The Social Construction of Female Genital Mutilation

On November 20th, 2018, a federal judge in Michigan ruled that the Female Genital Mutilation Act 1996, which federally prohibits female genital mutilation (FGM/C) in the United States, was unconstitutional within the context of a case that has presented the first legal challenge to this law in US history.1 His ruling set a new precedent, and it captured media interest because of its potential implications for this contentious practice. However, one of the most interesting aspects of the media coverage of this case is the way in which FGM/C is spoken about, rather than the judgement itself. Pam Belluck from The New York Times called FGM/C “an ancient practice,” and within the first two paragraphs of her article she identifies the girls involved in the case as “belong[ing] to a small Shiite Muslim sect” (Belluck, 2018). Even the newspaper sections in which articles were published reveal that this ruling has particularly loaded social significance; in The Washington Post, the article is published in the Social Issues section, while in NPR coverage it appears in the Law section (Domonoske, 2018; Schmidt, 2018).

FGM/C is a contentious subject, and everything from the medical ethics of the practice to the terminology used to reference it are highly controversial. However, as exemplified by the media coverage of the ruling on November 20th this year, these debates often happen in isolation. The disputes around this practice bring issues of human rights, femininity, colonialism, vocabulary, and legal processes into the same space, and the way in which we silo these highly entangled issues leads to problematic interpretations and understandings of FGM/C. In this essay, I will reframe discussions concerning vocabulary and legal codification to comment on the global nature of FGM/C. Specifically, I will argue that the very term “female genital mutilation” is a Western legal construction, designed to simultaneously (1) erase histories of FGM/C from the Western world and (2) extend principles of neo-colonialism and imperialism through the regulation of black and brown female bodies.2

First, I will outline the practice of FGM/C and related terminology. Subsequently, I will move onto a brief outline of evidence that FGM/C was, in fact, an established practice in the Western world for centuries, and discuss how this evidence has been treated over time. Then I will examine two federal bans of FGM/C – one from the United Kingdom and one from the United States. In closely examining each law and the climate that surrounded its approval, I will be able to discuss the way that social processes, gendered values, and colonial relationships were actively codified throughout the legal process. Finally, I will end by contextualizing the evidence I have presented and conclusions I have drawn within larger social processes and theories, as well as share the story of an American FGM/C survivor.

Practice and Terminology

While the subject of this paper is not the actual practice of FGM/C, it is necessary to understand the basics of the surgery in order to analyze its history and related debates. According to an influential interagency statement released in 2008, FGM/C “refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons” (Interagency, 2008, p. 1). There are four different classifications of FGM/C, ranging from a small prick or cut made on the female genitalia to total infibulation (Interagency, 2008, p. 4). Today, the WHO estimates that more than 100 million girls and women have undergone some form of FGM/C. The report asserts that these surgeries largely take place in African nations, as well as a few countries in the Middle East and Asia (Interagency, 2008, pp. 4–5). In 1997, the WHO released a report titled “Female genital mutilation: A Joint WHO/UNICEF/UNFPA Statement.” This was the first time a major interagency statement had been released that pertained to FGM/C, and it was also the first time any of these organizations took a firm position on the practice. The report advocated the global eradication of FGM/C (Interagency, 1997, p. 2). Since the report, global health organizations have maintained this position, and a multitude of government and NGOs internationally have invested significant resources into eliminating the practice globally (Interagency, 2008, p. 2).

Over the past few decades, the terminology used to refer to the practices of FGM/C has become a topic of debate. These terms are so significant to debates about and understandings of FGM/C that in the most recent interagency statement, the report specifically notes that “the terminology used for this procedure has undergone various changes.” FGM/C can be referred to as “female genital mutilation,” “female genital cutting,” “female circumcision,” “clitorectomy,” and “clitoridectomy” (Interagency, 2008, p. 22). The vocabulary used to refer to FGM/C in the Western world is distinctly political – the changes in language associated with this practice have not been organic. The term “mutilation” was first used with reference to FGM/C in the 1970s during debates around the ethics of the practice in Kenya, and it has since become the most popular way to refer to the practice (Murray, 1976, p. 93).

History of Female Genital Mutilation in the West

The history of FGM/C in the Western world – specifically the US and UK – is extensive and well-documented. While often portrayed as a modern phenomenon in the West, caused by relatively recent influxes of immigrants, FGM/C was an established and accepted surgery for centuries in Western countries. It is documented in various medical texts and journals, which have largely been ignored in recent decades. However, scholarship and research by social scientists have brought these sources and their evidence back into academic discourse. While the purpose of this paper is not document histories of FGM/C in the Western world, I will touch on them and related scholarship briefly in order to contextualize the federal bans on FGM/C that were passed in the UK and US in the 1980s and 1990s, respectively.

Histories of FGM/C are evidenced in a plethora of medical texts (Library of the Surgeon-General’s Office, 1880), where it is most commonly referred to as “clitorectomy” or “clitoridectomy” (Ricci, 1945).3 The practice is ancient, and it be traced back to the Greek, Roman, and Ottoman empires (Abu-Sahlieh, 2001). In the Western world, it became a verifiable practice in the 1600s. These surgeries largely fell out of favor with most medical practitioners at the turn of the 20th century, and by the mid 1900s, the practice was rarely (although not never) performed (Finzsch, 2018). These surgeries were justified for a number of reasons which varied by time period and national context. Reasons for performing FGM/C included hysteria, the size or appearance of the clitoris, masturbation, homosexuality, hysteria, and frigidity (Frederiksen, 2008; S. B. Rodriguez, 2014; S. W. Rodriguez, 2008).

After Western physicians had all but rejected the practice, there was a latent period during which FGM/C was hardly discussed. This period came to an end in two phases. The first phase entailed the passage of federal (and, in the US, state) laws in multiple countries, notably the US and UK. They will be the main subject of my analysis in the following sections. The sentiments contained within these laws was eventually mirrored in statements released by various influential global health organizations, as detailed in the previous section. The second phase was a reaction to the first. The growth in governmental attention to this issue was mirrored in the academic community; the first journal article about FGM/C was written in 1976, and there has been a general increasing trend each year since in the number of academic papers and articles published on the subject (Sweileh, 2016, p. 3). The way Western powers had legislated against and dealt with FGM/C practices in previous decades came under intense academic scrutiny for two primary reasons. First, anthropologists in particular were critical of Western powers and global health organizations for passing seemingly uninformed judgements on the practices of other cultures (Johnsdotter, 2012; Lane & Rubinstein, 1996; Mende, 2018). Second, social scientists, predominantly historians, were critical of the erasure of FGM/C histories in Western nations (Bashir, 1997; Fleming, 1960).4 However, even today, these two types of critiques are rarely discussed in conjunction, and they are characterized as two separate bodies of literature, despite the fact that these criticisms are not mutually exclusive. In order to bring these two compelling critiques into conversation with one another in a meaningful way, I will examine two influential Western laws that pertain to FGM/C prohibition.

Prohibition of Female Circumcision Act 1985

The original law that prohibited FGM/C in the United Kingdom is worthy of analysis when it comes to understanding the politicization of the practice and related terminology for three reasons. First, at the time of the law’s passage, the United Kingdom was facing the dismantling of their colonial empire, including many African states where FGM/C was and continues to be an established practice. Taken together with the influx of immigration that the UK was experiencing from those same countries, the political climate was very informed by colonial legacies, perhaps more so than other Western countries that were wrestling with the same debates during the same period. In addition, the British government keeps Hansards – verbatim reports of all debates and discussions that take place in the House of Lords and House of Commons. These Hansards are publicly accessible, and they offer significant insight into the reasoning and logic of the bill, as well as the different factors and considerations that were at play in crafting the terminology of the law itself. Finally, it is notable that the Prohibition of Female Circumcision Act 1985 has since been replaced by the Female Genital Mutilation Act 2003 – a distinct change in terminology that is loaded and significant.

The prohibition of FGM/C in the United Kingdom was debated in Parliament over the course of more than two years, and eventually passed in 1985 (Prohibition of Female Circumcision Act 1985, 1985). It was introduced by Wayland Hilton Young, 2nd Baron Kennet. In examining the Hansards for this bill, which date back to April in 1983, I suggest a reader can draw two important conclusions pertaining to the implications of this codification. The first is that this legislation was introduced and passed in direct response to increasing immigration from Africa, as well as Asia and the Middle East. Secondly, while a history of FGM/C in the United Kingdom was somewhat acknowledged in the debates detailed in the Hansards, this history is construed as being markedly different from the practice being legislated against. The Hansards reveal an active process whereby everything that was considered disagreeable and abhorrent about FGM/C was removed from the United Kingdom and its history, and relocated to other nations and cultures.

On the first point, it becomes clear within the first page of the Hansards that the bill was introduced in direct response to increasing awareness of the prevalence of FGM/C in other nations that had some relationship with and effect on British society. Frequent mention of BBC media material is made. In introducing the bill, Lord Kennet references a physician who spoke on the BBC Radio 4 program in 1982 and detailed his observation of FGM/C in the United Kingdom (HL Deb, 1983). What is more, throughout the debates, multiple Peers reference a television documentary from a BBC2 series called “Forty Minutes,” which aired shortly before the bill was introduced in the House of Lords. In fact, Lord Kennet cites the documentary as his primary motivation for drafting the bill (HL Deb, 1983).

The tone of Lord Kennet and other Peers towards immigrants is implicitly hostile. “This Bill has nothing to do with Africa,” Lord Kennet explained. “The reason for the Bill is that this operation has begun to appear in this country, among people who come from the belt in Africa and South-West Asia (HL Deb, 1983). Over the two years between the introduction of the bill and the eventual passing of the law, the sentiments expressed by Peers grew more and more accusatory. “They will group together to preserve the customs of their country and culture,” said one Peer (HL Deb, 1984), implicitly positing that FGM/C was a growing practice exclusively among immigrant communities (HL Deb, 1984).

On the second point, to say that the history of FGM/C in the United Kingdom was comprehensively discussed with reference to this legislation would be a large overstatement. However, the “tens of thousands of operations…carried out every year for the physical health of the patient,” in the United Kingdom that might potentially qualify as a type of FGM/C were referenced (HL Deb, 1984). The surgeries in question were ones that were performed occasionally by British physicians, most often in relation to childbirth or genitalia defects. These operations were seen by Peers as legitimate on the basis of “physical health,” and the legislation contained a clause that permitted these operations with the approval of a licensed physician. This clause drew a clear distinction between ‘legitimate’ FGM/C (surgeries performed by British doctors on British women) and ‘illegitimate’ FGM/C (surgeries performed on recent immigrants from other cultures).

This same tension is exemplified in a series of debates that took place concerning the inclusion of ‘mental health’ as a permissible justification for legal FGM/C. Some Peers suggested that mental health should be “ground[s] for the operation,” but that the definition of mental health should, “exclude…any depression or mental illness which is based on custom or ritual” (HL Deb, 1984). As Peer bluntly stated, “Quite simply, it means that white mental health is a good ground for the operation but black mental health is not (HL Deb, 1984). After debating this issue at length, the inclusion of ‘mental health’ in the law was qualified by the rule that, “No account shall be taken of the effect on that person of any believe on the part of that or any other person that the operation is required as a matter of custom or ritual.”

Female Genital Mutilation Act 1996

FGM/C was federally banned in the US in 1996, more than a decade after analogous legislation was passed in the UK. The American law drew significant inspiration from the corresponding one in the UK – it contains multiple repeated phrases (Female Genital Mutilation Act 1996, 1996). However, despite the similarities between the two laws, there are unique aspects of the Female Genital Mutilation Act 1996 that make it an important object of analysis. Firstly, the fact that the law was passed in a different temporal and cultural context to the Prohibition of Female Circumcision Act 1985 provides the opportunity for important comparisons. Even the language contained within the two titles – “mutilation” instead of “circumcision” – is reflective of a significant change in attitudes towards the practice. What is more, I had the opportunity to interview Patricia Schroeder, the congressperson who introduced the Female Genital Mutilation Bill in Congress. This was not possible with reference to the previous law; the comparable figure in British politics, Lord Kennet, passed away in 2009. Finally, and possibly most importantly, the Female Genital Mutilation Act 1996 commissioned an accompanying report that provides incredible insight into how the term “female genital mutilation” was actively defined and geographically located within an American context.

Discussing the events that led up to the Female Genital Mutilation Act 1996 in the US with Patricia Schroeder made it clear that the immediate impetus for the bill’s introduction was immigration from non-Western countries. Schroeder sat on the Armed Service Committee throughout the 1973 Arab-Israeli War. She said of the legislation: “We saw an increase in awareness of the practice, it was taking place in the Middle East and Northern Africa, and at the same time, we were talking to more and more leaders of those nations, finding out about this.” It became a national concern in the US a few decades later as communities from those nations began to immigrate to the US. “People who immigrated brought it with them,” said Schroeder, “and we didn’t know it was transpiring here. Not in America.” As is evidenced in the report that accompanied the law, this initial impetus was legitimized by codification and targeted research. Schroeder was also able to speak to the decision to use the word “mutilation” in the title of the law, which represented a significant departure from the comparable law in the UK. “It was the biggest catch-all term, the most generic.” There was also a pervasive sentiment that FGM/C should not be described as “circumcision,” so as to avoid association with male circumcision (Schroeder, 2018).

When this law was passed, Congress commissioned the Department of Health and Human Services to write an accompanying report that aimed to identify, among other things, the number of women in the US who had undergone FGM/C (104th Congress, 2nd Session, 1996; Jones, Smith, Kieke, & Wilcox, 1997). The report generated an estimate of around 200,000 women and girls. However, the interesting aspect of the estimate is not the number itself, but the methodology used in order to arrive at this conclusion. In determining how many people in America had undergone FGM/C, the Department of Health and Human Services drew on 1990s census data and rates of FGM/C in the countries where it was most prevalent at the time. The report made two critical assumptions: firstly, that the only women in the US who had undergone FGM/C were from immigrant communities, and secondly, that the rate of FGM/C within these American immigrant populations exactly mirrored that of their nations of origin (Jones et al., 1997). These two assumptions distinctly and deliberately located FGM/C in particular, non-Western populations and countries, and effectively erased any history or possibility of FGM/C happening in the US prior to immigration from other nations. The influence of this report should not be discounted – it became the basis for a significant body of literature, global debates, laws, and positions of a multitude of governments and NGOs – put simply, it was influential.

A Biosocial Lens

I propose that the active process by which FGM/C was erased from Western histories and exclusively located in non-Western nations can only be understood using biosocial theories. This is often the case with global health issues; the authors of Reimagining Global Health: An Introduction assert that significant global health “failures…may be attributed, in part, to a lack of historical reflection and biosocial analysis” (Farmer, Kleinman, Kim, & Basilico, 2013, p. 33). In this case, the theory of social construction of reality and historical approach facilitate nuanced political and social understandings of the connection between the different social issues and processes embedded within FGM/C and its histories. These approaches explain the complex entanglements between FGM/C terminologies, vestiges of neocolonial legacies, and the emergence of global health.

Berger and Luckmann’s idea of the ‘social construction of reality’ asserts that facts, knowledge, and reality are created and perpetuated through social processes (Berger & Luckmann, 1967). This is particularly germane to this topic. The construction of FGM/C as an exclusively non-Western practice is just that – a construction. Many actors have been involved in this process, and it is impossible to attribute it to one organization or one government. However, the codification of FGM/C prohibition into law in both the US and the UK was a fundamental step in defining FGM/C as a practice that was characteristic of other countries. Through analysis of both laws and their accompanying materials, it is clear that both legislative bodies were distressed to encountered FGM/C in their own countries, and were driven to action to locate the onus for the practice in non-Western nations. Furthermore, both governments, the British Parliament in particular, went to extensive lengths to distinguish more local surgical procedures that were seen as “legitimate” from the types of FGM/C that were being legislated against. In doing so, the government had to create an artificial separation between surgeries performed on Western women and those performed on recent immigrants, by differentiating FGM/C performed as a cultural or religious practice from FGM/C performed for ‘medical reasons’ within a Western context.

This separation is also problematic because it fails to draw on a historical approach. Throughout the legislative processes that led to the Female Genital Mutilation Act 1996 and the Prohibition of Female Circumcision Act 1985, almost no consideration was given to the fact that there is a lengthy and documented history of FGM/C in the Western world. Patricia Schroeder confirmed this; when I asked, she told me that histories of FGM/C in the US never entered into discussion when the bill was being drafted or discussed. In the UK, it was only acknowledged insofar as it pertained to creating a clause in the law that would allow for “legitimate” surgical procedures that might otherwise be classified as FGM/C (Schroeder, 2018).

A historical perspective also yields important insights in this analysis, particularly with reference to ideas of neocolonialism and global health. The legislation against FGM/C represents a critical inflection point in the movement away from international health and towards global health. International health, an ideology which dominated the strategies, missions, and frameworks of governments and nongovernmental agencies for much of the 19th and 20th century was first and foremost concerned with the “control of epidemics across the boundaries between nations.” The 1990s and 2000s saw a shift from this priority towards an increase in “consideration of the health needs of the people of the whole planet above the concerns of particular nations,” otherwise known as “global health” (Brown, Cueto, & Fee, 2006). The legislation in question was passed during the transition period between these two competing ideologies, and the tensions between them are visible. An international health lens explains the language of invasion that was used to describe the practice of FGM/C, particularly in the Hansards for the Prohibition of Female Circumcision Act 1985. The idea that immigrants were “bringing” the practice with them into the UK is similar to how one might discuss an epidemic or growing infection. This rhetoric, while far less prevalent, is still somewhat visible in the Female Genital Mutilation Act 1996; this is representative of the shift towards global health that had occurred over the previous decade.

Furthermore, a historical perspective makes clear the presence of neocolonial ideologies that were codified by the Prohibition of Female Circumcision Act 1985 and the Female Genital Mutilation Act 1996. Neocolonialism refers to the techniques that originate from the vestiges of colonialism and imperialism, used by Western nations to exert control over non-Western countries. While fundamentally antithetical to postcolonial thought and theory, neocolonialism is often masked and shrouded in dialogues about postcolonialism; Kwame Nkrumah comments that “the methods of neo-colonialists are subtle and varied,” (Nkrumah, 1966, p. 1). Neocolonialist ideologies are intrinsically linked to the proliferation of global health frameworks and an increasingly “globalized way of thinking,” (Mbembe, 2008). With reference to the FGM/C laws in question, dialogues about “immigration” into the US and UK became tools by which Western powers could pass judgement on the practices of other cultures, all the while failing to acknowledging their own extensive histories with the same types of surgery.

Conclusion

In his book about the history of circumcision, Sami Awad Aldeeb Abu-Sahlieh states that female “circumcision performed by white people in the West has never even interested researchers” (Abu-Sahlieh, 2001, p. 299). In light of the evidence presented in this paper, his deduction could not be more compelling. The legal and literary evidence presented in previous sections demonstrate moments of codification that took histories of FGM/C, removed them from the West, and relocated them in other nations, often previous African colonies. Drawing on the theories of postcolonial feminists and other social scientists, the treatment of FGM/C, from the way it was codified to the terminology in each subsequent WHO report, is an extension of the colonization and attempted regulation of black and brown female bodies (Crenshaw, 1990; Morsy, 1991). Despite the fact that this surgery has been performed throughout history in nations around the world, the word “mutilation” seems to have been reserved only for non-Western countries.

It is hard to ascertain how many women and girls in the United States and United Kingdom have undergone FGM/C; there is only enough evidence to state that it was an established and accepted practice for many years. One of the most outspoken survivors of FGM/C in the US is Dr. Renée Bergstrom. Dr. Bergstrom was cut when she was a young girl, and has spent a significant portion of her life engaged in FGM/C activism domestically and internationally. I had the chance to speak with her about her personal and professional experiences (Bergstrom, 2018). She confirmed, as one might expect, that many people are “shocked” when they find out that she is an FGM/C survivor. Even other survivors are often surprised. When she attended a conference a number of years ago and sat down, another survivor was perplexed, and exclaimed, “What are you doing here?”

I have attempted to avoid discussing the ethics of FGM/C, as they were not the topic of this paper. However, given that I wrote this paper in direct opposition to a siloed approach to discussing the different “components” of FGM/C, I feel compelled to offer some comment on the ethics of the practice itself. Throughout my literature review for this paper, I became increasingly aware of the pressing human rights and feminist issues associated with FGM/C. The acknowledgement of histories of FGM/C in the West and the construction of the term “female genital mutilation” makes this position a critique of a globally and historically pervasive practice, rather than a criticism of any particular culture. This position is perhaps best exemplified by Dr. Bergstrom’s opinions and experiences. In the last minute of our call, she said:

“If I had started my advocacy, even a decade ago, I would have been seen as a white woman criticizing another culture. Today, I am in good company. There are young women all over the world fighting it within their own cultures. It is mutilation, it is a human rights issue, not a cultural practice. Because it has happened, and America has a long history of denying atrocities that have happened. Cutting is not the exception, it is the rule.”

The last question I posed to Dr. Bergstrom concerned the loaded debates around the terminology used to refer to FGM/C. She paused for a moment before answering. Then, she said, “I understand why some people do not want to call it ‘mutilation.’ It’s just important to have discussions, whatever language will enable that.” By prioritizing complex and difficult discussions over the nuances of terminology, and acting as a representative for a forgotten history that is so critical to the issue of FGM/C, Dr. Bergstrom exemplifies ways in which we can all take a beneficially biosocial approach to FGM/C.

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References

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Endnotes

1.) As will be discussed in this paper, this procedure has many names. I consistently refer to the surgery as FGM/C (female genital mutilation/cutting) because it is the most neutral and encompassing term available.

2.) The “West” is a constructed and contentious idea. I use it throughout this paper, and hope it will be read with the understanding that the “West” only exists in so far as it treats itself as an entity. This is certainly characteristic of the laws discussed in this paper.

3.) It is important to note that there is virtually no way of knowing how many of these procedures were carried out in the US or UK. While it was certainly an established practice, I will note that it cannot be characterized as routine or common.

4.) These critiques were and still are contentious within academic communities; further research that supports FGM/C as effectively an imported practice without cultural justification continues to be published (Black & Debelle, 1995).