Like many other concepts, there is some difficulty in defining the term female genital mutilation (FGM), sometimes also known as female circumcision (FC). Since scholars have been proposing and conceptualizing the term with respect to the area they are in favor of and serious arguments among scholars particularly feminists as if FGM/C or FC is the correct term that has to be used to define the traditional practice of which removal of female external genital organs.

Alexia [1] noted that there are different traditional practices of cutting of female genitals named as female circumcision, female surgeries, female traditional surgery, cutting and excision; however, FGM is a collective name that can be used in common. In other words, it is a term for any procedure performed for cultural or otherwise non-medical reasons involving partial or complete removal of the female external genitalia or damaging them in some other ways.

WHO - Female Genital Mutilation [2] stated that FGM is the widely used term to express the traditional practices that damage or simply removal of partial or all of the external genitalia of girl and women. Additionally, [3] argued that the term FGM is more accurate to describe the results of the procedures of all forms of mutilation than Female circumcision, which is commonly used to describe only the first type of mutilation. Therefore, we also used the term FGM because we believed that it describes the severity of the practices and illustrates the action as a violation of rights of girls and women.

FGM is a cultural practices that comprises all types of female genitalia, which ranges from Clitoridectomy/removing the tip of the clitoris up through infibulation/removing of all of the external female genitalia including some part of vagina using different methods [4-6].

There is no clear evidence that illustrates exactly when and when the practice of FGM was stated. However, there are some documents, which suggested that FGM has been found in ancient Egypt around 2000 BC [3]. To the contrary, there is also an assumption that FGM has been initiated in ancient Greece, Rome, Pre-Islamic Arabia and the Tsarist Russian Federation [7]. Subsequently, there is also an idea that FGM was practiced in Britain, Canada and the USA in the 18th century to prevent masturbation, cure hysteria and some psychiatric conditions. During that time, this harmful traditional practice was known as female circumcision [8]. Late 1970s is time that the term FGM has gained support from the international community and it is used to distinguish from male circumcision and to show the gravity of the practice [9].

Nowadays, FGM is not only practiced among communities in Africa and the Middle East. I is widely practiced among some communities in Australia, the Far East and the immigrant population in European countries like Norway, Denmark, Netherlands, Sweden, Uk, and France, and the Americas. Moreover, recent data reveal that it occurs on a much larger scale than previously thought [9-11].

About 100-140 million infants, girl-children and women undergo the operation every year. That is about 6,000 per day or one in every 15 seconds women and girls have undergone some form of female genital mutilation. This practice has often takes place in remote rural areas by untrained village midwives who use instruments such as knives, razors or even broken glass [12,13].

In spite of this, the majority of girls at risk of undergoing FGM are from round 30 Africa countries and the Middle East [13]. Within this continent, as Layli [14] has stated an estimated 3 million girls are at risk of FGM each year, of these nearly half are from Egypt and Ethiopia. Therefore, whenever and wherever the practice has originated, whatever the statistics, the existence of the practice by itself is the most persistent, pervasive and silently endured human rights violations.

Types of FGM

Different communities practice FGM in different ways, and some forms are much more extensive than others are and cause greater health problems for girls and women. According to the recent classification published by the World Health Organization, there are four types of female genital mutilation. These are;

Type I Clitoridectomy: It is a type of FGM that involves the excision or removal of the clitoral hood, with or without removal of all or a part of the clitoris this partial or total removal of the clitoris.

Type II Excision: It is also commonly referred to as excision, involves the excision or removal of the clitoris, in addition to part or all of the labia minora (the inner vaginal lips). As cited in Morrison [15] the United Nations Office for the Coordination of Humanitarian Affairs noted that 85% of female genital mutilation consists in Type I and Type II operations.

Type III Infibulation: It is also a type of FGM known as “pharaonic circumcision” that involves the excision or removal of part or all of the external genitalia (clitoris, labia minora and labia majora). Followed by a stitching or narrowing of the vaginal opening, leaving a very small opening about the size of a matchstick that allows for the restricted flow of urine and menstrual blood. This type is commonly practiced in Somalia, Sudan and in parts of Egypt, Ethiopia, Kenya, Mali, Mauritania, Niger, Nigeria and Senegal [15]. According to WHO - Female Genital Mutilation [3] and Rachelle C [15], Infibulation is the extremely severe because the mutilated young women’s legs are bound for approximately a month in order to allow for the formation of scar tissue across the genital area.

Type IV Other: It is a general category of FGM that involves any picking, piercing or incision of the clitoris and/or labia including but not limited to, the burning or cauterization of the clitoris and surrounding tissue. The scraping or cutting of the vagina or the vaginal orifice, stretching of the clitoris and/or labia, as well as the introduction of corrosive substances in to the vagina to cause bleeding or the introduction of herbs into the vagina to tighten or narrow the aperture [15].

What we can understand from this is that the type III/Infibulation operation is more severe that others and causes complicated health problem for the girls and women who are mutilated. However, this does not mean that the other types does not cause health problem.

When we look at the rationales behind the practice of FGM/C it varies depending on the cultural, social and religious background of the communities who are engaged in the practice. The widely cited justifications for the practice of FGM/C include cultural, moral, social, financial and sexual reasons as well as aesthetics and cleanliness [2,11,13,15-22]. Hence, we will try to discuss some of the justifications here under.

The first and commonly cited justification for the practice of FGM is socio-cultural reason. Communities who practicing FGM seen it as prerequisite of maturity or transition from childhood to adulthood to be able to carry out marriage, child bearing, and other community affairs [3,11,22]. Likewise, Ashenafi [13] stated that “for most African women as well as other Third World women marriage is not an option but a must for survival, to gain economic security and social status”. Therefore, as far as marriage is necessary and FGM is precondition for marital status, child/girls are obliged to be mutilated. This indicates us that child/girls are undergone the procedure of FGM not because it is important for them rather for the social and cultural values of the society.

Psychosexual reason is also another justification to practice FGM. There are assumptions in which women are weak in areas of emotion and they are unable to control their sexuality so far so that uncircumcised girls are assumed to run wild, or are considered of loose moral, bringing shame to their parents. Here, FGM is expected to reduce the girl’s sexual desire and prevent sexual experience before marriage, and to ensure faithfulness of the woman to her husband [3,13,23]. Therefore, FGM is also practiced to control the sexual desire of women.

Thirdly, there are also communities who believed that removing the external genitalia of girls and women is necessary to make them spiritually clean and then required by religion [2]. For instance, FGM is widely practiced by Muslim communities and they believe that Sunna circumcision is mandated in the Koran, and as they are following the traditions of the Prophet Mohammed. However, authors like those that Waris cited in [23] argued that there is clear information about FGM in religious books. Ashenafi [13] also pointed out that FGM is not practiced by all Muslims and has been wrongly associated with Islam since he believed that the main teachings of Islam and Christianity, as expressed in the Holy Koran and Holy Bible respectively, do not prescribe or enforce the practice of FGM.

The last but not least justification cited for the practice of FGM is hygienic and aesthetic reasons. The external female genitalia are considered dirty and unsightly and will continue to grow ever bigger if they are not cut away, and are to be removed to promote hygiene, prevent illness and provide aesthetic appeal [2]. Kratz cited in [17] also noted that when we talk about FGM it should be in terms of “cleanliness, beauty and adulthood rather than affecting/damaging/ destroying the sexual pleasure of women. FGM is also considered as part of raising a girl in a proper manner, and shameful to the young girl and her family if not/reject the practice since it is a means of cleanness and beauty of the girls [13].

When we come back to our country Ethiopia, as Ethiopia Demographic and health survey (2006) noted that about 74% of Ethiopian girls and women are undergone the practice of FGM. The practice varies among religious and ethnic group, and it is most common in eastern part of the country particularly in Afar and Somalia [24]. FGM is also practiced by nearly all religious groups, especially Christians and Islamic. In Ethiopia where Christianity is dominant religion followed closely by Islam, FGM is prevalent with slightly higher rate among Muslims (79.6%), than among orthodox Christians (69.1%). This shows us that FGM is widely practiced and deeply rooted in cultural practice of the societies.

Because of this, the Ethiopian government outlawed the practice of FGM in 2005 as harmful cultural practice, which violates the rights of girls and women [23]. Particularly Article 565 of the Criminal Code of Ethiopia explicitly stated, “Whoever circumcises a woman of any age is punishable with simple imprisonment for not less than three months, or fine not less than five hundred Birr”.

Similarly, the NCTPE has worked on awareness creation on the harmful cultural practice of FGM throughout the country and have come-up with the positive results and able to decline the supporters of FGM from 60% to 29%. This means that awareness creation is the best instrument to mitigate harmful cultural practice in addition to outlawing the practice. Besides, the NCTPE has signed a tripartite agreement with the Disaster Prevention and Preparedness Commission and the Ministry of Health to do more actions together to eradicate harmful cultural practices like FGM [25].

Furthermore, the government has given more emphasis on the eradication harmful traditional practice and mandated regional bureaus to have materials/documents, text books and others that discourages harmful practices including FGM in primary school curricula. As a result, children are taught to identify bad cultural practices like FGM, wife beating and others and music, arts, literature as good culture as well as it initiates the Ministry of Education to conduct research about the effects and procedures of FGM in particular (Ibid).

From the very successful and positive results of the Ethiopian government’s efforts is for instance the result from the seminar on FGM in Wellega. There has been one participants of the seminar, who was a former excisor, and she mentioned as “She had been so affected by the seminar she changed her livelihood. She now washes and irons clothes for a living [25].”

Besides, some religious leaders have started preaching that this practice has no basis in the Bible or Quran and, in fact, have negative health effects. In September 1998, Christian and Muslim leaders publicly denounced this practice (Ibid.). Here, we understand that law is not enough by itself but also education, discussion and advocacy with society who are in a position of harmful traditional practices seem imperative to eradicate harmful practice like FGM.

The tension between universalism and cultural relativism in this regards has begun when universalism insisted that human rights are universal and tightly attached with every individual without regards of sex, color, language, culture, religion, ethnicity and other status, which leads to the adoption of United Nations Declaration on Human Rights in 1948. Particularly, since three decades ago the practice of FGM/C was became the central issue of the serious arguments between cultural relativists and Universalists approaches as whether it is the issue of culture or human rights [26]. Let us examine the viewpoints of both Universalistic and cultural relativist approaches towards the practice of Female Genital Mutilation/cutting.

Universalist perspectives

Universalists like [13,19,27] each argued as FGM is widely performed with unsanitary and unsterile materials and used for multiple girls, which affects the health and wellbeing of the girl and women as well as there have possibility for the transmission of HIV/ ADIS.

Xiaorong Li [27] also stated that FGM does not provide any physical, psychological and biological benefit for girls and women who have mutilated but it effects for the immediate and long health problem like “recurrent bladder and urinary tract infections, cysts, infertility, an increased risk of childbirth complications and newborn deaths, and the need for later surgeries”.

As cited by Morrison [15] FGM especially the “infibulation” which commonly practice in African countries like Ethiopia, is extremely severe because the young women’s legs are bound for approximately a month and it creates so as to prevent any access across the body periphery with the exception of the minimal passage of urinary and menstrual fluids. Additionally, practitioners may use knives, scissors, scalpels, pieces of glass or razor blades to carry out the practice with little or no knowledge of human anatomy or medicine then in long term the mutilated girls and women may experience problems with their sexual, reproductive and general health [16].

Interestingly, Abusharaf [28] also strongly opposed the relativist’s idea regarding FGM and gender inequality, and argued that genital mutilation can be seen as reflective of women's inferiority in other spheres of life. As it has been mentioned earlier one of the rationale behind FGM is to suppress a young girl's sexual desire by removing her most sexually sensitive parts, believing that this will ensure her chastity and thus protect the honour and integrity of the family. Here, what the cultural relativists have failed is as FGM is predominantly practiced on children and girl without their consent, and to analogize with “cosmetic surgeries”, which performs based on the best interest of women, and never practiced on children and it performed with sanitary and sterile instruments [29]. Therefore, as it will be briefly discussed in the next part, the practice of FGM is aims at control women and makes them excessively willing to serve men’s sexual and reproductive desire and interest [27].

Furthermore, there are myths, as FGM is the precondition to women to be mature and have a full membership of human race unless and other wise she would not have the right to interact with others and socially isolated. Again, it is useful to ensure a girl’s virginity, which is the prerequisite for marriage. Accordingly, we can assert that FGM is gender-based discrimination of human rights of women to equality as far as FGM is merely the precondition for women to marriage [2,13].

As cited by Platt [18] Universalist feminists also argued that female circumcision is practiced to weaken a woman’s sexual desires, which cause women to be vulnerable to male domination. Besides men especially from the polygamous societies in Africa believed that, he will be sexually satisfied while he has a mutilated wife. This is clearly meant that women are mutilated for the sake of men’s sexual satisfaction and not vice versa.

Very interestingly, Reichert [29] also criticized cultural relativists as they argued as universal human rights are a western concept as why they said when they comes to use technological aspects like telephone, car and others from western as it is incompatible and not our culture. Reichert also argued that culture is changing, pluralistic, and they are not sacred, and that is why racism and fascism had been the cultures of Germany and Italian society so far so these were considered as harmful cultural practice, which violates the human rights to life, liberty and some other fundamental freedoms, however, these are the culture of the westerners. Therefore, FGM like fascism and racism is a harmful cultural practice that has to be prohibited as a violation of child and women’s right since a culture that cannot defend human beings to live a better life is worthless.

Reichert further argued that the human right to take part in a person’s culture has the same importance as any other human right. However, the human right of culture does not validate practices that clearly cause physical, severe emotional or other harm to another. In other words, individual are not tolerated to participate in a culturally accepted domestic violence like wife beating, FGM, rape, and so forth the then violate human rights to dignity and freedom from cruel treatment [29].

In spite of these facts, cultural relativists counter argued as FGM is a cultural practice of a certain society do not worry the negative consequence of the tradition, is valid, ethical and moral for the society who are practicing so far as part of their culture without looking to the responses/conceptions of other societies about [27]. This is because of the notion that all cultures are equal, truth and ethical, and each culture has a freedom of practicing all that is relevant and valuable to the society regardless of the responses and viewpoints of other culture for [29].

Obermeyer and Edgerton cited in Shweder [17] are also argued that girl and women are not at risk and die because they have been circumcised since the operation was performed sensationally so far so that women can enjoy their sexual relations and give born as well. Besides, Kratz stated that when we talk about FGM it should be in terms of “cleanliness, beauty and adulthood rather than affecting damaging/destroying the sexual pleasure [17].

Relativists further argued that FGM is part of raising a girl in a proper manner, and shameful to the young girl and her family if not/ reject the practice since it is a means of cleanness and beauty of the girls. Ashenafi [13] also stated, as cultural relativists have seen clitoris as dangerous and poisonous organs and must be removed for health reasons.

Similarly, some African communities who practiced FGM cited in Ashenafi [13] are delude girls and women as it is healthy and beneficial as;

Ashenafi “leaving a girl uncircumcised endangers both her husband and her baby; if the baby’s head touches the uncut clitoris during birth, the baby will be born hydrocephalic (excess cranial fluid). The milk of the mother will become poisonous. If a man’s penis touches a woman’s clitoris, he will become impotent [13].”

Accordingly, they are preaching both women and men to favor the tradition, as a child would die whilst the mother’s clitoris touches the infant’s head during birth, and child rearing would be easier in the future. This means that the practice of FGM has to be continued as good culture as it helps to prevent women and child from health problems via cleaning/removing her poisonous organs known as clitoris and make ready and safe her vagina to birth and sexual intercourse.

The points raised by the cultural relativists in favor of the practices of FGM are not the question of gender inequality as there are many cultures in which they are performed only boys and both sexes, and it is poor example of patriarchal domination over women since there are many other cultures, which dominates women [17]. In other words, feminists of color noted that FGM is not necessarily part of the structure of male domination even they said that in some part of societies it does not carried out to control women’s sexuality [29]. Moreover, African feminists argued that FGM is not only the practice that should be exemplified as the practice of which manifests patriarchal domination and gender inequality but also “cosmetic surgeries” considered as harmful cultural practice performed in a painful manner and creates a hierarchical ordering of sexuality and gender, and seen as a means of beauty and attractiveness in western. Within this, they simply insisted that the notion of criticizing FGM as a harmful cultural practice is merely because of it is widely practicing in non-western countries [29].

We conclude in view of that the overall arguments between Universalists and cultural relativists disclose the tension that has begun before three decades ago between the tolerance of “different cultures” and the activist intolerance of repressive or violent cultural traditions like FGM, wife beating and other. FGM is indeed harmful, dangerous and a violation of one’s right to health, and it has been administered without knowing the health-related implications. It also has complications and risks that extend beyond that of the mental state or sexual urge of a woman, the risks are not only detrimental to the overall wellbeing and health of an individual, they can also be life threatening. Rather, we do not believe, as it is healthy and beneficial like what the African communities have used as a justification to preach the societies to support the practice and being continued [27].

Female genital mutilation has been an issue of the United Nations since1948 within the context of the universal declaration of human rights and it was seen as a harmful tradition practice in the 70s and 80s, during the United Nation´s year for women 1975-1989 [23]. Rahman and Toubia [28] also stated that the practice of FGM has increasingly been considered a human rights violation since 1980s. The Universal Declaration of Human Rights which was adopted by the United Nations General Assembly in 1948 was translated into human rights law by two general covenants, both adopted in 1966. These are the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR). These Covenants prohibits discrimination on the grounds of sex and emphasizes the need for the respect of the rights of persons and for the promotion and protection of health.

Additionally, The Convention on the Elimination of All Forms of Discrimination against Women (1979), the Convention against Torture, and other Cruel, Inhuman or Degrading Treatment or Punishment, prohibits the infliction of physical or mental pain or suffering on women and the Convention on the Rights of the Child (1989) which are part of binding international law, oblige member states that are signatories to protect their own nationals from harmful practices such as FGM. Therefore, addressing FGM as a violation of international human rights law places responsibility on governments who have a duty to ensure the enjoyment of human rights in their jurisdictions.

Internationally, there is a shift away from thinking about female genital mutilation as primarily as a health issue and towards considering it as an issue of women’s health and human rights. The 1994 Declaration and Programmed of Action of the International Conference on Population and Development (ICPD) specifically mentions female genital mutilation and calls for its prohibition. It urges governments to give vigorous support to efforts among non-governmental and community organizations and religious institutions to eliminate the practice. The Declaration and Platform for Action of the Fourth World Conference on Women, held in Beijing in 1995, lists FGM as one of the various sexual and economic exploitation of girls and calls for an end to the practice.

Female genital mutilation (FGM), in any form, is recognized internationally as a gross violation of human rights of girls and women (END FGM; European Campaign, p. 11). Different scholars have discussed human rights violated by the practice of FGM. For example, Efua Dorkenoo argued that female genital mutilation is a clear demonstration of gender-based human rights violation, which intends to control women’s sexuality and freedom [23]. Various international and regional instruments have been also drawn up to protect these rights. According to [11,23,28] the following are some of the human rights of child and women at risk due to the practice of FGM.

Right to health

The International Human Rights law including the Universal Declaration of Human Rights (1948) proclaims the right for all human beings to live in conditions that enable them to enjoy good health and health care. The problems associated with the procedure of FGM often have brutal consequences for a woman’s physical and mental health. All types of FGC have health complications related to the procedure often being performed outside health care facilities by non-professionals using unsterile cutting instruments [23]. According to Dalal et al. [7] FGM results in serious health problems such as” infections, abscesses, small benign tumors, hemorrhages, and clitoral cysts”. Similarly [28] asserted that;

“Depending on what type of FGM is performed, the immediate health consequences of the procedure can include such complications as pain and bleeding that can lead to hemorrhage and even death. Long-term consequences can include irreversible loss of the clitoris, and possibly the outer and inner labia.

Chronic infection, infertility, difficult pregnancy and childbirth, as well as painful sexual intercourse and menstruation are also common permanent effects of the procedure”..

In her research when she made interview with one of a mutilated girl she told her that her friend “die after the process because she lost a lot of blood”. Kerubo also stipulated that girls and women are victims of different diseases because of the tools used to perform the procedures which transmit germs and viruses from one to others including HIV AIDS [5,9]. Therefore subjecting person to health risks, in the absence of medical necessity is a violation of that person’s right as using any medication during the procedure is not common which is violations of rights to health.

The right of the child

As it has been discussed earlier the victims of this harmful traditional practice are infants, little girls and women ranges between the ages of 7 and 8 after birth and 10-14 years-old. United States Department of State, Ethiopia [23] also argued that FGM violates the rights of child because it is usually performed on girls when they are as young as few months after birth to 17 years. This means the practice FGM contravene Art.3 of CRC which stipulates that “…the best interests of the child shall be a primary consideration which is a central notion of the Convention on Rights of Child. Female Genital Mutilation, Ethiopia [28] also stated that FGM poses a serious psychological and physiological health risk to children on whom it is performed

The right to sexual and physical integrity

Female genital mutilation violates the rights of women and girls to sexual and physical integrity. [29] Asserted that Violations of the right to physical integrity are most obvious when girls and women are forcibly restrained during the procedure. FGM is practiced without women’s and girl’s full consents. An unauthorized invasion of a person’s body represents a disregard for that fundamental right. According to United States Department of State, Ethiopia [23] one of the reasons behind the practice of FGM is that society believes female sexuality is very dangerous and has to be controlled. Additionally, [3] identified that one of the long term complication resulted from FGM is a pain during sexual intercourse. Women who have been infibulated may experience painful intercourse through their life and even in cases where there is no pain there is no sexual fulfillment [23]. These are clear violations of women’s right to sexuality.

Right to be free from discrimination

The practice of FGM is also a gender-based discrimination against women because it has been taken as a pre-requisite for marriage, to gain economic and social security. For instance in Gikuyu society there is a tradition that prohibits men to marry uncircumcised women. As cited by Ashenafi [13], in Gikuyu community;

“A woman without children or an unmarried woman will have a very difficult life and a devastated old age, especially ones without any support from their relatives or community. The whole practice of FGM is the base for marriage. Without undergoing FGM, a woman is denied the right of marriage, in most cases also the denial of receiving bride price. An unmarried woman is an outcast in the society.”

From this, we can argue that putting FGM, as a precondition merely for women to marry is explicitly discrimination against women based of sex.

Free from torture, cruel, inhuman and degrading treatment

The UN Special Rapporteur on Violence against women has clearly stated that FGM amounts to torture. The report “views cultural practices that involve pain and suffering and violation of physical integrity” as amounting to torture under customary international law, attaching to such practices strict penal sanctions and maximum international scrutiny regardless of ratification of CEDAW or reservations made thereto (END FGM - European Campaign, P.12).

Generally, regardless of the reasons for its practice, FGM is a traditional harmful practice that violates the rights and dignity of women and girls, the rights to health and life (in a case when the procedure result into death), sexuality and physical integrity of the person, the right to be free from torture and degrading treatment.

• Convention of Elimination All form of Discrimination Against Women (CEDAW)

• Convention on the Rights of the Child

• Criminal Code of The Federal Democratic Republic of Ethiopia, May 2005

• Declaration and Programme of Action of the International Conference on Population and Development (ICPD)

• International Covenant on Civil and Political Rights (ICCPR)

• International Covenant on Economic, Social and Cultural Rights (ICESCR).

• The Declaration and Platform for Action of the Fourth World Conference on Women, held in Beijing in 1995

• Universal Declaration of Human Rights (UDHR)

Generally FGM covers a range of procedures, but in the great majority of cases, it involves the excision of the clitoris and the labia minora. At its most extreme, the procedure entails the excision of almost all the external genitalia and the stitching up of the vulva to leave only a tiny opening. This cultural practice of cutting female genitalia for non-medical reason is a harmful phenomenon, especially when the society believes that FGM is the entry point for the girls to become a woman.

Despite diversity in types and reasons for the practicing of FGM and health complications that result from it, FGM goes beyond these as far as human rights are concerned. FGM has been considered as one of the most significant human rights violation against young girls and woman. Recently the international community and human right law attempt to address FGM as a serious human right violation and call up on governments and societies to combat the practice. As a result of violation of girls and women rights, international human right instruments impose obligations to parties to use all measures to ensure eradication of FGM.

Therefore, efforts to address FGM are part of a long-term process aimed at ensuring greater government involvement in the protection of women’s rights. By invoking human rights standards, advocates can hold governments accountable for their inaction in response to FGM. The experience of nations around the world in addressing FGM reveals that no single approach can eliminate FGM [29]. Criminalizing the practice only will not change people’s behavior, unless governments undertake a multi-strategy approach to eliminating FGM. However, all of these activities must be guided by a respect for the human rights of women and girls.