February 6 has been designated by the UN as “International Day against Female Genital Mutilation,” a day to raise awareness about the dangers and health consequences of this traditional practice in sub-Saharan Africa and the Middle East.1 Female genital mutilation (FGM) refers to the partial or total removal of the external female genitalia for cultural, religious, or other non-therapeutic reasons.2 It has no health benefits and frequently causes both immediate and long-term problems for women and girls: in addition to severe bleeding, infection, and problems urinating, it can cause infertility and complications with childbirth.1,3 An estimated 130 million women alive today are currently living with the consequences of FGM.
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FGM is entrenched in the cultural and religious beliefs in many communities.4 In many parts of West Africa, this cutting is presented as a religious obligation to Muslim women.5 It is internationally recognized as a violation of the human rights of girls and women: it is nearly always performed on minors,2 and it is sometimes used to facilitate sexual relations with child brides.5 Additionally, FGM is just one component of cultures in which women have no voice in decisions that affect their everyday health and well-being. For example, Amnesty International recently called attention to the high rate of maternal deaths in Burkina Faso, which it ascribes to gender discrimination: many women are unable to access sexual and reproductive health services due to discriminatory attitudes and illegal demands for payments by corrupt medical staff. Burkinabe women have little to no say in when they can seek medical care or the timing and spacing of their pregnancies, and they are still being subjected to early marriages and FGM.6
There has been recent progress by governments, human rights groups, and NGOs in persuading communities to abandon the practice. In Mauritania, 34 imams and Muslim scholars recently signed a fatwa, or religious ruling, against the practice.7,8 Authorities in Niger recently took steps to enforce a ban enacted in 2003 by administering fines and jail sentences to 45 mothers who allowed their daughters to be cut.7 Tostan, an NGO that works primarily in Sénégal, has worked with thousands of villages that have made the decision to abandon FGM: the group educates villagers and then allows them to make their own conclusions. Because the practice is often tied to marriage opportunities, intramarrying groups must make a collective decision to abandon the practice in order for efforts to be effective.4 Since 1997, 4,580 communities working with Tostan have declared their decision to end the practice.
The UN and other international health and human rights groups have campaigned aggressively to end FGM, and more countries are passing laws against the practice. Recent indications that communities in West Africa are moving away from it are encouraging. However, two million girls are still at risk every year.2 As the international community observes this day of awareness, we should be attuned to the need for culturally sensitive approaches to end FGM in order to protect the rights of women and girls.