Understanding FGM: Historical, Cultural and Medical Perspectives

Female Genital Mutilation (FGM) is a practice involving the partial or total removal of the external female genitalia for non-medical reasons. It is a violation of human rights and has severe physical, emotional and psychological consequences for those affected. 

Globally, it is estimated that over 200 million women and girls have undergone FGM, with the practice concentrated in Africa, the Middle East and Asia. Despite international efforts to eradicate it, FGM persists. The practice is often driven by complex cultural, social and religious factors.

In the UK, FGM is a critical issue due to migration from regions where the practice is common. It is estimated that around 137,000 women and girls living in the UK have been affected by or are at risk of FGM. Although FGM is illegal under the Female Genital Mutilation Act 2003, it continues to occur both within and outside the UK, often within specific communities.

Understanding FGM requires a comprehensive examination from historical, cultural and medical perspectives. Each of these facets provides valuable insight into the reasons behind the persistence of the practice and the significant efforts required to combat it. 

In this article, we aim to explore the historical roots of FGM, the cultural contexts that sustain it, and the medical consequences faced by those affected. 

FGM’s Historical Context

The origins of Female Genital Mutilation (FGM) are difficult to pinpoint, but historical evidence suggests the practice dates back over 2,000 years. It is believed to have originated in ancient Egypt, with some scholars pointing to the existence of references to FGM in Egyptian mummified remains. The practice then spread across regions through trade routes, migration and cultural exchanges, becoming entrenched in various societies in Africa, the Middle East and parts of Asia. Historically, FGM was often linked to ideas of purity, sexual control and societal status, becoming a symbol of honour and respectability for women in certain communities.

FGM has also been tied to traditional gender roles and patriarchal systems where women’s sexuality is strictly controlled. In some cultures, it was (and still is) believed that removing parts of female genitalia reduces sexual desire, ensuring virginity before marriage and fidelity afterwards. As a result, FGM became interwoven with the identity and cultural norms of certain ethnic and religious groups, perpetuating its endurance despite the harm it causes.

Evolution of the Practice Over Time

Over the centuries, FGM evolved in its methods and justification, but its core purpose remained consistent: to regulate female sexuality and preserve cultural norms. While some regions abandoned the practice, others adapted it in response to external influences such as colonisation, religious reform or modernisation. For instance, during colonial rule in Africa, European powers often regarded FGM as barbaric and sought to eradicate it as part of their broader mission to ‘civilise’ indigenous populations. However, this often led to a cultural backlash, where communities clung to FGM as a way to assert their identity in the face of colonial oppression.

In the 20th century, the global movement against FGM began to gain momentum, particularly as international human rights discourse expanded. Governments and civil society organisations started to recognise FGM as a violation of women’s and children’s rights. The development of medical knowledge also exposed the severe health risks associated with the practice, adding urgency to efforts aimed at its elimination.

Historical Efforts to Address and Eliminate FGM

Efforts to eliminate FGM date back to the late 19th and early 20th centuries, though these early initiatives were sporadic and often unsuccessful. In Egypt, as early as the 1920s, health professionals and feminists began campaigning against FGM, highlighting the severe medical consequences. However, their efforts were met with resistance from religious leaders and communities that saw FGM as integral to their cultural and religious identity.

The rise of the feminist movement in the latter half of the 20th century helped bring global attention to FGM as a form of gender-based violence. In 1979, the World Health Organization (WHO) held a landmark seminar in Khartoum, Sudan, which marked the first time FGM was discussed as a public health and human rights issue on the international stage. This was followed by the adoption of several international conventions, including the 1981 African Charter on Human and Peoples’ Rights, known as the Banjul Charter, which called for the elimination of harmful cultural practices, including FGM.

In recent decades, international organisations, governments and grassroots movements have significantly intensified their efforts to combat FGM. These include legal reforms, awareness campaigns and community-based education initiatives. However, despite these efforts, FGM remains a deeply entrenched practice in many regions and historical efforts to eliminate it continue to face challenges from cultural and societal resistance.

Understanding the historical context of FGM highlights how deeply ingrained the practice is in certain societies and why it persists despite widespread condemnation. This context is essential for developing effective strategies to eradicate it, recognising that legal prohibitions alone are insufficient without addressing the complex social and historical factors that sustain the practice.

Cultural Perspectives on FGM

Female Genital Mutilation (FGM) is often perpetuated by deeply ingrained cultural and social norms. In many communities, it is viewed as a rite of passage into womanhood, marking a girl’s transition from childhood to adulthood. The practice is closely associated with ideals of purity, modesty and honour, with families often believing that FGM ensures a girl’s virginity before marriage and fidelity within it. The fear of social stigma plays a significant role in the continuation of FGM; families that refuse to participate risk being ostracised, shamed or seen as dishonourable.

In some cultures, FGM is linked to notions of femininity, with the removal of genital tissue seen as essential for a girl to be considered ‘clean’ or ‘beautiful’. These perceptions are passed down through generations, becoming an unquestioned part of community identity. Mothers who have undergone FGM themselves often see it as a necessary tradition and may support the practice to secure their daughters’ futures, believing it increases their chances of marriage and acceptance in society. 

Religious beliefs also play a role, although no major religion explicitly mandates FGM. In some communities, FGM is mistakenly thought to be a religious obligation, particularly in parts of Africa and the Middle East where both Muslim and Christian populations practise it. Religious leaders sometimes endorse or condone FGM, framing it as a way to control female sexuality or uphold religious teachings, even though such views are often based on cultural interpretations rather than scripture.

Variations of FGM Practices Across Different Cultures and Communities

FGM is practised in various forms and the type of procedure performed can vary significantly depending on the cultural or ethnic group. 

The World Health Organization (WHO) classifies FGM into four main types, ranging from partial removal of the clitoris (Type 1) to more extreme forms such as infibulation (Type 3), where the vaginal opening is narrowed through cutting and stitching. Each community may practise different forms of FGM, with some viewing more invasive types as preferable due to stronger cultural or religious significance.

For instance, in Somalia, where over 90% of women are affected by FGM, infibulation is common and seen as a mark of chastity. In contrast, in countries like Sierra Leone or Kenya, less severe forms such as clitoridectomy (Type 1) or excision (Type 2) are more widespread. The variations in the practice reflect differing beliefs about female sexuality and the specific social roles women are expected to play within their communities. 

Across certain ethnic groups, FGM is not only a personal or family decision but a communal event, often accompanied by elaborate ceremonies celebrating the initiation of girls. This communal involvement reinforces the practice, as it becomes intertwined with the social fabric of the community.

Impact of Cultural Beliefs and Traditions on the Perpetuation of FGM

Cultural beliefs and traditions have a profound influence on the persistence of FGM. This makes it difficult to eradicate without addressing the social structures that support it. 

In many communities, FGM is seen as a way to control female sexuality. The practice is perceived as protecting girls from promiscuity or immoral behaviour. These cultural values are often rooted in patriarchal systems where female bodies are controlled and regulated for the benefit of male dominance. Consequently, FGM becomes not just a personal choice, but a community obligation that is reinforced by generations of tradition.

In societies where FGM is practised, marriage is often seen as the ultimate goal for women. Those who have not undergone the procedure may be considered undesirable for marriage. 

This places enormous pressure on families to conform to the practice, as failing to do so could harm their daughters’ prospects and social standing. Cultural myths surrounding FGM, such as the belief that it increases fertility or enhances cleanliness, further reinforce its necessity. This makes it difficult for individuals or families to challenge these norms without facing social consequences.

Another significant factor is the role of older women, including mothers and grandmothers, who are often the most vocal advocates for FGM. Having undergone the procedure themselves, they may see it as a cultural obligation to ensure their daughters and granddaughters do the same. This generational cycle of FGM highlights the complexity of tackling the practice, as it is not only men but also women within these communities who drive its continuation.

Breaking cultural norms requires a sensitive and informed approach, acknowledging that FGM is often a deeply cherished tradition. Education and community dialogue are needed to challenge long-held beliefs, as is the involvement of local leaders and influencers who can advocate for change from within. Cultural shifts, particularly regarding the role and value of women in society, are crucial to any long-term solution to ending FGM.

Medical Perspectives on FGM

As mentioned, Female Genital Mutilation (FGM) is classified into four main types, each carrying distinct medical risks:

Type 1 – Clitoridectomy

This involves the partial or total removal of the clitoris. Although considered less severe compared to other types, it still results in significant physical and psychological harm, including loss of sexual sensation and complications during childbirth.

Type 2 – Excision

This procedure involves the removal of the clitoris and the labia minora, with or without the labia majora. The more extensive tissue damage in Type 2 increases the risk of infections, chronic pain and difficulties with urination and menstruation.

Type 3 – Infibulation

This is the most severe form, involving the narrowing of the vaginal opening by cutting and repositioning the labia, sometimes leaving only a small opening for the passage of urine and menstrual blood. Infibulation carries the highest risk of complications, including chronic infections, difficulty during intercourse and life-threatening childbirth complications due to obstructed labour.

Type 4 – Other Harmful Procedures

This category includes any other harmful procedures to the female genitalia, such as pricking, piercing, incising, scraping or cauterisation. Though less invasive than Types 1-3, these practices still result in pain, trauma and potential infection.

Each type of FGM has serious medical implications, contributing to both immediate and long-term health complications that vary in severity based on the method used and the hygiene conditions during the procedure.

Short-term and Long-term Health Consequences

The immediate health consequences of FGM can be severe and even life-threatening. Following the procedure, girls and women are at risk of:

• Severe pain and bleeding – Due to the cutting of highly sensitive genital tissue, FGM often results in excruciating pain, which is rarely managed due to the lack of anaesthesia.
• Infection – The use of non-sterile instruments and unsanitary conditions frequently leads to infections such as sepsis, which can be fatal.
• Shock – Blood loss and the intense pain associated with FGM can cause traumatic shock, which may result in death if not treated promptly.
• Urinary issues – The swelling and damage to the urinary tract can result in retention of urine or difficulty urinating.

In the long term, the consequences of FGM are just as severe. Women who have undergone FGM often suffer from:

• Chronic pain – Persistent pelvic and lower abdominal pain is common due to nerve damage and scar tissue.
• Reproductive health problems – Infertility and complications during childbirth, such as obstructed labour, are common among women with Type 3 FGM, leading to higher rates of caesarean sections and maternal mortality.
• Increased risk of neonatal death – Babies born to mothers who have undergone FGM are more likely to suffer birth complications and death.
• Menstrual problems – FGM can lead to painful menstruation or blocked menstrual flow, increasing the risk of infections.

Psychological and Emotional Impact on Individuals Affected by FGM

The psychological effects of FGM are often as devastating as the physical consequences. Many women experience:

• Trauma and anxiety – The pain and fear associated with the procedure can lead to long-lasting trauma, often manifesting as anxiety, depression or post-traumatic stress disorder (PTSD).
• Sexual dysfunction – FGM often leads to a loss of sexual pleasure due to the removal of sensitive genital tissue. For many women, this can result in distress, feelings of inadequacy and difficulty in intimate relationships.
• Body image issues – Women who undergo FGM may experience feelings of incompleteness or shame about their bodies, particularly in cultures where the practice is not universally accepted.

The psychological toll is further exacerbated by the societal expectations and pressures surrounding FGM. In some cases, women who have undergone FGM may be celebrated by their communities, while others who resist or reject the practice may face ostracism, stigma or even violence. The emotional burden of conforming to such harmful traditions can have profound and lasting effects on mental health.

Current Medical Practices for Managing and Treating the Effects of FGM

Medical professionals worldwide are increasingly involved in both the prevention of FGM and the treatment of its effects. In many countries, including the UK, healthcare providers are trained to identify and support girls and women affected by FGM.

• FGM reversal surgeries – In cases of infibulation (Type 3 FGM), deinfibulation surgery can be performed to open the vaginal opening. This procedure is particularly important for improving sexual function and facilitating childbirth.
• Treatment for chronic pain and infections – Medical care includes addressing the chronic complications associated with FGM, such as infections, menstrual difficulties and complications during childbirth. Psychological support is often necessary to help women manage the emotional trauma associated with the practice.
• Counselling and support services – Specialist FGM clinics and counselling services provide both physical and psychological care. These centres, such as those in the NHS, offer confidential support, including deinfibulation services, sexual health advice and trauma counselling. Women affected by FGM are often referred to these clinics by GPs or midwives during pregnancy or after childbirth.
• Education and prevention – Healthcare professionals also play a critical role in educating families and communities about the dangers of FGM. In the UK, this includes working with at-risk communities to prevent the practice and ensuring that healthcare staff are trained to recognise signs of FGM in girls and women.

Global and Local Efforts on FGM

Over the last few decades, a global movement to eradicate Female Genital Mutilation (FGM) has gained significant momentum. International organisations, governments and NGOs have taken a multifaceted approach, combining education, legal frameworks and advocacy to address the root causes of the practice and protect vulnerable girls and women.

On a global scale, the United Nations (UN) has been instrumental in promoting the elimination of FGM. In 2012, the UN General Assembly adopted a resolution calling for a worldwide ban on FGM. This was reinforced by Sustainable Development Goal 5, which aims to eliminate all harmful practices, including FGM, by 2030. The UN’s specialised agencies, such as UNICEF and the World Health Organization (WHO), have been pivotal in supporting countries with high FGM prevalence through research, awareness campaigns and partnerships with local governments and civil society groups.

Non-governmental organisations (NGOs) like 28 Too Many and Equality Now have played a key role in raising awareness about the dangers of FGM and lobbying for stronger legislation. These organisations work with affected communities to challenge the cultural norms that perpetuate the practice. They also provide resources to survivors, offering psychological and medical support as well as legal assistance.

Locally, many countries have implemented laws to criminalise FGM. In the UK, for example, the Female Genital Mutilation Act 2003 made it illegal to carry out FGM within the country or take someone abroad for the procedure. In addition, the Serious Crime Act 2015 introduced tougher penalties, including the provision for life imprisonment for those convicted of FGM. The UK has also established FGM Protection Orders, which allow courts to intervene when a girl is at risk of being subjected to FGM.

Despite these legal frameworks, enforcement remains a challenge, particularly in communities where FGM is seen as a deeply rooted cultural tradition. To address this, community-based initiatives are essential. Grassroots movements, often led by survivors of FGM, have emerged in many countries, including Kenya, Ethiopia and the UK, where activists engage with religious leaders, parents and educators to raise awareness and promote alternative rites of passage for girls.

Success Stories and Case Studies of Communities That Have Addressed FGM

Several success stories highlight how targeted initiatives can lead to significant reductions in FGM practices. In Senegal, for instance, the NGO Tostan has pioneered a community-led approach to end FGM by involving religious leaders, local authorities and families. Tostan’s Community Empowerment Program has enabled over 8,000 communities in West Africa to abandon FGM through education on human rights, health and child protection, leading to a significant decrease in the practice.

In Kenya, the Maasai community has been at the forefront of innovative solutions to replace FGM with alternative rites of passage. Organisations like Amref Health Africa have worked with Maasai elders to create ceremonies that celebrate girls’ transition into womanhood without genital cutting. These alternative rites preserve cultural traditions while protecting girls from harm, leading to widespread community acceptance and a reduction in FGM rates.

In the UK, a key success story involves the establishment of specialist FGM clinics that provide support and medical care to survivors. These clinics, run by the NHS, offer deinfibulation services (for those who have undergone Type 3 FGM) as well as psychological counselling. The availability of culturally sensitive healthcare has not only improved the lives of survivors but also raised awareness among at-risk communities. Collaboration between healthcare professionals, social workers and the police has also been crucial in identifying and protecting girls at risk.

Role of Education, Advocacy and Policy in Eradicating FGM

Education is central to the eradication of FGM. Raising awareness about the medical, psychological and legal consequences of FGM empowers individuals and communities to challenge the practice. 

In many regions, public health campaigns focus on educating both women and men about the risks of FGM, debunking myths surrounding its necessity and providing alternative ways to uphold cultural values without harming girls. Schools play a critical role in this, with programmes designed to teach young girls about their rights and bodily autonomy, ensuring that future generations are less likely to perpetuate the practice.

Advocacy efforts are equally important. In the UK, organisations such as FORWARD (Foundation of Women’s Health Research and Development) have campaigned tirelessly to raise awareness about FGM, particularly within migrant communities. Their work includes running workshops, engaging with young people and training healthcare and social services professionals to recognise and report FGM cases. By empowering survivors to share their stories, these advocacy groups break the silence surrounding FGM and provide a platform for dialogue and change.

Policy is another essential tool in combating FGM. Comprehensive legal frameworks, such as those in the UK and other European countries, criminalise FGM and protect potential victims. However, laws alone are not enough. Governments must ensure that policies are enforced effectively through adequate training for law enforcement, healthcare professionals and educators. Additionally, policies should be supported by community-based strategies, ensuring that legal approaches are sensitive to the cultural complexities surrounding FGM.

Conclusion

Female Genital Mutilation (FGM) is a complex practice that persists across various cultures, despite the severe physical, psychological and social harm it causes. By examining the historical, cultural and medical perspectives, we gain a comprehensive understanding of why FGM continues and the urgent need for its eradication. Historically, FGM has been practised for thousands of years, often tied to notions of purity, gender control and social acceptance. Culturally, it is perpetuated by deeply ingrained beliefs, passed down through generations, that view FGM as a rite of passage, a marker of modesty and a precondition for marriage. 

Medically, the consequences of FGM are devastating, resulting in severe pain, complications during childbirth, lifelong health issues and lasting psychological trauma. The global fight against FGM has seen significant progress, with international and local efforts, including laws, education campaigns and healthcare services, leading to meaningful reductions in FGM rates. Success stories from countries like Senegal, Kenya and the UK demonstrate that with concerted and culturally sensitive efforts, FGM can be challenged and, ultimately, eliminated.

Eliminating FGM requires the involvement of everyone—governments, local communities, healthcare professionals and individuals. 

Resources for Further Reading and Involvement

For those interested in learning more about FGM and how to take action, the following resources provide valuable information and opportunities to get involved:

• 28 Too Many – This research organisation works to end FGM by providing data, reports and resources to support communities, policymakers and activists in their fight against the practice.
• FORWARD UK – A leading UK-based charity that advocates for the rights of women and girls affected by FGM and other forms of gender-based violence. They offer educational workshops, support services and legal advocacy.
• Equality Now – This international organisation campaigns for the protection of women’s rights globally, with a focus on ending harmful practices like FGM through legal advocacy and policy change.
• World Health Organization – The WHO offers comprehensive information on the health risks associated with FGM, along with guidelines for healthcare providers and strategies for global prevention efforts.
• UNICEF – UNICEF’s website offers insights into global initiatives aimed at eliminating FGM, with resources for those looking to support international advocacy and education efforts.