Salma Abou Hussein first learned about Female Genitle Mutilation (FGM) ten years ago while visiting a community school in rural Upper Egypt. The area had a high prevalence of FGM and there were ads and campaign posters warning parents from practicing it. Abou Hussein was shocked to learn the practice was so widespread and she has been working to end this practice ever since, conducting research as well as working on abandonment campaigns so that girls and women can reclaim their right to bodily autonomy.

The World Health Organization defines FGM as  “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.” An estimated 200 million girls and women alive today living in 30 countries have undergone FGM. Thanks to targeted campaigns, the rate of FGM has been slowly declining over the last several decades. Today in the 30 countries with nationally representative prevalence data, around 1 in 3 girls aged 15 to 19 today have experienced FGM versus 1 in 2 in the late-1980s.

FGM is often associated with controlling women’s sexuality. While now largely confined to Western Africa, the Horn of Africa, Sudan and Egypt, it was historically also practiced in parts of Asia, Latin America, Eastern Europe and North America. In the US, for example, FGM was medicalized and physicians performed cliterodectomies and other forms of FGM to treat a number of supposed sexual dysfunctions such as hysteria, nymphomania, and frigidity, practices that were covered by Insurance until 1977 and weren’t made illegal until the late 1990’s.

February 6 is International Day of Zero Tolerance for Female Genital Mutilation. Yarrow Global caught up with Abou Hussein to learn about her work and research, and talk about the connection between gender,FGM, and the control of women’s sexuality.

YG: How did you get involved in this work and what are you studying?

SAH: I started off with the research work on FGM when I was working for the Population Council. It’s an international research agency that has around 14 offices around the world, one of which is in Egypt. And part of their work focuses on gender based violence research. So that includes, of course, FGM. The Evidence to End FGM Research Program, which I was working under back then, was trying to unpack the research gaps on that topic and and provide evidence to inform policies and programs across seven African countries, one of which was Egypt. So I was leading the research in Egypt and this is how I got to deepen my understanding on the topic.

YG: Could you just briefly explain kind of what it is and why it’s a problem for both physical, but also kind of moral reasons? 

SAH: There are four types of FGM. Type 1 involves cutting parts of the clitoris. Type 2 is the cutting of parts of the clitoris and the labia minora. Type 3 is called infibulation and consists of narrowing the vaginal orifice sewing the labia minora and/or labia majora, with or without removal of the external part of the clitoris. Type 4 is the pricking or piercing of that area. In Egypt, we have type one and type two, and there is some evidence that there’s type four as well. 

People believe that it makes women less promiscuous, so like, sort of constrain their sexual desires and decreases their sexual drive. Some people believe that it’s aligned with religious norms, whether it’s Islamic or Christian norms. The parents feel that it’s the right thing to do for their girl if they want to secure marriageability. 

On the other hand, it creates short and long term physical complications and sexual frustration with woman. It’s also traumatic, even more so because it often happens at an early age. In Egypt, for example, usually the cutting happens between ages of 8 and 14. It’s an age where the girl still remembers the practice.

YG: What are the different ways you are studying FGM and what are you concerned about?

One of the areas we tried to look further into was the medicalization of FGM in Egypt because Egypt has the highest level of medicalization of FGM in the world. Based on the latest Egyptian Demographic Health Survey, which is actually quite dated now- dates back to 2014 – uncovered that 72 percent of FGM is carried out by medical professionals. 

YG: Why does that matter? What does it show if you see a higher rate of medicalization? And why is that either concerning or, you know, good or bad?

SAH: So it’s extremely bad, just because it negates medical ethics and the oath that medical professionals take which is to “do no harm”. Medical doctors who operate on girls are doing a lot of harm to girls and women, even if there’s consent. It harms women on the physical side, but also has a great negative impact on the mental health side. So there are no benefits there.

One of the research studies we conducted was looking at the perceptions of medical professionals on the matter and we even integrated a mystery client approach. It was quite interesting just because we got researchers acting as if they want to get their girls cut and they’re seeking consultation from the doctors. We saw the kind of consultation that was given to them and how medical health professionals were uninformed and tended to majorly understate [the impacts on women] due to the lack of knowledge, driven by social norms and influenced by financial incentives. So that was one study. The other study was looking into social marketing campaigns on FGM over the years. So we wanted to unpack the nuances around the social marketing rhetoric being used, how social marketing messages on FGM was being perceived by multiple target populations, whether they’re mothers, fathers, young girls, young men, village leaders, for example, because these campaigns against FGM have been going on since the 1990’s. 

What this study actually unraveled was the resistance some of these campaigns created in the beginning because it was a top down approach rather than it being a bottom up approach. And then national entities designated to address this started calling for community awareness and mobilization where they supported public declarations for the abandonment of the practice in rural Upper Egypt, in specific. 

This was more of a bottom up approach. It was quite good. But then political unrest, for example, the revolution came into play. And you see people who are actually very supportive of the practice, like the Muslim brotherhood, came in with the rhetoric that FGM is aligned with religion and discussions on changing the law around the criminalization of FGM started arising. The law on the criminalization of FGM was first introduced in 2008. 

Things have stabilized in Egypt but it’s even better now because you have so much awareness. Information on FGM abandonment being integrated into medical school curricula and education is a big factor. Also social media. There have been talks on various social media platforms, especially on Facebook, Instagram and Twitter that FGM is a harmful practice for women and girls. Also, there’s a shaming factor where you wouldn’t find any proponents of the practice showing support of it online or they would run the risk of getting potentially reported or even arrested. 

YG: One of the things that I think was really interesting is that some of the campaigns you have helped create have focused on men, not women. Can you talk to me a little bit about both that campaign and also kind of the different roles of men and women in carrying out this practice?

SAH: Of course, it’s driven by patriarchal influences but men aren’t really involved in the process within the context of Egypt as you’d expect. When you come to talk with the mothers, you’d find out that men are only involved in terms of finances. But it’s the women who actually decide whether to cut their daughters or not. Men’s involvement has increased with medicalization just because medicalization requires more money. Whereas if someone cuts her daughter at the midwife, it will not cost them as much. So with the increase of associated cost of the procedure, men then became more involved. But again, the decision-making process is highly reliant on women, mainly mothers and grandmothers.

Mothers and grandmothers rarely discuss the matter with their husbands. So indeed there are expectations where the mothers believe their husbands would want their daughters to get cut, but there’s not much talk around that. In terms of campaigning, the majority of the campaigns were initially targeting women but the UN agencies were the first to realize that we are actually doing something wrong here. Men are actually involved one way or another given that it is intrinsically a patriarchal practice.  So  we had to address men as well. That’s why in 2010, campaigns started targeting fathers. Even in terms of intervention, now there are sessions that are targeting specifically the father. 

What I see as a big problem, honestly, and some of the studies have talked about that, is the lack of information on sexual and reproductive health rights among young men, the future fathers, and their ideas around sexuality and promiscuity and chastity, which are very much distorted. They associate uncut women with being loose and they hold very strong opinions around that.

YG: After working in this field for so long, how do you see the connection between gender and FGM?

SAH: Of course it’s driven by gender. The idea behind it is to control women’s sexuality at the end of the day. So making sure that she’s not promiscuous, ensuring the whole idea of chastity and so forth. It’s about controlling women’s bodies. Also, we heard a lot of talks that FGM is good because it sort of guarantees that women’s sexual drive isn’t higher than that for men, so she wouldn’t overpower him. There’s a lot of gender dynamics in there, right? There is a strong connection between FGM and child marriage, FGM and domestic violence and FGM and sexual harassment. So they’re all driven by the same factors, which is controlling women and their sexuality. 

YG: where do you see the practice going? Are you hopeful it will eventually stop?

SAH: Going forward, honestly I’m optimistic. Already, you see major changes on the ground related to gender-based violence matters like sexual harassment, for example. Now, people are actually afraid of assaulting or harassing women on the streets because they’re afraid that they will get caught on camera and the videos would go viral, which means they may get arrested for it. Sexual harassment is being publicly shamed and this is being replicated within the FGM discourse, although it is slightly more challenging because it happens in private spaces. But this discourse is already taking place on social media platforms, creating much needed awareness especially among young people, especially women. I still believe, however, that a lot of work needs to be done with young men.

A dangerous projection is currently being used to justify the practice in Egypt that FGM is a beautification procedure. It could be attributed to the rise of labiaplasty, a surgery to reduce the size of the labia minora and is becoming increasingly common in the US. Some medical professionals are using this as a leeway to continue practicing FGM. But with increased awareness, I believe it’s going to die eventually. 

Find out more about Salma and her work:

http://www.popcouncil.org/research/evidence-to-end-fgm-c-research-to-help-girls-and-women-thrive1

http://www.popcouncil.org/uploads/pdfs/2017RH_MedicalizationFGMC.pdf

https://www.linkedin.com/in/salma-abou-hussein-3b1a9513/

Cover Photo: Mekiya with her parents in their house. She was about to get cut on her mother’s wish,but her father Mude Mohammed was against the idea. Credit: UNICEF Ethiopia/2020/ Mulugeta via Flickr Creative Commons