The person performing female genital cutting differs according to the context. In rural areas, FGC may be performed by traditional birth attendants or cutters. Often FGC will be carried out in unsterile conditions using a basic instrument such as a blunt knife or a piece of glass.  In other places, there may be a known cutter, who has high regard within her community. Generally, the person undertaking the cutting is a woman.

In other contexts, FGC is performed by medical practitioners under sanitised conditions. It is believed that globally, up to 18% of all FGC is now carried out by medical professionals. In Egypt where prevalence is as high as 91% of women, 77% of FGC is carried out by medical practitioners (UNFPA). 

We are often asked why we use the term female genital cutting and not female genital mutilation. Our project partner Tostan often gets asked the same thing; in June 2011 they posted this blog answering those questions (the original can be found here):

A Facebook contact recently posed a question to Tostan asking about the use of the term female genital cutting (FGC) versus female genital mutilation (FGM) when talking about this cultural practice. Gannon Gillespie, Tostan’s Director of External Relations, responded:

Dear Walter,

Thank you for your question, which is one we have received regularly for many years. Let me begin by saying that terminology around this issue is challenging. Three separate terms have been widely used to describe the practice: female circumcision, female genital mutilation, and female genital cutting. We avoid the term “circumcision,” as it incorrectly implies a parallel between FGC and male circumcision. Unfortunately, all other terms have limitations as well, and fall clearly short of accurately describing this practice—which has four major and infinite minor variations in practice around the world. No one term is truly “accurate”.

But we must use words, and so among these options, Tostan has for over 13 years chosen the term female genital cutting (FGC) based on what communities that are giving up the practice have told us: the term “cutting” allows them to accomplish more than the others because it is less judgmental and value-laden. As a result, the term is more effective for engaging groups in dialog around this practice, and eventually bringing about its end.

Let me be very, very clear. We do not use this term in an attempt to excuse or diminish the impact of the practice. I think anyone who has taken the time to learn about Tostan and watched the testimonies given by Tostan’s local partners, for example that of Marietou Diarra, knows that we are very far from hiding or excusing the real, significant consequences of this practice. Yet despite its serious health consequences, we have found that FGC itself is not done with the intent to “mutilate” a girl. Rather, parents who have their daughters cut want the best for them, and the practice is seen as a necessary step to enable her to be a fully accepted member of the community.

It seems counter-intuitive, but in our experience, if there is a dominant emotion involved in FGC, it is love—because not cutting your daughter risks her entire future. As explained by a former cutter turned Tostan advocate, Oureye Sall, in communities where FGC is practiced, community members will not eat food cooked by a woman who is not cut, will not accept water from her, will not even sit with her. She will have difficulty getting married. An uncut woman is viewed as unclean and therefore unable to participate fully in the community. With these social pressures, if a family chooses not to cut their daughter, they have risked severely damaging her social status. To imply that parents are actually “mutilating” their daughters through a decision made with love and concern for her well-being is unfair to them and risks alienating and offending them rather than convincing them to abandon the practice.

In addition, we have found that many communities do not fully understand the consequences of the practice—the effects of which are not always immediate or obvious, especially in cases of infections, tetanus, etc. Without an understanding of concepts such as germ theory, recognizing the true long-term health implications of FGC is difficult. When communities do get access to this information, presented in ways they trust, they come to understand the harm the practice causes and decide to stop—but if the person bringing these messages begins with judgmental terms, the chance of reaching this breakthrough disappears.

We should remember that all of us, no matter where we are from, tend to greet judgmental outsiders in similar ways. When our beliefs and actions are challenged or condemned by a stranger, we are likely to become defensive; rather than taking their concerns to heart, we view their accusation as an unwarranted and uninformed attack on our character. We certainly won’t feel inclined to change in order to satisfy this judgmental critic; we may even respond by holding on more tightly to the belief or action being questioned. Our experience has shown us that it is dialog and discussion that can lead to change, and dialog requires a relationship of trust and respect. But calling the practice “mutilation” prevents this relationship from developing and invites defensiveness rather than productive discourse.

And, if we take the example of Oureye Sall—who transformed her experience as a former cutter into a source of leadership against FGC—it becomes clear that we must avoid demonizing those who perform the practice. Oureye is not a “mutilator” and villain; she is a hero driven by her new knowledge. When she had cut girls, she did so because the experience and knowledge available to her told her it was right to do so. When she decided to stop and to become a champion of the movement to abandon FGC, it was because new experiences and new knowledge showed her that the practice was harmful and that change was necessary. Tostan’s experience has shown this to be the case for almost all cutters; they are not evil, they do not seek to “mutilate” girls or bring them harm, but rather they are acting based on what they believe is right.

Perhaps most importantly, we should be very cautious in labeling and stigmatizing the girls and women who have been cut. We do not believe it is our place to tell them that they are “mutilated.” As with other victims of violence, we believe they have the human right to self-identify in whatever manner they choose. I have personally met many women who have undergone FGC. Some prefer to call themselves mutilated, others simply “cut”, many others say less, or nothing, as they are not yet comfortable being public about this very private matter. And all of them (even those who themselves identify as “mutilated”) agree: women should be free to choose the term that best defines them, and that the term “mutilated” should not be forced upon them.

In short, our use of the term “FGC” is not apology, nor is it political correctness. It is simple practicality: this way of speaking opens doors to dialog that have led to thousands of communities standing up to abandon this practice, doors that more accusatory language would keep shut. We choose to use language that is working, that community leaders and evaluation data alike are telling us brings real, concrete change.

In keeping with the above approach, I can also tell you that we are not posting this in an effort to “fight” others who use different language. We respect the many differences of opinion on this truly complex subject and the language that accompanies it. We do encourage others to study our experiences, both in relation to FGC and the many, many other areas on which our program works. We hope to continue supporting community-led work in the field to ensure all girls–cut and uncut–have human dignity. These actions are our main focus, and we believe they speak much louder than words.

For those interested in learning more about FGC as a social norm, I recommend that you read “Female Genital Cutting: the Beginning of the End” an article by political scientist Gerry Mackie. The article explains why a program like Tostan’s can be effective in sparking a movement to abandon FGC. The section on pages 277-278 entitled “Propaganda and Prohibition” discusses the results of respect-based approaches versus shame-based approaches to effecting social change.

Sincerely,
Gannon Gillespie

Female genital cutting (FGC) is the partial or total removal of a girl’s external genitals. Her body is physically damaged when the healthy tissue of her genitals are cut away. There are no health benefits to FGC. Complex cultural and social reasons are often given about why it is practised.

FGC has harmful effects on the health and wellbeing of a woman throughout her life and contravenes human, women’s and child rights. Female genital cutting is also commonly referred to as female genital mutilation (FGM).

When a girl undergoes female genital cutting, some or all of her external genitals are cut away. This can be part or all of her labia, part or all of her clitoris and part or all of her clitoral hood (the prepuce). In its most extreme form, all of her external genitals will be cut away. This often happens in very basic circumstances with rudimentary tools; it is unlikely that there is any anaesthetic or that conditions are sterile.

In the harshest form of FGC, the wound that is left may be sewn closed with thorns or string. A small hole is left for menstrual blood and urine. The wound then heals over and the scar tissue “seals” her vagina. A girl will then have to be cut open, just enough for sexual intercourse. When she goes into labour, she is cut open even more. After this she may be re-sewn and cut open again every time she gives birth.

Why are there different classifications for FGC?

The entire female external genital organ is called the vulva and is composed of the labia majora (the outer lips), labia minora (the inner lips) and the clitoris which has a hood (the prepuce). 

The World Health Organization (WHO) classifies FGC into four categories dependent on severity (initially there were three categories, the fourth was added later):

Type 1: The clitoris or clitoral hood is partially or fully removed (also known as clitoridectomy)

Type 2: As well as the clitoris, the labia minora are partially or fully removed. The labia majora may also be cut

Type 3: The clitoris, labia minora and labia majora are cut away, and the remaining skin is sewn or sealed together leaving a tiny hole for menstrual blood and urine. This is commonly known as infibulation

Type 4: All other harmful procedures to the female genitals including pricking, piercing, rubbing, scraping and the use of herbs or other substances.

The detailed WHO classifications contain sub-divisions for each type:

Type I — Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).

• When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris with the prepuce.

Type II — Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

• When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora.Note also that, in French, the term ‘excision’ is often used as a general term covering all types of female genital mutilation.

Type III — Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

• Type IIIa, removal and apposition of the labia minora; Type IIIb, removal and apposition of the labia majora.

Type IV — All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.