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How Development Agencies Should Tackle the Issue of Female Genital Mutilation in Egypt

Introductionn

Through a survey that was conducted by the Ministry of Health and Population in 2014, it was noted that 92% of women aged between 15 and 49 who were presently or formerly married had undergone FGM. Though this survey noted that between the periods of 2005 to 2014 the number of women who underwent FGM had reduced, about 56% of girls below the age of 19 years were still expected to undergo the harmful traditional practice (Coyne & Coyne, 2014).

Differences between two selected articles

Critiquing the articles

Egypt is a highly medicalised country or rather it has a well-developed medical practice of which the participation of medical doctors in practice has dampened the progress of eradicating the harmful traditional practice. The survey mentioned above also noted that certified medical doctors performed 82% of FGM and this greatly creates the presumption that it is a safe traditional practice (Coyne & Coyne, 2014)

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In 2008, Egypt national government through parliament passed through laws, which illegalized FGM. However, majority of the population have not adhered to these laws and they bash it for being contradictory to their beliefs and traditional practices (Serour, 2013). This is agitated by the fact that the society perceives the uncircumcised females to be ill-mannered and bad-behaved in nature and most of the time been shunted out, forcing the majority of a parent to conform to the pressure citing that they want the best for their children. The tradition aspect of the FGM is a rite of passage to womanhood. In most parts of the country, FGM has a major backing from Imams and other religious decors, although this is in longer the case but there still those who have the same mentality (Østebø & Østebø, 2014).

Theoretical Concept

Female Genital Mutilation (FGM) is a harmful traditional practice with severe health complications. FGM primarily involves removing partial or all external woman genital organs thereby causing injury to female genitalia for no apparent medical reasons. According to World Health Organization (2008), FGM has no known or documented medical benefits. On the contrary, its physical and psychological consequences are harmful to the victims. The removal of normally functional body parts interferes with the normal functionality of the organ especially during childbirth that many led to complication, infant or maternal death (Pacho, 2015). Although, the practice was largely undertaken by communities traditionally, it is against social work values that advocates for mutual engagement of all society members (Children, girls, boys, men, and women)

The practice is wildly condemned internationally as discriminatory and it is considered as violence against girl child and women due to serious health concerns, the pain it causes, and risk involved. In the study by Kaplan et al. (2011) on the health consequences of FGM in Gambia, majority of women who underwent the operation report cases of complication, infections, psychological trauma, and even death, during or after the procedure regardless of the type of FGM operation. Despite its grievous consequences, the practice is still deeply rooted in developing nation especially in Africa (Andro & Lesclingand, 2016).

In a study by Kaplan-Marcusan et al., (2009), it noted that the problem of FGM persist in the mostly in primary care centers with increasing cases documented by the professionals (Pediatrics and gynecologist), tripling in the three year time period. World Health Organization (WHO) (2015) estimate that about 100-140 million girls and women have undergone FGM worldwide with an additional two million at risk of the same yearly, while 3.6 million are affected directly and indirectly by it (UNICEF, 2013). Unfortunately, traditional healers who do not have medical education/qualification or experience in performing surgical operations are the leading culprits in performing FGM. However, Kaplan-Marcusan et al, (2009) indicated that nations such as Egypt, Sudan, and Kenya have high number of medical personnel performing the procedure, 61%, 36%, and 34% of the total FGM reported respectively. FGM is continuously practiced by communities in these three countries due to various reasons of which the most common is the fact that is perceived to safeguard against premarital sex and as resultant, it preserves morality through prevention of female promiscuity (Yirga et al. 2012). According to Yirga et al. (2012), in Kenya and Nigeria, 30 and 36 percentages of women respectively agrees with the above-misconstrued claim. On the other hand, 51 percent of Egyptian women believe that FGM prevents adultery, while 33.4 percent of the subject attributed the practice to important religious traditions (WHO, 2008).

A brief history of FGM in Egypt

Female ‘circumcision’ has been practiced in Egypt for centuries with many historians citing its origin there (Ofor & Ofole, 2015). In the study by Pacho (2015), he stated that the most radical practice of FGM was performed nearly 2500 years ago (by examining of Egyptian mummies), which means it began before the development of Islam or Christianity. The practices gained popularity in the 1970s with majority advocating for it while human right organization voiced against the practice and calling for it abolition (Pacho, 2015). In the same period, the concept of female genital mutilation was coined to establish the gravity of the act on the victims and its violation of girls and women rights.

Before 2008, FGM procedures were legal in Egypt and hence performed by qualified doctors in Hospitals. Although, the law later banned its practice, the prevalence of the practice remains high, with an increase in proportion of operation performed by traditional healers (Refaat, 2009). In 1994, Egypt’s ministry of Health permitted government doctors to perform FGM terming it as effort to promote and monitor safe procedure, despite the ban of decree after Human rights criticizing it, some hospitals (Private hospital) offer alternative procedure (Shell-Duncan, 2001). It was after the publicized death of an 11-year old girl in 2007 during the operation that the government subsequently barred and restricted any licensed medical staff and hospital from FGM operation and even contributed to the enactment of laws barring FGM. (Guilbert, 2016) As a resultant of this restriction and illegalization, the practice has gone underground mostly performed by unlicensed mid-wives under the authorization of the girl’s parents (Rasheed, 2011). However, there are still cases where licensed practitioners performing the procedure have been reported (Andro & Lesclingand, 2016).

Psychoanalytic Theories

In most cases, females undergo the genital mutilation at a very tender age, between ages 3 to 15 years. Occasionally, women in their adulthood are equally subjected to the same harmful traditional practice if they had not undergone during their childhood. Sigmund Freud in his theory of psychoanalytic emphasized on the importance and significance of childhood events and experience for every child (Cherry, 2016). Therefore, the psychological impact of mutilation on a

girl child is permanent, and it has the possibility of affecting her academic and social life in the long term. Erikson in his theory of stages of psychosocial development asserted that that every person’s stage of life, experiences, and events faced determines the kind of life that one will live. According to Erikson’s theory, at a tender age in particular, six to fifteen years, the experiences encountered will greatly influence the social and economic outcome of the individual (Erikson and Joan, 1997).

Prevailing Factors That Enable the Continued Practice of FGM in Egypt

Social aspect

The arguments on FGM practices have been controversial since the late 1970s because it conflicts with some of the most basic human rights, traditional, and religious values. Blanket presumption that perpetrators of the violence have been emotionally deprived or abused in the same way during their childhood, being victims of FGM, confers that most parents, guardians and midwives will perpetrate the same deeds done onto them themselves (Boyden et al., 2012). In the Egyptian culture, the practice has been conducted dating back several millenniums (24 BC) with every female generation undergoing the procedure (Hoffman, 2013

In the same perspective, parenting norms arise from the social values within the community. Girls’ circumcision (FGM), in traditional African society is a norm, and a condition to womanhood and marriage hence perceived ‘appropriate’ necessity for those conditions (Kaplan et al., 2011). In the same context, the Egyptian parents perform the harmful traditional practice in accordance to the ways things were with no regard to the modern scientific facts. In fact, in Egypt, there is a substantial social pressure for everyone especially the parent to conform to the social norm stating that female circumcision is a normal practice (Rossem, 2016).

Economic Valuation

Traditionally, social acceptance of uncircumcised girl is very low. The communities consider them adulterous, immature and ‘children’ regardless of age (Monagan, 2010). Many believe that by having this harmful traditional procedure, it reduces sexual desires which eventually reduces the number of sexual partners hence reduces likelihood transmission of sexually transmitted disease (STDs). Furthermore, many believe that traditional education taught during this practice enhances the honor and behavior of the woman (Zaki, 2016). Monagan (2010) in his writing stated that feminine sexuality could bring shame and dishonor unto the family. In the social context, the parents who refuse to perform this practice are also shunt out of the community as their daughter are perceived to represent dishonor to the entire community.

Economic aspect

In certain Egypt communities, especially those in rural areas that are poverty-stricken the family economic survival depend on bride price paid during marriage (mostly early marriage). Generally, following the social norms, FGM practices as an imperative means to make a girl grow to a woman favorably respected by the society therefore making her, or rather, increasing her marriage ‘market value’/ payable bride price (Yirga, 2012). Therefore, it is upon the family to ‘protect’ and conserve the girls’ purity from social and physical risks of immature and extramarital sexual intercourse and abortion (Kingsley, 2016). This, in the parents’ perspective, necessitates the harmful traditional practice to curb loss of virginity by girl more so when a bride price was already paid in advance when the girl was young.

Political Aspect

The political structure and system in Egypt limits access or influence of woman on the political sphere. The extremely low representation of women and their influence results in lack reenactment of laws that are discriminatory and against the interest of women and girls, or passing legislation that protect their values and virtues (Darwish, 2014). For instance, the FGM was allowed by the government and permitted to be performed in public hospital in the early 1990s. In addition, the recent political unrest have overshadowed many Egypt social problems including FGM. The issue of FGM has been marginalized, according to Vivian Fouad, the head of the capacity building and communications department at Egypt’s National Population Council (NPC) that champions the campaign against FGM (Darwish, 2014). Furthermore, the instability has led to 75 percent reduction in FGM-related donor funds from the government and slow progress in official effort in curbing the issue (Sharma, 2011).

Moreover, the rise Muslim Brotherhood is feared by many as a potential obstacle in eradicating the practice since the group greatly agitates for Islamic laws, which do not condone the vice (Hoffman, 2011). Saad El Katani, as the leader of the Brotherhood movement/ group was once quoted stating that Islam does forbid circumcision. However, many members of the party initially argued in support of the ban on FGM but they do not speaking against the practice resulting to dormant legislation (Sharma, 2011).

Legal aspects

In 2008, FGM practices were criminalized. Since then, the government have partnered with NGOs in the fight to eradicate the practice. Despite this, there has been slow improvement in the incidence rate due to lag in enforcement of the law (Rasheed, 2011). Since the enactment of the law in 2008, prohibiting FGM with punishment ranging from two months to two years imprisonment of El-Bataa’s (father a 13 year old girl who died after being subjected to an FGM) and the operating doctor in 2013 was the first time anyone has been charged with FGM-related cases (Darwish, 2014).

Past Policies and Intervention

Conclusion

Various mechanisms have be deployed to curb the menace particularly in Egypt. Despite the ban and criminalization of the practices in most of countries including Egypt and Kenya, eradicating the practice is termed problematic by many scholars as the problem is undertaken by the society secretly and out of the public glare (Hoffman, 2013). Most countries have strict laws against the practice. For example, in Spain, parents found guilty of practicing FGM faces six to twelve years in prison and girls are taken care by the social services (Kaplan-Marcusan, 2009).

Laws and policies that are against the vices are not sufficient to stop the vice neither is offering refuge nor prosecuting the people performing these atrocities also enough to stop the harmful traditional practice. This is because traditional and religious beliefs are the bases of its continued practices. Therefore, engaging Government agencies, Non- Government Organizations (NGOs) and Internationals Organization such as WHO, the United Nations Development Programme (UNDP), UNICEF, the UN Population Fund, UN Women, the European Union (EU), the National Population Council and other the major corporation over the years without solving the people’s beliefs have seen a disappointing gradual reduction of FGM practices. Of which the gradaual reduction is linked with strict limitation of medical practitioners in engaging in the practice (WHO, 2014).

Eradicating the practice in totality highly relies on the level awareness and education about the outdated traditional practice and its harmful effect. Recently, for instance, adoption of more inclusive approach that entails incorporating communities into the fight against the harmful traditional practice has shown a slight decrease in the case of FGM in Egypt (Lee-Johnson, 2015). For example, in Kenya, the Kenya Women Parliamentary Association in support of UNICEF is reaching out to the communities through education on the consequences of FGM and Human rights violation. According to Kaplan-Marcusan et al. (2009), developing a positive and inclusive intervention models such as campaigning for human rights, offering protection and legal services to the victims and empowering them with education and skill, will result in linkage of this health problem to other cultural beliefs and values that in long run projects a success in combating this menace.

Trends of FGM over the years in Egypt

FGM in Egypt is reported to affect 90-97 percent of women, though the number of women undergoing the procedure dropped considerably since 2014, six in every ten down from nine in every ten in 2008 (Zaki, 2016). Although the 2008 legislation prohibits medical practitioners from performing the practice, a study by Rashid et al. (2011) found that the incidence remained relative high. Furthermore, the study showed that most procedure are performed by general practitioners.

Although there are four types of FGM varying with the procedure and depth of the cut, namely Type I (Clitoridectomy, involves partial or total removal of clitoris). Type II (Excision entails removing clitoris and labia partially or totally). Type III (Infibulation, this is most severe involving narrowing the vagina opening without removing clitoris). Lastly, Type IV, (this mainly involves all other procedure to genitalia such as pricking, piercing, incising and cauterization). However, the most common type of FGM procedure practiced in Egypt is Type I, II and III, which are occasionally performed by doctors (Refaat, 2009).

As stated earlier, According to the Egypt Demographic and Health Survey (EHDS) (2014), 92 percent of married and formally married women between the age of 15 and 49 years are genitally mutilated. However, 87 percent women between 20 and 24 years and 95 percent of their counterpart between 35 and 49 years are reportedly circumcised. Most studies confirm a 10 percent difference in prevalence of FGM among girls between the age of 10 to 19 years and their mothers, showing a declining FGM practice (Rossem et al., 2016).

According to EDHS (2014) data, the people opposing the FGM increased in the year between 1995 and 2014. In 1995, only 13 percent of ever-married women were against the FGM but by 2014, the number had increased to 31 percent. This is illustrated the image below.

Trends of FGM opposition among ever-married

Figure 1: Trends of FGM opposition among ever-married Egyptian women Source: Rossem et al., 2016)

Possible solutions that Development Agencies can adopt to Curb FGM in Egypt

The FGM practice tends to be complex and problematic when dealing with it more so in the case of Egypt where medical practitioners also participate in the harmful traditional practice. As stated earlier, this vice is associated with both traditional, religious and patriarchy aspects of the society, which have collectively made combative measures to be unsuccessful over the years in Egypt. Laws, policies, and interventions are ineffective in the total eradication of FGM inEgypt unless local context is amicably understood. The punitive laws and measures only pushes the practice underground to the underground scene, subsequently presenting more severe consequences to the health and life of the females. The need to understand why and what drives the communities to practicing female mutilation is of great importance in curbing this menace (Darwish, 2014). Basing on traditional perspective, it is not about stiffening the law but rather addressing people’s mindset on the FGM practice, which is the key to changing the social belief and attitude. In Kenya, for instance, though the practice is not completely eradicated, inclusion of parliamentary women members, influential athletes, and communal leaders has seen drastic fall in the FGM case (Cloward, 2015). The societies are educated on the negative consequence, adultery notion, STDs prevention mechanism and alternative means of educating the girls to grow to respectable persons in the society, such as taking their modern education serious and foregoing the notion of ‘honorable’ wife in the society (Cloward, 2015). Therefore, engaging with vulnerable girls and their parents in endangered communities helps to understand the drivers of FGM and possible measures in dealing with the problem. Mostly, laws are made without consolation with the local communities especially the girls. The social acceptance and experience of the uncut girls may cause majority to engage voluntarily in the practice (Kingsley, 2016). It is observed that, girls make decisions on basis of their social assessment of their future adult chances and lives; whereas parents do, what they think is in the best interest for their children. Therefore, effective strategies is for development agencies to first gain an understanding on the Egyptian culture and thereafter, formulate a comprehensive educational programme targeting mostly those living in rural areas and lower class areas in order to debunk the myths associated with the benefits of FGM and even educate them on the risks.

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Conclusion

Child as symbol of innocence juxtaposed to adults’ world of chaos and lack of morals and values Conferring rights not only onto girls but also women transforms them to recognizing their moral equalities with men in the society and therefore underscoring universal moral worth of all human beings (Diptee, 2013).. Moreover, the women particularly girls need to be treated as rights holder and those rights need to be advocated on their behalf by communities and developmental agencies. The perceived concept of ‘stolen childhood’ ignores the reality that child’s social experiences does not deviate away from values and conditions conferred to them by the society in general (Diptee, 2013).

The concept of FGM arguably disregards the basic human rights particularly the girl-child. The traditional notion of preparing the girl to womanhood and curb adultery through ‘circumcision’ is outdated. As discussed, FGM is entwined with many complexities varying between traditional and religious aspect of the society particular in Egyptian society. Therefore, legislative laws prohibiting the practice are not an effective solution but rather understanding the roots and its bases then combating those drives is the key to succeeding in the fight. Finally, it is imperative for development agencies to engage more with the communities and changing their mindset not only the parent, guardians, society member but also the girl-child is a major key step towards combatting the issue of FGM in Egypt.

References

Andro, A., & Lesclingand, M. (2016). Female genital mutilation. overview and current knowledge. Population, 71(2), 216-296.

Coyne, C. J., & Coyne, R. L. (2014). The Identity Economics Of Female Genital Mutilation. The Journal of Developing Areas, 48(2), 137-152

Darwish, P. (2014). FGM eradication in Egypt since 2011: A forgotten cause? - Politics - Egypt - Ahram Online. English.ahram.org.eg. Retrieved 6 March 2017, from http://english.ahram.org.eg/NewsContent/1/64/97618/Egypt/Politics-/FGM-eradication-in-Egypt-since--A-forgotten-cause.aspx

Diptee, A. (2013). Stolen Childhood: Slave Youth in Nineteenth Century America. Slavery & Abolition, 34(1), 191-193.

Egyptian government supports medicalisation of female genital mutilation. (1995). Reproductive Health Matters, 3(5), 134.

Erikson. Erik H. and Joan M. (1997) The Life Cycle Completed: Extended Version. New York: W. W. Norton

Guilbert, K. (2016) Death of Teenage Girl Casts Doubt on Egypt’s Efforts to End FGM: Activities. Reuters [online] retrieved from http://www.reuters.com/article/us-egypt-fgm-idUSKCN0YM287 [accessed 5 March 2017]

Hoffmann, N. (2013). Female Genital Mutilation in Egypt. Global Journal Of Medicine And Public Health, 2(3).

Kaplan, A., Hechavarría, S., Martín, M., & Bonhoure, I. (2011). Health consequences of female genital mutilation/cutting in the Gambia, evidence into action. Reproductive Health, 8(1).

Kaplan-Marcusan, A., Torán-Monserrat, P., Moreno-Navarro, J., Fàbregas, M., & Muñoz-Ortiz, L. (2009). Perception of primary health professionals about Female Genital Mutilation: from healthcare to intercultural competence. BMC Health Services Research, 9(1)

Kingsley, P. (2017). In Egypt, social pressure means FGM is still the norm. the Guardian. Retrieved 4 March 2017, from https://www.theguardian.com/world/2015/feb/06/female-genital-mutilation-egypt

Monagan, S. (2010). Patriarchy: Perpetuating the Practice of Female Genital Mutilation. Journal Of Alternative Perspectives In The Social Sciences, 2(1), 161-181.

Østebø, M. T., & Østebø, T. (2014). Are religious leaders a magic bullet for Social/Societal change? A critical look at anti-FGM interventions in ethiopia. Africa Today, 60(3), 82-101,152-153.

Pacho, T. (2015). Complexity of Female Genital Mutilation/Cutting. Journal Of Social Work Values And Ethics, 12(2), 63-75.

Rasheed, S., Abd-Ellah, A., & Yousef, F. (2011). Female genital mutilation in Upper Egypt in the new millennium. International Journal Of Gynecology & Obstetrics, 114(1), 47-50.

Refaat, F. (2009). Medicalization of female genital cutting in Egypt. Eastern Mediterranean Health Journal, 15(6), 1379-88.

Serour, G. (2013). Medicalization of female genital mutilation/cutting. African Journal Of Urology, 19(3), 145-149.

Sharma, B. (2011). For Young Women, a Horrifying Consequence of Mubarak’s Overthrow. New Republic. Retrieved 6 March 2017, from https://newrepublic.com/article/96555/egypt-genital-mutilation-fgm-muslim-brotherhood

Shell-Duncan, B. (2001). The medicalization of female ‘‘circumcision’’: harm reduction or promotion of a dangerous practice?. Social Science & Medicine, 52, 1013-1028.

Van Rossem, R., Meekers, D., & Gage, A. (2016). Trends in attitudes towards female genital mutilation among ever-married Egyptian women, evidence from the Demographic and Health Surveys, 1995–2014: paths of change. International Journal For Equity In Health, 15(1).

World Health Organization (2008). Eliminating female genital mutilation: an interagency statement. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Geneva,

Yirga, W., Nega Kassa, Mengistu Gebremichael, & Aro, A. (2012). Female genital mutilation: prevalence, perceptions and effect on women's health in Kersa district of Ethiopia. International Journal Of Women's Health, 4, 45-54.

Zaki, M. (2016). Egypt seeks tougher punishment for female genital mutilation. news.trust.org. Retrieved 6 March 2017, from http://news.trust.org/item/20160829144755-55827/


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