Female Genital Mutilation/Cutting (FGM/C)
Introduction
As provided by MA General Laws Chapter 149 of the Acts of 2020, this information is intended to provide education about the practice of female genital mutilation (FGM), or female genital cutting (FGC), as this practice is sometimes called.
The Department of Public Health is committed to providing education on genital mutilation (FGM), as well as female genital cutting (FGC) and utilizes the term "FGM/C" which is inclusive of both concepts.
What is Female Genital Mutilation/Cutting (FGM/C)?
The World Health Organization (WHO) defines female genital mutilation or cutting (FGM/C) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”
- FGM/C is considered to be child abuse and a human rights violation. It is a product of pervasive social injustices and harmful gender norms and contrary to common belief, is not rooted in any religious or theological tradition. This practice has no health benefits, as it involves the removal of part or all of healthy and normal female genitalia and is most often carried out on girls between infancy and age 15, though adult women are also at risk. FGM/C has both immediate, as well as life-long health and psychological consequences.
How many girls and women are affected by FGM/C?
Worldwide, at least 200 million girls and women have experienced female genital mutilation/cutting (FGM/C). Researchers at the Centers for Disease Control and Prevention’s Division of Reproductive Health (CDC) estimate that as many as half a million girls and women in the United States (U.S.) have undergone FGM/C in the past or may be at risk for FGM/C in the future (Centers for Disease Control and Prevention, 2020).
In the US, approximately 513,000 women and girls have undergone or are at risk of female genital mutilation (FGM). (Equality Now, 2020)
Women and girls who were born in the US may be subjected to FGM here or even during vacations to their families' countries of origin — a practice known as “vacation cutting” (Equality Now). FGM/C occurs to U.S. born girls including 1st generation, 2nd generation, 3rd generation born.
Four main types of FGM/C
The World Health Organization names four categories of FGM/C:
Type 1: This is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/clitoral hood (the fold of skin surrounding the clitoral glans).
Type 2: This is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva). (World Health Organization, 2022)
Type 3: Also known as infibulation, this 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/clitoral hood and glans.
Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g., pricking, piercing, incising, scraping, and cauterizing the genital area.
These procedures alter the appearance of the genital area in the absence of clear physical or functional medical necessity. This includes procedures such as labiaplasty, clitoral hood reduction, perineoplasty (tightening of the vaginal opening), genital piercing and genital tattooing, etc. (World Health Organization, 2022)
Who is at risk of FGM/C?
FGM/C happens in communities of all backgrounds, ethnicities/races, religions, cultures, socioeconomic status, educational level, citizenship status, etc.
FGM/C is mostly carried out on young girls between infancy and adolescence, and occasionally on adult women. According to historically collected international data from 32 countries where FGM is practiced in the Western, Eastern, and North-Eastern regions of Africa, and some countries in the Middle East and Asia, more than 200 million girls and women alive today have been subjected to the practice. (World Health Organization, 2022) It is important to note that not all who are impacted by FGM/C are cisgender women and girls. FGM/C occurs to those who are assigned female at birth and come from an FGM/C practicing community, but they may not identify as female as an adult.
Research seeking to gauge the broader scope of FGM/C globally, beyond those 32 countries, has documented 92 countries across the globe where there is evidence of women and girls living with FGM/C or who are at risk of having FGM/C performed on them. (https://equalitynow.org/fgm-a-global-picture/)
Estimates for the prevalence of FGM among immigrants rely on statistics from the country of origin, and on the number of immigrants and their daughters in the US. However, such estimates are not able to consider factors such as ethnicity, since the practice of FGM/C varies greatly by ethnicity, and the fact that immigrant women and girls are not necessarily representative of all women and girls in their country of origin. (Yoder & Wang, 2013)
FGM/C is also practiced in the US with US born girls. Adolescent girls in the US comprise an extremely vulnerable population, with rates of FGM/C increasing among teenagers (Kalampalikis & Michala, 2021).
FGM/C has no health benefits
FGM/C has no health benefits and causes harm in many ways. It involves removing and damaging healthy tissue and interferes with the natural functions of girls’ and women's bodies.
All forms of FGM/C can cause life-long consequences on a woman's/girl's reproductive health, as well as causing negative mental health and sexual health consequences. (World Health Organization, 2022)
Why is FGM/C practiced?
Families or girls may seek FGM/C for a number of reasons:
- Social pressure to conform to what others do and have been doing; to conform to a standard of what is considered beautiful or “normal.”
- To be accepted socially; to avoid being rejected.
- The belief that FGM/C increases the chances of the child having healthy adult intimate relationships; the belief that FGM/C increases the chances of marriageability.
- FGM/C may be considered a necessary part of raising a girl, and a way to prepare her for adulthood and marriage. It may be a rite of passage. (World Health Organization, 2022)
Families or girls may seek FGM/C for a number of reasons:
-
FGM/C is often motivated by beliefs about what is considered acceptable sexual behavior.
- FGM/C is associated with ideals of femininity and modesty, which include the notion that women and girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine, or male.
- Some people believe that the practice has religious support, although misconceptions exist about religious scripts that prescribe the practice. While not prescribed in religious texts, there may be a religious connection in some cultures.
- It is important to note that, regardless of the justification, the practice is harmful and high-risk.
Short term FGM/C health consequences
The type of FGM/C done may affect how much and how serious health problems are after all forms of FGM/C. While this list is not exhaustive, some of the immediate medical problems can include:
- Severe pain
- Serious bleeding
- Infection of the wound
- Trauma
- Problems going to the bathroom, including burning and pain
- Tetanus and other infectious diseases
- Death
Long term FGM/C health consequences
FGM/C can cause long-term problems with a girl's or woman's physical, mental, and sexual health. The type of FGM/C done may affect how much and how serious the health problems are. It is important to note that because FGM/C is often performed on minors, people may not know what has happened to them until much later in life. Long-term health problems include:
- Infections, such as genital abscesses (sores filled with pus that must be drained) and infectious diseases such as hepatitis B and sexually transmitted infections.
- Problems having sex. Scar tissue from FGM/C can cause pain, especially during sex and childbirth.
- Depression and anxiety.
- Painful and prolonged menstrual periods. FGM/C may cause some girls and women to have painful menstrual periods. Some women may also have recurrent infections.
- Urinary problems. FGM/C may slow or strain the normal flow of urine, which can cause urinary tract infections or bladder stones.
- Fistula is an opening between the urethra and vagina that lets urine run into the vagina. This can happen when the urethra is damaged during FGM/C. Fistula causes incontinence and other problems. (US Dept of Health and Human Services, 2021)
How does FGM/C affect childbirth?
FGM/C does not usually cause problems during pregnancy, but people who have been cut face unique health risks during childbirth. These include:
- Prolonged labor. People with FGM/C are at greatest risk for a longer second stage of labor.
- Excessive bleeding after childbirth
- Higher risk for episiotomy during childbirth. A doctor makes a cut in the perineum, the flesh between the vagina and anus. There is also a higher risk that this flesh will tear on its own during birth. These risks are especially high for people who have had type 3 FGM/C.
- Higher risk for cesarean section (C-section). Doctors who are unfamiliar with scarring from FGM/C may suggest a C-section. However, a C-section may not be necessary. But health care providers may not have the experience or training to provide adequate health care for people who have been cut.
- Risks to the infant include low birth weight (smaller than 5½ pounds at birth), breathing problems at birth, and stillbirth or early death. (US Dept of Health and Human Services, 2021)
Laws prohibit the practice of FGM/C on minors
The practice of FGM/C on minors is against Massachusetts and federal law:
- MA General Laws MGL Chapter 149 of the Acts of 2020
- Federal STOP FGM Act of 2020
MA General Laws MGL Chapter 149 of the Acts of 2020
Under current Massachusetts law, carrying out FGM on someone below the age of 18 is a crime, punishable by fine or imprisonment. The scope of punishable offenses include:
- Committing FGM shall be punished by imprisonment for up to 5 years, or by a fine of up to $10,000 and by imprisonment up to 2 ½ years.
- Transporting a person with the intent to commit, or that another person will commit, FGM shall be punished by imprisonment for up to 5 years, or by a fine of up to $10,000 and by imprisonment for up to 2 ½ years.
- A victim of FGM may bring a civil action for FGM and may be awarded damages and relief and attorney’s fees and costs. The victim may bring this civil action within 10 years of the acts of FGM, however, the time limit for commencement of an action shall be tolled for a child until the child attains the age of 18.
- A licensed medical provider conducting medically necessary procedures or for gender reassignment as requested by the person on whom it is performed is not a violation of this law.
- It prohibits a defendant from asserting, as a defense, that FGM was conducted as a matter of custom or ritual or that the victim’s parent or guardian consented to the procedure.
- A link to the full law is included in the reference section.
STOP FGM Act of 2020
Under current federal law, carrying out FGM on someone below the age of 18 is a crime, punishable by fine or imprisonment. H.R. 6100 would expand the scope of punishable offenses related to FGM to include:
- Attempting or conspiring to perform FGM
- Being the parent, guardian, or caretaker of a minor and facilitating or consenting to FGM of that minor, and
- Transporting a minor for the purpose of subjecting her to FGM.
H.R. 6100 the maximum prison sentence for FGM offenses is 10 years. The law also prohibits a federal criminal defendant from asserting, as a defense, that FGM is required as a matter of religion, custom, tradition, ritual, or standard practice.
A link to the law is included in the reference section.
How does education impact addressing FGM/C?
- Educate parents and communities. Educate health care providers.
- The International Center for Research on Women published a report on FGM and education that stated that, while more research needs to be done, “emerging evidence illustrates that basic education can be an effective instrument for abandoning the practice of FGM.”
- Education exposes all students, regardless of gender, to a variety of competing ideas and concepts and a broader worldview. This allows them to make more informed decisions regarding their own reproductive health and agency. (International Center for Research on Women, 2016)
- It is critical to work with local structures of power and authority, such as community leaders, religious leaders, circumcisers, and medical personnel who often contribute to upholding the practice. When informed on risks and impact, they can be effective advocates for abandonment of FGM/C.
Resources about FGM/C
National resources:
- Equality Now: https://www.equalitynow.org/female-genital-mutilation/
- The U.S. End FGM/C Network: https://endfgmnetwork.org/
Massachusetts resources:
- African Women’s Health Center (AWHC) at Brigham and Women’s Hospital https://www.brighamandwomens.org/obgyn/african-womens-health-center
- Division of Global Populations and Infectious Disease Prevention, MA Dept. of Public Health: https://www.mass.gov/refugee-health
- Refugee and Immigrant Assistance Center: https://www.riacboston.org/
- Sahiyo: https://sahiyo.org/
Connect with DPH
X (Formally known as Twitter): @MassDPH
LinkedIn: Massachusetts Department of Public Health
Our Website: mass.gov/dph
References
Centers for Disease Control and Prevention. (2020, May 11). Female genital mutilation/cutting (FGM/C). https://www.cdc.gov/reproductivehealth/womensrh/female-genital-mutilation.html
Equality Now, End FGM European Network and the US End FGM/C Network. (2020). Female Genital Mutilation/Cutting: A Call For A Global Response https://equalitynow.org/fgm-a-global-picture/
International Center for Research on Women (ICRW). (2016). Leveraging education to end female genital mutilation/cutting worldwide. https://www.icrw.org/wp-content/uploads/2016/12/ICRW-WGF-Leveraging-Education-to-End-FGMC-Worldwide-November-2016-FINAL.pdf
Kalampalikis, A., & Michala, L. (2021). Cosmetic labiaplasty on minors: a review of current trends and evidence. International Journal of Impotence Research, 1-4. https://doi.org/10.1038/s41443-021-00480-1
Mass. Gen. Laws Chapter 149 (2020). An Act Relative To The Penalties For The Crime Of Female Genital Mutilation. https://malegislature.gov/Laws/SessionLaws/Acts/2020/Chapter149
Strengthening the Opposition to Female Genital Mutilation Act of 2020 (STOP FGM Act of 2020), 18 U.S.C. § 116 (2020). https://www.congress.gov/bill/116th-congress/house-bill/6100/text/enr
World Health Organization. (2022, January 22). Female genital mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
US Dept of Health and Human Services. (2021, February 22). Female genital mutilation or cutting. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/female-genital-cutting
Yoder, P. S., & Wang, X. (2013). Female Genital Cutting: The Interpretation of Recent DHS Data. DHS Comparative Reports No. 33. Calverton, Maryland, USA: ICF International. https://www.dhsprogram.com/publications/publication-cr33-comparative-reports.cfm