Medicalising FGM in Egypt: A 'less brutal' way to sustain an illegal procedure in decline?

Nada Zaki, Sunday 30 Sep 2018

Despite a significant decline in the number of Egyptian girls forced to undergo circumcision, the number of those undergoing the illegal procedure under the supervision of a doctor or nurse is on the rise

File Photo: A counsellor holds up cards used to educate women about female genital mutilation (FGM) in Minya governorate, Egypt (Reuters)

“I remember every single detail as if it were yesterday. The phantom pain that shivered down my spine, the floor whose colour you could not see because of the blood stains, and my tied hands and opened legs.

They said it is a must; every girl has to be circumcised. It’s the only way to save her virtue.” Sixty-year-old Hanaa Mansour was relating her Female Genital Mutilation (FGM) experience, which she underwent a little less than 50 years ago.

Mansour is like millions of other Egyptian women who were forced to undergo FGM at a young age. Nonetheless, statistics reveal that her fate will not be shared by thousands of other young girls.

Recently released figures indicate that the number of girls below 17 who are still being circumcised is currently less than ever before in Egypt. But the majority of those who underwent it — unlike their ancestors — have undergone the surgery at the hands of a doctor or nurse.

According to the latest research conducted by the Population Council, circumcised girls aged 13-17 dropped to 72 per cent in 2018.

The research, released two weeks ago, revealed the number of FGM operations in Egypt had sharply decreased, as 92 per cent of married women aged 15-49 have been circumcised, while 85 per cent of women aged 20-25 have undergone FGM.


However, the research raises a red flag. There is a significant increase in the number of circumcision surgeries by doctors on young girls.

It revealed that the percentage of girls being circumcised by healthcare providers has reached 65 per cent among the 13-17 age group, compared to 31 per cent among married women between 15-49 years old.

The results are from two studies: the Population Council in cooperation with Egypt’s Ministry of Health; and the National Population Council.

The first study focused on how to eliminate FGM while the other researched implementing more effective social marketing campaigns to end FGM in Egypt.

According to the World Health Organisation (WHO), FGM is defined as “any operation involving partial or total removal of female genitalia."

At 12, Mansour was one of the oldest girls in her small rural village who had not undergone FGM.

“They usually start circumcising from six to eight years old,” she said.

She explained that it was well known in her village that the older a girl gets the higher the surgery risks, so most families decide to have their daughters undergo FGM at that age.

Like all of the girls in her village, Mansour was circumcised by the town’s only barber.

“They told me to lie down so that the weird smelling man could take a look at my vagina, so I did. A few minutes later, both my hands and legs were tied. I felt nothing but the pain,” Mansour said, shedding tears.

From where Mansour comes, a girl has to be circumcised in order to get married, “otherwise, she gets the reputation of being ill-mannered.” If left uncircumcised, “she will probably not be able to control her desires and will have sex with any man.”

It’s not certain whether this is what Mansour sincerely believes or whether this is what she was told to believe.

Dr Amr Hassan, assistant professor of obstetrics and gynaecology at Cairo University, explained that in underprivileged areas, people undergo FGM under the banner of religion, which he added, is interpreted wrongly most of the time.

“It is a wrong mainstream thought that Islam orders circumcising women. Despite Al-Azhar’s decision that it has nothing to do with Islam, less educated preachers in underprivileged areas call for it as a means to protect the society from adultery,” Dr Hassan said.

Dr Hassan, founder of Enty Al-Aham (You Are More Important), one of the leading campaigns in fighting FGM, and one of the doctors who debated criminalising the law on FGM in parliament in 2016, believes the decreasing numbers indicate the progress both the government and NGOs are playing in raising people’s awareness regarding the severe harms of FGM.

“The percentage of young girls below 15 that undergoes FGM is the real indicator of the campaign’s efficiency. From what we see, these numbers are continually dropping which clearly states we are on the right track.”

The results of the Health Demographic Survey indicate that the proportion of married women aged 15-49 who have been exposed to FGM dropped from 80 per cent in 2005, to 72 per cent in 2008, to 35 per cent in 2014.

Dr Hassan added that because Egypt started combating FGM as far back as 20 years ago, a noticeable decrease in numbers is being realised every year.

From his experience, direct communication with families has shown to be the most effective method in raising awareness.

Nahla Abdel-Tawab, the Population Council’s country director in Egypt, concurrs.

Abdel-Tawab stated in a press release that research had also shown that “the use of more personal contact has proven to be more effective in changing behaviour to overcome the fear of societal consequences that can result from abandoning circumcision.”

Having a daughter was Mansour’s ultimate nightmare, which eventually came true.

“I knew I did not want her to go through what I did but at the same time I knew I couldn’t protect her from the surrounding mentalities,” she said.

Mansour was forced by her mother-in-law, the child’s grandmother, to circumcise her daughter. Despite her attempts to postpone the surgery for years, she ended up forcibly taking her daughter to a nurse to do the job.

“I thought having a doctor or anyone experienced in medicine would be safer and maybe reduce some of the pain. There was a veteran nurse in our neighbourhood who accepted to do the surgery. But none of the pain, emotional breakdown or psychological effect was erased,” she added.

Heading to a healthcare provider instead of the usual barber is another solution people started turning to, believing it would reduce the harm caused by FGM. The research described it as “medicalising FGM”.

The research showed that medicalising FGM is currently the most widely spread action and, as such, is in need of standing up against, as a way of fighting circumcision.

Asserting that it is one of the most difficult challenges facing them, Abdel-Tawab explained that the information doctors and nurses have about sexual health “is very limited. They are not sufficiently aware of the psychological and health damages caused by circumcision.”

“Although most doctors are aware of the illegality of circumcision, some of them carry out the surgery under other names or suggest other doctors,” she added.

Hassan explained that many underprivileged people head to healthcare units based on the recommendation of local preachers.

“They have blind trust in those representing religion, so if somebody says a doctor is experienced enough to circumcise their daughter without causing them any harm, they don’t think twice.”

“It costs between EGP 100 to EGP 200 to circumcise a girl in our hometown, depending on her age, health and the size of the to-be-cut part,” Mansour said.

Egyptian law did not criminalise FGM until 2008 after a young girl, Bodour Shaker, died while being circumcised in surgery.

Shaker's video went viral on social media.

However, the 2008 law stipulated that an accused doctor pay only a maximum EGP 5,000 fine in order not to face a minimum six months to two years in jail.

It wasn’t until 2016 when the law redefined FGM as a felony and increased prison sentences to 15 years.

When Mansour’s daughter married, she already had her mind set on not forcing her daughter into FGM, even if that meant leaving their hometown and moving to Cairo where the chances for her daughter to be socially accepted and get married while uncircumcised is higher.

“She swore that she will never make her daughter, my grandchild, go through such an experience no matter what she has to do,” Mansour said.

*A version of this article appears in print in the 27 September 2018 edition of Al-Ahram Weekly under the headline: Medicalising FGM

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