Female genital mutilation (FGM), also known as female genital cutting (FGC), female genital mutilation/cutting (FGM/C) and female circumcision, is practiced in 30 countries in western, eastern, and north-eastern Africa, in parts of the Middle EastFGM – Where is it practiced? European Campaign on FGM & Amnesty International (2012)Barbarani, Sofia (March 4, 2013) Tackling Female Genital Mutilation in the Kurdistan Region. The Kurdistan Tribune and Southeast Asia,World Health Organization, Female genital mutilation: an overview. 1998, Geneva: World Health OrganizationClarence-Smith, William G. (2012) "Female Circumcision in Southeast Asia since the Coming of Islam", in Chitra Raghavan and James P. Levine (eds.), Self-Determination and Women's Rights in Muslim Societies, Brandeis University Press. pp. 124–146. and within some immigrant communities in Europe, North America and Australia, as well as in specific minority enclaves in areas such as South Asia and Russia. The WHO defines the practice 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.""Female genital mutilation", World Health Organization, February 2010.

In a 2013 UNICEF report covering 29 countries in Africa and the Middle East, Egypt had the region's highest total number of women that have undergone FGM (27 million), while Somalia had the highest percentage (prevalence) of FGM (98%).

The world's first known campaign against FGM took place in Egypt in the 1920s. FGM prevalence in Egypt in 1995 was still at least as high as Somalia's 2013 world record (98%), despite dropping significantly since then among young women.The taboo has been broken: Fighting Female Genital Mutilation in Egypt . According to this UNDP report, FGM prevalence among 15 to 30-year-olds dropped to 72% already in 2008 after having been 96% in 1995, which means that the prevalence among all women in 1995 was even higher than 76%. Estimates of the prevalence of FGM vary according to source.

Classifications of FGM

The WHO identifies four types of FGM: Type I: removal of the clitoral hood, the skin around the clitoris (Ia), with partial or complete removal of the clitoris (Ib) Type II: removal of the labia minora (IIa), with partial or complete removal of the clitoris (IIb) and the labia majora (IIc) Type III: removal of all or part of the labia minora (IIIa) and labia majora (IIIb), complete removal of the clitoris, and the stitching of a seal across the vagina, leaving a small opening for the passage of urine and menstrual blood (infibulation) Type IV: other miscellaneous acts, might or might not include cauterization of the clitoris, cutting of the vagina (gishiri cutting), and introducing corrosive substances into the vagina to tighten it (extreme and rare cases)Momoh, Comfort (ed). "Female Genital Mutilation", Radcliffe Publishing, 2005, pp. 6–7.

Prevalence

The term "prevalence" is used to describe the proportion of women and girls now living in a country who have undergone FGM at some stage in their lives. This is distinct from the "incidence" of FGM which describes the proportion of women and girls who have undergone the procedure within a particular time period, which could be contemporary or historical. FGM is practiced in some but not all African countries, the Middle East, Indonesia and Malaysia, as well as some migrants in Europe, United States and Australia.Berggren, Vanja (2005) Female Genital Mutilation: Studies on primary and repeat female genital cutting . Karolinska Institutet, Stockholm, Sweden. pp. 2–4 It is also seen in some populations of South Asia.Female circumcision fear as fundamentalists roll back women's rights Ben Doherty, The Sydney Morning Herald (January 25, 2012) The highest known prevalence rates are in 30 African countries, in a band that stretches from Senegal in West Africa to Ethiopia on the east coast, as well as from Egypt in the north to Tanzania in the south.

In a 2013 UNICEF report based on surveys completed by select countries, FGM is known to be prevalent in 27 African countries, Yemen and Iraqi Kurdistan, where 125 million women and girls have undergone FGM.Female Genital Mutilation/Cutting. UNICEF (2013), pp. 3–26. The UNICEF report notes FGM is found in countries beyond the 29 countries it covered, and the total worldwide number is unknown.UNICEF 2013 , pp. 114, 22

Other reports claim the prevalence of FGM in countries not discussed by the 2013 UNICEF report.Female Circumcision World Health Organization, United NationsFemale genital mutilation: Strategies for eradication Fran P. Hosken (1989), The First International Symposium on Circumcision, Anaheim, California

In West Asia, the practice mostly occurs in Kurdish regions, and to a lesser extent in Jordan,Birch, Nicholas (10 August 2005). "Female circumcision surfaces in Iraq", Christian Science Monitor. Oman, United Arab Emirates and Qatar. Earlier reports claimed the prevalence of FGM in Israel among the Negev Bedouin, which by 2009 has virtually disappeared."Bedouins shunning FGM/C – new research", IRIN, March 4, 2009.

As a result of immigration, FGM has also spread to Europe, Australia, and the United States, with some families having their daughters undergo the procedure while on vacation overseas . As Western governments become more aware of FGM, legislation has come into effect in many countries to make the practice a criminal offense. In 2006, Ethiopian citizen Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter."Georgia: Man Convicted in Daughter's Mutilation", Associated Press, 2 November 2010.

The United Nations has called for elimination of the practice by 2030. A 2017 UCLA Fielding School of Public Health study, measuring trends in the prevalence of FGM over the course of three decades, found that they dropped significantly in 17 of the 22 countries surveyed. The researchers found a 2–8 percentage points increase in Chad, Mali and Sierra Leone during the 30-years period.

Data reliability Much of the FGM prevalence data currently available is based on verbal surveys and self-reporting. Clinical examinations are uncommon. The assumption is that women respond truthfully when asked about their FGM status and that they know the type and extent of FGM that was performed on their genitalia. Many FGM procedures are performed at a very young age, many cultures feel a taboo about such discussions, and a number of such factors raise the possibility that the validity of survey responses might be incorrect, potentially underreported.A. Rahman and N. Toubia, Female Genital Mutilation: A Guide to Worldwide Laws and Policies, Zed Press, London, UK, 2000 In Oman, for example, some do not wish to discuss FGM from the fear that such discussion is showing their culture's dirty laundry to the world, causing criticism of a practice that they believe is purely religious.The issue of female genital mutilation in Oman Susan Mubarak, Muscat Daily (January 01, 2013)

In countries where FGM has been outlawed, fear of prosecution of family members or self, and social disapproval from elders may cause women to deny that they underwent or were subjected to FGM. For example, the self-reported circumcision status of women aged 15–49 was verbally surveyed in 1995 in northern Ghana. The same women were interviewed again in 2000 after the enactment of a law that criminalized FGM and Ghana-wide public campaigns against the practice. This study discovered that 13% of women who reported in 1995 that they had undergone FGM denied it in the 2000 interview, with youngest age group girls denying at rates as high as 50%.

UNICEF has revised its data on the FGM prevalence rates in the Kurdistan region of the Middle East:

Africa

In July 2003, at its second summit, the African Union adopted the Maputo Protocol promoting women's rights and calling for an end to FGM. The agreement came into force in November 2005, and by December 2008, 25 member countries had ratified it."Female Genital Mutilation (FGM) or Female Genital Cutting (FGC): Individual Country Reports", U.S. State Department, 1 June 2001.

As of 2013, according to a UNICEF report, 24 African countries have legislations or decrees against FGM/C practice; these countries are: Benin, Burkina Faso, Central African Republic, Chad, Côte d'Ivoire, Djibouti, Egypt, Eritrea, Ethiopia, Ghana, Guinea, Guinea-Bissau, Kenya, Mauritania, Niger, Nigeria (since 2015), Senegal, Somalia, Sudan (some states), Tanzania, Togo and Uganda (see page 9 of the report) and Zambia and South Africa (see page 8). In 2015, Gambia's president Yahya Jammeh banned FGM.

In 2014 The Girl Generation, an African-led campaign to oppose FGM worldwide, was launched.

General Although estimates of the prevalence of FGM vary, sources have consistently found the practice to be undergone by the majority of women in the Horn of Africa, in the West African countries of Guinea, Sierra Leone, Gambia, Mauritania, Mali and Burkina Faso, as well as in Sudan and Egypt. Of these countries, all have laws or decrees against the practice, with the exception of Sierra Leone, Mali and some states of Sudan.

Infibulation Infibulation, the most extreme form of FGM, known also as Type III, is practiced primarily in countries located in northeastern Africa.Yoder, P. Stanley and Khan, Shane (March 2008) "Numbers of women circumcised in Africa: The Production of a Total", USAID, DHS Working Papers, No. 39, pp. 13–14: "Infibulation is practiced largely in countries located in some countries in northeastern Africa. Survey data are available for Sudan, Eritrea, Ethiopia and Djibouti. Sudan alone accounts for about 3.5 million of the women. ... [T]he estimate of the total number of women infibulated in [Djibouti, Somalia, Eritrea, northern Sudan, Ethiopia, Guinea, Mali, Burkina Faso, Senegal, Chad, Nigeria, Cameroon and Tanzania, for women 15–49 years old] comes to 8,245,449, or just over eight million women." Also see Appendix B, Table 2 ("Types of FGC"), p. 19.UNICEF 2013 , p. 182, identifies "sewn closed" as most common in Djibouti, Eritrea, Somalia for 15–49 age group (survey in 2000 for Sudan was not included), and for daughters, Djibouti, Eritrea, Niger and Somalia. UNICEF statistical profiles on FGM, showing type of FGM: Djibouti (December 2013), Eritrea (July 2014), Somalia (December 2013).

The practice is the removal of the inner and outer labia, and the suturing of the vulva.Gruenbaum, Ellen (2001) The Female Circumcision Controversy: An Anthropological Perspective, University of Pennsylvania Press, pp. 43–45. It is mostly practiced in northeastern Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia and Sudan.

The procedure leaves a wall of skin and flesh across the vagina and the rest of the pubic area. By inserting a twig or similar object before the wound heals, a small hole is created for the passage of urine and menstrual blood. The procedure is usually accompanied by the removal of the clitoral glans. The legs are bound together for two to four weeks(up to 40 days) to allow healing.Momoh, Comfort (2005) "Female genital mutilation," in Female Genital Mutilation, Radcliffe Publishing p. 7.

The vagina is usually penetrated at the time of a woman's marriage by her husband's penis, or by cutting the tissue with a knife. The vagina is opened further for childbirth, and usually closed again afterwards, a process known as defibulation (or deinfibulation) and reinfibulation. Infibulation can cause chronic pain and infection, organ damage, prolonged micturition, urinary incontinence, inability to get pregnant, difficulty giving birth, obstetric fistula and fatal bleeding.

Algeria