Female Genital Mutilation/Cutting
Female Genital Cutting (FGC), sometimes labelled Female Genital Mutilation (FGM) or Female
Circumcision, is a deep rooted traditional practice that adversely affects the health and well-being of
millions of girls and women worldwide. It is estimated that 140 million females worldwide have been
subjected to FGM, with 3 million girls at risk each year.
The practice of FGC is concentrated in 29 countries in Africa and the Middle East, where it is
estimated 125 million girls and women have been subjected to FGC (Unicef, 2013). Two-thirds of
these girls and women (83m) live in four countries: Egypt (27.2m); Ethiopia (23.8m); Nigeria (19.9m);
and Sudan (12.1m) (Unicef, 2013). Unicef (2013) state that an additional 30 million girls and women
are at risk of FGC in these 29 countries in the next decade. Prevalence rates of FGC vary between
these 29 countries ranging from 98% in Somalia to 1% in Cameroon and Uganda. Unicef has placed
countries into five groups according to FGC prevalence levels amongst females aged 15 to 49. These
are shown in Figure 1.
Groupings by FGC prevalence levels (15-49
Countries
year old females)
Group 1
Very high Prevalence Countries
8 Countries:
Prevalence rates >80%
Somalia, Guinea, Djibouti, Egypt, Eritrea, Mali,
Sierra Leone, Sudan.
Group 2
Moderately High Prevalence Countries
5 Countries:
Prevalence rates 51-80%
Gambia, Burkina Faso, Ethiopia, Mauritania,
Liberia.
Group 3
Moderately Low Prevalence Countries
6 Countries:
Prevalence rates 26-50%
Guinea- Bissau, Chad, Ivory Coast, Kenya, Nigeria,
Senegal.
Group 4
Low Prevalence Countries
4 Countries:
Prevalence rates 10-25%
Central African Republic, Yemen, Tanzania, Benin.
Group 5
Very Low Prevalence Countries
6 Countries:
Prevalence rates <10%
Iraq, Ghana, Togo, Niger, Cameroon, Uganda.
Figure 1: Groupings of the 29 countries where FGC is concentrated by FGC prevalence levels
amongst girls and women aged 15-49. (Adapted from Unicef, 2013, 27).
Due to the increase in international migration the practice of FGC is no longer restricted to the 29
countries of Africa and the Middle East where FGC is concentrated (Equality Now, 2012). FGC is
occurring in other parts of the world, including Asia (particularly Malaysia and Indonesia), North
America, Australasia and Europe. There are no reliable statistics for the prevalence of FGC in Europe,
however the European Parliament believe it is a serious issue in those Member States, such as the
UK, that are home to significant numbers of migrants from high prevalence countries. In 2009 the
European Parliament estimated that up to 0.5m women living in the EU had been subjected to FGC
with a further 180,000 at risk (EP, 2009).
It is known that FGC is practised in the UK (RCM, 2013). A study published in 2007, based on the UK
2001 Census, estimated that 66,000 women in England and Wales had undergone FGC and 23,000
girls under the age of 15 were at risk (Dorkenoo, Morison & Macfarlane, 2007). Another study, using
the UK 2001 Census together with birth registration data from 1993-2004, suggests that over 98,376
girls under the age of 15 living in the UK have been subject to FGC or are at risk (Equality Now,
2012). These figures are, according to the Royal College of Midwives (2013, 10), ‘alarming’. The
number of girls at risk of FGC in the UK is increasing as the births to women affected by FGC has
increased from 1.04% in 2001 to 1.67% in 2008 (Equality Now, 2012; RCM, 2013). According to the
Royal College of Midwives FGC is a hidden phenomenon in the UK with the numbers of girls and
women affected by FGC increasing.
FGC: definition and classification
The WHO defines FGC as ‘all procedures involving partial or total removal of the female external
genitalia or other injury to the female genital organs for non-medical reasons.’ (WHO, 2008,
4). WHO recognise four types of FGC, which are described in Figure 2. Types I to III reflect increasing
invasiveness of the cutting, whilst Type IV includes unclassified genital injuries where flesh is not
removed but bleeding occurs. EndFGM (2010) estimate that globally, of females who have been
affected by FGC, 90% have been subjected to Types I, II and IV, with 10% subjected to the more
serious Type III which predominates in Sudan and Somalia.
FGC Classification
Type I
Clitoridectomy
Type II
Excision
Type III
Infibulation
Partial or total removal of the clitoris and/or the prepuce.
Partial or total removal of the clitoris and labia minora, with or without excision
of the labia majora.
Narrowing of the vaginal orifice by cutting and bringing together the labia
minora and/or labia majora to create a type of seal, with or without the excision
of the clitoris.
All other harmful procedures to the female genitals for non-medical purposes,
for example: pricking, piercing, incising, scraping, cauterisation.
Type IV
Symbolic
Circumcision
Figure 2: WHO classification of FGC (Adapted from WHO, 2008; Unicef, 2013)
There is a range in the type of FGC performed in a selection of countries. Figure 3 shows the diversity
of FGC performed within countries. For example, despite having FGC prevalence in excess of 90%, in
Somalia 63% of girls under 15 have been subjected to FGC Type III, whereas in Djibouti the
proportion is 30%. This illustrates the difficulties of using one term, FGC, to refer to the range of FGC
practices.
Country
Type IV
Types I and II
Type III
Benin
Djibouti
Eritrea
Mali
Nigeria
Somalia
Tanzania
% of total FGC
2
15
52
16
16
5
1
% of total FGC
95
53
6
71
69
25
98
% of total FGC
2
30
38
3
6
63
2
FGC prevalence
rate (15-49 years)
13
93
89
89
27
98
15
Figure 3: Percentage of girls who have undergone FGC, by type, as reported by their mother.
(Compiled from Unicef, 2013).
In the UK a recent study estimating the numbers of girls under 15 with or at risk of FGC indicates
that all types of FGC are present in the UK (Equality Now, 2012). This study suggests that over 24,000
girls under the age of 15 have or are at risk of FGC Type III. A further 9,000 girls are at high risk of
FGC Type I or II, with over 65,000 girls at low or medium risk of FGC (Figure 4). This study also
highlights that over 80% of under 15 year old girls with or at risk of FGC have been born in England
or Wales, with almost 72% of girls with or at risk of Type III having been born in England or Wales.
British citizens and permanent residents are continuing to be victims of FGC, despite FGC being
illegal in the UK since 1985, with an extraterritoriality clause added in 2003, making it illegal for a
British citizen or permanent resident to have the procedure performed overseas.
Countries by Unicef
Born in country
FGC Grouping
Group 1
High risk of FGM 6,800
Countries
Type III
Born in England and
Wales
17,212
Total
24,012
Group 1 and 2
countries
High risk FGM
Type I or II
1,972
6,941
8,913
Group 3 and 4
countries
Medium risk
FGM Type I or II
2,346
13,488
15,834
Group 4 and 5
countries
Low risk FGM
Type I or II
7,622
41,995
49,617
18,740
79,636
Total
98,376
Figure 4: Estimated numbers of girls aged under 15 living in England and Wales with or at risk of FGC
and type of FGC. (Adapted from Equality Now 2012, 25).
The EU frames FGC as domestic violence against females, a violation of human rights and a form of
discrimination against females. Most EU Member States have criminal legislation which defines the
practice of FGC as an offence. Austria, Belgium, Cyprus, Denmark, Italy, Portugal, Spain, Sweden and
the UK all have specific provisions associated with FGC. Other Member States address FGC under
general criminal law, such as grievous bodily harm. Most also have an extra territoriality clause.
However there have been few convictions in the EU indicating that the law is not enforced.
FGC has been a criminal offence in the UK since 1985 under the Prohibition of Female Circumcision
Act which was replaced in 2003 by the Female Genital Mutilation Act (updated to address FGC
performed on UK citizens and permanent residents outside the UK) with a maximum 14 years
imprisonment penalty. To date there have been no prosecutions in the UK although three doctors
have been found to have committed serious professional misconduct by the General and the Dental
Medical Council in relation to FGC and have been struck off (RCM, 2013).
UK law treats FGC as child abuse and as such frontline professionals, including doctors, nurses,
teachers, social workers and others have a legal duty to protect girls from FGC. It is Local
Safeguarding Children’s Boards which have the responsibility for developing inter-agency policies
and procedures for safeguarding and promoting the welfare of children, which covers FGC. There is
evidence that child protection guidelines are not being followed when girls affected by FGC are
identified (RCM, 2013). In 2013 the NSPCC launched a national FGM helpline (0800 028 3550) for
children at risk and as a point of reference for the public and professionals to report concerns. In the
first three months of the setting up of the helpline, 102 enquiries were received and 38 referrals
made to the police (RCM, 2013). This indicates a serious under-reporting of FGC in the UK, by those
who have undergone or are at risk of the procedure, as well as those who encounter FGC
professionally.
References
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