The Ceremonial Knife

Few ethnic rituals have provoked as much international indignation as the practice known as female genital mutilation (FGM). Surrounded by controversy, this broad term comprises several procedures, some of them 2,000 years old, ranging in severity, complexity and risk.

In its mildest and most ritualistic form, which takes place in some parts of Indonesia, the clitoris of a young girl is pricked once with a needle in order to draw a symbolic drop of blood. In other forms, an infant or young girl's clitoral "hood" is removed, and sometimes the entire clitoris and all or part of the labia minora is excised. In a still more severe form—infibulation—the labia majora is excised, and the vaginal opening is stitched together, leaving a hole the width of a pencil for the release of menstrual blood and urine.

FGM is performed on more than 6,000 girls daily.

Labeled "female genital mutilation" by some organizations—the United Nations, the African Union and the CDC, for example—the controversial practices are also referred to in less extreme terms such as "female genital cutting" and "female circumcision."

The forces perpetuating FGM, which may date back to the Pharaonic era, are aesthetics, tradition and myth. Some claim that it protects a woman's virginity and makes her more marriageable. Others believe the clitoris to be ugly or unclean. And then there are those taken in by myths—that FGM fosters fertility, or that it is mandated in the Qur'an, or that contact with the clitoris will poison a baby during childbirth.

FGM is practiced in 28 African countries and in Asia and the Middle East. 

In one way or another, between 100 million and 140 million women worldwide have been touched by the ceremonial knife. Every year these rituals affect the lives of 2 million to 3 million girls in 28 African countries, where it is most prevalent (particularly in Egypt, Somalia and Mali), as well as in Asia and the Middle East. But there are reports of its use in Central and South America, and, with ever-increasing tides of immigration, the phenomenon has made its way to Europe and North America.

Internationally, however, resistance to the procedure has swelled. Opponents challenge FGM as cruel and unusual punishment and a violation of human rights. In February, 10 UN agencies pledged to work toward the goal of reducing or eliminating the practice by 2015, the year that the Millennium Development Goals are to be achieved.

Top 6 African nations practicing FGM: Somalia, Egypt, Djibouti, Mali, Eritrea and Ethiopia.*

The most persuasive argument against FGM, though, seems to be its association with adverse health effects. Last year, the case of a 12-year-old Egyptian girl who died of complications during the procedure made international headlines. And recent studies conducted by the WHO show that the practice puts mothers and children at risk during childbirth—the risks increasing with the severity of the cut. Postpartum hemorrhaging, the need for caesarean section delivery, and infant death (55 percent higher infant mortality for the mothers with severe forms of FGM compared to the women who had not been cut) are a few of the effects.

"Female genital cutting has no uncontested medical benefits," says Stella Babalola, assistant professor in Health, Behavior and Society. "On the contrary, evidence abounds to link the practice with short- and long-term complications." But Babalola, PhD, urges "bottom-up approaches" in intervention. Engaging in meaningful dialogue is essential, she says: "It would be wrong and counterproductive to dismiss the practice as barbaric."