to — they relish the supernatural powers of their ritual leaders over against men in society, and they embrace the legitimacy of female authority and particularly the authority of their mothers and grandmothers.

You can read more about this in Dr. Ahmadu’s essays or in this critique of the global campaign against female genital mutilation, written by another participant in Saturday’s discussion, Richard Shweder of the University of Chicago.

Dr. Shweder says that many Westerners trying to impose a “zero tolerance” policy don’t realize that these initiation rites are generally controlled not by men but by women who believe it is a cosmetic procedure with aesthetic benefits. He criticizes Americans and Europeans for outlawing it at the same they endorse their own forms of genital modification, like the circumcision of boys or the cosmetic surgery for women called “vaginal rejuvenation.” After surveying studies of female circumcision and comparing the data with the rhetoric about its harmfulness, Dr. Shweder concludes that “‘First World’ feminist issues and political correctness and activism have triumphed over the critical assessment of evidence.”

If I were asked to make a decision about my own daughter, I wouldn’t choose circumcision for her. But what about the question raised by these anthropologists: Should outsiders be telling African women what initiation practices are acceptable?

Comments are no longer being accepted.

When such initiation practices result in the death, mutilation and suffering of thousands of women, then I think yes – we should be telling African women (or anyone else) what is acceptable. Just because it’s part of another culture doesn’t mean we should tolerate mutilation and dubious rituals.

Do you know how female circumcision is actually done? It is not the benign, joyful procedure alluded to by these researchers.

Should African men with AIDS be permitted to have sex with a virgin? Many in Africa believe this cures AIDS, but that hardly makes it right. Cultural imperialism seems an odd phrase to use when discussing female circumcision, a practice that most of the world views as barbaric. I refuse to accept practices such as this, or others such as “honor killings” that are acceptable in certain regions, but should never be accepted in the civilized world.

Anything that puts women at high risk of massive infection, sterility or fistula is ill advised.

The removal of the clitoris cannot be justified by any reasonable ethos.

Adult females should be able to decide for themselves if they want to have their genitals mutilated. People in the West do things like genital piercing and other body modifications that aren’t much different.

What I object to is that young girls might be subjected to it against their will, just as I object to circumcising male babies. A person, male or female, should be able to make that decision for themselves once they are old enough to understand what is going to happen to them.

Before things fell apart in Somalia, the Somali women were engaged in this debate. A pan-African conference was convened by them in Mogadishu which included important Islamic (male) leaders who clarified for them that female circumcision and infibulation was not, rpt not, Koranic. Rather, the cultural origins seem to be Pharaonic, perhaps sharing a timeline with male circumcision as practiced with minor objection even today. The sense of the conference was that, with more medical and cultural information, the practice will find its own end days…without outside pressure.

I am in many ways a believer in cultural relativism, but the reality is that this particular initiation ritual is at best painful but meaningful, and at worst traumatic, crippling and even fatal. Any cultural practice that causes long-term physical or emotional harm to children should be criticized by “outsiders.” For Dr. Schweder to compare female genital mutilation to vaginal rejuvination is absurd- wealthy adult women choosing cosmetic surgery is completely different from young girls being held down against their will to have an important part of their body severed by dirty razorblades and dull knives. There is an important element of choice involved when adults decide to undergo any procedure. For the record, I wouldn’t support American or European women forcing their daughters to have vaginal rejuvination either.

In general, if the practice is one that is done with full consent of all concerned, then it is hard to argue against the doing of such a procedure. The comparison with circumcision is a powerful, and fitting, one.

As to outsiders telling African women (or men) what is acceptable, much of the ‘civilized’ world seems to think it is their right and duty to educate the poor ignorant masses. Evidently, they all need to be dragged to our level of compassionate warfare, backstabbing politics, and ‘laissez-faire morality’. So, no. Outsiders should probably shut their mouths, or at least come to some level of true understanding of the procedure. And then write a book or something.

As to barbaric practices, please. As mentioned, there is circumcision and vaginal rejuvenation along with various breast (and body) augmentations, other vaginal procedures often done for purely cosmetic reasons (e.g., labia augmentation), and a number of other invasive procedures, many having little to do with the individual’s health (the (weak) argument of one’s mental health notwithstanding). And let’s not forget the ‘practice’ of killing innocents in the name of peace and humanitarian aid. Humans are quick to condemn, and far quicker to be hypocrites.

And the last sentence of the blog says much: “If i were asked tomake a decision about my own daughter…”. No one should be making a decision such as this about one’s child, be it FGC or circumcision. Or should they? The debate would be quite interesting.

Mutilation of the female body bathed in cultural relativism is still mutilation, even wtih the anaethesia of brainwashing the victims,

I am glad to read about this subject. I am a white American guy, who has traveled around the world a bit and been to Africa several times (my favorite continent). One of the things I have learned is culture is hard to learn from those who are outside it. Over time, I have come to respect culture even if I don’t “get it.”

I have read and thought about the concept of female circumcision (and like John I have a daughter and would not recommend the procedure to her — but she’s an American girl). The obvious answer to someone of my background is that female circumcision is wrong and perhaps anti-female. Nonetheless (and I am aware that it is generally conducted under female auspices), we American types probably do not fully understand the cultural aspects of this act. So I cannot condemn a procedure where I do not fully (or even partially) understand the background. (I am nominally Jewish and we practice circumcision of our sons when they are eight days old. This is a procedure that many — including myself although my son was ritually circumcised– consider bizarre. Indeed my Jewish wife was against it, and I do not have any compelling reason as to why I wanted it done other than, perhaps, culture.)

The American culture is at best five hundred years old. Yet our culture, admittedly the dominant one today, often attempts to impose its views on all cultures even those thousands of years old. Why does that make sense? Why are we unable to have some minor humility regarding what we know or do not know about different cultures.

One of the wonderful things about life is that there are other cultures. I bemoan the Americanization of the world. The two hour French lunch is gone; fast food places in Paris greatly outnumber the cafes that used to be in the formers’ place. This is not progress, but, of course, we cannot really do anything about it. We can — and I think this is Tierney’s point — simply attempt to be aware of different cultures and also be aware that what seems barbaric at first glance might not be.

With male circumcision as prevalent as it is in our society, and medical reasons no longer a non-religious justification for same, it’s hypocritical for us to call into question another culture’s rituals.

She does have a point regarding our tolerance of male circumcision. Perhaps we should take a look at that.

If degrading female genitals is the only way to express the power of women in Africa, we need to ask why. And probably do something about it. What we should do is beyond me.

Should outsiders be telling African women what initiation practices are acceptable? Not in Africa, they should not, but here in the United States it is, I believe, against the law.

Personally, I feel educated women who defend this practice are irrational. Highly irrational.

You, paleface, would never be asked to circumsize your daughter.

Can the word ‘barbarism’ still have any use in a world ‘contextuarlized’ by anthropology? For me, questions of aesthetics and who is performing the ritual or the claims about hygiene are not what is most important. (If there were real health advantages to such a procedure I suspect it would be more widely practiced) Male circumcision is performed in infancy and the trauma and pain exist in a pre-memory state before the self has been formed. Many still consider it barbaric but it seems to me that consciousness is required for such an ordeal to be described as torture. Hirsi Ali’s description of her own ‘procedure’ undergone when she was a fully cognizant child is almost too harrowing to read. She was pinned down by her (female) relatives and operated on without any anesthesia. I don’t know if it diminishes or enhances sexual pleasure but this seems to be a question for scientists not stewards of tribal ritual.

This article doesn’t mention whether there exists an anti-circumcision movement among female members of the ethnic groups that adhere to this practice. Is there such a movement? If so, what do those women have to say?

It is saying God created us imperfect. We are making an improvement on His creation. This applies both male and female circumcision. Those who believe in circumcision are true unbelievers.

Let’s not be pusillanimous about it or start pussyfooting, female circumcision is inexcusable.

If, as in some instances which have been made public, young females are subjected to the swipe of a crude blade, cutting or tearing labia as well as the clitoris, then these are criminal acts of mutilation, and cannot, morally, be defended by any cultural claim. If, on the other hand, as is implied in the story above, the procedure involves ‘the removal of parts of the clitoris,’ which would have to be a very precise procedure, and no harm is done to urethra or the labia, then it would not be mutilation. But if it has the consequence of reducing, if not eliminating, the sexual pleasure of women, the representatives of the Kona people would have to explain how that could be justified.

If a woman wants to submit to an alteration of her genitals I would think it is her right to do so. Same for a man. Their genitals = their decision. It is when genital alteration is done on some one who does not consent or is unable to consent that I believe we have waded into unethical waters. No one should alter the genitals of some one else because of their own personal preferences. That is highly abusive.

This is not a “new” debate. African women have been discussing these points for more than twenty years. My question is: Why did it take a group of anthropologists so long to discuss female circumciion in a less culturally-biased manner?

I can’t believe such ignorance. Please lets get the facts right. Female mutilation is *not* circumcision. The name says it all, circum-cision means “cut around”, i.e. cut around the extra skin on a man’s penis, which has many health benefits — penis cancer is unknown among circumcised men, plus the penis is allowed to grow more freely without a constricting fold of skin.

This has nothing to do with excising the clitoris, which should be rightfully named Mutilation. This abhorrent practice is often done with a razor blade or even a glass shard, with no anesthetics , a screaming girl held by relatives while the practitioner (an older woman) cuts a large part of her female organ. Bleeding often causes serious infections, sterilty and even death. Try to imagine doing this to your daughter,niece or another little girl you love.

There is no health benefit whatsoever and much less an “aesthetic” benefit as has been claimed. This is sheer oppression of women and cruel abuse of children in the name of “tradition” – the same spurious argument that supported slavery and many other abominable practices that decent people have abolished.

Many FGM practitioners have laid down their instruments and refused to carry on this abomination on the new generation of girls although the practitioners have status in their communities.

Also, many Muslim communities adopt this practice but it is never mentioned in the Koran. (The Koran also never said women must be covered from head to toe, this is just an interpretation of the commandment to be “modest”.)

*** The sole real purpose of female genital mutilation is to prevent women from feeling sexual pleasure. ***

While I believe that everyone should respect the traditions of other cultures, I think there also need to be limitations based on common sense. Two rules come to my mind: Is the practice damaging to the health of the participant in the ritual? Secondly, does the tradition involve cruelty and coercion? In other words, is the participant given a choice, or more or less forced to undergo the ritual? If either of these two situations is the case, then I think outsiders as well as members of the community practicing that tradition have every right to be critical and to come up with “alternatives.” A physician in Florence Italy has come up with an alternative genital ritual for young females of families who insist that their daughters undergo this procedure. The physician’s “ritual” does not permanently damage the young patient’s health but satisfies the needs of the parents and their community. Perhaps this “Third Way” is the approach which should be used.

I don’t think there should be ANY debate! It’s wrong.

Footbinding was also endorsed and performed by mothers on their daughters. That doesn’t mean the practice originated with them. As a nurse, I have personally witnessed and can attest to the medical impact of so called female circumcision: infection, fistula, pain. You can only take cultural relativism so far. I would hope that others who can see more clearly would make critical comments about the foibles of our culture. -Anna

De gustibus non est disputandum.

What's Next

The Complexity of Female Circumcision: Your Thoughts

Many readers were jarred by an Atlantic interview with an anthropologist who tackled a controversial question: What if some women choose to get cut — and even celebrate it?

write an argumentative essay on the topic should female circumcision be abolished

One of the most provocative pieces on The Atlantic recently came from Olga Khazan, who interviewed anthropologist Bettina Shell-Duncan on the persistent problem of female circumcision in many parts of Africa and the Middle East, despite decades of campaigns led by the United Nations and others. Thousands of you commented via Disqus, Facebook, Twitter, email, and yelling through your screen—"FGM apologist!"—but I tried to compile the most productive points, seen below.

Parsing a reader debate on the best way to end female circumcision—no one is arguing for the practice—is difficult because people are often talking past each other. That difficultly is due to the vast diversity of the 125 million individuals who have gone under the knife; each case is different. Is she an adult, a teenager, or clearly a child? Does she live in a country where the ritual is widespread or a Western nation where it defies all norms? Does she undergo "nicking," excision, infibulation—in which the labia are stitched together—or something in between? Is she forcibly held down, or does she join willingly, even joyfully in some cases?

One such case was described in Olga's interview with Shell-Duncan, who witnessed the ritual cutting of a Rendille woman at her wedding in northern Kenya: "The bride came out [afterwards] and joined the dancing." Olga, though horrified by the practice, emerged from the interview with a more nuanced understanding of how it's performed in various places:

In fact, elderly women [as opposed to men] often do the most to perpetuate the custom. I thought African girls were held down and butchered against their will, but some of them voluntarily and joyfully partake in the ritual. I thought communities would surely abandon the practice once they learned of its negative health consequences. And yet, in Shell-Duncan's experience, most people who practice FGC recognize its costs—they just think the benefits outweigh them.

Here's Shell-Duncan in her own words, prodding people to consider a woman's choice when it comes to circumcision:

The sort of feminist argument about this is that it’s about the control of women but also of their sexuality and sexual pleasure. But when you talk to people on the ground, you also hear people talking about the idea that it’s women’s business. As in, it’s for women to decide this. If we look at the data across Africa, the support for the practice is stronger among women than among men. So, the patriarchy argument is just not a simple one.

Many upset commenters, including Rosemary Fryth , found the interview rife with "cultural relativism":

We are told that in a multicultural country all cultures have equal value—and thus, all cultural practices as well. Well, it is clear that not all cultures are equal, and pretending that they are allows this sort of inhumane cultural practice to thrive.

Guishe Garra agrees:

The article almost acknowledges female genital mutilation as an OK practice given "their culture." This is a great example of a "liberal" publication flirting with extremely illiberal values in the name of misunderstood "diversity and minority's cultures." If we can't emphatically argue that humanistic values and liberal values are clearly better, we are doomed.

Though to be clear, Shell-Duncan is working with the Population Council to reduce female circumcision "by at least 30 percent across 10 countries over five years"—hardly the goal of someone who "almost acknowledges [FGM] as an OK practice." Arwen McCaffrey puts it well:

The researcher is clearly not in support of the practice. The point of the article isn't to lessen the horror of FGM but rather to contextualize it. Societal pressure to belong is incredibly powerful. This is true in Western cultures as well. Shell-Duncan is remarking how she learned about the many sociocultural factors influencing the practice and that there is no one easy way to end it.

So the core debate should be: What's the most pragmatic, effective way to end the practice? That's difficult to say, since legal prohibitions and health messaging have yielded mixed results so far. One controversial idea from Shell-Duncan is to call it "cutting" rather than "mutilation"—the term officially used by the World Health Organization. But "mutilation," she says, "sounds derogatory and can complicate conversations with those who practice FGC [female genital cutting]." Hilary Burrage isn't buying it:

The wish of leading African women themselves is clearly to refer to the practice as MUTILATION—formally, at least, per the 2005 Bamako Declaration . The United Nations has also recently agreed to refer to this harmful traditional practice only as FG*M*. Please let's hear NO MORE about "FGC." Children's lives and future health are more important than comforting —whether to practitioners or observers —euphemisms. Female genital "cutting" also plays very well to Westerners if they want to evade the cruel truth of how defenceless (undefended) children are being tortured because of "respect" for "tradition."

Maria Alisa , on the other hand, sees the logic of calling it "cutting":

The point of the name change is that if you go in as an outsider and tell people how horrible they are and they have to change a cultural practice, do you think that will work? No. They'll cling to it twice as hard. In our discussions with those cultures over the practice, we must do what works, not what makes us feel smug and self satisfied.

Ilona Geary elaborates on that view:

I n the West, we have the luxury of making decisions based on our own beliefs without our children or ourselves being ostracized or disenfranchised or having their future threatened. We enjoy a certain amount of autonomy that doesn't seem to be present in the people groups discussed here. But when you live in a collective, the traditions that signify a belonging and duty to the group become paramount. I appreciated the article's explanation of the social pressure, especially in a nomadic/small village setting, that drives these mothers and young women to make this decision. In their estimation, it is an important way to secure solidarity and a prosperous future for their child within the circumstances in which they live. I think the practice is definitely dangerous and doesn't have the actual benefits that the people group believe they do, but the only way to change hearts and minds is to continue a respectful dialogue and create OTHER opportunities within these communities. One can't march in with disgust, disdain, and legislation and think this will instantly vanish. Constant communication that provides a connection to a larger world view and more options will eventually turn the tide. Sooner rather than later I hope.

Perhaps "mutilation" and "cutting" are equally useful terms; it just depends on the audience. For anti-FGM activists who want to increase awareness and fundraising in the West, "mutilation" rhetoric is more effective. For anti-FGC anthropologists and health officials who confront the cultural divide on the ground, "cutting" is more effective. Here's how this reader frames the tension at play:

The feminist discourse runs up against the post-colonial one. At which point is it okay to dictate terms to native cultures?

Thop looks to history:

Wikipedia It is without doubt that in the cultures practicing human sacrifice, a significant number of young sacrificial victims (or should I be PC and say "celebrants") participated willingly, even joyfully. In colonial India, the Brits effectively ended—though not totally eradicated—the ancient practice of Sati, the burning alive of the widow on the dead husband's funeral pyre. They started with education and mild restrictions, but with little result. That was dropped for a more heavy-handed ban. But the Brits were all about respecting national customs : General Sir Charles James Napier, the Commander-in-Chief in India from 1859 to 1861 is often noted for a story involving Hindu priests complaining to him about the prohibition of sati by British authorities. "Be it so. This burning of widows is your custom; prepare the funeral pile. But my nation has also a custom. When men burn women alive we hang them, and confiscate all their property. My carpenters shall therefore erect gibbets on which to hang all concerned when the widow is consumed. Let us all act according to national customs."

Another dividing line in the reader debate is the age of the females getting cut. How Liz Deutermann sees it:

I think if a woman wants to be circumcised it should be her choice. What's horrible is when a girl is forced into it.

And girls are clearly the ones suffering the most :

Most often, FGC happens before a girl reaches puberty. Sometimes, however, it is done just before marriage or during a woman’s first pregnancy. In Egypt, about 90 percent of girls are cut between 5 and 14 years old. However, in Yemen, more than 75 percent of girls are cut before they are 2 weeks old. The average age at which a girl undergoes FGC is decreasing in some countries (Burkina Faso, Côte d’Ivoire, Egypt, Kenya, and Mali). Researchers think it’s possible that the average age of FGC is getting lower so that it can be more easily hidden from authorities in countries where there may be laws against it.

Which would be a dark irony indeed. But what about adults who undergo FGC? Should it be "their body, their choice"? Sarah White thinks that's a fallacy:

It is not a choice if it is a cultural expectation and one faces ostracism (which means much more in tribal cultures) if one dares to deviate. This is not consent; it is acquiescence. Read Alice Walker's Possessing the Secret of Joy .

Walker also wrote a nonfiction book on FGM, Warrior Marks . Here's a gripping scene from her documentary of the same name:

Even when the participant is an adult, this reader suggests it's still brainwashing:

A lot of people are pointing out that this 16-year-old Rendille girl [witnessed by Shell-Duncan] apparently "chose" to get the procedure done, as if such a thing would have ever occurred to her without getting it drilled into her head since birth that this makes her worthy in the eyes of her community.

Shell-Duncan noted that the Rendille teen "was young by their standards. Mostly they’re 18, 19, 20, around that"—which raises the difficult question of when exactly a minor becomes an adult. When I emailed Hilary Burrage, the aforementioned activist, she had a nuanced take on the consent question:

Regarding the "adults can choose" issue, yes, it is more complex. Some might say there’s a grey area between FGM and female genital "cosmetic" surgery (FGCS), but in reality (regardless of my views on FGCS), I don’t think there is a grey area. FGCS does not remove physiological functions—everything from normal secretions and dampness to obstruction in childbirth—nor does it remove sexual feelings and sensations. FGM often does interfere with function to one degree or another. We have to be careful that those who claim they want FGM as adults don’t also get it done on minors. One example is this interview with an woman who grew up in the US but returned to Sierra Leone to undergo FGM—but submitted her eight-year-old sister to one as well.

Burrage was upset over Olga's piece:

It is a matter of serious regret (and hurt to survivors) that Melinda Gates commended the Shell-Duncan interview on Twitter: I disagree with the practice, but this article has great insight on understanding different cultures: http://t.co/NodZhzRDpF via @olgakhazan — Melinda Gates (@melindagates) April 15, 2015

The Gates Foundation has undertaken excellent work (e.g. maternal malaria), so the praise for Shell-Duncan's analysis contrasts very poorly with this positive contribution to women’s health. Ms Gates should be strongly encouraged to reconsider her position in the light of the evidence cited in my email and elsewhere. You will I’m sure be aware that the UK Royal Colleges (which also produced our national guidelines on issues around FGM) have produced a strong statement explaining why they found the article unacceptable; and I imagine you may have seen my own post written shortly before then.

I am sure The Atlantic (and, perhaps separately, Ms Gates) will wish as a matter of urgency to make it crystal clear that any position on FGM—a totally illegal practice unanimously condemned by the UN—which falls short of outright denunciation is, in one word, unacceptable.

Olga's response:

The problem here is that the communities where FGC/M occurs are all very different. There are many in which girls are coerced and even tortured. There are some, as Shell-Duncan describes, where the practice is seemingly celebrated. I've always been interested in why so many female elders support this practice. How do you go about ending FGM in those societies? Shell-Duncan's description of the girl who was proud to have the procedure done on her was certainly fascinating, but it was by no means descriptive of all women who undergo FGM. However, it does reflect a need for a different type of approach to ending FGM in these areas, and that's what Shell-Duncan provided. Also, I reject the notion that there are "acceptable" and "unacceptable" ideas, as Burrage describes, when it comes to attempting to end a problem as entrenched as FGM. Shell-Duncan was offering one potential solution for a certain type of community; surely there are other solutions that are more applicable to other situations. We all have the same goal in the end.

Our final reader is Soraya Miré, a Somali woman who penned a memoir about her own experience with FGM, The Girl With Three Legs. Here's Soraya 's response from the comments section:

The article failed to understand why our mothers and grandmothers put our bodies through the mutilating ritual and watch us become nothing more than the pleasurable commodity of men. What happened to these women? What about their deep wound, private pain? Didn’t they become wives and mothers, knowing the unthinkable pain? Why then continue the circle of pain? I didn't own a clean razor but felt the prick of the sharp needle as rough hands plucked at my lips like a giraffe feasting on thorny branches. The doctor who was performing my mutilation turned to my mother and said,"Would you like to look at it?" She did and said, "Perfect. Just perfect!" That high praise was meant for my future husband who would find me desirable. I said this many times, that ending the abuse of girls and women is seen as a threat to manhood and a man’s psyche. The article failed to understand the one holding the social and cultural identity mirror. What is the purpose of holding this mirror? And when a young girl looks into that mirror finds a message that reads, “You were born into a female body which automatically labeled you a defected human being in need of reconstruction.” I would love to speak to Bettina Shell-Duncan and offer her education about the cultural mindset of society that views women like chicken without heads. Those of us who survived the horror of Female Genital Mutilation are left with an option to either go along with the cultural torture and abuse or detach ourselves from our roots, our culture and even our family. Reading this article brought back the nightmares about needles biting into my skin and envisioning myself landing on the field of thorns, cut glass, and bloody scissors.

Another Somali-born woman who suffered from FGM, Ayaan Hirsi Ali, touched on the issue in yesterday's Atlantic piece on honor killings in the U.S.:

In the United States, more than half a million women are estimated either to have undergone female genital mutilation (FGM) or to be at risk of it. This number marks a sharp rise in the prevalence of FGM in the U.S. compared to just over just a decade ago. The reason for the increase, according to the Population Reference Bureau, is the rise in the number of immigrants from countries where FGM is common. Those trends show no [sign] of abating.

That trend was the subject of an Atlantic Monthly cover story back in October 1995, "Female Circumcision Comes to America," just at Congress was finally passing a law against FGM. Linda Burstyn's essay opens with an Ethiopian immigrant mother, Genat, frightened that her own mother will circumcise Genat's newborn girl:

"Mother says she will do it anyway, herself—when I'm out of the house—if I don't agree to get it done soon," Genat confides to the woman she hopes will help her. "She says she will take a razor blade and do it." [FGM activist Mimi] Ramsey nods. She has heard this story many times before, and responds by reciting a long list of reasons why the older woman must be stopped, trying to give Genat the courage to buck tradition and disobey her mother. "You cannot let her do this to your child. Please. It is wrong. You know how painful it is. How damaging. Your daughter may hate you for life for what you allow to happen to her." Genat shakes her head. She doesn't want her baby girl, just born in this country, to be circumcised, as is customary in her native land, but her mother is adamant. "She believes in it so strongly," Genat says. "She said if I don't do these things, the girl will grow up horny. She'll be like American girls."

Readers at the time reacted to Burstyn's piece here . Thanks to all the readers this month who commented on the Shell-Duncan interview. We're thinking of posting a similar follow-up on the male circumcision vs FGM debate that also raged in the comments section . If you'd like to offer your take on the subject, email [email protected] and you'll have a much better chance of seeing it posted.

About the Author

Envisioning an End to FGM/C

Stephanie Desmon

Female genital mutilation or cutting—in which all or part of a girl’s or woman’s genitalia is altered or removed for nonmedical purposes—has been a traditional practice in many countries for over a millennium. More than 200 million women and girls alive today are FGM/C survivors.

In 2012, the UN General Assembly designated February 6 the International Day of Zero Tolerance for Female Genital Mutilation . Guided by Sustainable Development Goal 5 , the UN aims for the elimination of the practice by 2030.

In this Q&A, adapted from the February 5 episode of Public Health On Call , Michele Decker , ScD, MPH, Bloomberg Professor of American Health in Population, Family and Reproductive Health , and Nicole Warren , PhD, MPH ’99, MSN, associate professor in the Johns Hopkins University School of Nursing, explain the importance of challenging long-standing cultural norms to end FGM/C, and the need to provide appropriate care for those who have experienced the practice.

They also discuss the launch of Johns Hopkins Center for Global Women’s Health and Gender Equity and some of its priority areas, including eliminating FGM/C.

Tell me about the Center for Global Women’s Health and Gender Equity. How did it come about, and why?

Michele Decker: We’re in a watershed moment for global women’s health and women’s rights. We see that in the Sustainable Development Goals. We see it in the inaugural U.S. National Plan to End Gender-Based Violence , the White House Gender Policy Council , and a number of other domestic and global policy initiatives that are elevating gender equity and women’s health.

The Center formed in October 2023 with the mission to advance global women’s health and gender equity through a combination of action-oriented research, training, and translation. We have an incredible wealth of gender equity and global women’s health research underway at Johns Hopkins. This new center allows us to synergize that expertise.

A couple of our priority areas are around eliminating gender-based violence and other harmful practices, including child marriage and female genital mutilation, as well as empowering women and girls and strengthening health systems to optimize gender equity.

Is this an international center? Or does it also have domestic components?

MD: We’ve got people working around the world, including in the U.S. We have gender equity issues right here in our backyard, like the gender wage pay gap and differential jobs and opportunities based on gender. And gender-based violence continues to be a leading driver of women’s morbidity and mortality, and it’s taking way too many people. We also have some U.S.-based work on FGM, or female genital mutilation or cutting.

We’re ready with the evidence base, and we’re ready for evidence-informed change.

Nicole, as an expert on FGM, can you tell us a little about that practice?

Nicole Warren: FGM is the acronym for “female genital mutilation.” That is the term the WHO and many other agencies use. It is a traditional practice that does not have any medical advantages, and that essentially harms some part of the female genitalia.

Is there a difference between FGM and FGC?

NW: As a nurse midwife, I tend to use the term “female genital cutting” because I want to use language that will be acceptable to my clients. Some people I care for absolutely do feel mutilated, and I use that term, FGM, if that’s what they’re using. Otherwise, I tend to use the term FGC, because I try to avoid creating that victim-perpetrator dynamic that just isn’t consistent with how some affected communities view the result of the procedure.

What is the traditional rationale for FGM/C?

NW: Communities would have many different answers, a lot of the rationales boil down to control—controlling behavior, minimizing the potential for promiscuity, and keeping people modest. It’s really about diminishing the potential for a girl or a woman to behave inappropriately. For many communities, FGC is also a way to ensure that she will be marriageable. And in some communities, marriage is what allows survival. So the impetus for families to continue the practice is really powerful.

I want to be clear that FGM/C is not required by any religion. In many countries, you see people of all faiths who practice FGC—Christians, Muslims, and those who follow traditional religions. It crosses financial, religious, and socio-cultural boundaries. Ministers of health do it just as folks who would be considered disenfranchised and poor.

Is this something that can be prevented through behavior change work?

MD: Absolutely—but not just at the individual level. These controlling norms have disproportionate and gendered harm, and we need to address those at the community normative level. We won’t get to prevention at the individual level alone.

NW: It’s really hard for an individual in a community to decide not to participate in the practice because social acceptability is a big driver. The sense of, “this is how female external anatomy looks most beautiful, looks most proper” means there’s a lot of demand for it from men and women.

There are also a lot of people who want to see the practice end, but right now, they’re still getting the cutting done because that risk-benefit ratio hasn’t quite tilted far enough. It is happening, but much more slowly than we’d like to see.

Could laws against FGM/C help?

NW: Well, some countries have laws and some don’t. Even in many countries where it’s illegal, there’s no enforcement. I have worked in Mali for quite some time, and they do not have a law on the books because there is a fear that it will drive the practice underground and make an unsafe practice even more unsafe.

MD: The limitations of criminalizing a behavior like this are a common thread across all forms of gender-based violence. It’s really important to have laws on the books, but it’s not a potent deterrent. We’ve got to think about the normative environment and address those social norms. We can’t just criminalize our way out of it.

You mentioned earlier that there’s a U.S. component to this.

NW: Where the U.S. gets involved is when women migrate here from countries where FGM/C is normative.

After people are affected by the practice, there’s a whole range of sequelae—medical, psychological, sexual, the list goes on. When people migrate to a place where FGC is not normative, they face health care systems and providers that don’t understand how their body is different and sometimes don’t even know the therapies available to treat those sequelae.

In the U.S., we have over half a million women and girls who are potentially affected by this practice, yet we have no consistent training for health care providers on the topic. We see higher C-section rates, for example, and other indicators of poor outcomes, and we can solve that. We can reduce the risks people face after they’ve been cut.

And when we can reduce that risk, develop a good rapport, and provide good care, now we hopefully have a trusting relationship to start talking about prevention. We can start talking about, “What are your plans for your daughter after you have this baby?” We can start thinking about making sure that primary prevention—preventing the first cut—also happens in the U.S.

Stephanie Desmon is the co-host of the Public Health On Call podcast. She is the director of public relations and communications for the Johns Hopkins Center for Communication Programs , the largest center at the Johns Hopkins Bloomberg School of Public Health.

Johns Hopkins Launches Center for Global Women’s Health and Gender Equity
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Reconciling female genital circumcision with universal human rights

PMID: 28922561
DOI: 10.1111/dewb.12173

One of the most challenging issues in cross-cultural bioethics concerns the long-standing socio-cultural practice of female genital circumcision (FGC), which is prevalent in many African countries and the Middle East as well as in some Asian and Western countries. It is commonly assumed that FGC, in all its versions, constitutes a gross violation of the universal human rights of health, physical integrity, and individual autonomy and hence should be abolished. This article, however, suggests a mediating approach according to which one form of FGC, the removal of the clitoris foreskin, can be made compatible with the high demands of universal human rights. The argument presupposes the idea that human rights are not absolutist by nature but can be framed in a meaningful, culturally sensitive way. It proposes important limiting conditions that must be met for the practice of FGC to be considered in accordance with the human rights agenda.

Keywords: cross-cultural bioethics; cultural sensitivity; female genital circumcision; human rights; moral relativism.

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Article Contents

1. introduction, 2. precedent, 3. culture/religion, 4. health/medicine, 5. better reasons, 6. conclusions.

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Why Family Law Treats Female Genital Mutilation and Circumcision Differently: An Explanation

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Nick Brown, Why Family Law Treats Female Genital Mutilation and Circumcision Differently: An Explanation, Oxford Journal of Law and Religion , Volume 12, Issue 1, February 2023, Pages 96–120, https://doi.org/10.1093/ojlr/rwad012

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Family law in England and Wales draws a fundamental and categoric distinction between female genital mutilation (FGM) and male circumcision (circumcision). The former is a criminal abuse of human rights which, for the purposes of section 31 of the Children Act 1989, can never fall within the ambit of reasonable parenting. The latter is, in principle, reasonable and is therefore not in itself a basis upon which the state can seek to intervene in family life. 1 It will be argued that the reasons given for this distinction in the authorities to date (reasons based on precedent, culture/religion and health/medical issues) are problematic and are not ultimately capable of explaining the distinction satisfactorily. Nevertheless, it will be further argued that a distinction can be properly justified but only when we consider some core underlying features of family law in our contemporary democratic society and that it is only with those features in mind that the different treatment can be explained and viewed as acceptable.

On 14 January 2015, Sir James Munby P handed down judgment in the leading case of Re B (Children) (Care Proceedings) . 2 The case focused on an allegation, pursued by a local authority within care proceedings, 3 that two Muslim parents had subjected their daughter to a form of female genital mutilation (FGM). Having heard expert evidence (of extremely varying quality), the court concluded that it could not make the key finding sought. Nevertheless, ‘given its obvious importance’, 4 Sir James Munby P went on to consider the groundbreaking point—on which he had heard the argument—as to whether FGM amounts to ‘significant harm’ for the purposes of section 31 of the Children Act 1989—the threshold/core statutory provision permitting the removal of children from their parents’ care. The answer to that enquiry was that ‘any form of FGM’ constitutes such harm 5 and that, again for the purposes of section 31 of the Children Act 1989, ‘it can never be reasonable parenting to inflict any form of FGM on a child.’ 6

I conclude therefore that although both involve significant harm, there is a very clear distinction in family law between FGM and male circumcision. FGM in any form will suffice to establish ‘threshold’ in accordance with s31 of the Children Act 1989; male circumcision without more will not. 8

It will be argued, that whilst the fundamental conclusion that there is a distinction to be drawn between FGM and circumcision is sustainable, the reasons given for that distinction within Re B and the authorities upon which it relies are problematic. In broad terms, those reasons are as follows: first, precedent-based arguments support the contention that there is a distinction to be drawn; secondly, issues pertaining to culture/religion allow for different treatment; and thirdly, health/medical-based arguments allow for different treatment. Sections 2–4 will address each of these areas in turn with an investigation as to whether such reasons can satisfactorily ground the distinction that family law maintains between FGM and circumcision—with the conclusion being, in each case, that they cannot. Section 5 will then endeavour to set out better reasons for understanding the different treatment and will point to the conclusion that, ultimately, it can be explained only by understanding some core underlying features of family law itself with a particular focus on what it can/cannot achieve—a point which, it will be contended, is linked to societal priorities which are at large beyond the sphere of family law but which nonetheless provide family law with its particular approach to FGM and circumcision.

In terms of contribution to the field, whilst the literature includes examples of challenges to the different treatment of the practices, 9 it is suggested that there is a lack of sustained and detailed consideration of the reasons given for that difference in the specific context of family law and religion— with there being a particular absence of focus on the nature of family law and what that may tell us about the appropriateness or otherwise of the distinction drawn between the practices.

For the contention that there is ‘no equivalence’ between FGM and circumcision, Re B places reliance upon two asylum cases— K v Secretary of State for the Home Department, Fornah v Secretary of State for the Home Department and SS (Malaysia) v Secretary of State for the Home Department 10 —and this reliance ought to be regarded as problematic.

It cannot be compared to other cultural or religious practices, such as female genital mutilation, which involve a far more serious violation of physical integrity of the body and an expression of subservience. 11

The authority for the above proposition is cited as Fornah and so SS (Malaysia) becomes vulnerable for the same reasons that will be explored in respect of that case itself. Further, Re B in fact clashes with SS (Malaysia) because it specifically negatives the analysis that FGM per se represents a greater invasion of bodily integrity than does circumcision with Re B going so far as to determine that some forms of FGM are ‘on any view much less invasive than male circumcision’ 12 —and with both FGM and circumcision constituting significant harm. 13 SS (Malaysia) and Re B are also at odds because the former describes FGM as a religious practice, whereas the latter asserts it is a practice that ‘has no basis in any religion.’ 14 So as Re B actually departs from SS (Malaysia) on these critical points it is hard to see how SS (Malaysia) can help ground the precedent-based argument that Re B deploys to justify the distinction drawn between FGM and circumcision.

(…) within the familiar definition of ‘refugee’ in article IA(2) of the 1951 Convention relating to the Status of Refugees and the 1967 Protocol (…) The only issue in each case is whether the appellant’s well-founded fear is of being persecuted ‘for reasons of … membership of a particular social group.’ 16

Because neither of the linked cases were about circumcision, Fornah references no detailed evidence, argument or analysis concerning the practice. Its direct/specific commentary on circumcision is contained within only three of the judgment’s 122 paragraphs 17 —two of those paragraphs restricting their observations on the topic to a single sentence. 18 What is said about circumcision does not go directly to the ‘only issue in each case’ (ie ‘membership of a particular social group’) and ought, therefore, to be regarded as dicta . 19 Whilst ‘there are obiter dicta and obiter dicta’ Fornah’ s dicta ought to be regarded as falling on the non-binding or non-persuasive ‘passing remark’ side of the equation as opposed to the potentially binding or persuasive ‘considered judgment on a point fully argued’ side—in particular, because the judgment discloses no ‘purifying ordeal of skilled argument’ on the question as to whether circumcision and FGM are comparable practices. 20

Further, Fornah contends for there being no comparison between FGM and circumcision 21 but without any consideration of what drawing a comparison entails. That is a gap given the abundance of authority for the proposition that, when drawing comparisons between X and Y, the attributes of them both which are said to ‘come into the frame’ are a matter of opinion, out-look and value judgment. 22 This consideration is absent within Fornah and so it goes on to exclude from the analysis points of obviously arguable comparison. So, there is a fundamental point of comparison between FGM and circumcision in that both involve the non-consensual removal of children’s genital parts for non-therapeutic reasons and, therefore, a fundamental interference with the right to bodily integrity. 23 Linked to that are the other essential points: both practices involve pain 24 and are irreversible. 25 Both practices are regarded (at least by some communities) as religious obligations 26 and are, in any event, customs intended to mark a life-stage transition and/or an initiation. 27 Both practices can be driven by mutually held expectations as between the sexes that go to marriageability, 28 beliefs in cleanliness, and perceived aesthetics. 29

Like male circumcision, the cutting of girls is an expression of certain deeply held beliefs about the body, human sexuality and individual and social identity (…) the themes the Western world abhors - removing part of the genitals to reduce sexual pleasure, carving children’s bodies to conform to certain social ideals, visiting pain on helpless children - are all fully present in the history of male circumcision. 30

Finally here, as Re B itself states both practices involve significant harm 31 —a highly notable point of comparison from a basic child welfare perspective and also simultaneously from a legal/procedural perspective as the proof of significant harm (or its likelihood) is one of the requirements to be met to establish jurisdiction for state intervention in family life under section 31 of the Children Act 1989.

Moving on, gaining an understanding of both FGM and circumcision is a task that requires the consideration of expert opinion—an essential point recognized in Fornah given the involvement of the expert in the case to assist on the background of FGM in Sierra Leone. However, the judgment does not disclose any detailed consideration of any expert opinion on circumcision. 32 Further, an expert in family proeedings must set out where there is a ‘range of opinion’ 33 and so in this context, a key difficulty with Fornah arises because the case-critical opinion that FGM evidences an inferiority of women in Sierra Leone is simply not an opinion universally held amongst experts within the field and yet there is nothing in Fornah that would let us know that. 34

Fornah’s ‘procedures’ analysis, with its focus on the circumstances in which FGM can be carried out, conflates procedures with their setting. 35 After all, FGM can be carried out hygienically with anaesthetic and circumcision can be carried out unhygienically without anaesthetic. 36 Further, as Re B observes FGM Type Ia, whilst ‘apparently very rare, is physiologically somewhat analogous to male circumcision.’ 37 That acceptance must also bring with it an acceptance that the procedures are comparable given that the purpose and function of the procedures is to change physiology.

That FGM can have severely harmful consequences is beyond argument 38 but circumcision too may have harmful, even fatal, consequences. 39 More fundamentally, it is not clear why the severity of harmful consequences is necessarily helpful when considering the question of reasonableness/acceptability. Repeatedly stabbing somebody in the face with a knife is a far more serious assault than punching somebody once in the face but it does not follow that the punch to the face is reasonable/acceptable conduct, less still that it is in the best interests of the victim. After all, even a de minimis assault is an assault. 40

It follows from the above that any contention that circumcision can or ought to be regarded as an acceptable practice simply because it is less harmful than FGM is a non sequitur and, consequently, unsustainable—as Steinfield says, ‘this isn’t a harm competition.’ 41 In any event, Re B negatives any suggestion that circumcision is a matter demanding little/no concern by concluding it amounts not only to harm but ‘significant harm’ 42 ie harm that is not ‘trivial or unimportant’ 43 but ‘considerable, noteworthy or important.’ 44 Indeed, on the issue of severity (and as already noted), Re B goes so far as to determine that some forms of FGM ‘are on any view much less invasive than male circumcision.’ 45

Finally, on the ‘procedures’ analysis, if circumcision results in a diminution in sexual pleasure due to the removal of sensitive tissue and/or significant negative psychological sequelae (as evidence in the field suggests 46 ) then it can equally be said of circumcision that, as with FGM, its ‘effects last a life time.’ 47 Further, Re B itself accepts that the ‘long-term consequences, whether physical, emotional or psychological’ of certain forms of FGM may be the same or less great than those associated with circumcision. 48

Nor can the context be compared with male circumcision. As the UNICEF Innocenti Digest, Changing a Harmful Social Convention: Female Genital Mutilation/Cutting (2005) observes: In the case of girls and women, the phenomenon is a manifestation of deep-rooted gender inequality that assigns them an inferior position in society and has profound physical and social consequences. This is not the case for male circumcision, which may help to prevent the transmission of HIV/AIDS. 49

The three contentions that (i) FGM is a ‘manifestation of deep-rooted gender inequality’, (ii) circumcision is not such a manifestation, and (iii) circumcision has been linked to HIV/AIDS prevention are not contentions that, without more, can be said to justify the argument that there is no comparison to be made. For all we have here are the identification of three purported facts that point to a difference but where there is difference there can still be substantial comparison/similarity. More specifically on this UNICEF citation (and as already touched upon) the assertion that FGM is a manifestation of inequality and inferiority finds extensive challenge in the literature as an oversimplification, including in relation to Sierra Leone—the very country under consideration in Fornah . 50 Further, as Möller argues ‘Patriarchal oppression may make an otherwise rights-violating act even worse, but it cannot ground its wrongness.’ 51 In other words, irrespective of the extent to which FGM is an outworking of patriarchal oppression it is a wholly unacceptable practice with any associated intention to subjugate on the grounds of sex/gender being an ‘aggravating factor’ 52 rather than the wrong itself.

Moving on within the UNICEF citation, as with FGM, so too does circumcision have ‘profound physical and social consequences.’ 53 Further, in jurisdictions such as our own where FGM is unlawful and circumcision lawful, circumcision itself becomes a manifestation of ‘deep-rooted gender inequality’ and itself becomes a form of—to borrow Fornah’ s own phrase—‘gender-specific violence.’ 54

On HIV/AIDS, it is of note that, rightly, the UNICEF material cited is in fact equivocal—circumcision ‘may’ help transmission prevention. 55 This is, therefore, not itself a wholly safe basis upon which family law can draw any firm conclusions about the reasonableness or otherwise of circumcision (as will be argued fully in Section 4).

Further again on the specifics of the UNICEF material, it contains a non-sequitur . The purported logic/reasoning of the second sentence (‘This is not the case for male circumcision (…)’) is that the HIV/AIDS point distinguishes circumcision from FGM which has been noted in the first sentence to have a number of characteristics; but the HIV/AIDS point cannot negative the contention that circumcision also shares (or can share) those aforementioned characteristics.

Finally here, it should be noted that the UNICEF material makes merely passing reference to the practice of circumcision touching upon the issue in just three of its introductory sentences in a document running to a total of 54 pages. It cannot be said to be a document that provides any substantive analysis as to the possible comparison of FGM and circumcision. It also falls foul of the analysis that only FGM can be regarded as a grave act which, as already touched upon, is an analysis specifically negatived by Re B. 56

Building on the themes of the UNICEF material, Fornah then introduces the link between FGM and the control of female sexuality 57 but here it must be recognized that circumcision has itself not been a practice untainted by endeavours to contain, constrain, oppress, and attach shame to the experience of sexual pleasure. 58

The contrast with male circumcision is obvious: where performed for ritualistic rather than health reasons, male circumcision may be seen as symbolising the dominance of the male. FGM may ensure a young woman’s acceptance in Sierra Leonean society, but she is accepted on the basis of institutionalised inferiority. 59

The analysis that circumcision concerns the dominance of the male over other males is problematic for two key reasons. First, it is another oversimplification of matters relating to sex, gender and power as evidenced, in particular, by the active support from/involvement of certain women within numerous circumcision traditions/contexts—Antonelli noting, by way of stark example, that ‘Jewish women have died rather than repudiate the practice.’ 60 Secondly, even if there were no oversimplification here, how could this intra-sex domination contribute to the argument that circumcision should be regarded as categorically acceptable/reasonable? Surely any suggestion that the ‘dominance’ of A over B is acceptable/reasonable simply, or even in part, because A and B are both male is a suggestion that is inherently weak and ignores the point that patriarchy can harm boys/men and not just girls/women. 61 It also ignores the fact that Fornah itself rejects any suggestion, certainly in the context of persecution, that a harmful practice is somehow more tolerable if inflicted on an intra-sex basis. 62

Finally on the issue of patriarchy/gender inequality: when transposed into the family law analysis, the issue results in a loss of focus on the paramountcy principle/rights-based arguments. Let us, for a moment, take the patriarchy/gender inequality argument at its very highest. FGM is, in all circumstances, ‘an extreme and very cruel expression of male dominance.’ 63 Let us say that is not, in any way, an oversimplification but how does that actually help the family court determine whether it is reasonable/in accordance with the welfare paramountcy principle to allow for a boy to be circumcised? The argument is leading to another non-sequitur: conduct X is very cruel, in particular conduct X is, for the purposes of asylum law, a very cruel form of persecution; conduct Y is not; therefore conduct Y is reasonable—this notwithstanding the fact that conduct Y could, for the purposes of family law, be any number of unreasonable acts—anything from stubbing out a cigarette on a child’s arm, to making him eat dog food, or to breaking his back in a fit of anger: the examples are limitless. In short, whilst abhorrence of FGM is wholly justified, that abhorrence tells us nothing meaningful about why circumcision is regarded as reasonable.

In Re B another ‘important’ distinction between FGM and circumcision is as follows, ‘FGM has no basis in any religion; male circumcision is often performed for religious reasons.’ 64 This essential proposition is supplemented and contextualized by the observation that ‘large numbers of circumcisions are performed for reasons which (…) are as much to do with social, societal, cultural, customary or conventional reasons as with anything else (…)’ 65 and also by the observation that ‘The fact that it may be a “cultural” practice does not make FGM reasonable.’ 66 Within Re B , therefore, there appears to be a distinction drawn between religion and culture which is then accompanied by the following sub-distinctions: FGM is not religious but cultural (and in any event unreasonable) and circumcision is religious and cultural (and in any event reasonable). These interrelated contentions are problematic for five key reasons.

First, there are issues of definition. If it is to be said that there is a material distinction between culture and religion with purportedly different practices falling into one of these separate categories (or across categories) then consideration would have to be given to issues of definition—to where culture ends and religion starts (and vice versa). Yet Re B is silent on this and takes no account of the complexity of the following interrelated questions: what is ‘culture’, what is ‘religion’, and what is the relationship between ‘culture’ and ‘religion’, in particular in the context of FGM and circumcision? 67

Re B is further open to challenge here because, in overlooking definitional issues, it takes no account of the ‘trend of authority’ towards a more expansive understanding of what ‘religion’ is 68 —an approach that necessarily enhances the prospect of any particular practice being regarded by the law as religious. Moreover, even where we find workable definitions of ‘culture’, it is clear that it can be hard to extract the religious from the cultural 69 with the often-overlapping nature of culture and religion having also been identified in the specific context of FGM. 70

All this points to ‘culture’ as a very broad concept/phenomenon covering an extremely wide range of human activity/conduct some of which may be religious ie ‘religio-cultural activity/conduct’ and some of which may not be ie ‘cultural-only activity/conduct.’ To some extent, Re B’s analysis accounts for the subtleties of these dynamics because it recognizes that circumcision can be both religious and cultural but its analysis is silent on the possibility of similar subtleties being at large in respect of FGM—that being classified, in essence, as a ‘cultural-only’ practice with no consideration being given as to whether that classification may be incomplete/erroneous.

The second, and closely related key reason as to why the contention that FGM ‘has no basis in any religion’ is problematic, is that the assertion reads as a statement of concluded fact and one which is made in a context in which the court had apparently heard or been presented with no expert evidence and/or argument on the point. 71

Third, it is right that there is nothing in the Quran which specifically mandates the practice of FGM but that can equally be said of the Quran and circumcision—but with both practices being referred to in the hadith (reported sayings of the Prophet Muhammed). 72 Quranic silence alone, therefore, does not allow for any credible assertion that a particular practice is unIslamic; nor, because of the hadith , can it necessarily be said that there is no authoritative textual basis for FGM within Islam. For as Esposito and Delong-Bas note, there are hadith which have been understood by some (albeit controversially) to refer to and support FGM in consequence of which: ‘[Islamic] Law schools are divided on whether FGM/FGC is permitted, obligatory, forbidden, or to be left to parental discretion.’ 73

Accordingly, it is not necessary for a belief to be shared by others in order for it to be a religious belief, nor need a specific belief be a mandatory requirement of an established religion for it to qualify as a religious belief. A person could, for example, be part of the mainstream Christian religion but hold additional beliefs which are not widely shared by other Christians, or indeed shared at all by anyone. 74

Another aspect of the scriptural/textual issue is this: if the assertion that FGM ‘has no basis in any religion’ is underpinned by a purported lack of scriptural/textual mandate for FGM then the implication of that is that were there to be such a mandate then there would be a commonality with circumcision (mandated as it is in the Hebrew Bible 75 ) and further, because of that scriptural/textual mandate, there would be a capacity for FGM to be regarded as a reasonable/acceptable practice. However, a key difficulty here, for both practices , is that the law does not recognize any necessary connection between conduct being mandated (or arguably mandated) by scripture and its acceptability. For rightly the law recognizes that just because X is (or is arguably) mandated by scripture it cannot necessarily follow that X is reasonable. 76 Building on that point, it also has to be recognized that the law does not recognize any necessary connection between religion, reasonableness and a child’s best interests—which is to say that just because X is a religious practice cannot necessarily make it a practice that the law can recognize as acceptable. 77

The above analysis cuts to the core of the purported culture/religion distinction between FGM and circumcision for the following fundamental reason: if, ultimately, a religious practice can be properly deemed as unreasonable then it must follow that the religious quality of circumcision cannot, alone, be determinative of the categoric acceptability of the practice.

Fourth, the assertion that FGM ‘has no basis in any religion’ takes no account of the wealth of evidence that, for many people, FGM does have such a basis. That is clear even from material that was before the court in Re B itself—in the form of UNICEF’s Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change. 78 According to its foreword, the statistical overview ‘examines the largest ever number of nationally representative surveys from all 29 countries where FGM/C is concentrated, including 17 new surveys undertaken in the last three years.’ 79 It reports that in 4 out of 14 countries (namely Mali, Eritrea, Mauritania, and Guinea) more than 50 per cent of girls/women questioned regarded FGM as a religious requirement. In 2 of the same 14 countries (namely Mauritania and Egypt) more than 50 per cent of boys/men questioned regarded FGM similarly (with 49 per cent of girls/women questioned in Egypt regarding it as a religious requirement). 80 Whilst in other countries the percentages were not as high, they were plainly of statistical relevance pointing to the notable existence of a belief in those countries that FGM is a religious requirement.

there is an important distinction between arguing that a particular Islamic community is incompatible with international human rights or the fundamental ideology of the United Kingdom State, and arguing that it is unIslamic. 82

Now had the Court in Re B engaged with the fact of the widespread belief evidenced by UNICEF what would the outcome have been? The court would either have had to reach a different conclusion ie determine that, in fact, FGM does have a basis in religion thereby allowing for one of its ‘important distinctions’ 83 between FGM and circumcision to fall away; or, it would have held fast in its determination. However, in light of the fact of the widespread belief could the court have actually maintained its determination that FGM ‘has no basis in any religion’? To do so would be to conclude, essentially, that those who regard FGM as a religious requirement are wrong . That, it is argued, would be a determination which the court simply could not have made. For in doing so, it would have been impermissibly adjudicating upon the content and validity of a belief and compromising the principle of state neutrality. 84

Fifth, the assertion that FGM ‘has no basis in any religion’ is one that, without any explanation, simply assumes that FGM can be ‘de-linked’ from religion. Whilst it is arguable that there can be such a de-linking, 85 we have here only the statement of a conclusion with no preceding analysis—thereby leaving the conclusion vulnerable. Further, in respect of the attempt to distinguish FGM from circumcision, no detailed reference is made to the arguments that circumcision can be also de-linked from religion. 86 The key point here then is this: if both practices can be so de-linked then plainly another important purported distinction between them breaks down.

Re B notes that ‘comparatively few male circumcisions are performed for therapeutic reasons’ 87 but that ‘the justifications’ sometimes advanced for male circumcision are that it is ‘hygienic or has prophylactic benefits, for example, the belief that it reduces the incidence of penile cancer in the male, the incidence of cervical cancer in female partners and the incidence of HIV transmission.’ 88 Latterly, these observations ground one of the ‘at least two important distinctions’ between FGM and circumcision namely, ‘FGM has no medical justification and confers no health benefits; male circumcision is seen by some (although opinions are divided) as providing hygienic or prophylactic benefits. Be that as it may, “reasonable” parenting is treated as permitting male circumcision.’ 89

Re B is correct in its necessarily pithy summation of the health/medical evidence in relation to FGM and circumcision, but does that make it right to posit the health/medical argument, for the specific purposes of family law, as one of the ‘important distinctions’ between FGM and circumcision?

First, whilst Re B correctly observes that ‘opinions are divided’ 90 on circumcision, there is a clear preponderance of high-level professional opinion that points away from the conclusion that circumcision is generally beneficial. The British Medical Association, the Danish Medical Association, the Royal Dutch Medical Association, the Canadian Paediatric Society, and the Royal Australasian College of Physicians have all concluded that the purported benefits of circumcision do not outweigh its associated risks/justify the intervention in the vast majority of cases 91 —a point, in respect of the BMA, which underpins the essential fact of there being no policy of routine neonatal circumcision in the UK. The obvious outlier, taking the contrary view, has been the American Academy of Pediatrics but even here there has been internal inconsistency in the analysis—‘the health benefits of newborn male circumcision outweigh the risks and justify access to this procedure for families who choose it’ and yet, as the BMA notes, 92 there is no recommendation made by the AAP for routine circumcision on health grounds. Indeed, according to the AAP, ‘Parents should weigh the health benefits and risks in light of their own religious, cultural and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.’ 93 So even for the AAP it is clear that, ultimately, the decisive factor in favour of circumcision may well be religious/cultural rather than health/medical-related. It is also of note that the AAP’s risk/benefit analysis has been ‘heavily criticised.’ 94

Following on from the above, Re B’s observations as to the purported health benefits of circumcision are weakened by the fact that no detailed consideration is given to the potential disadvantages/risks associated with the procedure—which can be numerous, grave and even fatal. 95 Further, should it be said that that the rarity of significant complications is such that circumcision can remain categorically reasonable, it must be remembered that family law’s general approach to risk and medical certainty/uncertainty shows us (in a manifestation of ‘the precautionary principle’) that even where there is apparent medical certainty (let alone uncertainty) and even where the risk of serious harm is low, courts are ever mindful of the possibility of error and pitfall. 96

As to those conditions where circumcision may be an appropriate intervention, the medical literature points to those conditions being uncommon if not positively rare, especially in young children. It also points to circumcision being an intervention appropriate for consideration only when other, less invasive treatments, have been unsuccessful. 97

In respect of purported prophylactic benefits, Re B cites three specific examples: the reduction in the incidence of penile cancer, cervical cancer, and HIV transmission 98 but what is plain here is this: even according to the AAP, the obvious peer national medical organization with the most sympathetic view of circumcision, a boy is unlikely to get penile cancer 99 and his circumcision is unlikely to have an appreciable impact on the incidence of cervical cancer. 100 As to HIV prevention, it is right that there is evidence pointing to circumcision having reduced transmission in certain areas of Africa. 101 It is hard to see, however, why that fact might make the procedure a necessary response to the welfare needs of a boy born in a country where, once of a sexually active age, he will have other less invasive options for practising safe sex readily available to him and according to his own informed choice—the British Association of Urological Surgeons noting that even the World Health Organization (which has taken a lead on reporting the case for circumcision to combat HIV transmission) ‘does not recommend routine circumcision in developed nations (…).’ 102

So, at this point in the analysis, it would seem very difficult to conceive of circumstances in which the family court could actually allow for the circumcision of a boy for any of the above prophylactic reasons from which it must follow that reference to penile cancer, cervical cancer, and HIV transmission cannot feed into a sound justification for family law’s categorically different treatment of FGM and circumcision.

Reliance upon prophylactic possibilities as a reason to justify circumcision also brings with it the issue of third-party interests—ie the interests of those who might, in future, come into contact with the boy whose circumcision might be contemplated; but an analysis of how third-party interests are addressed in family law shows that they could not be regarded as determinative. First, there is the paramountcy principle within section 1 of the Children Act 1989 which makes it plain that it is ‘the child’s welfare’ which shall be the court’s ‘paramount consideration’—ie the child who is the subject of the given application before court and not others who here might be the future sexual partners of the subject child. 103 Further, it seems reasonable to assume that much, if not all, of the sexual activity in question would, in due course, be taking place between adults but under section 1 the court is concerned primarily with determining questions pertaining to ‘the upbringing of a child’ not questions pertaining to that child’s future adult life. 104

This analysis is supported by the law concerning incapacitous adults and whether they can be subject to medical intervention for the benefit of others—it having been stated in Re A (Male Sterilisation) that ‘Social reasons for carrying out of non-therapeutic invasive surgery is not part of the present state of the law.’ 105 It is also supported by the law on vaccination—there being an obvious third-party benefit from such an intervention. In Re H (A Child) (Parental Responsibility: Vaccination) it was noted both at first instance and on appeal that vaccinating children is for ‘the public good’ 106 and ‘society more generally.’ 107 However, in both these passages and the first instance and appeal judgments taken as a whole, it is clear that the wider third-party interest of vaccination is a supplementary or a tangential ‘bolt-on’ point to the primary issue, namely whether standard childhood vaccinations are for the benefit of the subject child in question and there is no suggestion that it is the third-party benefit that makes it in the welfare interests of such a child to receive those vaccinations. 108

It also has to be noted that any proposition that circumcision might be reasonable in order to protect a boy’s future sexual partner ultimately brings into the frame the question as to whether and, if so, in what circumstances it could be right for A to ask/permit B to harm C for the benefit of D—where, in these circumstances, A is the parent/judge, B the circumciser, C the boy being circumcised and D the person who might be at risk of cancer/HIV. That question, in turn, brings to the fore the related concepts of self-defence and necessity, in particular in so far as they may be at large when health/medical intervention is being considered.

The leading authority here remains Re A (Children) (Conjoined Twins: Surgical Intervention) 109 where the Court of Appeal considered whether the conjoined twins of devout Roman Catholics (Jodie and Mary who were held to be separate persons) could be lawfully separated in circumstances where, in any event, Mary would die and Jodie could only live were that separation to take place. The appeal ‘ranged quite widely over many aspects of the interaction between the relevant principles of medical law, family law, criminal law and fundamental human rights’ 110 and, exceptionally, saw the provision of written submissions from the Archbishop of Westminster. In dismissing the appeal and allowing for the separation, the court concluded that those involved in the procedure would be able to avail themselves of the principles of self-defence and/or necessity thereby allowing for the lawfulness of Mary’s death which would inevitably flow from the separation.

The circumcision of a boy to benefit a future sexual partner would fail the tests both of quasi-self-defence and necessity as identified in Re A 111 and for comparable reasons. It would fail the former because the action of circumcision exceeds what is reasonably required for practising safe sex, with the BMA noting the obvious point that ‘some of the anticipated health benefits of male circumcision can be realised by other means—for example, condom use.’ 112 Further, and specifically in relation to reducing the incidence of cervical cancer, the circumcision of a boy to meet that aim plainly assumes that that boy will go on to have only, or mainly, female sexual partners. Were that not the assumption there would be no rationale behind the aim and the assumption is, of course, unjustifiable. Similarly, circumcision would fail the necessity test at its very first hurdle because it cannot be said that the circumcision of a boy is, in the language of Re A , ‘needed to avoid inevitable’ 113 incidence of cervical cancer in female partners or the incidence of HIV transmission—the medical literature being clear that such incidences are far from an inevitable consequence of a boy not being circumcised.

The other point of real note arising from the various related legal principles considered in Re A is the reminder/clarification as to just how significant the right to bodily integrity really is—it is part of the doctrine of the sanctity of life and the right to life. Further, in respect of Jodie, who could survive, that right to bodily integrity was held in the balance in favour of the operation. That much is perhaps unsurprising but more to the point—as evidence of the centrality of the right to bodily integrity—is the fact that that right was in respect of Mary also held in the balance in favour of the operation—ie one of the reasons why the operation was permitted was because it would allow Mary her right to bodily integrity even though that would bring about her swifter death. 114

The overall point here is not that what Re B says about the health/medical science is wrong. The point is, the science cannot, for the purposes of family law, help ground a generalized proposition that circumcision is categorically reasonable; it can merely ground the proposition that in some specific but rare circumstances it may be necessary; but in those circumstances, circumcision is no different to any other form of required medical intervention—it is simply something that is needed and in respect of which there is unlikely to be realistic argument. 115 It is further of note here that, pursuant to section 1(2) of the Female Genital Mutilation Act 2003, interventions which would otherwise amount to an offence do not trigger liability when ‘necessary’ for a girl’s ‘physical or mental health’ or if carried out in connection with labour. So, to this extent, circumcision and FGM (or certainly interventions that would otherwise amount to an offence) are the same—they can both, in limited circumstances, be regarded as necessary.

Linked to this, is the point that (of course) there is no generalized policy of removing the body parts of children that might, in the future, succumb to or spread disease. Noting that penile cancer is, essentially, a form of skin cancer, 116 Gollaher puts it like this, ‘A high percentage of skin cancers eventually develop on the nose (…); but this has not led physicians to recommend prophylactic rhinoplasties.’ 117

A. Wider context

The life of the law has not been one of logic; it has been experience. The felt necessities of the time, the prevalent moral and political theories, intuitions of public policy, avowed or unconscious, even in the prejudices which judges share with their fellow-men, have had a good deal more to do than the syllogism in determining the rules by which men should be governed. 119

The pragmatic approach to law was announced in the famous opening sentence of The Common Law (1881) (‘The life of the law has not been logic; it has been experience’) (…) Holmes rejected the then orthodox notion that judges could decide difficult cases by a process of or very similar to logical deduction from premises given by authoritative legal texts, or by unquestioned universal principles that inspire and subsume those texts (‘natural law’). He argued that judges in difficult cases made law with reference to the likely social and economic consequences of their decisions, and that their intuitions about those consequences, rather than the abstract moral principles and formal legal analysis deployed in conventional judicial opinions, drove legal change and had made the law what it had become. 120

With this theoretical background in mind, we turn to section 1 of the Children Act 1989 and the principle that a child’s welfare is the court’s ‘paramount consideration.’ Welfare is assessed not simply by reference to the statutory criteria of section 1(3) of the 1989 Act (the ‘welfare checklist’) but also with reference to a more fundamental understanding of what ‘welfare’ is and it is of particular note here that in the very same paragraph in Re B where Sir James Munby P cites Holmes, he also signposts us to a passage within one of his own earlier judgments addressing the interaction of family law and religion— Re G (Education: Religious Upbringing) 121 —a passage which sits within a wider discussion as to the meaning of ‘welfare.’ 122

In Re G , we see the court touching upon what are five interrelated limbs which are collectively vital for an understanding of what family law is and vital, therefore, for our identifying better reasons for family law’s different treatment of FGM and circumcision. These are as follows: (i) welfare is concerned with ‘general community standards’; (ii) family law must, within certain ‘limits’, tolerate parental autonomy; (iii) save for in exceptional circumstances, there is ‘no bright-line test’ when assessing welfare; (iv) family law is concerned with social change; and (v) by way of overall conclusion, in family law ‘context is everything.’

B. General community standards

According to Re G , ‘A child’s best interests have to be assessed by reference to general community standards (…).’ 123 With the introduction of this notion, comes the argument that what is deemed reasonable and in the best interests of a child is intimately connected to (albeit not coterminous with) what is and/or has been common, customary or conventional practice. 124 With this in mind, we can see an obvious distinction between FGM and circumcision—at least within this jurisdiction—which is this: unlike FGM, circumcision has been a practice widely familiar to this jurisdiction for centuries.

In considering this disjunct of old and new, it is instructive to consider the context in which it became possible to legislate against FGM, in particular, by looking at the passage of the Prohibition of Female Circumcision Act 1985—the predecessor to the Female Genital Mutilation Act 2003.

Writing in 1988, Sochart notes ‘It has only been in the last few years that the subject of female circumcision has begun to be discussed openly in Britain’ 125 and that ‘the first step (…) which would eventually set the issue of female circumcision firmly on the British political agenda’ was Lord Kennet’s tabling of Parliamentary Questions for Written Answer in—and this is the critical point—1982. 126 This date goes to the crux of the matter—when Parliament (rightly) criminalized FGM (‘female circumcision’ as it was then known) it was tackling what it perceived to be a largely new issue in the UK— a new phenomenon.

While people have been coming from overseas to settle in England since time immemorial, the level of immigration from former British colonies and the New Commonwealth since 1945 has created many distinct ethnic minority communities (…) many of their customs (…) are the product of traditions and value systems in countries and communities whose economic and social structures are vastly different from those of modern Britain. The role of women and their legal status furnish just one very clear example of what may be broadly portrayed as a ‘clash of cultures’ when people from traditional rural societies in Africa or Asia settle and work in English towns and cities. 127

The mutilation and impairment of young girls and women have no part in our way of life . 128

When the British public realised that young girls, adolescents and women were being mutilated and impaired because of the practice of female circumcision being undertaken in Britain there was an upsurge of revulsion and horror among many people. It must be clearly spelt out that there is no place in our society for this custom and that it is no part of our way of life (…) I hope the message will be put over to all the groups concerned that in Britain women cannot be mutilated in this way; it is just not done (…) this is not part of our British culture. 129

What is plain from the above, is that the arguments that allowed for the criminalization of FGM in 1985 were not arguments predicated simply upon health or rights-based issues—they were arguments predicated on FGM being seen as new, unknown, foreign, and ‘un-British.’ What we have with circumcision is very different—circumcision has, for a number of reasons, been a known and accepted community standard in this jurisdiction for a long time . Going back to Poulter, by 1985 there were in excess of 300,000 members of the Jewish community in Britain and over a million Muslims—communities for whom the circumcision of boys was and is entirely mainstream and expected. 130 Whilst Britain’s Muslim population has only become of particular numerical/cultural significance since 1945, 131 Jewish communities settled in England following the Norman Conquest—being expelled from the country under Edward I in 1290 132 and returning under Oliver Cromwell in 1655. 133 In 1667, the first reported case to make reference to circumcision acknowledged the centrality/value of the practice to the Jewish faith 134 and by the late 19th century there were Jewish MPs and, in the form of Benjamin Disraeli, a Prime Minister who according to Goodman maintained an ‘open pride in his Jewish background.’ 135

It must also be recognized here that there is no disconnect between Christianity and circumcision—on the contrary, its relationship with Judaism means that the circumcision tradition, whilst not regarded as a literal obligation, is one that is nevertheless acknowledged and respected as forming part of its own religio-cultural heritage. A particularly acute example of that point is the fact that the Book of Common Prayer (readily available on the Church of England’s website) includes—as it has done for centuries—text making direct reference to the circumcision and naming of Jesus—all to be read on 1st January ie on the eighth day after his birth with the established Church thereby referencing, respecting, and underpinning the Jewish tradition that circumcision and naming take place on that given/particular day. 136 Nor is there any religio-cultural disconnect between Christianity and Islamic circumcision—Islam, like Judaism and Christianity, ultimately being an Abrahamic tradition with circumcision, therefore, being a commonly respected thread within all three faiths. 137

Looking then to the relationship between religion and law—and very much including how that relationship affects children—it must be acknowledged that our legal decision-making has long since and inevitably been influenced by the UK-dominant, ie a white Judaeo-Christian, world view. So it is that Hale and others frankly note that ‘(…) for many of us the “norm” is actually our understanding of the ethnic European White model of families.’ 138

the relatively liberal approach taken by the Court and Commission to the definition of religion or belief is subtly undermined at the manifestation stage (…) Whilst minorities and individualistic believers are recognized as deserving of protection under the Convention, that protection has only extended to manifestations that are highly analogous to Christian beliefs (…) Both tests disproportionately affect minorities whose practices may be less familiar to the Court and who are likely to be subject to great social pressure from private actors such as employers to forgo their religious practices in order to better assimilate into the dominant culture. 140

Aside from issues of religion and looking now to purported health/medical reasoning, the circumcision of boys both in the USA and the UK had, by the first half of the 20th century, become a very common—effectively routine—procedure with Carpenter noting that ‘By 1940, about 40 percent of British boys and 60 per cent of US boys were circumcised as a preventative health measure.’ 141 Whilst, certainly in the UK, these figures have dropped significantly over the decades, 142 the high water mark of that 1940 figure shows that circumcision was a very well established practice in the UK such that by 1985 there was a good prospect that any man in his mid-forties or thereabouts would have undergone the procedure.

So, the overall point then on ‘general community standards’ is this: by the time we get to 1985 there was, unlike with FGM, nothing new, unknown, foreign, or somehow ‘un-British’ about circumcision. That FGM could be characterized in that manner aided its criminalization which has then since fed into family law’s ability to treat circumcision and FGM differently—it being of note that the very first point that Sir James Munby P rightly makes in Re B , having just posited the question as to whether FGM amounts to significant harm, is that FGM is ‘a criminal offence.’ 143

C. Toleration and parental autonomy

We have moreover to have regard to the realities of the human condition, described by Hedley J in Re L (Care: Threshold Criteria) [2007] 1 FLR 2050 , [50]: … society must be willing to tolerate very diverse standards of parenting, including the eccentric, the barely adequate and the inconsistent. It follows too that children will inevitably have both very different experiences of parenting and very unequal consequences flowing from it. It means that some children will experience disadvantage and harm, while others flourish in atmospheres of loving security and emotional stability. These are the consequences of our fallible humanity and it is not the provenance of the state to spare children all the consequences of defective parenting. In any event, it simply could not be done. 144

Re G , with this citation of Re L , 145 tells us that parents, in reality, have a considerable degree of scope to care for their children as they see fit— even where that care may be said to cause disadvantage and harm. 146 This principle of tolerance and the parental autonomy to act in a way that may seem to be, or actually is , harmful to children, is a significant factor in understanding why family law treats FGM and circumcision differently. Re G and Re L show us that, as a matter both of principle and practicality, family law recognizes that it can only go ‘so far’ in its interventions. It is a system that has to accept its limits and with that a system that has to accept that there will be harm (even significant harm) caused to children that some may find objectionable. Looping back to the Holmes/Posner point, what would be the consequences of Sir James Munby P having decided otherwise in Re B— which is to say, what would have been the consequences of him having decided that circumcision, like, FGM could never fall within the ambit of reasonable parenting and that the practices must be treated exactly the same ?

Leaving aside any question of appeal, that would have resulted in a situation whereby (with the tap of a keyboard) circumcision, likely practiced in this jurisdiction on and off since time immemorial, would have been categorized by way of unelected judicial determination as being not only unreasonable but—like FGM and forced marriage—‘evil’, ‘repulsive’, ‘utterly unacceptable’, a ‘gross abuse of human rights’, and ‘an abomination’ 147 —for that is what it would actually mean to say that FGM and circumcision are the same. That would have been a sudden and radical departure from the ‘general community standards’ according to which circumcision has long since been regarded as acceptable and that so without any kind of consultative or legislative process which we might reasonably argue would be necessary given that, to date, Parliament has seen fit to legislate against FGM but not circumcision.

On a practical level, any such determination of equality would have to trigger state intervention. 148 Under section 47 the Children Act 1989, local authorities have a duty to investigate where there is ‘reasonable cause to suspect’ a child in their area is likely to suffer significant harm with a view, in particular, to ‘establishing’ whether an application for public law orders should be made—the relevant statutory guidance making specific reference to concerns around FGM triggering this duty. 149 Were circumcision to be treated by family law in the same terms as FGM then there would have to be public law applications from local authorities across the jurisdiction for the immediate removal of every Jewish and Muslim boy who might be likely to be circumcised. In respect of the Jewish community—given the tradition of circumcision on the eighth day 150 —that would entail applications for the removal of new-born babies with the leading authorities having long since recognized the particularly draconian nature of such removal. 151

The above developments would be horrifying for any member of the Jewish and Muslim community. It is also hard to imagine that the majority outside those practising communities would accept such an outcome. As postulated in Re G , ‘the reasonable man or woman (…) is (…) broad-minded, tolerant, easy-going and slow to condemn.’ 152 With that characterization in mind, it is hard to see how wider public opinion would support judge-made law going in the direction of equal treatment—for that ‘easy-going’ temperament would surely not tolerate the sight of likely thousands of Jewish and Muslim boys being removed from their parents’ care pending court determinations as to their long-term futures.

D. Exceptionality and bright-line tests

40. Where precisely the limits are to be drawn is often a matter of controversy. There is no ‘bright-line’ test that the law can set. The infinite variety of the human condition precludes arbitrary definition. 41. Some things are nevertheless beyond the pale: forced marriages (always to be distinguished of course from arranged marriages to which the parties consent), female genital mutilation and so-called, if grotesquely misnamed, ‘honour-based’ domestic violence. 153

The above appears to contain a tension: on the one hand, there is ‘no “bright-line” test’ but on the other ‘Some things are nevertheless beyond the pale.’ According to Lord Hughes in R (Tigere) v Secretary of State for Business, Innovation and Skills , a bright-line rule is a rule which is ‘simply stated, readily understood and easily applied.’ 154 They are ‘rules based on readily ascertainable facts’ as opposed to ‘rules based in part on an evaluative exercise.’ 155 With that in mind, it would seem that the point Munby LJ makes above is that, ordinarily, family law does not involve bright-line tests but that, equally, there are exceptions to that in the form of certain types of conduct, including FGM, which are necessarily and always to be condemned as unreasonable. Re B ’s contention then that ‘it can never be reasonable parenting to inflict any form of FGM on a child’ 156 becomes a rare but wholly justified ‘bright-line’ rule in family law. This is in the sense that once the basic facts are established—ie FGM has taken place or is likely to—then, automatically and with no further evaluation being required, unreasonable parenting is established.

Now the extent to which family law does or does not contain clear rules has been remarked upon widely. For example, Ferguson and Brake ask rhetorically ‘What defines family law? Is it an area of law with clean boundaries and unified distinguished characteristics, or an untidy grouping of disparate rules and doctrines?’ 157 Answers to those questions have, over the years, included Douglas’ view that family law ‘has emerged as a body of law concerned with regulating a non-legal concept (…) it has grown piecemeal in response to perceived social changes, often presented as “problems” to be tackled’ 158 and Dewar’s idea of ‘normal chaos’ which he extrapolates in this way: ‘I want to suggest that many contemporary developments in family law can be characterised as chaotic, contradictory or incoherent (…) Family law, I shall suggest, is contradictory, disordered, incoherent and, in part at least, antinomic.’ 159

With this understanding of what family law is—and more importantly is not—the picture as to why FGM and circumcision are treated differently becomes clearer. That is to say, the question ‘why does family law treat female genital mutilation and circumcision differently?’ implies (albeit not unreasonably) an expectation of obviously equal treatment. However, there is in fact no reason to expect family law to have or generate clear ‘bright-line’ rules and, where it does exceptionally confront an issue by that means, there is limited reason to expect that rule to have an obvious counterpart on a separate but arguably similar or even very similar issue. To expect such a counterpart or a broader application/formulation of a ‘bright-line’ rule would be to expect a coherence or consistency within family law which it is widely acknowledged as not having. Whether that absence of coherence or consistency is a good, bad, or indifferent thing is not—for present purposes—the issue. Rather what is central here, is that that absence is a feature of family law which goes to explain its different treatment of FGM and circumcision—that different treatment being, in part, a natural outworking of what family law is.

Taking the analysis a step further, it is suggested that a core reason underlying the lack of coherence in the law regarding FGM and circumcision lies in the constraints associated with the consistent application of any bright-line rule according to which both practices were to be regarded as, in all circumstances, unreasonable. As already touched upon, any such approach/rule would have significant legal and practical consequences which—absent the endorsement of Parliament—would be unlikely to enjoy public support. So whatever fundamental similarities there may be between FGM and circumcision there could be no judge-made extension of the bright-line rule to cover both practices—as Dewar notes (with reference to the French sociologist Pierre Bourdieu and with an echo of Holmes), ‘the logic of following a rule ceases at the point at which logic ceases to be practical.’ 160

E. Social change and ‘Felt Necessities’

It is a fundamental fact in this argument that in 1985 the movement against FGM had garnered enough traction for the passage of legislation criminalizing the practice and family law has, over time, responded to the essential social change that is criminalization. Whilst in recent decades there has been growing opposition to the circumcision of boys, the move against the practice has not attained a momentum that is remotely comparable. 161 So, in allowing for the different treatment of FGM and circumcision family law is simply responding to social change or its lack thereof—which is family law acting entirely in accordance with its own essential nature. To say that, somehow, family law is ‘wrong’ to allow for such different treatment would be to overlook what family law is and what it is capable of doing.

As we focus in further on the ‘social change’ point— why does family law promote (or to use Re B ’s language) ‘tolerate’ there having long-since been change for girls and not for boys—in particular, given that equal treatment lies at the heart of human rights discourse? 162 This is a question which takes us back to the Holmes quotation and, in this context, it is suggested that the legitimate ‘felt necessities’ of our time are, and have been for some time, two-fold. First, there is the drive for the protection of women and girls from all forms of violence. That FGM is rightly regarded as a form of violence against women and girls was a point articulated during the course of the passage of the Prohibition of Female Circumcision Bill 163 as was the related point that the fight against the practice was being advanced within the wider context of the United Nations Decade for Women. 164 Far more recently, this theme continues to be seen in the Government’s 2021 strategy document, Tackling Violence Against Women & Girls . FGM is referred to over 50 times in this 85-page document including twice within the lead forward. Further, reflecting the strategic significance of the linking of FGM to policies designed to combat violence against women and girls more generally it is of importance that, according to the strategy’s ‘note on terminology’, FGM is— by definition— to be understood as falling under the core umbrella term of ‘violence against women and girls.’ 165

It is hard to think of a more appalling decision. Did the court know that circumcision is the most ancient ritual in the history of Judaism, dating back almost four thousand years to the days of Abraham? Did it know that Spinoza, not religious but with John Locke the father of European liberalism, wrote that brit milah in and of itself had the power to sustain Jewish identity through the centuries? Did it know that banning milah was the route chosen by two of the worst enemies the Jewish people ever had, the Seleucid ruler Antiochus IV and the Roman emperor Hadrian, both of whom set out to extinguish not only Jews but also Judaism? Either the court knew these things or it did not. If it did not, then how was it competent to assess the claim of religious liberty? If it did, then are judges in Germany quite willing to say to religious Jews, in effect, ‘If you don’t like it, leave.’ Do judges in Cologne today really not know what happened the last time Germany went down that road? 166

F. Context and conclusion

The final and concluding ‘wrap around’ point arising from Re G is that, in family law ‘context is everything.’ 167 When we place FGM and circumcision in their broadest contexts we can see material differences between the practices: FGM was barely known to this jurisdiction when it was first criminalized in 1985; the same could not be said of circumcision. By the time of Re B in 2015, FGM had then long since been recognized as a crime and a breach of human rights; the same could not be said of circumcision. Had Sir James Munby P determined in Re B that FGM and circumcision could never fall within the ambit of reasonable parenting then judge-made law would have—overnight—triggered the need for public law applications in respect of thousands of otherwise unimpeachable parents who, up until that point, had simply been adopting or intending to adopt a practice which had long since been regarded by the state as reasonable. The fight against FGM represents a particular concern within a wider and long-standing global movement aimed at advancing the rights and protections of girls and women; in contrast, and for want of comparable necessity, there has been no such global movement in relation to boys and men within which the circumcision question might be pressed. 168 In the minds of some within the Jewish community, there is a direct and understandable link between any challenge to the circumcision tradition and manifestations of antisemitism in Europe, in particular the Holocaust. In respect of FGM, there is no such linkage or association. The wider context within which FGM and circumcision are set is, therefore, very different thereby allowing a distinction to be drawn.

It is suggested that what we see in the leading authorities on FGM and circumcision is a repeated judicial effort to establish a distinction between the practices so as not to fall foul of that maxim that like cases should be treated alike. 169 However, this endeavour to rationalize the different treatment by reliance upon (i) precedent-based arguments, (ii) cultural/religious arguments, and (iii) health/medical arguments is an endeavour that falls short or is incomplete. This is because when each of these arguments is scrutinized in detail, it becomes apparent that the practices are not materially different in the way contended. It also has to be remembered here that, prima facie , the authorities countenance no appreciable similarities at all— a position which makes the law, as it currently stands, particularly vulnerable in the sense that we need to only identify one ‘black swan’ of similarity to undermine the universal ‘white swan’ claim that there is no comparison. 170

This falling short does not mean, however, that good reasons cannot be found or developed to justify a distinction being drawn but those reasons are to be found elsewhere—beyond the particularities upon which the leading authorities specifically rely and within the wider fundamentals of family law itself. In particular, the core of a properly drawn distinction between FGM and circumcision lies in the interaction between the five interrelated limbs as referenced in and extrapolated from Re G .

These collectively point to the nature of family law as a pragmatic system which develops in an ad hoc manner by way of responding to particular social problems, challenges, or pressures with FGM having been democratically perceived as demanding a categoric and zero-tolerance response in a way that circumcision simply has not. To demand equal treatment of boys and girls in respect of the practices is, on one analysis, entirely reasonable but it is a demand that does not take account of what family law is and, in particular, what the primary question is for judges dealing with children. That question is not ‘How do I enforce obviously equal treatment?’ but rather ‘What is in this child’s best interests?’—the question which brings into the frame the five interrelated limbs/principles of Re G.

In challenging judgments as I have done, I must also conclude, to some extent, in defence of the judiciary. The writing of a judgment is not an ‘examination’ 171 and as Posner says judges are not (at least when sitting) ‘law professors.’ 172 Their task is not to take the broadest discursive approach to a topic—it is to decide a specific dispute and under pressure of time. 173 It also has to be noted that Lady Hale does point to the centrality of context as a justification for the different treatment, 174 and Sir James Munby P notes the pragmatism of Holmes as relevant to understanding that different treatment. 175 In a sense, therefore, the better reasons for the different treatment are touched upon within the leading authorities but, as has been argued, their primary focus is on far more specific purported differences which, upon detailed scrutiny, fall away.

Also, whilst judgements are not ‘examinations’ and whilst judges are not ‘law professors’ the subject matter here is multidisciplinary and highly complex with a literature base that is ever burgeoning. 176 Rightly then, expert evidence has been adduced in the leading cases and, rightly, Re B notes ‘These are deep waters (…)’ 177 but the family justice system ought not to be able to have it both ways—by which I mean it ought not to be able to contend that family judges are simply busy decision-makers lacking the capacity to navigate the ‘deep waters’ whilst simultaneously permitting them to set out across those waters by drawing/adopting comparisons in circumstances where those comparisons become extremely vulnerable to challenge.

Either the judiciary is well placed to make and examine the comparisons between FGM and circumcision or it is not and the position as we currently have it sits unsatisfactorily between the two ends of that spectrum.

Re B (Children) (Care Proceedings) [2015] EWFC 3, [2015] 1 FLR 905 [55], [64], [72]–[73].

[2015] EWFC 3, [2015] 1 FLR 905 as followed, in particular, by Re L (Children) (Specific Issues: Temporary Leave to Remove from the Jurisdiction: Circumcision) [2016] EWHC 849 (Fam), [2017] 1 FLR 1316 and Re P (Circumcision: Child in Care) [2021] EWHC 1616 (Fam), [2022] 4 WLR 53.

Proceedings by which the state secures the temporary or permanent removal of children from their parents’ care.

Re B (n 1) [54].

Re B (n 1) [68].

Re B (n 1) [71].

Re B (n 1) [68]–[72].

Re B (n 1) [73].

Marie Fox and Michael Thomson, ‘Foreskin is a Feminist Issue’ (2009) 24 Australian Feminist Studies 195; Brian D Earp, ‘Female Genital Mutilation and Male Circumcision: Toward an Autonomy-Based Ethical Framework’ (2015) 5 Medicolegal and Bioethics 89; J Steven Svoboda, Peter W Adler and Robert S Van Howe, ‘Circumcision is Unethical and Unlawful’ (2016) 44 The Journal of Law, Medicine & Ethics 263; Brian D Earp, Jennifer Hendry and Michael Thomson, ‘Reason and Paradox in Medical and Family Law: Shaping Children’s Bodies’ (2017) 25 Medical Law Review 604; E Katariina Paakkanen, ‘Entitled, Empowered or Victims – an Analysis of Discourses on Male and Female Circumcision, Genital Mutilation/Cutting and Genital Cosmetic Surgery’ (2019) 23 The International Journal of Human Rights 1494; Kai Möller, ‘Male and Female Genital Cutting: Between the Best Interest of the Child and Genital Mutilation’ (2020) 40 Oxford Journal of Legal Studies 508.

Re B (n 1) [64], [72]; [2006] UKHL 46, [2007] 1 AC 412; [2013] EWCA Civ 888, [2014] Imm AR 170.

SS Malaysia (n 10) [14].

Re B (n 1) [60].

Re B (n 1) [69].

Re B (n 1) [72].

Fornah (n 10) [2], [4].

Fornah (n 10) [1]. See also [70].

Fornah (n 10) [31], [91], [93]. It is unclear whether [53], [95] make indirect reference to circumcision.

Fornah (n 10) [31], [91].

Halsbury’s Laws of England (5th edn, LexisNexis 2020) vol 11, para 26: ‘Statements which are not necessary to the decision, which go beyond the occasion and lay down a rule that is unnecessary for the purpose in hand are generally termed “dicta”; they have no binding authority on another court, but they may have some persuasive efficacy.’

Re X (A Child) (No2) [2021] EWHC 65 (Fam), [2021] 4 WLR 11 [59]–[60]; Brunner v Greenslade [1971] Ch 993, 1002; Cordell v Second Clanfield Properties Ltd [1969] 2 Ch 9, 16.

Fornah (n 10) [91]–[92].

Ghaidan v Mendoza [2004] UKHL 30, [2004] 2 AC 557 [9]; HLA Hart, The Concept of Law (first published 1961, 3rd edn, Oxford University Press 2012) 161; Sandra Fredman, Discrimination Law (2nd edn, Oxford University Press 2011) 168.

Claire Fenton-Glynn, ‘Male Circumcision vs Female Genital Mutilation: Two Sides of the Same Coin?’ [2018] Family Law 652, 653.

Svoboda, Adler and Van Howe (n 9) 265.

Fornah (n 10) [92]; Re J (A Minor) (Prohibited Steps Order: Circumcision) [2000] 1 FLR 571 (CA) [32].

See Section 3.

A point evident from Fornah itself (n10) [53] if that passage is taken to include indirect reference to the circumcision of boys. In any event, see Michelle C Johnson, ‘Becoming a Muslim, Becoming a Person: Female “Circumcision,” Religious Identity, and Personhood in Guinea-Bissau’ in Bettina Shell-Duncan and Ylva Hernlund (eds), Female “Circumcision” in Africa: Culture, Controversy and Change (Lynne Rienner 2000) 215, 217–18; Brian D Earp, ‘Female Genital Mutilation (FGM) and Male Circumcision: Should There Be a Separate Ethical Discourse?’ ( Practical Ethics , 18 February 2014) < www.blog.practicalethics.ox.ac.uk/2014/02/female-genital-mutilation-and-male-circumcision-time-to-confront-the-double-standard > accessed 29 April 2023; Elizabeth Schroeder, Renata Tallarico and Maria Bakroudis, ‘The Impact of Adolescent Initiation Rites in East and Southern Africa: Implications for Polices and Practices’ (2022) 27 International Journal of Adolescence and Youth 181, 183, 185.

David L Gollaher, Circumcision: A History of the World’s Most Controversial Surgery (Basic Books 2000) 46, 90; World Health Organization, Male Circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability (World Health Organization 2007) 21; Ibrahim Lethome Asmani and Maryam Sheikh Abdi, Delinking Female Genital Mutilation/Cutting from Islam (Frontiers Program 2008) 4; UNICEF, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change (UNICEF 2013) 67; Brian D Earp, ‘Male or Female Genital Cutting: Why “health benefits” are Morally Irrelevant’ (2021) 47 Journal of Medical Ethics e92.

Gollaher (n 28) 106, 133; World Health Organization (n 28) 25; Fox and Thomson (n 9) 195, 202, 203; UNICEF (n 28) 66–67; Danda G, Mavundla T and Mudokwenyu-Rawdon C, ‘The Role of Women in Promoting Voluntary Medical Male Circumcision Uptake: Literature Review’ (2022) 27 Health SA Gesondheid a1794.

Gollaher (n 28) 204–5. See also Richard A Shweder, ‘The Prosecution of Dawoodi Bohra Women: Some Reasonable Doubts’ (2022) 12 Global Discourse 9 for the point that ‘Wherever there is female circumcision there is male circumcision – the custom is gender-inclusive.’

Fornah (n 10) [53]. In contrast, and for the detailed consideration of expert evidence on circumcision in other cases see for example: Re J ( Specific Issue Orders: Muslim Upbringing and Circumcision) [1999] 2 FLR 678 (F) (consultant paediatrician and experts in Islamic law); Re S (Children) (Specific Issue Order: Religion: Circumcision) [2004] EWHC 1282 (Fam), [2005] 1 FLR 236 (experts on Hindu Jainism and Islam); AT v FS T v S (Wardship) [2011] EWHC 1608 (Fam), [2012] 1 FLR 230 (paediatric surgeon); Re L (n 2) (expert on Islam, consultant paediatrician and consultant urologist).

Family Procedure Rules 2010, SI 2010/2955 25B PD 9.1 (g).

Ellen Gruenbaum, The Female Circumcision Controversy: An Anthropological Perspective (Penn 2001) 36–47; Lisa Wade, ‘Learning from “Female Genital Mutilation”: Lessons from 30 Years of Academic Discourse’ (2012) 12 Ethnicities 26, 28; Earp, Hendry and Thomson (n 9) 609, 610; Ellen Gruenbaum, Brian D Earp and Richard Shweder, ‘Reconsidering the Role of Patriarchy in Upholding Female Genital Modifications: Analysis of Contemporary and Pre-Industrial Societies’ [2022] International Journal of Impotence Research 1.

Fornah (n 10) [92]: ‘They are usually performed by traditional practitioners using crude instruments and without anaesthetic.’

Earp (n 27); Samuel Kimani, Hazel Barrett and Jacinta Muteshi-Strachan, ‘Medicalisation of Female Genital Mutilation is a Dangerous Development’ (2023) BMJ 380: p302.

Re B (n 1) [60]. See also Möller (n 9) 508, 516.

Fornah (n 10) [92].

Svoboda, Adler and Van Howe (n 9) 265–67; Re L (n 2) [69].

AP Simester and GR Sullivan, Criminal Law: Theory and Doctrine (7th edn, Hart Publishing 2019) 449; United Nations Committee on the Rights of the Child, General Comment No.13 (United Nations 2011) para 17. See also (in tension with the UN’s view on ‘legalized violence’) R v Brown [1994] 1 AC 212 (HL) 231 for circumcision as lawful violence/injury.

Rebecca Steinfeld, ‘Like FGM, Cut Foreskins should be a Feminist Issue’ ( The Conversation , 18 November 2013) < https://theconversation.com/like-fgm-cut-foreskins-should-be-a-feminist-issue-20328 > accessed 29 April 2023.

Re B [2013] UKSC 33, [2013] 1 WLR 1911 [185].

Re B (n 43) [193].

Earp (n 9) 93–94; Ronald Goldman, Questioning Circumcision: A Jewish Perspective (Vanguard 1998) 41–42.

Re B (n 1) [63].

Fornah (n 10) [91]–[93]; UNICEF, Innocenti Digest, Changing a Harmful Social Convention: Female Genital Mutilation/Cutting (UNICEF 2005) 1.

See (n 34).

Möller (n 9) 526.

The physical consequences have already been alluded to and will be considered further in Section 4. The social consequences will be addressed fully in Sections 3 and 5.

Fornah (n 10) [74], [87]. See again R v Brown (n 40) for the point that circumcision is violence.

Re B (n 1) [72] is also equivocal on this and other health-related points. See also Earp, Hendry and Thomson (n 9) 619–20.

UNICEF (n 49) 1–2.

Fornah (n 10) [93].

Gollaher (n 28) 101–6; Shaye JD Cohen, Why Aren’t Jewish Women Circumcised? Gender and Covenant in Judaism (California University Press 2005) 143–73; Leonard Glick, Marked in Your Flesh: Circumcision from Ancient Judea to Modern America (Oxford University Press 2005) 64–65, 151, 165; Shmuley Boteach, The Modern Guide to Judaism (Overlook 2012) 72–74; Anita Diamant, The New Jewish Baby Book (2nd edn, Jewish Lights Publishing 2014) 92; Earp, Hendry and Thomson (n 9) 618.

Fornah (n 10) [31].

Judith S Antonelli, In the Image of God: A Feminist Commentary on the Torah (Rowman & Littlefield 2004) 275. For examples of circumcision being the wish of the mother not the father see Re S (A Child) (Change of Names: Cultural Factors) [2001] 2 FLR 1005 (F); Re S (n 32); Re A (A Child) [2021] EWHC 3467 (Fam). For further examples of women actively engaging in/supporting the practice see also Erick Silverman, ‘Anthropology and Circumcision’ (2004) 33 Annual Review of Anthropology 419, 421, 424; Jacob Olupona, African Religions: A Very Short Introduction (Oxford University Press 2014) 58; Josephine DeVito, ‘Understanding the Orthodox Jewish Family During Childbirth’ (2019) 54 Nursing Forum 220, 224; Alyson Krueger, ‘Jewish Women Move Into a Male Domain: Ritual Circumcision’ The New York Times (New York, 1 March 2020) < www.nytimes.com/2020/02/28/nyregion/circumcision-bris-mohels-women.html > accessed 29 April 2023; Glick (n 58) 58–59; Diamant (n 58) 84–99; Francesca Cerchario and Laura Odasso, ‘“Why do we have to circumcise our son?” Meanings Behind Male Circumcision in the Life Stories of Mixed Couples with a Muslim Partner’ [2021] Journal of Ethnic and Migration Studies 1, 10; Danda, Mavundla and Mudokwenyu-Rawdon (n 29).

Fox and Thomson (n 9) 200 ‘the concept of patriarchy often functions to allow men’s experiences to remain unquestioned.’

Fornah (n 10) [31], [110].

Re B (n 1) [72]. See also [55], [71].

Re B (n 1) [61].

Re B (n 1) [71]. See also [57].

On the complexity of definitions see Sarah Song, ‘The Subject of Multiculturalism: Culture, Religion, Language, Ethnicity, Nationality, and Race?’ in Boudewijn de Bruin and Christopher F Zurn (eds), New Waves in Political Philosophy (Palgrave Macmillan 2009) 177; Avigail Eisenberg, Reasons of Identity: A Normative Guide to the Political and Legal Assessment of Identity Claims (Oxford University Press 2009) 7; Farida Shaheed, Report of the Independent Expert in the Field of Cultural Rights (United Nations Human Rights Council 2010) 4; Heiner Bielefeldt, Nazila Ghanea and Michael Wiener M, Freedom of Religion or Belief: An International Law Commentary (Oxford University Press 2017) 387. See also Émile Durkheim, The Elementary Forms of Religious Life (First Published 1912, Carol Cosman tr and Mark S Cladis ed, Oxford University Press 2008) 6; Walter Capps, Religious Studies: The Making of a Discipline (Fortress Press 1995) 1–52; David Wulff, Psychology of Religion (2nd edn, John Wiley & Sons 1997) 1–20; Carolyn Evans, Freedom of Religion Under the European Convention on Human Rights (Oxford University Press 2003) 51–66; Russell Sandberg, Law and Religion (Cambridge University Press 2014) 39–58; R (Hodkin) v Registrar General of Births, Deaths and Marriages [2013] UKSC 77, [2014] AC 610 [34].

R (Williamson) v Secretary of State for Education and Employment [2005] UKHL 15, [2005] 2 AC 246 [54].

Will Kymlicka, Multicultural Citizenship: A Liberal Theory of Minority Rights (Oxford University Press 1996) 76; Shaheed (n 67) 4; Patti Tamara Lenard, ‘Culture’, The Stanford Encyclopedia of Philosophy (Winter edn, 2020) < https://plato.stanford.edu/archives/win2020/entries/culture/ > accessed 29 April 2023. For an example of the overlapping nature of culture and religion being recognized within family proceedings, see Salford City Council v W [2021] EWHC (Fam), [2021] 4 WLR 21 [17]–[18], [29], [30], [33].

Rigmor C Berg and Eva Denison, ‘A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systemic Review’ (2013) 34 Health Care for Women International 837, 854. See also Gruenbaum (n 34) 49 for the point that ‘each region or culturally identified group is likely to have more than one explanation for any practice’ - which is reiterated within UNICEF (n 28) 65–67.

Such evidence would have been necessary in accordance with the principle that the subject matter falls outside the expertise of the court and is not an issue upon which a court could simply take judicial notice.

Re L (n 2) [59]; Naila Minai, Women in Islam: Tradition and Transition in the Middle East (John Murray 1981) 97; Sami A Adleeb Abu-Sahlieh, ‘Islamic Law and the Issue of Male and Female Circumcision’ (1995) 13 Third World Legal Studies 73, 77; Muhammad Lutfi al-Sabbagh, The Right Path to Health: Health Education through Religion: Islamic Ruling on Male and Female Circumcision (World Health Organization 1996); Gollaher (n 28) 45, 92; Asmani and Abdi (n 28) 8; UNICEF (n 28) 69; John Esposito and Natana Delong-Bas, Shariah: What Everyone Needs to Know (Oxford University Press 2018) 214.

Esposito and Delong-Bas (n 72) 214. See also Asmani and Abdi (n 28) 14.

[2008] UKEAT/0123/08/LA, [2009] ICR 303 [29].

Genesis 17:10; Leviticus 12:3.

Williamson (n 68) [56]. See also Lady Hale [75] on the point that the court is not ‘required to consider whether a particular belief is soundly based in religious texts.’

Newcastle City Council v Z [2005] EWHC 1490 (Fam), [2007] 1 FLR 861 [56].

Re B (n 1) [9]; UNICEF (n 28).

UNICEF (n 28) iii.

UNICEF (n 28) 71.

Williamson (n 68) [32]–[33] (emphasis added).

Peter W Edge, ‘Hard Law and Soft Power: Counter-Terrorism, the Power of Sacred Places, and the Establishment of an Anglican Islam’ (2010) 12 Rutgers Journal of Law & Religion 358, 380.

Williamson (n 68) [22]. See also [75]–[77], Re G [2012] EWCA Civ 1233, [2013] 1 FLR 677 [35]–[51] for the essential point that ‘Religion – whatever the particular believer’s faith – is not the business of government or the secular courts (…)’ and Moscow Branch of the Salvation Army v Russia (2007) 44 EHRR 46 [58] for the core principle that ‘The State’s duty of neutrality and impartiality (…) is incompatible with any power on the State’s part to assess the legitimacy of religious beliefs.’

Asmani and Abdi (n 28).

Goldman (n 46); Odasso (n 60).

British Medical Association, Non-therapeutic Male Circumcision (NTMC) of Children – Practical Guidance for Doctors (British Medical Association 2019) 4. See also the Royal Dutch Medical Association, Non-therapeutic Circumcision of Male Minors (Royal Dutch Medical Association 2010); the Canadian Paediatric Society, ‘Position Statement: Newborn Male Circumcision’ (2015) 20 Paediatr Child Health 311; the Royal Australasian College of Physcians, Circumcision of Infant Males (Royal Australasian College of Physicians 2022).

British Medical Association (n 91) 4.

American Academy of Pediatrics, ‘Male Circumcision: Task Force on Circumcision’ (2012) 130 Pediatrics e756, e778. See also American Academy of Pediatrics, ‘Circumcision Policy Statement’ (2012) 130 Pediatrics 585. For APP statements on circumcision having been ‘models of ambiguity (…)’ see Gollaher (n 28) 200.

British Medical Association (n 91) 4. See also Morten Frisch and others, ‘Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision’ (2013) 131 Pediatrics 796; Robert S Van Howe, ‘Response to Vogelstein: How the 2012 AAP Task Force on Circumcision Went Wrong’ (2018) 32 Bioethics 77.

British Association of Urological Surgeons, British Association of Paediatric Surgeons, British Association of Paediatric Urologists, Commissioning Guide: Foreskin Conditions (British Association of Urological Surgeons 2016) 8. See also British Association of Paediatric Urologists (on behalf of the British Association of Paediatric Surgeons and the Association of Paediatric Anaesthetists), Statement: Management of Foreskin Conditions (British Association of Urological Surgeons 2006) 14 and Re L (n 2) [67], [69].

Re C and B (Care Order: Future Harm) [2001] 1 FLR 611, [2000] 2 FCR 614 (CA) [28]; Re LU (A Child), LB (A Child) [2004] EWCA Civ 567, [2005] Fam 134 [23]; Re R (Care proceedings: Causation) [2011] EWHC 1715 (Fam), [2011] 2 FLR 1384 [19]; Re BR (Proof of Facts) [2015] EWFC 41 [7]. See also Mike Feintuck, ‘Precautionary Maybe, but What’s the Principle? The Precautionary Principle, the Regulation of Risk, and the Public Domain’ (2005) 32 Journal of Law and Society 371.

British Association of Paediatric Surgeons, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Royal College of Surgeons of England, and the Royal College of Anaesthetists, Male Circumcision: Guidance for Healthcare Practitioners (Royal College of Surgeons of England 2000) 2. See also British Association of Urological Surgeons and others (n 95) 7; British Medical Association (n 91) 7.

American Academy of Pediatrics (n 93) e767–e768.

American Academy of Pediatrics (n 93) e768.

World Health Organization, Neonatal and Child Male Circumcision: A Global Review (World Health Organization 2010) 7; American Academy of Pediatrics (n 93) e764; British Medical Association (n 91) 11.

British Association of Urological Surgeons and others (n 95) 8.

Re Y (Children) [2014] EWCA Civ 1287, [2015] 1 FLR 1350 [38]–[39].

Re A (Leave to Remove: Cultural and Religious Considerations) [2006] EWHC 421 (Fam), [2006] 2 FLR 572 [40].

[2000] 1 FLR 549 (CA) 556. Thorpe LJ states, ‘In relation to whether the interests of others may legitimately be regarded in the application of a best interest test, the point was not fully argued in the present appeal and I would prefer to leave it open’ 558.

Re H (A Child) (Parental Responsibility: Vaccination) [2020] EWCA Civ 664, [2021] Fam 133 [34].

Re H (n 106) [9].

Re H (n 106) [5], [33], [104].

[2001] Fam 147 (CA).

Re A (n 109) 176.

Re A (n 109) 204, 240.

British Medical Association (n 91) 11.

Re A (n 109) 240.

Re A (n 109) 240, 258–59.

British Medical Association (n 91) 7.

‘Symptoms: Penile Cancer’, < www.nhs.uk/conditions/penile-cancer/symptoms > accessed 29 April 2023.

Gollaher (n 28) 146. See also Earp (n 28) e92.

Re B (n 1) [64]; Oliver Wendell Holmes Jr, The Common Law (first published 1881, Dover Publications 1991) 1.

Richard A Posner, How Judges Think (Harvard University Press 2010) 232.

Re G (Education: Religious Upbringing) [2012] EWCA Civ 1233, [2013] 1 FLR 677—a case concerning the education of children from an ultra-orthodox Jewish family.

Re G (n 121) [32]–[34].

Re G (n 121) [39].

See again Re B (n 1) [61].

Elise A Sochart, ‘Agenda Setting, the Role of Groups and the Legislative Process: The Prohibition of Female Circumcision in Britain’ (1988) 4 Parliamentary Affairs 508, 509.

Sebastian M Poulter, ‘Ethnic Minority Customs, English Law and Human Rights’ (1987) 36 International & Comparative Law Quarterly 589, 589.

HC Deb 19 April 1985, vol 77, col 586 (emphasis added).

HL Deb 15 May 1985, vol 463, cols 1223–1224 (emphasis added).

Poulter (n 127) 589.

Sophie Gilliat-Ray, Muslims in Britain: An Introduction (CUP 2010) 1, 44–45; Houssain Kettani ‘Muslim Population in Europe: 1950-2020’ (2010) 1 International Journal of Environmental Science and Development 154, 157.

Martin Goodman, A History of Judaism (Penguin Books 2019) 238.

Goodman (n 132) 363.

Harrison v Doctor Burwell (1667) Vaugh 206, 124 ER 1039, 1051.

Goodman (n 132) 444–45.

‘The Circumcision of Christ’, < www.churchofengland.org/prayer-and-worship/worship-texts-and-resources/book-common-prayer/collects-epistles-and-gospels-8 > accessed 29 April 2023.

Gollaher (n 28) 44, 206.

Brenda Hale and others, The Family, Law & Society: Cases & Materials (6th edn, Oxford University Press 2009) 2.

Re A (n 109) 212. For a classic example of the point see (in a case concerning whether to grant a man the right to succeed to the tenancy of his female partner when they had been living together for 25 years but were not married) Gammans v Ekins [1950] 2 KB 328 (CA) 334, ‘It may not be a bad thing that by this decision it is shown that, in the Christian society in which we live, one, at any rate, of the privileges which may be derived from marriage is not equally enjoyed by those who are living together as man and wife but who are not married.’

Evans (n 67) 132.

Laura M Carpenter, ‘On Remedicalisation: Male Circumcision in the United States and Great Britain’ (2010) 32 Sociology of Health & Illness 613, 614.

Re B (n 1) [55].

Re G (n 121) [39]; Re L (Care: Threshold Criteria) [2007] 1 FLR 2050 (F) [50].

For the development and re-iteration of the Re L (n 145) analysis see also Re A (A Child) [2015] EWFC 11, [2016] 1 FLR 1 [15]–[17]; Stephen Gilmore, ‘The Limits of Parental Responsibility’ in Rebecca Probert, Stephen Gilmore and Jonathan Herring (eds), Responsible Parents and Parental Responsibility (Hart Publishing 2009) 79–80: ‘parents have considerable discretion as to how parental responsibility is exercised. Beyond any specific parental duty, and in the absence of any court order, the law does not require parents to act in particular ways which positively advance a child’s welfare or best interests, nor is the scope of parental discretion drawn in such a way as to avoid all harm to the child’ (footnote omitted).

Re B (n 1) [56]–[57].

Peter W Edge, ‘Male Circumcision after the Human Rights Act 1998’ (2000) 5 Journal of Civil Liberties 320, 355.

HM Government, Working Together to Safeguard Children (HM Government 2018) 21.

Genesis 17: 12; Leviticus 12:3. See also Board of Deputies of British Jews, Jewish Family Life and Customs: A Practical Guide (Board of Deputies of British Jews 2017) 7.

Re C (A Child: Interim Separation) [2019] EWCA Civ 1998, [2020] 1 FLR 853 [2].

Re G (n 121) [34].

Re G (n 121) [40]–[41].

[2015] UKSC 57, [2015] 1 WLR 3820 [60].

Tigere (n 154) [60].

Lucinda Ferguson and Elizabeth Brake, ‘Introduction: The Importance of Theory to Children’s and Family Law’ in Lucinda Ferguson and Elizabeth Brake (eds), Philosophical Foundations of Children’s and Family Law (Oxford University Press 2018) 1.

Gillian Douglas, An Introduction to Family Law (2nd edn, Oxford University Press 2004) 4.

John Dewar, ‘The Normal Chaos of Family Law’ (1998) 61 The Modern Law Review 467, 468.

For an overview of the anti-circumcision movement see Gollaher (n 28) 161–85; Silverman (n 60) 434–36; Roger Collier, ‘Ugly, Messy and Nasty Debate Surrounds Circumcision’ (2012) 184 Canadian Medical Association Journal E25, E25; Amanda Kennedy and Lauren Sardi, ‘The Male Anti-Circumcision Movement: Ideology, Privilege, and Equity in Social Media’ (2016) 11 Societies Without Borders 1.

Re B (n 1) [64]; Fredman (n 22) 1: ‘Equality as an ideal shines brightly in the galaxy of liberal aspirations. Nor is it just an ideal. Attempts to capture it in legal form are numerous and often grand: all human rights documents, both international and domestic, include an equality guarantee, and this is bolstered in many jurisdictions with statutory provisions.’

HL Deb 15 May 1985, vol 463, col 1239.

HL Deb 15 May 1985, vol 463, col 1233; HL Deb 2 July 1985, vol 465, col 1142; HL Deb 2 July 1985, vol 465, col 1139. For context see also Judith Zinsser, ‘The United Nations Decade for Women: A Quiet Revolution’ (1990) 24 The History Teacher 19, 21: ‘The United Nations Decade for Women spanned the years 1975-1985 and consisted of three international forums and conferences: in Mexico City in 1975 to inaugurate the Decade; in Copenhagen in 1980 to give a mid-Decade report; in Nairobi in 1985 to formulate strategies and goals for the future. In addition to these international meetings the Decade occasioned numerous regional meetings of United Nations agencies and organizations (i.e., the United Nations Economic and Social Council [UNESCO], the World Health Organization [WHO], ECLA, the Euro- pean Economic Council [EEC]) and regional meetings of non-governmental organizations (i.e., YWCA, World Council of Churches, National Association of Women), all to consider the status of women and to make recommendations for women. The Decade also occasioned a multitude of documents from governments and from public and private agencies and organizations, both national and international.’

HM Government, Tackling Violence Against Women & Girls (HM Government 2021) 8.

Jonathan Sacks, ‘The Europeans’ Skewed View Of Circumcision’ The Jerusalem Post (Jerusalem, 6 July 2012) www.rabbisacks.org/archive/the-europeans-skewed-view-of-circumcision-jerusalem-post > accessed 29 April 2023. For the persistence of antisemitism in the UK see also Jonathan Sacks, Future Tense: A Vision for Jews and Judaism in the Global Culture (Hodder & Stoughton 2010) 89–111 and for the arguable link between efforts to ban circumcision and antisemitism see Ben Cohen, ‘The Jews are our Misfortune!’ Contemporary Antisemitism as a Hydra-Headed Phenomenon’ (2023) 29 Israel Affairs 5.

Re G (n 121) [45] with Munby LJ citing another one of his earlier judgments on the interaction between family law and religion— Newcastle City Council (n 77) [56]—a case concerning a Muslim mother’s religiously based objections to the adoption of her child.

For the importance of 'a mass social movement' for the advancement of human rights see Jack Snyder, Human Rights for Pragmatists: Social Power in Modern Times (Princeton University Press 2022) 127.

HLA Hart (n 22) 159. See also Ghaidan (n 22) [9].

Fornah (n 10) [91], [93]; SS Malaysia (n 10) [14]; Re B (n 1) [64].

Re F (Children) [2016] EWCA Civ 546, [2016] 3 FCR 255 [22].

Posner (n 120) 204.

Posner (n 120) 206–7.

Re B (n 1) [64].

Gollaher (n 28) 71.

Re B (n 1) [65].

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Published: 01 March 2021

It’s a woman’s thing: gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana

Patricia Akweongo ORCID: orcid.org/0000-0001-6728-3365 1 ,
Elizabeth F. Jackson 2 ,
Shirley Appiah-Yeboah 3 ,
Evelyn Sakeah 4 &
James F. Phillips 2 , 5

Reproductive Health volume 18 , Article number: 52 ( 2021 ) Cite this article

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Introduction

The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women’s empowerment and changing gender roles.

This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders.

The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women.

Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women’s social networks for offsetting their extended family familial roles in sustaining FGM/C practices.

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Female circumcision is a deeply rooted custom in many African societal settings. The practice of female genital mutilation (FGM/C) occurs in 28 African countries, although national borders are less relevant to delineating zones for this practice than transnational cultural zones. According to the United Nations Children Fund (UNICEF), at least two hundred million girls and women are “circumcised” in 31 countries across three continents, with more than half of these “circumcisions” occurring in African countries [ 1 ]. Although the practice has existed for centuries among different groups, beginning in the 1990s this practice became a matter for international discussion [ 2 , 3 , 4 ] that continues to the present [ 5 , 6 , 7 , 8 , 9 ].

The determinants of FGM/C are complex, ranging from socio-cultural norms and economic factors, to health services and hygiene, religion, and gender stratification customs amongst others [ 10 ]. Gender determinants are typically emphasized by feminist commentators who argue that FGM/C is rooted in the need for men to control women’s sexuality, prevent promiscuity, ensure premarital virginity, marital fidelity and male sexual satisfaction [ 10 ]. While this discourse is neither monolithic nor unidimensional, FGM/C is widely recognized as a consequence of patriarchal oppression and the subjugation of women. In concert with this perspective, an advocate of FGM/C abandonment stated in a formative article in the 1990s that, “FGM/C is…as a culturally approved form of violence against women….” [ 11 ]. Moreover, its practice is known to have detrimental perinatal survival effects [ 12 , 13 ]. This finding has fostered a series of recommendations on what must be done to end the practice and views about gender roles in sustaining FGM/C. Although three decades have elapsed since the Hosken report was disseminated, passages continue to have widespread currency nearly three decades later:

“To claim- as many African men do (as well as male, Western anthropologists)- that women are the ones who perpetuate the operations in societies where women have never had any choice about anything, least of all their bodies, is ludicrous. Clearly, it is a matter of sexual politics. As soon as men stop demanding FGM/C as a price for marriage and stop paying for having their daughters mutilated, the operations would stop” [ 11 ].

It has become the conventional wisdom to attribute gender stratification as the fundamental exogenous determinant of the practice, with many influential observers concluding that addressing the FGM/C problem requires prior social change leading to gender development. In recent years, the Western media has garnered a plethora of accounts from African women who were subject to the cruel and inhuman bodily mutilation that FGM/C represents to foster the view that African traditions of male dominance and the patriarchal system must change for the practice of female circumcision to be eliminated. As one respected commentator has noted:

“In the eyes of many educated people, female genital mutilation is the consequence of a patriarchal and polygamous society which has always sought to tame and subdue women” [ 14 ].

There is little doubt that feminist discourse on the root causes of FGM/C has correctly identified the underlying gender determinants of this harmful practice. Evidence based programmatic implications of this perspective are less clear, however. Instead, international discourse has assumed the character of exhortations for African governments to take punitive action. In several countries, particularly in Ghana, this perspective has generated reliance on laws that attempt to criminalize the excisor performance of the practice [ 15 ]. While laws may have had some impact, and comprise a needed component of public policy, it is likely that legal sanctions drive the practice underground in many settings [ 16 , 17 , 18 ], thereby complicating efforts to understand the practice and to address the issue openly in a manner that would lead to sustained social change. As yet, social science has contributed little to guiding policy and action. Although clarifying social dynamics associated with the practice could improve program efforts to eradicate FGM/C, deliberations on what to do about the practice have been relegated to essays, critiques or commentaries rather than to empirical research. In particular, there is a dearth of information on how sustain the practice gender roles that is derived from interaction with women and men themselves. As one writer noted:

“Research on female ‘circumcision’ not only has to take into account the place of the practice in the culture in question but also has to be foregrounded in a multifaceted analysis of the lives of those women whose genitals have become the subject of study” [ 19 ].

This paper provides qualitative data from field based study to explicate the gender dynamics of female circumcision in the Kassena-Nankana district of northern Ghana, a locality of northern Ghana that is known to have a high FGM/C prevalence [ 20 , 21 , 22 , 23 ]. Focus group discussions with women and men are employed to illustrate the gender roles that influence the practice of female circumcision in a rural, traditional African setting. It investigates the social, cultural, and physical mechanisms that sustain female circumcision, with particular attention to clarifying gender roles in FGM/C decision-making.

FGM/C or female circumcision is a generic term for traditional practices involving the cutting of female genitalia leading to the partial or the total removal of the female genitalia or injury to the female genital organ for cultural or any other non-therapeutic reasons [ 6 , 24 ]. Four major types of FGM/C have been identified [ 24 ]. Type 1, also known as Sunna or “circumcision”, is defined as the partial or total removal of the clitoral glands and/or the prepuce/clitoral hood. This practice typically represents only a small proportion of women who undergo FGM/C and only a few ethnic groups practice it. Type 2 involves the partial or total removal of the clitoral glans and the labia minora, with or without removal of the labia majora. Type 2 is also known as clitoridectomy or excision. WHO estimates that about 85 percent of women who undergo FGM/C have experienced excision [ 7 ]. Type 3 also known as infibulation is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce and glands. Type 4 involves all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. Though all the four types of FGM/C are associated with increased health risks, imminent complications can include psychological hazards including pain, trauma, and severe physical complications, such as bleeding, genital tissue swelling, urinary problems infections, or even death, as well as indirect psychological effects on women’s self-image and sexual lives [ 3 , 25 ].

FGM/C is prevalent in the three northern regions of Ghana where the Kusasi, Frafra, Kassena, Nankam, Busanga, Walla, Dagaabas, Builsa and Sisala ethnic groups reside [ 26 ]. In the Upper East Region, FGM/C is prevalent in the Bawku Municipality, Pusiga District and the two Kassena-Nankana districts [ 23 ]. Although FGM/C is not a cultural practice in the southern parts of the country, migrants from the three northern regions and neighboring Sahelian countries sustain the practice it in the areas in where they have settled. The national prevalence in Ghana at the time of this study was estimated to range between 20 and 30 percent, while the combined prevalence for Upper West and Upper East regions was estimated to be 86% [ 4 ]. The prevalence of FGM/C in Ghana was recently estimated by the Ghana Multi-cluster Survey to be 4% of women of reproductive age [ 5 , 27 ]. However, marked regional disparities in prevalence of FGM/C were documented in this study. In the Upper East the prevalence of FGM/C was reported at 27.8%; 41% in the Upper West and 2.8% in the Northern Region. Although the practice has declined in recent years, estimates show that FGM/C persists as a common practice [ 28 , 29 ]. Although the practice is declining nationally, there are pockets of rural areas where the practice is still prevalent. In rural areas women are three times as likely to have experienced FGM/C than women living in urban areas [ 30 ]. In the Pusiga district of the Upper East region of Ghana, 62% women report having undergone FGM/C [ 31 ].

In 1995, the Navrongo Health Research Centre (NHRC) initiated research aimed at describing and understanding the practice of female circumcision in Kassena-Nankana district of the Upper East Region. Studies of various sub-groups in the district revealed that FGM/C is practiced among the Nankam, Kassem, and Builsa ethnic groups that comprise nearly all of the population of the district. A 1995 survey of households in the district revealed that 77% of 5275 randomly selected women of reproductive age had undergone FGM/C. In 1995–1996, a clinic-based study of 398 pregnant women seeking prenatal care found that all three types of FGM/C (circumcision, excision, and infibulation) are practiced in the Kassena-Nankana district. The majority of the women (62%) were circumcised between 15 and 19 years of age, and by age 20, 80% had already undergone FGM/C [ 13 ]. In a more recent study, 29% of 5071 deliveries in the Kassena-Nankana district were FGM/C associated. Additionally, the prevalence of FGM/C was 61.5% was among women who were over 40 years and 14.4% among those less than 20 years [ 32 ].

Among the Kassena-Nankana, FGM/C usually takes place after puberty and before marriage to mark the beginning of womanhood. After the harvest of the early millet in August, circumcision is organized at the clan or village level. Although, age is a consideration in determining eligibility for FGM/C, other factors such as impending marriage, development of breasts, early menstruation and growth of pubic hair influence the age at circumcision.

Religious belief systems are also a factor in FGM/C decision-making. Traditional religion among the Kassena-Nankana involves a process whereby an extended family patriarch consults with a shaman, termed a “soothsayer” for the purpose of contacting ancestral spirits to explain the past, interpret the present or forecast the future on matters of current concern to his lineage [ 33 ]. Often a girl’s father or extended family head consults with a “soothsayer” to determine if ancestral sprits designate a girl as being ready for circumcision or eligible for exemption from the practice. Thus, the rites of traditional religion may exempt a girl from circumcision [ 33 ]. However, more typically, beliefs about FGM/C are embedded in traditional religion in ways that support the practice. The piligo (in Nankam) and sogo (in Kassim) is a terra cotta pottery bowl that is broken in the middle of the funeral procession of a deceased woman by the daughter. It is first, a sign of farewell to the woman. Secondly, it shows that the woman was fertile in her lifetime and had children. Most importantly, the breaking of the ‘piligo’ (or sogo) is believed it is to enable the deceased woman to continue her duties as a woman in the next world. A woman who does not have a daughter to do this for her is believed to roam in the ancestral world hungry and thirsty and is not welcomed by her ancestors.

Discussion of FGM/C in Kassena-Nankana district reveals that adult women and men justify the practice as a mechanism that is believed to instill societal morals and values in a young girl before she assumes a larger role in the community as wife and mother. Traditionally, after the harvest of the early millet in August, girls who are deemed physically mature are organized to undergo circumcision by an excisor who visits the various villages. FGM/C is mainly performed on girls ranging in age between four and 14 [ 34 ]. Studies suggest that most Ghanaian girls who undergo the procedure are were under age five when FGM/C is conducted [ 26 ]. However, in some cases, FGM/C is performed on girls immediately prior to marriage [ 34 ]. Elderly women who are present at the circumcision ceremony will encourage the young girls to be brave during the procedure. Afterwards, the girls are assembled in one compound under the guidance of two or three elderly women who nurse their sores while providing education on societal values, norms and morals. The girls who have undergone the circumcision prior to marriage are taught how to cook and how to be a wife and member of their husband’s extended family [ 13 ]. At menarche life skills are discussed and the community members are expected to recognize circumcised young woman as a person who is allowed to receive marriage proposals.

The Navrongo Health Research Centre launched an experimental study to test hypotheses about means of reducing the incidence of FGM/C through social action and community outreach. The Navrongo program developed in collaboration with local government and non-governmental organizations to change the behaviors and attitudes associated with FGM/C through education to all sectors of the community and the provision of livelihood activities for adolescent girls. A cohort of adolescent girls in six villages were exposed to different social action programs and observed over a five years period of time [ 35 ]. The current study was the component of this investigation that provided a baseline appraisal of social determinants of FGM/C in study areas.

Data collection . This paper is based on the analysis of twenty-two focus group discussions with men and women in 11 communities of the Kassena-Nankana district of northern Ghana: Mirigu, Paga-Bagtua, Chiana-Katiu, Natugnia, Pungu, Nayagnia, Gomongo, Mayoro, Janania, Gongnia, Chiana-Kayoro. Sessions were convened prior to the implementation of social interventions for mobilizing community support for FGM/C eradication. Since open discussions of FGM/C with different groups in the community is common, focus group discussions (FGDs) were deemed to be an appropriate form of eliciting views on the topic from a wide array of social groups.

Categories of potential respondents could be readily compiled for this study for Demographic Surveillance System (NDSS) at the Navrongo Health Research Centre (NHRC) system delineates groups of extended families compounds into clusters that were stratified into zones from the north, south, east and west sub-districts of the district for random selection, based on NDSS household enumeration numbers [ 36 , 37 , 38 ]. Based on randomly selected household numbers, Field staff of the NDSS, known as a Community Key Informants (CKIs) identified the precise location of the selected compounds was known. NDSS staff visited sample households and invited members to participate in focus groups according to designated gender and age groups represented by each session. This procedure was intended to identify at least one participant per compound. Sample substitution was unnecessary because all sample compounds yielded one or more individuals who agreed to participate in discussion sessions. Two focus group discussions comprising a male and female group each was held in each community. Written and oral informed consent was sought from participants who participated in the study. A total of 22 focus groups were selected, each ranging in size from 8 to 10 participants. The interviews were conducted either in Kassim or Nankam, the two main language groups in the district. The interview guides were developed in English and the translated into the two languages and back translated into English to ensure translation accuracy.

Participants for fifteen focus group discussions were selected based on the following age and sex criteria defining panels of adolescent boys and adolescent girls (aged 20–24); reproductive aged men and women (aged 26–34 and 35–49) and older men and women (aged 50 and above). This classification was sufficient for representing the experiences and beliefs associated with FGM/C as they differ among age and gender groups. Participants for seven of the focus group discussions were females selected according to age and marital status categories defining polygamous unions (aged 25–35 and 35–49) and single unions (aged 25–35 and 35–49). There were two adolescent female groups and 2 adolescent male groups (20–24). Female marital status was chosen as a selection criteria based on the assumption that having co-wives will have an observed effect on circumcision status after marriage. There were 11 female groups and 11 male groups of various ages and marital status.

A moderator and a note taker were present at each discussion. The moderators’ questions and participants answers were recorded on an audiotape. The interview guides were pretested in the central zone of the district. The FGDs were conducted to obtain insights on how engrained the practice of FGM/C was, social norms governing and sustaining the practice, perceptions of change in the practice and the extent of participant’s understanding of the health risks and law banning the practice of FGM/C. Participants were also invited to discuss factors which could facilitate social action for eradicating the practice. A transcriber, who was not present at the time of the discussion, described the data from the audiotapes and translated discussions into English before analysis of the transcripts. Data were entered with a conventional word processor, stored electronically, and dispensed to the research team without labels that could identify the participants. Analysis embraced the conventions of grounded theory analysis whereby verbatim transcripts, which were coded by key words, categorized into specific themes and utilized for the extraction of key themes [ 39 ]. Quotes representing these key themes are presented in this paper. All quotes chosen were extracted in a manner that portrays discussion that was common to all of the focus group sessions. In the presentation that follows marital status has been noted with each quotation. Although quotes that are selected are chosen to portray the general view of the focus group participants, citations do necessarily represent views of all individuals. Care has been taken to ensure anonymity, although coding recorded age groups and community where sessions were convened. Occasionally words or phrases in parenthesis are added to clarify the meaning of words and statements of the quotes.

The FGM/C decision-making process

Both men and women support the notion that there are distinctly different parental roles in the sequence of decision leading to the practice of female circumcision. Typically, the mother takes primary initial responsibility for encouraging her daughter to be circumcised:

“Your mother would always tell you that your colleagues are going to get circumcised, so you should join them. After you have gone, she would then tell your father, and he would get ready with a fowl and millet to pay the practitioner.”

—Mirigu woman, aged 35–49, single union

Thus, the father or compound heads play a role in the initial decision to undergo FGM/C and are sometimes asked to permit the circumcision, but the father’s actions are undertaken in response to decisions taken by women. Once a man is asked to sanction FGM/C, he consults with the soothsayer, and when the consultation is completed, the father or compound head informs the girl’s mother of the outcome of the consultation. Thus, while men do not initiate FGM/C decisions, their concurrence is essential. As one woman noted:

“…if the man did not support, her daughter could not be circumcised. If your father did not give his consent, you could not be circumcised…”

—Paga Bagtua, woman, aged 25–35, single union

Circumcision is performed in the post harvest season. In the months preceding the harvest, women consult with their peers in neighboring compounds to discuss plans for undergoing circumcision for girls in the community who are considered ready for the procedure. After a decision is reached to proceed with circumcision, girls are informed that circumcision rites will be performed. Respondents in all FGD panels of this study denied that any form of compulsion was employed. Instead, they stressed the view that girls are asked to decide on whether or not to undergo the procedure. It is nonetheless clear from this study that personal agency in a girl’s FGM/C decision-making is more an illusion than reality. Instead, powerful social pressure is exercised by key players: mothers, mother-in-laws, compound heads and their wives, fathers, husbands, co-wives, peers and birth attendants.

Once a group of girls have been identified the parents and community leaders extend an invitation for a local excisor to circumcise their daughters. Other families from neighboring towns and villages who hear about the arrival of the excisor may also ask that their daughters join the group of girls undergoing the circumcision. Both the mother and the father give the excisor different forms of payment. Payment may range from cash to goods. The mother is usually responsible for providing cloth, calabash, shea nuts, while the father provides cash, fowls or millet.

“….she provided fibre threads [cloth], calabashes and shea-nuts. The man only gives a fowl….”

—Paga Bagtu woman, aged 25–35, single union

“When I have my daughter, I make her get circumcised and all the fines are mine to pay. I will have to give some fowls, guinea fowls, and millet.”

—Chiana-Katiu man, aged 35–49

The role of men

Husbands and fathers each have specific roles to play in female circumcision. Focus group discussions indicated that fathers rarely exert pressure on their daughters to be circumcised. The role of husbands is even less pronounced than the father’s role. Nonetheless, men play a significant role in the decision-making system.

Fatherly duties It is evident from the FGD data that men are not instigators in the circumcision of their daughters. Fathers grant permission for their daughters to undergo circumcision, but seldom encourage their daughters to undergo circumcision. When a girl is very young, her father consults with a soothsayer to determine whether or not his daughter should be circumcised. In the animist traditions of the Kassena and Nankana, women are believed to be the property of a lineage and lineal gods are the guiding spirit of all individuals. Women are not allowed to consult with soothsayers. However, men often seek spiritual guidance in religious séances. A soothsayer is a spiritual leader who performs traditional rites that are believed to establish communication with ancestral spirits. In this course of consultation, a girl may be exempted from the practice if the soothsayer consultation reveals that she belongs to a god who does not want her to be circumcised. When eligible girls are old enough for circumcision, fathers pay fees to the circumciser:

“Men do not insist at all but it is the mothers.”

—Natugnia woman, aged 35–49, polygamous union

“If there is pressure on the girls to get circumcised then I feel it is the mothers because men do not really care about the practice”.

—Pungu man, aged 26–24

Some women reported that fathers had to be consulted before the act, though in some cases, circumcision took place without the father knowing about it. In such cases, fathers are asked to pay fees afterwards. A compound head or family head may also be responsible for the circumcision fees for girls in his compound.

“It is the compound head who gives the millet and fowls to be given to the circumcisor…”

—Nayagnia man, aged 35–49

“Sometimes the compound heads do not even know that the girls have gone for the circumcision. It is when they are asked to pay some fees that they get to know about it.”

—Chiana-Katiu men, aged 35–49

Marriage of daughters: It is the responsibility of fathers to arrange the marriage of daughters. In the tradition of the Kassena-Nankana, a man seeking a husband for his daughter will approach fathers of young men to discuss marriage and bridewealth. In the past, circumcision status was an important prerequisite to marriage. However, this has changed:

“[Before]…it is only when the girl is circumcised that she can get married but now the men are impatient and do not wait for all the customs [FGM/C] to be done”.

—Pungu man, aged 26–34

Once a girl has been circumcised, either before or after marriage, her father is eligible to receive a full bride wealth payment.

“In the past when an uncircumcised woman got married, her parents could not claim her dowry. So if she wanted to get married then she had to get circumcised.”

—Chiana Katiu woman, aged 26–34

A father of an uncircumcised girl may have no right to bride wealth payments. Still, if a dowry is given to an uncircumcised girl, her brothers may benefit from the bride wealth while her parents do not. Since the bridewealth payments are obligatory if a bride is circumcised, economic incentives derived from bridewealth undoubtedly influence the beliefs and motives of the father and other men in the family.

Nonetheless, the economic role of FGM/C in bridewealth appears to be eroding, as suggested by the focus group discussions. It is apparent that circumcision status is less of a determining factor in the payment of bride wealth fees now that it has been in the past.

The risks posed to the man’s extended family by wife’s sexual desires Men voiced strong opinions about the relationship between FGM/C and female sexuality. Men often noted that circumcision was a social necessity in the past because wife’s sexual desires were a threat to harmony in the extended family.

“What I know is, our grandparents could travel for long without returning, by the time they are back, their wives would have had contact with other men. So it was done to reduce the sexual anxiety in women”.

– Nayagnia man, aged 35–49

Such beliefs and FGM/C values may be grounded in African customs of polygamous marriage and family building that is associated with weak emotional bonds between spouses and an element of spousal mistrust [ 40 , 41 , 42 ]. FGM/C is perceived by men as a mechanism that is needed to control sexual desires or urges ( nyane ) in women, thereby inhibiting sexual rivalry among co-wives. This is because once a woman’s interest in sexual pleasure and ability to enjoy sex is decreased, she is likely to be unfazed by the sexuality of her co-wives. In keeping with this perspective, some men stated that they wanted their wives to be circumcised to prevent sexual liaisons between their wives and other men:

“I will like my wife to go through circumcision. There is the belief that when she is not circumcised, she has ‘nyane’ (sexual urge), sometimes in her that makes her want to sleep with other men.”

—Gomongo adolescent male, aged 20–24

Men thus see women’s sexual urges as dangerous and destructive to the extended family. So extreme are sentiments about this danger that some men believe that unbridled sexual passion can even kill plants. For example, an uncircumcised woman’s nyane can cause calabash plants to wither and die:

“I have seen it with my naked eyes before (uncircumcised woman crossing a calabash plant and harming it). This is because since she is not circumcised, she is still a child and she has a lot of nyane in her, which destroys things.”

Several discussions nonetheless revealed that this traditional view of the dangers of sexuality has shifted. Although some FGD participants believe that female sexuality is dangerous more participants believed that intercourse with uncircumcised women would be more enjoyable and exciting than intercourse with a circumcised woman.

“Some men want the two for variety, but the old type needed the circumcised ones because they were the traditionally obedient ones. Today, no man would go for a circumcised woman, because they feel they are not as exciting as the uncircumcised ones.”

Women and adolescent girls also stated men now preferred uncircumcised women:

“Most men prefer uncircumcised women especially when it comes to sexual intercourse. They claim uncircumcised women are better in bed as compared to circumcised women.”

—Mayoro adolescent woman, aged 20–24

The husband’s contribution Some men express the view that circumcised brides are more wholesome and more likely to be a virgin, particularly if the girl had no objection to undergoing FGM/C:

“If she refuses[to undergo circumcision], the father will say that she is not a virgin that is why she has refused to be circumcised.”.

—Gomongo adolescent boy, aged 20–24

Most men stated that they did not care if a wife was uncircumcised or not. In many cases, men do not know if their bride has been circumcised.

“When a man is going to marry a woman, who will know whether the woman is circumcised or not?”

—Janania man, aged 50 +

Women, concur with the notion that men do not really care about FGM/C:

“…the men do not care because they are not insulted [if their wife is uncircumcised]. What he needs is the vagina, and the clitoris does not block his interest, so he does not mind whether his wife is circumcised or not.”

—Gongnia middle-aged man (age unknown)

While pressure may arise from the husband’s household, the husband himself may not have a direct influence on his wife’s circumcision status, even after marriage.

“It is because of the insults. It isn’t your husband who will insult you. It is your co-wives and your husband’s mother [who will do so]. If you are staying with only your husband, there won’t be any problem.”

—Gyanania woman, aged 35–49, polygamous union

Discussions thus suggest that for men, the various factors that explained their support for FGM/C in the past have changed in present times. While men appear to embrace the notion that a circumcised woman is valued for her fidelity this cultural perspective is increasingly offset by males’ preference for uncircumcised women.

In the Kassena-Nankana tradition, the relationship between FGM/C and girl’s chastity enhances the circumcised woman’s ability to find a husband. However, in present times, the weak significance of FGM/C for husbands has diluted the relationship between FGM/C and marriage. As many men admit their indifference towards marrying an uncircumcised or circumcised woman; and, an increasing number of younger men preferring to marry uncircumcised women, a husband should no longer expect to pay a high bride price for his bride based on her circumcision status. As discussed earlier this will in turn affect the economic incentives for the girl’s father who no longer can expect a high bride wealth for his circumcised daughter.

“…formally if you went courting and the lady wasn’t circumcised she would be told to do it now. When she is finally circumcised she would be made to choose from amongst the contestants (boyfriends), but today the men just go and take the girls away without doing the customary rites, so that is why you find men with uncircumcised wives.”

—Pungu men, aged 26–34

In summary, the role of men in sustaining FGM/C is important, but remote and eroding in the causal system. Chiefs exercise a role in deciding on the legitimacy of village activities. If an excisor visits a village for the purpose of performing circumcisions, he is obligated by custom to visit the chief. A council of chiefs and elders cannot ban the practice of FGM/C, but they can diminish access to excisors, alerting community members to the risks associated FGM/C, requiring parental travel and costs that would not otherwise arise. And they can affect the climate of opinion about FGM/C through comments at community gatherings. Male leaders are rarely proponents of FGM/C, however, men in general have a minor role in sustaining the practice. Economic incentives that are implicitly derived from bridewealth are being weakened by changes in male values and marriage preferences. As a consequence, most men in this FGD study were open to the idea of change.

The role of women

Maternal care Women view their role in fostering the circumcision of their daughters as a part of their responsibility as good mothers. Therefore, mothers try as much as possible to ensure that their daughter gets circumcised so that a mother will retain a respectable status among the women in the community. A mother who arranges the circumcision of her daughter has fulfilled her responsibilities as a good mother. The practice is associated with womanhood and the readiness for marriage. Traditionally, as aforementioned, young girls learned specific skills during the circumcision ceremony. However, even in modern times, many women subscribe to the normative value of circumcision in the belief that a girl will be considered a woman only after circumcision. Therefore, a woman wants her daughter to be circumcised so that she is thought of as a responsible mother who has raised her daughters properly.

“To be precise it is the mothers who push their daughters to circumcise because if your daughter is not circumcised, the mother would be seen in the village as an irresponsible mother. So if a mother does all that is necessary for a daughter without circumcision, she has failed in bringing up her daughter well… Mothers who witness their daughters being circumcised, are made proud and respected for the good upbringing of their daughters.”

—Gongnia woman, middle aged

In polygamous households, tensions can arise if one woman has not circumcised her daughters while her co-wives have circumcised her daughters. Therefore, when a woman arranges the circumcision of her daughter, she also eludes ridicule from the co-wives and her children.

“Mothers can force their daughters to be circumcised just because her rivals [meaning: co-wives] are insulting her and her daughters.”

—Gomongo adolescent boys, aged 20–25

Maintaining mother to daughter traditions. Women point out that if the mother had undergone circumcision, daughters should also expect to undergo the practice. Since circumcision has existed for generations respondents did not see any reason why girls today should not be circumcised if their mothers and grandmothers were able to endure the practice. Elderly women consistently support the practice. This is illustrated by the following statement:

“In the past, we were circumcised, but today we have been told that we should not circumcise our daughters. To me, I think the practice is good. Our grandmothers have all been circumcised, so why should it be stopped now?”.

—Chana-Kayoro woman, aged 50 +

“I think it [FGM/C] should be continued. I have no clitoris so why is it that my daughter should not be circumcised? My daughter will be circumcised.”

—Minigu woman, aged 50 +

The younger women held the contrasting view that, from their experience, there are health risks associated with the procedure.

I have undergone FGM/C, but I will not advice any girl to undergo it following the rumours we hear these days. Today, it is death, tomorrow, it is loss of blood and so on.

—Mayoro adolescent female 20–24 years

Moreover, participants noted that parents who compel daughters to undergo FGM/C are liable for arrest if law enforcement officers are aware of this action:

I think that policemen should be brought here to arrest practitioners and parents who want to force their daughters into FGM/C.

—Natugnia adolescent female 20–24

If most girls are educated, they could explain to their fathers about the law banning circumcision and this would make them afraid of going to jail. So no girls will be forced to undergo FGM/C. Mayoro adolescent female 20–24.

Maternal funeral rites. Many women feel it is especially important to circumcise their first-born girls because a first-born girl plays an important role in her mother’s funeral rites. Among the Kassena-Nankana, daughters carry their deceased mother’s personal effects in the funeral procession. Her personal effects will include the piligo , which is a pot that a woman keeps as a safe for all her valuable and emergency items. Only circumcised girls are allowed to participate in her mother’s burial. For this reason, mothers often insist that her first-born daughter is circumcised for to be buried without a daughter’s participation would bring shame on the family. As one woman stated, her mother insisted on having her circumcised so that her that her own funeral rites will be proper:

“I got circumcised because my mother wanted me to take an active part in her funeral preparation when she dies.”

But, once the eldest daughter is circumcised a woman will not be so concerned about arranging the circumcision of her other daughters.

“The mother also sees it as very necessary for her first daughter to undergo FGM/C. She will not be much worried if only her first daughter undergoes FGM/C, leaving the younger ones.”

In contrast, male groups discuss the significance of undergoing circumcision, not in respect to parental burial rites but for rather for the girl’s own burial and ultimately, her role in the after life:

“Another tradition is that, when the woman dies uncircumcised, she would be sent off without household accessories like, calabashes and pots.”

—Paga male, aged 50 +

“It is believed that when a woman dies uncircumcised, she would be buried like a man, to prevent that they circumcise, that is what I have also heard.”

—Nayagnia male, aged 35–49

Marital life. In the parental home, kin, parents, or peers can exert pronounced social pressure on a girl to undergo circumcision. Once a woman is married, however, the FGM/C opinion leaders in her father’s compound cease to have any influence whatsoever. Instead, the women of the husband’s home often have an even greater influence on the decision to undergo circumcision than her parents had during her adolescence. As the following statements suggest, the pressure to undergo circumcision can be unbearable for a young woman who has yet to have children.

“Maybe the pressure at her parent’s home to get circumcised was not very great. But in the husband’s home, the mother-in-law and co-wives would not take it easy, they will insult her thus pushing her to get circumcised.”

“It is always from your mother-in-law and co-wives. They will insult you in such a way that even if you think you will die when you do it, you will still do it.”

About one-third of marriages in the Kassena-Nankana district are polygamous and many women in monogamous unions anticipate the eventual onset of polygyny. Women are particularly sensitive to pressure from co-wives to undergo circumcision, which often takes the form of circumcised co-wives flaunting their status and openly insulting uncircumcised women in their compound. This can create a tension in the household, which an uncircumcised woman feels she can mitigate by undergoing the procedure. She may seek to undergo FGM/C even if she has married a husband who harbors no particular interest in her circumcision status:

“Look! My friends, co-wives can force you to circumcise…I have seen co-wives being mishandled because they are not circumcised. So the impact is felt more from the co-wives.”

Within the husband’s house, an uncircumcised woman living among the circumcised is not even considered a woman. Any slight provocation will incite many insults referring to her circumcision status. This limits her ability to assert her role in the husband’s house and challenge her rights as a married woman.

“Rivals [a term connoting dysfunctional co-wife relationships] see their uncircumcised colleagues as not being women and at the least provocation she insults her ‘Momte giee’ [translation: protruding clitoris]… Rivals would also not give you any rest but would always be insulting you. In fact, there are times that a newly married woman cannot go to the backyard garden because there is that belief that when she crosses a calabash plant it would die or it would not bear fruits just because she is not circumcised.”

—Gongnia woman, 35–49

In general, it should be noted that the pressure is particularly difficult to fend off when a junior wife is living with co-wives. A married woman’s decision to undergo circumcision is viewed by discussants as not a practice done under duress, but is a decision women take in response to peer pressure from co-wives or the wife of the compound head:

“I feel the impact to circumcise is greater from the peer group. If you are married, [pressure is from]your fellow wives. If you are a girl, your colleagues. The rest can complain [about FGM/C to you] but they cannot force you.”

In most households, a married woman can expect to live and spend considerable time with her mother-in-law. A mother-in-law who values circumcision is likely to ostracize an uncircumcised daughter-in-law. A mother who is circumcised usually wants her son to marry a woman who is circumcised in the belief that she will be a good, upstanding wife for her son.

“The mother-in-laws would not leave you alone, they keep attributing every bad thing in the compound to you having a clitoris. So by all means to become free of those blames, you simply [get] circumcised.”

“It is the husband’s mother who brings about the whole problem. When she insults you and you cannot endure it you will have to get circumcised.”

—Mirigu woman, aged 50 +

Thus, an uncircumcised woman can face daunting social pressure from other married women. Older women, and most particularly wives of compound heads, exert a profound influence on FGM/C decision-making among all women in the compound. During childbirth, birth attendants are commonly the older women in the house. Older women who assist in delivery often attribute problems associated with delivery to not undergoing circumcision and sometimes spread rumors about the circumcision status of young mothers:

“Some circumcise after marriage because when she is in labor, the attendants say they saw a piece of wood and not a child. Some will also say they saw two children. Thus, out of anger, she could undergo circumcision.”

“You can not tell from their faces, but when she becomes pregnant and is in abor, those who would attend to her would know and through that everybody in the village would get to know.”

Peer support for FGM/C. Women of all ages expressed the view that circumcision is prerequisite for peer social acceptance in extended households. This sentiment becomes manifest in household discussion of circumcision as a mark of womanhood. An uncircumcised woman is alienated among women inside or outside the home, and made to feel that it is imperative that she becomes circumcised to be socially accepted. If she is not circumcised, she can expect to be socially maligned by her peer group. Among the Kassena-Nankana, girls are encouraged to eschew individualism and honor corporate familial values and group participation. Being excluded from a peer group is particularly feared, since adolescent girls have little autonomy and social interaction in highly valued. Adult women were consistent in expressing the view that peer pressure to undergoing circumcision was intense, mainly because circumcision is necessary for preventing familial discord:

“Living with circumcised women is very unpleasant, every where they go your name will be mentioned as one of the women who have not been circumcised. Mockery will be very common and you can never feel free conversing with them because you would be seen as a social outcast. That is why every woman was advised to circumcise, in order to be able to join the women fraternity.”

“It is true, when you are an uncircumcised woman in a group of circumcised women, you will never feel comfortable, because they keep looking down upon you. You had to get circumcised to be part of the group.”

—Chana Katiu woman, aged 25–34

Expressions of pressure to undergo circumcision after marriage, however, are sometimes less a matter of antagonism than a form of sisterly social support. “Friendly advice” maybe extended to young women by peers, a mother in law, or co-wives who warn young women about the ostracism that an uncircumcised woman will face in the future. The following statements express this view:

“When you are sick, your husband’s mother is concerned and tries to make you feel well. In the same way when you are uncircumcised, your husband’s mother gets you circumcised so that you can move and speak freely with members of the household.”

“Sometimes, too, when other people keep insulting you, good co-wives may advise you to get circumcised.”

The role of peers and colleagues appears to have the greatest a influence immediately prior to marriage; and co-wives have the greatest influence immediately following marriage. Peers and colleagues may influence a girl to the extent that a girl will undergo circumcision without her parent’s encouragement or active support. Young respondents elaborated on this peer pressure to undergo circumcision.

“Sometimes the girls themselves might demand to be circumcised. This could generate from the fact that their colleagues are circumcised and thus tease them when they are together.”

—Gomongo adolescent boys, aged 20–24

“It could also be your colleagues. They can mock at you and that will compel you to go in for FGM/C since you will not like to be a laughing stock and branded as weak…They refer to you as a man and call you ‘long clitoris’. This annoys you and gives you the urge to go and get circumcised.”

—Mayoro adolescent girls, aged 20–24

While it is apparent that FGM/C is not a practice that is undertaken by overt force, it is abundantly clear that adolescent girls face daunting social pressure from mothers, other adult women in the extended family and peers. The actors in the FGM/C decision-making system change when a young woman marries, and her autonomy on this issue typically diminishes further. A young woman “acquired” through family exchanges has little status in her new household and must demonstrate devotion not only to her husband, but also to his complex extended family. Given the FGM/C-supportive social structures that young women must operate in, it is little wonder that the practice has remained pervasive. Although circumstances under which circumcision occurs vary all over African countries, the concept of force merits some clarification in this context.

Social forces that impinge on a young woman’s FGM/C motives are complex, robust and pronounced. In general, women have a more active role in sustaining various roles in the practice of FGM/C than men. As mothers, daughters, peers, and co-wives, women are socially invested in the continuation of the FGM/C practice. A mother who influences her daughter to undergo circumcision avoids ridicule of herself and her daughter and insures that her own funeral rites will be performed correctly. Similarly, peers and co-wives also avoid this derisive behavior by encouraging a woman to undergo circumcision. Once a woman undergoes circumcision, she has the right and capability to negotiate her role in her community of women and an element of dignity in her extended family that she would otherwise lack.

Evidence of preferences that oppose FGM/C

Health concerns. Despite considerable evidence of the continuing social value of FGM/C, there is some indication that support for the practice is eroding and that prevalence of circumcision may be declining. It was a common theme in discussions that FGM/C is declining as part of the erosion of wholesome family values in general and the decline in FGM/C was perceived to be contributing to social malaise. Both female and male respondents nonetheless suggested positive reasons for this trend, which ranged from health concerns to the notion that circumcised women are often sought by men to the general sense that circumcision is “outdated”. Some of this change in social perception is based on misinformation, and some is based on actual factors regarding health problems associated with FGM/C. More typically, however, health concerns reflected a blend of information and misinformation. An example includes the perception that a decline in the nutritional content of food is believed to make it harder for women to recover the blood that they lose during circumcision.

“…now that the food we eat is not very nutritious as before, we can not risk wasting blood through circumcision.”

—Natugnia women, aged 35–49, polygamous union

Men who opposed the practice were sometimes cognizant of the health implications of practicing FGM/C such as the effect of FGM/C on childbearing, but expanded this notion to include child health more generally. For example:

“I prefer the uncircumcised [women] because whenever she brings forth, you will notice that the child is beautiful and healthier than the circumcised woman’s child.”

These views demonstrate the need to provide effective health education about the effects of FGM/C in ways that combat misinformation about FGM/C as well as provide a better understanding of why FGM/C should be prevented.

Ideational change Focus group respondents often noted ways in which FGM/C norms are changing. Although this is not the predominant view some women and many men stated that FGM/C is outmoded and that women who practice it are illiterate and ignorant. This view was expressed by a middle aged Natugnia woman:

“Whether married or not, circumcision is not practiced any longer. Only the illiterates stay indoors and still circumcise. If you assemble all girls here, the majority are not circumcised.”

Women expressing this view also acknowledge that the pattern of mockery that was once directed to the uncircumcised is now more typically expressed as mockery against those who are circumcised. For example, a respondent claimed that women who are circumcised are now lectured about the practice when they encounter health workers.

“These days when you are circumcised and you are in labor at the hospital, the nurses insult you so much.”

Some women cited that they have experienced being ridiculed for having an “empty vagina:”

“These days if a circumcised woman tries to look down on an uncircumcised one, she will be seen as ignorant or even an illiterate, because the practice is outdated now. So when you are insulted that you have a protruding clitoris, also return the insult by saying that she has an ‘empty vagina’.”

Still, while many circumcised women wanted their daughters and other women to undergo circumcision, some professed a sense of opposition against the practice. Reasons cited were usually health related, though some circumcised women expressed regret that sexual relations were enjoyed more by uncircumcised women.

“We those who are circumcised don’t enjoy sex as much as the uncircumcised women. We never knew it was harmful to us or we wouldn’t have done it.”

—Gyanania women, aged 35–49, polygamous union

“I have been circumcised, but when I have a daughter, I will not allow her to get circumcised, we were circumcised because we were ignorant.”

—Mirigu old women, aged 50 +

Thus, mockery among women is the main mechanism through which social pressure is exercised. Whereas ridicule was once directed to fostering FGM/C, it is now sometimes directed to deriding the practice. While fears of women’s sexuality once provided a rationale for FGM/C practice, there is evidence that sexual perceptions of uncircumcised women may be contributing to changing social acceptance of uncircumcised women.

But foremost, FGM/C no longer seems to be an issue that is encouraged by men and their preferences or dictated by their preferences. Moreover, many women are cognizant of the fact that men have become ambivalent about circumcision. Results of this investigation thus, challenge the view that women seek FGM/C in response to the dictates of men. Instead, women subscribe to the notion that circumcision is the concern of women only. Men have a role in the FGM/C decision making system; but all FGD age and gender groups lend emphatic support to the proposition that FGM/C is a woman’s matter that is sustained and promoted by mothers and mothers-in-law as one woman noted:

“The men would never open their mouths that a woman should [be] circumcised. It is a woman’s thing. The pressure comes from them.”

Since the practice of FGM/C is grounded in customs perpetuating the subjugation of women, it is widely assumed that male preferences and FGM/C beliefs are the decisive influences sustaining the practice of FGM/C in traditional societies. This investigation lends support to this perspective in the sense that the male dominated patriarchal system constrains women’s autonomy and leads to a system of social influence that a young woman is powerless to engage. But to conclude the analysis with this observation would do little to elucidate what happens in the daily lives of women that sustain FGM/C and what must be done to accelerate the erosion of this harmful practice.

The FGM/C decision-making system

The relationship of factors in the FGM/C decision-making system are illustrated in Figs. 1 and 2 . Two figures are necessary in keeping with our observation that a young woman seeking to avoid FGM/C must run the gauntlet of two complex systems of social pressure, one dominated by her mother before marriage, the second dominated by her mother-in-law after marriage. As the diagrams show, most men in study communities where the practice FGM/C is extensive do not play a prominent role in FGM/C decision-making. However, the important exogeneous role of the patriarchal system should not be dismissed as inconsequential. Both men and women are players in the institution of FGM/C, but the role of women is proximate and pronounced. As the figures show, women are the main perpetrators of the FGM/C practice. Male leaders play an important role in the legitimization of FGM/C- most excisors are men and religious rites prior to the FGM/C practice are performed by men. The important, but exogenous role of men appears in the diagrams as male influences on the left hand side of the diagrams.

Lines of relative social influence on FGM/C decision making among adolescents

Lines of relative social influence on FGM/C decision making among newly married

Figure 1 demonstrates the complex and systemic nature of social support of FGM/C. First, there is a strong component of gender stratification in the social forces that sustain female circumcision. Gender differentiation of the influences reflects the investment and benefits expected of both men and women. Fathers stand to gain monetarily from a daughter’s circumcision because of the bride wealth custom. However, the role of the bride wealth in marriage is diminishing and the value of FGM/C in determining bridewealth is eroding. These changes may be occurring at an even faster rate than change in FGM/C practice [ 43 , 44 ]. Nonetheless, mothers and other women in the extended family are socially invested in their daughter’s circumcision because of the social stigma of not being circumcised. For women, the relationship between social benefits and circumcision status has not changed, while the reasons for man to marry a circumcised woman or force his daughter to circumcise has diminished. Thus, the lines of influence diagrammed in the figures are weak for men but strong for women.

The role of peers further complicates the system of influences diagrammed in Fig. 1 . Girls are inculcated with the belief that group membership and corporate values are crucial to self-esteem. Ultimately, the decision to undergo circumcision thus, depends on whether or not the social climate favors being circumcised or not being circumcised. Women at all ages are immersed in a social environment that constrains social agency and perpetuates circumcision practice.

Figure 2 illustrates ways in which influences on FGM/C behavior shift with marriage. As in the Fig. 1 system, young married women have little autonomy in FGM/C decision-making, despite the common assertion that FGM/C is not compulsory. The role of extra-familial peer pressure virtually disappears with marriage and the young woman’s familial climate of FGM/C values indicated by in her husband’s extended family.

The continuing and robust influence that women play in sustaining the practice could be related to the need for women to create status for themselves in a women’s hierarchal society where power and influence is otherwise, vested in the male dominated, patriarchal system. Instead of representing an “exercise in male supremacy and the oppression of women” [ 45 ] or reasoning that women are “colluding with patriarchy to maintain subordination of women in society” [ 46 ], programs should seek to create “social space” for women that enhance the status of women that is associated with female circumcision without the actual performance of circumcision. As one writer has observed,

“to reduce adolescent girls’ belief that excision would transform them into adult women to patriarchal conspiracy would be to ignore how the institution of female initiation regulated relations among women as well as between men and women” [ 47 ].

Women could be portrayed less as victims or misguided perpetrators and more as women who can learn and create these same ideals to more positive social mechanisms and customs for themselves.

This study aimed at clarifying the gender dynamics that underlie social support for female circumcision in the Kassena-Nankana District of northern Ghana Results suggest that the FGM/C decision-making process is complex, involving multiple family members. However, in the course of family dynamics, the girl’s mother takes the primary initial responsibility for encouraging a daughter to be circumcised. The father’s role is also critical because he is responsible for permitting the circumcision procedure. But, the initiative for undergoing FGM/C is mainly the mother’s prerogative. This finding is consistent with conclusions reached by studies of the FGM/C decision-making process elsewhere in Africa. Qualitative research on FGM/C determinants in Sudan and Sierra Leone parallel our findings [ 48 , 49 ]. Moreover, a quantitative study conducted in Iran reported that mothers and grandmothers were the main decision makers in the circumcision of 85.1% of the study participants [ 50 ]. Patriarchy is nonetheless important. A possible explanation of the role of mothers or females in perpetuating FGM/C is likely to be influenced by their desire to maintain tradition and despite the dominant role of women in sustaining FGM/C, the practice cannot be disassociated from the more general context that patriarchy conveys. Social institutions in general are grounded in patriarchal context of Kassen-Nankana society [ 48 ],

Various studies have shown that a wide range of factors have been instrumental in reducing the prevalence of FGM/C [ 10 , 31 , 32 , 50 ]. In this study, respondents have attributed the decline in the prevalence of FGM/C to general concerns about the health risks associated with the practice, particularly pertaining to loss of blood, and the effects of FGM/C on childbearing and child health. Other factors accounting for the change in the receptiveness of FGM/C are linked to women being ridiculed for being circumcised, the general notion that sexual relations are enjoyed more by uncircumcised women and men’s increased preference for uncircumcised women. The concerns on the health risks associated with FGM/C might be due to the extensive focus on the health risk of FGM/C in numerous FGM/C abandonment interventions [48, 51]. The horrific experiences of circumcised women might have also played a role in strengthening the advocacy against FGM/C.

Since the practice of FGM/C is grounded in customs perpetuating the subjugation of women, it is widely assumed that male preferences and FGM/C beliefs are the decisive influences sustaining the practice of FGM/C in traditional societies. This investigation lends support to this perspective in the sense that the male dominated patriarchal system constrains women’s autonomy and leads to a system of social influence that a young woman is powerless to confront. But to conclude the analysis with this observation would do little to elucidate what actually happens in the course of the FGM/C decision-making process. Women promote, sustain, and initiate discussion of FGM/C in the household. For programs to effectively accelerate the erosion of this harmful practice, women’s advocacy of the practice must be in focus. What then can we conclude about the appropriate design of an FGM/C prevention program?

First, since the social forces that sustain FGM/C are complex and systemic, no one strategy or simple initiative will work. Just as FGM/C is sustained by a complex social system, prevention must be guided by a sophisticated sense of respect for the institutions that govern life, prevent social disorder, and sustain family values. It is particularly important to focus on the FGM/C motives of adults; program oriented to adolescents alone will fail.

Second, instituting change is possible. Social change in FGM/C values is already evident. Program action is not a hopeless endeavor. Lines of influence that were strong in the past, such as fathers, husbands and compound heads, appear to be eroding.

Third, there is a need to build on the receptive audience that men represent. Chiefs, elders and other male players in the patriarchal system can be active promoters of FGM/C prevention. The Navrongo experiment, for example, utilizes traditional village gatherings, known as durbars as mechanisms for communicating FGM/C lessons and correcting misinformation. It is more appropriate to utilize the lineage and chieftaincy system for disseminating health education about FGM/C than professional health workers who are engaged in ambulatory care. Rather than dismissing the patriarchal system as the social force that sustains FGM/C, the system of male social leadership and communication should be marshaled to foster abandonment of the practice.

Fourth, social interaction among women is dominated by exchanges in the extended family. There is a need to build extra-familial women group identity and social cohesion around activities that challenge traditional FGM/C views. Women who are opposed to FGM/C need social support for their perspective. Singing and dancing groups exist in all of the FGM/C experimental areas. Convening such groups for the purpose of fostering FGM/C prevention, would build a program around the strong value that women consign to group participation and collective decision-making. An effective program of mobilizing women’s extra-familial networks would offset the isolation and traditionalism that constrains the autonomy of young women.

Fifth, the needs of unmarried and married adolescents for FGM/C prevention programs cannot be separated from adolescent health needs more generally. Activities that build self-esteem and autonomy through livelihood training, peer leadership, or other adolescent outreach program, such as sport promotions, can include FGM/C educational components. Girls organized into peer groups for the Navrongo FGM/C experiment had no prior experience with extra-familial decision-making or discussion of matters involving individual preferences and personal autonomy. Building peer leadership for reproductive health is a crucial element of the Navrongo FGM/C eradication strategy.

Finally, adolescent outreach activities can be designed to have a “right of passage” component whereby young men and women receive traditional family life education and their completion of this process is acknowledged by a community celebration. In this manner, elements of social values that are so often cited as rationale for sustaining the practice of FGM/C can be re-associated with a program that is designed to foster prevention of this practice. Participants in this study were generous with advice on how this could be achieved through appropriate outreach to parents, women’s groups and community leaders. While the specifics of these recommendations may not transfer to other social groups that practice FGM/C, the general principle of consulting communities, seeking their advice, and implementing a socially informed program should apply to other settings. It is possible that other investigations may challenge conventional wisdom on what must be done to prevent FGM/C. At least in this setting, men are logical allies in instituting change; and women must be the focus of social intervention if efforts to institute change are to succeed.

Availability of data and materials

Data for study is available upon request.

Abbreviations

Community key informants

Focus group discussion

Female genital mutilation

Navrongo demographic surveillance system

Navrongo Health Research Centre

Institutional Review Board

United Nations Children’s Fund

World Health Organization

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Acknowledgements

The authors gratefully acknowledge advisory support of staff of the Navrongo Health Research Centre who provided support for the field organization and implementation of this study.

The FGM/C Abandonment Study was supported by grants of USAID to the Population Council. Writing activities of Columbia University coauthors was funded by the Doris Duke Charitable Foundation African Health Initiative grant to the Mailman School of Public Health of Columbia University [Grant 2009058B].

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Contributions

The FGM/C Abandonment initiative was designed by JFP in collaboration with PA and its protocol was developed by JFP in collaboration with the Ghana Health Service. The manuscript was initiated by PA, EJ, SA. Field work for this initiative was organized by PA and ES. Initial data analysis was conducted by PA, EJ, SA, ES and JFP. All authors read and approved the final manuscript.

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Ethical approval for the Navrongo FGM/C Abandonment project and its data collection processes, described in this case study, were approved by the Navrongo Health Research Centre Institutional Review Board (NHRCIRB-31-03-2003). Both written and oral consent was sought from the participants before data was obtained.

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Akweongo, P., Jackson, E.F., Appiah-Yeboah, S. et al. It’s a woman’s thing: gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana. Reprod Health 18 , 52 (2021). https://doi.org/10.1186/s12978-021-01085-z

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Female genital cutting
Social determinants
Gender stratification
Sahelian Africa
Harmful traditional practices

Reproductive Health

ISSN: 1742-4755

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Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations

Perspectives From a Women’s Rights NGO

Sociocultural Issues and Epidemiology (J Abdulcadir & D Bader, Section Editors)
Published: 12 November 2020
Volume 12 , pages 292–301, ( 2020 )

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Stéphanie Florquin 1 &
Fabienne Richard 1 , 2

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Purpose of Review

The goal of this paper is to discuss the juxtapositions between FGM/C and other medically unjustified genital alterations performed on adult women (aesthetical genital surgeries) and on children (male circumcision and intersex genital surgeries). The authors join the debate from their position as professionals working in Belgium’s main “anti-FGM organization” as well as researchers.

Recent Findings

Recent research and contributions from scholars have raised critique of policies around FGM/C, particularly in the global North. Some of the concerns include critiques of laws that infantilize adult women, problematic use of genital examination, discourses that stigmatize migrant persons from FGM/C practicing communities, and professionals who are insufficiently trained to support women with FGM/C in a respectful and empowering way. Scholars have also argued that there is a lack of medical distinction between different types of genital cutting such as FGM/C type I and type IV, male circumcision, and aesthetical genital cutting. Authors have stressed the discrepancy in terms of both discourse on genital cutting, and called for equal protection of girl, boy, and intersex children from medically unnecessary genital cutting, without discrimination in regard to ethnicity, religion, or immigration status of their parents.

The paper argues that the discussion on FGM/C and other genital alterations must consider existing socially constructed inequalities, particularly gender and “race”, and how they affect those submitted to genital alterations. The authors highlight practical challenges raised in their daily work in a women’s rights NGO and conclude with recommendations.

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A Review of Female Genital Cutting (FGC) in the Dawoodi Bohra Community:

Zero tolerance for genital mutilation: a review of moral justifications, medicalized female genital mutilation/cutting: contentious practices and persistent debates, explore related subjects.

Medical Ethics

While these practices are not integrated in the description or the specific examples, the WHO (2008 ) states that labia elongation « might be defined as a form of female genital mutilation » because of the social pressure on young girls to undergo it and because it created permanent physical changes. [ 12 , p. 27 ]

For information on care of women living with FGM/C in Belgium, see Caillet, M. et al. “Addressing FGM with Multidisciplinary Care. The Experience of the Belgian Reference Center CeMAViE”, Current Sexual Health Reports , vol. 10, p.44–49

We chose to use the term “survivor” as “this term to emphasize the woman or girl’s resilience and as an empowering element of language, but without prejudice to the fact that the woman or girl may prefer to use the term victim.” [ 1 ]

Even clitoridectomies were historically used in “the West” to treat female “conditions” such as hysteria, nymphomania, lesbianism, and other “deviant” behaviour.

For example, in Senegal, the Fulani use the term kaddungal , while the Wolof use the term xarafal

See for example the French organization « Droit au corps »

https://www.secularism.org.uk/news/2015/10/council-of-europe-retreat-on-circumcision-of-young-boys

“Cisgender” refers to a person whose gender identity fits the gender they were assigned at birth. A baby born with male sex attributes and therefore assigned male, who perceives himself to be a boy/man, is cisgendered. The opposite of cisgender is trans-gender.

While national studies on SGBV are lacking in Belgium, in the neighbour country France, the extensive VIRAGE study found that 14.5% of women and 3.9% of men reported experience of at least one form of sexual assault (excluding harassment and exhibitionism) in their lifetime. The authors stress that « [s]exual violence against women is not only much more frequent, but occurs in all life spaces throughout life. ». The study further shows that « [w]hatever the life space, sexual violence reported by women is practically always committed by one or more men (between 94% and 98%) » while the majority of cases of violence reported by men is also committed by other men. [ 8 ]

Intersex people are born with sex characteristics that do not fit typical binary notions of male or female bodies. See OII Intersex Network http://oiiinternational.com/

The exception is Malta who banned unnecessary genital surgeries on minors in 2015.

Contrary to common beliefs about the rarity of intersex persons, people who are intersex in Belgium probably represent several 100,000 if you go with the available data, a much larger group than women having undergone FGM/C.

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Florquin, S., Richard, F. Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations. Curr Sex Health Rep 12 , 292–301 (2020). https://doi.org/10.1007/s11930-020-00277-1

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Write an argumentative essay on a topic: should female circumsition be
Write an argumentative essay on a topic: should female circumsition be abolished give your reason... 1 Answers Available Asked by Last born on 19th September, 2023
Female Circumcision Argumentative Essay
Female circumcision, also known as female genital mutilation (FGM), is a major topic in the feminist spotlight. Based solely on the difference between the descriptions of the topic (circumcision vs. mutilation), it is easy to see there is conflict of opinions about the ethics surrounding the practice.
Argumentative Essay On Female Circumcision
Argumentative Essay On Female Circumcision. "The idea of female circumcision stems from a cultural tradition that includes cutting of female genitals without medical assistance or local anesthesia (Taylor & Francis, 686).". Female circumcision is a cultural practice that has been around for thousands of years and was once a global practice.
The Ethical Quandary: Female Circumcision in Cultural Crossroads
An ethnographic example from the article underscores the cultural significance of female circumcision within the Kikuyu Tribe in Kenya, where marriage to an uncircumcised woman is deemed inconceivable for a "proper Kikuyu." This example highlights the deeply rooted nature of such practices within specific cultural settings.
Debating medicalization of Female Genital Mutilation/Cutting (FGM/C
Background Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are ...
What About Female Genital
this 'barbarous custom' should be abolished, and that, like all other 'heathen' customs, it should be abolished at once by law."14 He goes on to argue that among the Gikuyu a genital alter ation, "like Jewish circumcision," is a bodily sign that is re garded "as the conditio sine qua non of the whole teaching of
Key points for abolishing Female Genital Mutilation from the
Findings: through the voices of men familiar with this tradition, five key points are presented for its gradual eradication: sensitisation and awareness building, team action, abolition-promoting media, focusing action on rural areas and applying educational means before punitive ones. Conclusion and practical implications: awareness-raising ...
Attitudes toward Female Genital Mutilation/Circumcision: A Systematic
1. Background. Female genital mutilation/circumcision (FGM/C), or female circumcision, refers to all intentional acts that partially or totally remove the external female genitalia or female genital organs of young girls for cultural, traditional, or nonmedical reasons [1,2].It is estimated that currently more than 200 million girls and women have undergone FGM in countries where this practice ...
A New Debate on Female Circumcision
Female mutilation is *not* circumcision. The name says it all, circum-cision means "cut around", i.e. cut around the extra skin on a man's penis, which has many health benefits — penis cancer is unknown among circumcised men, plus the penis is allowed to grow more freely without a constricting fold of skin.
Female Circumcision Is More Complicated Than You Think
Parsing a reader debate on the best way to end female circumcision—no one is arguing for the practice—is difficult because people are often talking past each other. That difficultly is due to ...
Envisioning an End to FGM/C
Female genital mutilation or cutting—in which all or part of a girl's or woman's genitalia is altered or removed for nonmedical purposes—has been a traditional practice in many countries for over a millennium. More than 200 million women and girls alive today are FGM/C survivors. In 2012, the UN General Assembly designated February 6 ...
Should female circumcision continue to be banned?
Female circumcision has returned to mainstream debate again and one hopes that this time a compromise acceptable to the abolitionists and the conservationists will be forged. The latter group should be given the opportunity of expressing its view without fear of being regarded with contempt. Such a cordial approach will foster a fair debate ...
Eradicating Female Genital Mutilation/Cutting
Abstract. Female genital mutilation/cutting is a form of violence against women and girls. It includes all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons. It is estimated that over 200 million girls and women worldwide have suffered the effects of ...
Argumentative Essay On Female Circumcision
152 Words. 1 Page. Open Document. Female circumcision continues to happen in many cultures. Women should have rights to their body and let no one violate it. The body is precious and a temple. Based on the statement from the United Nation Children Fund everyone has a right to make a decision about their body. The four types of circumcision are ...
Zero Tolerance for Genital Mutilation: a Review of Moral Justifications
In Australia at the time of writing, a person may be imprisoned for up to 7 years who either "excises, infibulates or otherwise mutilates the whole or any part of the labia majora or labia minora or clitoris of another person," or "aids, abets, counsels, or procures a person to perform" any of those acts, collectively defined as "female genital mutilation" or "FGM" for legal ...
Reconciling female genital circumcision with universal human rights
This article, however, suggests a mediating approach according to which one form of FGC, the removal of the clitoris foreskin, can be made compatible with the high demands of universal human rights. The argument presupposes the idea that human rights are not absolutist by nature but can be framed in a meaningful, culturally sensitive way.
Why Family Law Treats Female Genital Mutilation and Circumcision
Writing in 1988, Sochart notes 'It has only been in the last few years that the subject of female circumcision has begun to be discussed openly in Britain' 125 and that 'the first step (…) which would eventually set the issue of female circumcision firmly on the British political agenda' was Lord Kennet's tabling of Parliamentary ...
"Female genital mutilation can be stopped," says HC
In July 2020, the Human Rights Council adopted resolution 44/16 on the elimination of female genital mutilation to speed up efforts to reach zero tolerance for FGM by 2030 and to restate the global ban on the harmful practice as it constitutes a serious violation of women's rights. The number of women and girls mutilated every year globally ...
PDF SHOULD FEMALE CIRCUMCISION MORAYO ATOK[*
O esug-gestion is that clients should be at least sixteen y ars of age, asthis the age ofmajority in many African countries. 40 A lawinthis form, would bemore efficacious than one which bans female circumcision in ts entirety. Banning the practice will not eradi-cate it; it will only succeed indriving itunderground.
It's a woman's thing: gender roles sustaining the practice of female
The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in ...
Female genital mutilation; culture, religion, and medicalization, where
I NTRODUCTION. Female genital mutilation/cutting (FGM/C) is defined as all the procedures which involve the partial or total removal of the external female genital organs for nontherapeutic reasons [1,2].Different classifications have been used for FGM/C by various authors, but the most acceptable or adopted is the WHO classification [1,2,3,4].This classification is based on the extent of ...
Critical Discussion on Female Genital Cutting/Mutilation and Other
Purpose of Review The goal of this paper is to discuss the juxtapositions between FGM/C and other medically unjustified genital alterations performed on adult women (aesthetical genital surgeries) and on children (male circumcision and intersex genital surgeries). The authors join the debate from their position as professionals working in Belgium's main "anti-FGM organization" as well as ...
Frequently asked questions: Female genital mutilation
Globally, about 200 million girls and women have been subjected to female genital mutilation (FGM). FGM is a traditional cultural practice and a form of violence against women and girls. Under the 2030 Sustainable Development Agenda, UN Member States have committed to ending FGM by 2030 (SDG Target 5.3). Though important strides toward abandonment of the practice and achievement of this target ...

Write an argumentative essay on a topic: should female circumsition be abolished give your reason...

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The Ethical Quandary: Female Circumcision in Cultural Crossroads

Professor Salmon's Staunch Advocacy for Abolition

Exploring the Cultural Landscape through Ethnography

The New York Times

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The Complexity of Female Circumcision: Your Thoughts

About the Author

Envisioning an End to FGM/C

Tell me about the Center for Global Women’s Health and Gender Equity. How did it come about, and why?

Is this an international center? Or does it also have domestic components?

Nicole, as an expert on FGM, can you tell us a little about that practice?

Is there a difference between FGM and FGC?

What is the traditional rationale for FGM/C?

Is this something that can be prevented through behavior change work?

Could laws against FGM/C help?

You mentioned earlier that there’s a U.S. component to this.

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Why Family Law Treats Female Genital Mutilation and Circumcision Differently: An Explanation

A. Wider context

B. General community standards

C. Toleration and parental autonomy

D. Exceptionality and bright-line tests

E. Social change and ‘Felt Necessities’

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It’s a woman’s thing: gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana

Introduction

The FGM/C decision-making process

The role of men

The role of women

Evidence of preferences that oppose FGM/C

The FGM/C decision-making system

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Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations

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A Review of Female Genital Cutting (FGC) in the Dawoodi Bohra Community:

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