Seven Things to Know about Female Genital Surgeries in Africa
​
By the Public Policy Advisory Network on Female Genital Surgeries in Africa (2012)
Extracts: A type I female genital surgery, as classified by the World Health Organization, is restricted to procedures involving reduction of either the clitoral hood (the prepuce) or the external or protruding elements of clitoral tissue, or both. Type II involves partial or complete labial reductions and partial or complete reductions of the external or protruding elements of clitoral tissue. Approximately 90 percent of all female genital surgeries in Africa are either type I or type II…
​
Research by gynecologists and others has demonstrated that a high percentage of women who have had genital surgery have rich sexual lives, including desire, arousal, orgasm, and satisfaction, and their frequency of sexual activity is not reduced.9 This is true of the 10 percent (type III) as well as the 90 percent (types I and II). One probable explanation for this fact is that most female erectile tissue and its structure is located beneath the surface of a woman’s vulva. Surgical reductions of external tissues per se do not prevent sexual responsiveness or orgasm. It is noteworthy that cosmetic surgeons who perform reductions of the clitoris and the clitoral hood in the United States, Europe, and Canada recount that there is usually no long-term reduction in sexual sensation, which is consistent with the findings of research on African women…
​
The widely publicized and sensationalized reproductive health and medical complications associated with female genital surgeries in Africa are infrequent events and represent the exception rather than the rule.10 Reviews of the medical and demographic literature and direct comparisons of matched samples of “uncut” and “cut” (primarily type II) African women suggest that, from a public health point of view, the vast majority of genital surgeries in Africa are safe, even with current procedures and under current conditions…
​
The findings of the WHO Study Group on Female Genital Mutilation and Obstetric Outcome15 is the subject of criticism that has not been adequately publicized. The reported evidence does not support sensational media claims about female genital surgery as a cause of perinatal and maternal mortality during birth. The WHO study was published in the prestigious medical journal Lancet in 2006 and received widespread and rather sensationalized coverage by the media. A story in the New York Times began as follows: “The first large medical study of female genital cutting has found that the procedure has deadly consequences when the women give birth, raising by more than 50 percent the likelihood that the woman or her baby will die.”16 A careful reading of the WHO study reveals that the results are very complex. There were no statistically significant differences in reproductive health between those who had a type I genital surgery and those who had no surgery. The perinatal death rate for the women in the sample who had a type III surgery was, in fact, lower (193 infant deaths out of 6,595 births) than for those who had no surgery at all (296 infant deaths out of 7,171 births) and became statistically significant only through nontransparent statistical adjustment of the data. After statistical adjustments, there was no significant difference in risk of maternal mortality when comparing “uncut” women with the sample of women with type I and type III genital surgeries. “Infibulated” women did not have higher maternal mortality than “uncut” women, although women with type II surgeries did. Maternal death was not a frequent event…
​
We recommend that journalists, activists, and policy-makers cease using violent and preemptive rhetoric. We recommend a more balanced discussion of the topic in the press and in public policy forums. Female genital surgeries worldwide should be addressed in a larger context of discussions of health promotion, parental and children’s rights, religious and cultural freedom, gender parity, debates on permissible cosmetic alterations of the body, and female empowerment issues. The voices of African women who support female and male genital modification for their children and themselves have not been adequately represented in the media or in public policy forums. These parents are neither monsters nor fools: like parents everywhere, they want to do the right thing for their children and are concerned about their children’s health. Nor are they necessarily uneducated or ignorant or helpless prisoners of an insufferably dangerous tradition that they themselves would like to escape, if only they could find a way out. Many highly educated women in Africa embrace the practice and do so without negative health consequences. For the sake of a balanced discussion, it will be necessary to create a context where women can express their support for the practices without being attacked…
​
​
​
​