by Beverly J. Robinson-Rumble
In her report to the church’s 2016 Spring Council, Heather-Dawn Small, director of the General Conference Women’s Ministries Department, presented items voted by the Women’s Ministries Advisory a few weeks earlier, including two statements prepared by official church study groups regarding Female Genital Mutilation (FGM) and Family Violence, and appealed for church leadership to support these statements.
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Asked why she thought FGM was important, Small responded, “It has grave consequences in the area of abuse against women and girls. The topic of FGM is one that despite many efforts over the years to educate and wipe out this terrible threat to our girls, still causes much concern to the GC Women’s Ministries and to our division WM leaders globally, but especially in Africa. Our church leaders—pastors, leaders in our conferences, unions, and divisions are not speaking out against this issue as it impacts both the community and the church.”1
This article will focus on the female genital mutilation statement to which she referred, and its history as well as the implications of FGM for the church and larger society.
What is Female Genital Mutilation?
The World Health Organization defines Female Genital Mutilation as follows: “all procedures that involve partial or total removal of the female genitalia, or other injury to the female genital organs for non-medical reasons” and lists four major types of procedures, ranging from pricking or piercing the genital area to the more common forms that involve partial or total removal of the clitoris and labia, combined with sewing the vaginal opening shut to prevent intercourse, leaving only a small opening for urine and menstrual fluid.2
The procedure is usually performed on young girls before they begin to mature sexually, and in recent years, to children as young as toddlers.
How is FGM performed?
The cutting is generally carried out by elderly people in the community who are designated to perform this task or by traditional birth attendants, who use special knives, scissors, scalpels, pieces of glass, or razor blades. Anesthetic and antiseptics are generally not used, and unless performed by medical professionals, the procedure occurs under unsterile conditions. Girls’ legs are often bound together to immobilize them for 10-14 days to allow the formation of scar tissue. Thorns are often used to attach tissue together, and unsterile thread is employed for suturing. This results in excruciating pain and often infection, sometimes death.
The World Health Organization (WHO) warns that “The procedure has no health benefits for girls and women”3 and says that “FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”4
What are the risks of FGM to the health and well-being of women and girls?
FGM has serious implications for the sexual and reproductive health of girls and women. Its effects depend on a number of factors, including the type performed, the expertise of the practitioner, the hygiene conditions under which it is performed, the amount of resistance, and the general health condition of the girl/woman undergoing the procedure. Complications may occur in all types of FGM, but are most frequent with the more drastic forms.
Immediate complications include severe pain, shock, hemorrhage, tetanus, infection (wound, urinary tract), urine retention, ulceration of the genital region and injury to adjacent tissue, fever, and septicemia. Hemorrhage and infection can be severe enough to cause death.
Long-term consequences include complications during childbirth, anemia, the formation of cysts and abscesses and keloid scars, damage to the urethra resulting in urinary incontinence, painful sexual intercourse, sexual dysfunction, menstrual and urination disorders, recurrent bladder and urinary tract infections, fistula, and infertility, as well as increased risk of HIV transmission. Due to the damage to the pubic area, women may experience lifelong leakage of urine or fecal matter, which results in their becoming outcasts from their community.
Procedures that involve sewing the vagina shut create a physical barrier to sexual intercourse and childbirth. This means that the woman must undergo gradual dilation of the vaginal opening before sexual intercourse can take place. However, in many cases, these women are cut open on the first night of marriage (by the husband or a circumciser) to allow for sexual intimacy, which can be extremely painful.
What are the consequences for childbirth?
At childbirth, many women have to be sliced open because the vaginal opening is too small to allow for the passage of a baby. Women who have undergone FGM face a significantly higher risk of prolonged labor, which often requires a Caesarean section and an extended hospital stay, and also of suffering postpartum bleeding. The infants of mothers who have undergone more extensive forms of FGM have an increased risk of dying at birth.
Recent estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division reveal that most of the high-FGM-prevalence countries also have high maternal mortality ratios and high numbers of maternal death.
FGM may have lasting effects on women and girls. The psychological stress of the procedure may trigger behavioral disturbances in children, closely linked to loss of trust and confidence in caregivers. In the longer term, women may suffer feelings of anxiety and depression. Sexual dysfunction may also contribute to marital conflicts or divorce.5
How is FGM different from male circumcision?
Although sometimes referred to as “female circumcision,” the health implications of male circumcision and the procedures performed on girls and women are very different because male circumcision does not interfere with urination or sexual function, nor does it have the potential for causing lifelong pain and disability.
Where are women endangered by FGM?
The World Health Organization estimates that 200 million girls and women alive today have undergone FGM in the 30 countries in Africa, the Middle East, and Asia where FGM is concentrated, with rates above 80 percent in eight countries.6 The practice also occurs in nations with large populations of immigrants from countries where FGM is common. Globally, around three million girls undergo the procedure annually, according to the United Nations Population Fund,7 most before their fifth birthday.
In 1997, The World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA), issued a statement opposing FGM. An even broader group of UN agencies issued a statement opposing the practice in 2008.8
Origins and Reasons for the Practice
The origins of FGM are unclear. It predates the rise of Christianity and Islam. No major religion requires or even condones the practice, making it primarily a cultural tradition (although many people believe it is a religious requirement). Proponents believe that FGM is necessary for a variety of reasons:
• Psychosexual reasons: to control women’s sexual drive, which is assumed to be insatiable if parts of the genitalia are not removed. The practice is believed to ensure virginity before marriage and fidelity afterward, and to increase male sexual pleasure.
• Sociological and cultural reasons: FGM is seen as a part of initiation into womanhood and as an intrinsic part of the community’s cultural heritage. Myths about female genitalia (i.e., that an uncut clitoris will grow to the size of a penis, or that FGM will enhance fertility) help to perpetuate the practice.
• Hygiene and aesthetic reasons: In some communities, the external female genitalia are considered dirty and ugly, and removal is believed to promote hygiene and aesthetic appeal.
• Religious reasons: Though not endorsed by either Islam or Christianity, many cite religious doctrine as justifying the practice.
• Socio-economic factors: In many communities, FGM is a prerequisite for marriage and the right to inherit. In cultures where women are largely dependent on men, economic necessity can be a major driver of the procedure. It may also be a major income source for practitioners.9
Many countries, including the U.S., have outlawed the procedure, but it continues underground, and because of the rapid population increase in the nations where it is widespread, the number of girls at risk is growing rapidly. Many of these countries are the same places where the Seventh-day Adventist Church is also baptizing thousands of members a year.
Let’s look at one nation where Adventism is growing rapidly: The church has 865,000 members in the West-Central Africa Division,10 which includes the country of Nigeria, where 20 million woman and girls have undergone FGM, 10 percent of the global total. “Many Nigerian girls are cut as infants (16 percent before their first birthday) and 82 percent of women who have had FGM say that they were cut before the age of five, says charity 28 Too Many.”11
However, according to GC Women’s Ministries director Heather-Dawn Small, the church does not have any statistics on the incidence of FGM among its members (either where it is currently being performed or how many Adventist women and girls have undergone the procedure). Small warns that “It has grave consequences in the area of abuse against women and girls. Despite many efforts over the years to educate and wipe out this terrible threat to our girls, it still causes much concern to the GC Women’s Ministries and to our division WM leaders globally, but especially in Africa.”
FGM in the U.S.
“The U.S. Centers for Disease Control and Prevention warned in 2012 that 513,000 [U.S.] women and children were at risk of having this procedure done on them, more than three times the previous estimates based on data from 1990, estimating that “the number of females at risk below the age of 18 had increased by more than four times.”12
Those at risk in the U.S. and other Western nations are primarily immigrants who are members of ethnic groups from nations where FGM is an entrenched practice. In some cases, parents from these groups have sent their daughters overseas to have the procedure performed, a practice that is now illegal in the U.S.
In 2012, the FBI and U.S. Customs and Immigration Enforcement both recognized the International Day of Zero Tolerance for Female Genital Mutilation by calling for the custom’s “total eradication” and warning that anyone suspected of being involved in it – including those sending girls overseas to be cut – could be prosecuted by the Human Rights Violators and War Crimes Center.12
Medicalization of FGM
A recent development is the demand by parents for the FGM procedure to be done in a hospital or clinic (referred to as the “medicalization” of FGM) since the unsterile conditions and implements used in the traditional approach are a major cause of complications like infection, sepsis, shock, and occasionally even death. Depending on the country, between 20 and 75 percent of girls subjected to FGM were cut by a trained health-care provider. For example, in Indonesia, hospitals offer discount birth packages that include FGM, vaccinations, and ear piercing.13
The WHO and other international organizations actively oppose health-care personnel and institutions being involved with this practice.14
GC WM director Small said that she was not aware of any Adventist hospitals that are currently performing FGM, but if there were, “Women’s Ministries would be one department that will speak out loudly against such being done.”
Given the large number of Adventist hospitals and clinics worldwide, a survey should be done and policies established that prohibit this practice in our institutions.
What has been the Adventist Church’s response to FGM?
The Christian View of Human Life Committee was a bioethical group commissioned by the Seventh-day Adventist Church to study topics relevant to policy making at its healthcare institutions, and to create statements that would also provide guidance to employees and laity. Its 2000 statement on Female Genital Mutilation15 can be found online here. Although often referred to as an “Official Statement,” it was only “Received” and not officially voted as policy by the General Conference Executive Committee (as most of the other official statements had been) because the largely male decision-making group apparently did not see the need for it at that time.
The CVHL statement offers this advice in its concluding paragraph:
“Because female genital mutilation threatens physical, emotional, and relational health, Seventh-day Adventists are opposed to this practice. The Church calls on its health care professionals, educational and medical institutions, and all members along with people of good will to cooperate in efforts to eliminate the practice of female genital mutilation. Through education and loving presentation of the gospel, it is our hope and our intention that those threatened by this practice will find protection and wholeness and that those who have been subjected to this practice will find solace and compassionate care.”
Some recent steps have been taken to educate church members regarding the dangers of female genital mutilation, but more aggressive steps need to be taken to protect the millions of children and young women who are at risk of having these procedures inflicted upon them, and to ensure that medicalization of the practice is not occurring in Adventist hospitals and clinics. This no doubt accounts for the urgency expressed by Heather-Dawn Small in her 2016 Women’s Ministries Report: “as a department we have done much to educate our women in all division on the issue of FGM, as it is one area of abuse under our ENDITNOW [http:www.enditnow.org] campaign. We share with our directors information from the U.N. on this and other areas of abuse yearly.” She says she expects most of the division WM directors to take the three voted statements, including the one on FGM, to their executive committees after discussing them with their division presidents.
Ms. Small adds: “FGM is something that we in GC Women’s Ministries leadership are passionate about. It is one of many forms of abuse against women and girls that we focus on under our enditnow initiative. We have met women who have suffered because of FGM. We have visited our shelter in Kenya where young girls run to escape FGM. We have spoken with WM leaders who have shared stories of young Adventist girls who because of tradition have been subjected to FGM. And we have received information regarding our hospital in Germany where there is now a department that does reconstructive surgery for refugee women who have been subjected to FGM. This aspect of abuse is heartbreaking to us because of the lifelong effect it has on these innocent children and the adult women who have suffered because of FGM. So GC Women’s Ministries feels impelled to educate and promote better treatment of our girls.”
On April 12, 2016, “Ted N C Wilson, General Conference president, expressed support for these three statements and for Women’s Ministries”; and Spring Council “VOTED, To receive the Women’s Ministries report,” though church leaders voted no specific actions to implement its recommendations.16
What will happen next? Will the nearly all-male worldwide leadership of the church continue the laissez-faire policies of the past 16 years and offer little tangible support or specific strategies for implemention? Will they continue to be silent about the suffering of millions of millions of little girls and adult women around the world who have had their genitals hacked off and who are suffering the results of this barbaric human-rights violation? Or will they now invest the time and resources to support Women’s Ministries personnel as they seek to condemn this practice wherever it occurs, and to offer practical aid to its victims? Will male church administrators ensure that FGM is never performed in any Adventist hospital or clinic? Only time will tell.
NOTES AND REFERENCES
1. All quotes from Heather-Dawn Small are from e-mails from her to the author of this article in late 2016 and early 2017.
2. Female genital mutilation is classified into four major types:
“Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
“Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).
“Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).
“Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area” (From World Health Organization “Fact Sheet,” updated February 2017: http://www.who.int/mediacentre/factsheets/fs241/en/.) Hereafter abbreviated as WHO FAQ.
5. United Nations Population Fund, “Female Genital Mutilation (FGM) Frequently Asked Questions”: http://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions.
6. “Sexual and Reproductive Health: Female Genital Mutilation (FGM), World Health Organization: http://www.who.int/reproductivehealth/topics/fgm/prevalence/en).
8. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO, “Eliminating Female Genital Mutilation, An Interagency Statement” (2008): http://www.un.org/womenwatch/daw/csw/csw52/statements_missions/Interagency_Statement_on_Eliminating_FGM.pdf.
10. Seventh-day Adventist Church, West-Central Africa Division: https://www.adventist.org/en/world-church/west-central-africa/go/-/-/12/).
11. The Guardian, “Nigeria: 20 million women and girls have undergone FGM,” https://www.theguardian.com/society/2016/oct/11/fgm-nigeria-20-million-women-and-girls-undergone-female-genital-mutilation/
12. RT America, “FBI Investigating Female Genital Mutilation in US, Over 500,000 Women at Risk” (May 19, 2016): https://www.rt.com/usa/343692-fbi-female-genital-mutilation/.
13. Abigail Hasworth, “The Day I Saw 248 Girls Suffering Genital Mutilation,” The Guardian (November 17, 2012): https://www.theguardian.com/society/2012/nov/18/female-genital-mutilation-circumcision-indonesia).
14. WHO FAQ.
15. The draft of the statement was created by Gerald Winslow and Barbara Frye-Anderson, both of Loma Linda University, and then further developed by the CVHL committee.
16. E-mail from Tami Boward of General Conference Secretariat to Beverly Rumble, October 25, 2016. While condemning “social activism,” Ted Wilson, General Conference president, in an undated video for
ENDITNOW suggests “leading [victims of abuse] to Jesus,” and commends the work of the Adventist hospital in Germany for their efforts to assist victims of FGM. The video and other resources are available on the General Conference Women’s Ministries Website: http://www.adventistwomensministries.org/.
Beverly J. Robinson-Rumble is the Editor Emeritus of The Journal of Adventist Education and served as a member of the Christian View of Human Life Committee from 1988‒2000.