The dilemma of FGM Terminology and Typology.
The Dilemma of FGM Terminology and Typology. Abdel Magied, Ahmed (School of Health Sciences, Ahfad University for Women)
WHO (1996) suggested the following typology to be adopted as a unified worldwide classification of FGM:
Type I: Excision of the prepuce with or without excision of part or the entire clitoris.
Type II: Excision of the clitoris with partial excision of the labia minor.
Type III: Excision of part or all of the external genitalia and stitching/narrowing the vaginal opening (infibulation)
Type IV: Unclassified, includes piercing or incising of the clitoris and/or labia minor; scraping of tissues around the vaginal orifice and/or cutting of vagina, with the aim of tightening it, any other procedure which falls under the definition of the FGM given.
This classification (WHO, 1996) and the suggested typology seem nonspecific, ambiguous and confusing when trying to fit in the types and forms of FGM practiced in Sudan.
To begin with and for argument sake, let us agree that FGM includes any intended permanent damage to part/parts or all the external female genitalia, with particular emphasis on the girl child for non therapeutic purposes.
In the Sudan, FGM is inflicted on the victimized girl child without her mature consent at an age normally between 5 and 9, and rarely at 10. At this age the development of the prepuce (hood) of the clitoris is only vestigial, and removing it would need a dexterous surgeon and with sophisticated surgical equipment. Accordingly, clitoriectomies which are normally done by TBAs and midwives in the Sudan would involve at least excision of the glans clitoris and the vestigial prepuce. Consequently, recent forms of clitoridectomies practiced in the Sudan might fit in WHO (1996) Type I FGM. However, one alternative of Al Maakouf ([TEXT NOT REPRODUCIBLE IN ASCII]) form which does not involve excision, but longitudinal splitting of the whole clitoris (Abdel Magied et al, 2003c), neither fits in Type I nor in Type IV. Type II is not practiced in the Sudan; hence none of the Types and forms of FGM practical in Sudan would fit in WHO (1996) Type II. On the other hand the claimed Pharaonic ([TEXT NOT REPRODUCIBLE IN ASCII]) and intermediate ([TEXT NOT REPRODUCIBLE IN ASCII]) FGM practiced in Sudan, with all their forms, very well fit in Type III (infibulation). On the other hand, permanent damages inflicted on different parts of the genitalia, mentioned under Type IV, are not practiced in the Sudan. Moreover, introduction of substances or herbs to tighten the vagina are only temporary cosmetic applications by adult women on themselves; hence should not be considered under FGM. Consequently, the following classification of typology is suggested:
Type I (Clitoridectomy\[TEXT NOT REPRODUCIBLE IN ASCII]): This includes all degrees of excision or damage inflicted on the clitoris. The nature of excision or damage of the clitoris to be given the local name as "form" of clitoridectomy.
Type II (Infibulation\[TEXT NOT REPRODUCIBLE IN ASCII]): This includes all degrees of excision of the genitalia beyond clitoridectomy to include other part/parts of the external genitalia, followed by suturing or not. The nature of the degree of damage of the genitalia to be given the local name as a "form" of infibulation.
Type III (Re-infibulation or Re-circumcision \[TEXT NOT REPRODUCIBLE IN ASCII]): This includes decircumcision and re-circumcision of an already infibulated woman and suturing as in original infibulation.
Type IV (Unclassified): This includes all degrees of damage of part/parts of the genitalia that do not fall under Types I, II and III. The nature of and the degree of damage on the genitalia to be given the local name as a "form" of unclassified FGM (Abdel Magied, 2008-b).
The validity of WHO (1996) typology had also been challenged by Abdel Magied (1998) and recently by Al Musharaf et al (2006).
Mutilation and FGM:
The term "Female Genital Mutilation \[TEXT NOT REPRODUCIBLE IN ASCII]" (FGM) would be most appropriate to describe the state of a circumcised female irrespective of the degree of excision of the genitalia. The term "Female Circumcision [TEXT NOT REPRODUCIBLE IN ASCII]" may also be used when necessary.
The term "Sunna" implies linking with Islamic religion. Therefore, the habitual use of the term "Sunna" when used in connection with FGM, especially in Muslim countries, implies recognition and perpetuation of the type as an Islamic practice. Therefore, the term "Sunna circumcision [TEXT NOT REPRODUCIBLE IN ASCII]" should be abolished from the future FGM literature, except when rectifying a situation. The suggested alternative term is "Clitoridectomic Circumcision" or synonymously "Clitoridectomy" ([TEXT NOT REPRODUCIBLE IN ASCII]). This would also be consistent with the typology which has been suggested earlier,
Infibulation Versus Pharaonic Circumcision:
Since the origin of the practice is still controversial and to avoid unnecessary confusion, the term "Pharaonic Circumcision \[TEXT NOT REPRODUCIBLE IN ASCII]" should be abolished from future FGM literature. The alternative relevant term would be "Infibulation/[TEXT NOT REPRODUCIBLE IN ASCII]", being also consistent with the typology that has previously been suggested by the author.
Abolition versus Eradication:
The word "eradication\[TEXT NOT REPRODUCIBLE IN ASCII]" (extermination) implies a forceful physical act, while the word abolition deals with a holistic concept. Abolition on its own has always been used in connection with abolishment of slavery. Doubtless, FGM is a type of slavery specific to the female gender. It is, therefore, suggested that the term "Eradication" becomes excluded from future FGM literature and be replaced by the term "Abolition\ [TEXT NOT REPRODUCIBLE IN ASCII]". Consequently, the following suggested terminology would become relevant: Abolition of FGM ([TEXT NOT REPRODUCIBLE IN ASCII]) instead of Eradication of FGM ([TEXT NOT REPRODUCIBLE IN ASCII]).
FGM Abolition Campaigns([TEXT NOT REPRODUCIBLE IN ASCII]) instead of FGM Eradication Campaigns ([TEXT NOT REPRODUCIBLE IN ASCII]).
FGM Abolitionists ([TEXT NOT REPRODUCIBLE IN ASCII]) to be adopted synonymously for Anti-FGM Campaigners and their supporters (Abdel Magied, 1998).
State of Circumcision ([TEXT NOT REPRODUCIBLE IN ASCII]):
When describing a female's status of circumcision, the term "Uncircumcised" should be one of three alternatives:
Uncircumcised ([TEXT NOT REPRODUCIBLE IN ASCII]).
Clitoridectomised ([TEXT NOT REPRODUCIBLE IN ASCII]).
Infibulated ([TEXT NOT REPRODUCIBLE IN ASCII]).
Classifying the uncircumcised as one of the states of circumcision of a female, serves establishing a purposive definition. First, it will serve the purpose of recognition of her circumcision situation as the ideal state of circumcision of a female, worth of defending, protection and campaigning for. Second, it will help lifting the negative psychological stigma, resulting from the societal inferiorating attitude towards the uncircumcised female (Abdel Magied et al, 1999).
Nevertheless, Susan Al Musharaf et al (2006) concluded that self-reporting of types of FGM by Sudanese women was not reliable, Hence, recommended revision of WHO (1996) typology, but without suggesting alternatives. It is finally worth mentioning that the not yet endorsed WHO (2007) would also not accommodate the types practiced in Sudan.
List of References:
Abdel Magied, Ahmed; Hagir Al Musharaf; Insaf Adam (2003): Midwives, Traditional Birth Attendants (TBAs) and the Perpetuation of Female Genital Mutilation (FGM) in the Sudan. The Ahfad Journal Vol.20, No.2.
Abdel Magied, Ahmed and Muna Omran (1999): The Uncircumcised Female is an Ideal State of Circumcision. The Ahfad Journal, Vol. 16, No.2.
Abdel Magied, Ahmed (2008): Female Genital Mutilation in Sudan--a Human Rights Issue--(Unpublished book).
Abdel Magied, Ahmed (1998): Some FGM Terminology between the Negative and Positive Impacts. The Ahfad Journal, Vol. 15, No.(2).
Susan Al Musharaf; Nagla El Hadi; Lars Almorth(2006): Reliability of Self Reported Form of Female Gemital Mutilation and WHO Classification: Cross Sectional Study.BMJ,DOI:10.1136/bmj.38873.649074.55.
UNICEF, WHO, UNFPA (1996): Statement, Female Genital Mutilation. Geneva, WHO.
WHO (2007): WHO Typology Modified 2007 (not yet endorsed).