Prevalence of female genital mutilation by country

Female genital mutilation (FGM) is practised in 30 countries in western, eastern, and north-eastern Africa,^[5] in parts of the Middle East^[6][7] and Asia,^[8][9] and within some immigrant communities in Europe, North America and Australia.^[5][10] The WHO defines the practice as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons."^[11]

According to a 2013 UNICEF report, Egypt has the world's highest total number with 27.2 million women having undergone FGM, while Somalia has the highest prevalence rate of FGM at 98%.^[3] Estimates about the prevalence of FGM vary by source.

Classifications of FGM

The WHO identifies four types of FGM:

• Type I: removal of the clitoral hood, the skin around the clitoris (Ia), with partial or complete removal of the clitoris (Ib);
• Type II: removal of the labia minora (IIa), with partial or complete removal of the clitoris (IIb) and the labia majora (IIc);
• Type III: removal of all or part of the labia minora (IIIa) and labia majora (IIIb), and the stitching of a seal across the vagina, leaving a small opening for the passage of urine and menstrual blood (infibulation);
• Type IV: other miscellaneous acts, including cauterization of the clitoris, cutting of the vagina (gishiri cutting), and introducing corrosive substances into the vagina to tighten it.^[12]

Prevalence

The term "prevalence" is used to describe the proportion of women and girls now living in a country who have undergone FGM at some stage in their lives. This is distinct from the "incidence" of FGM which describes the proportion of women and girls who have undergone the procedure within a particular time period, which could be contemporary or historical. FGM is practiced in Africa, the Middle East,^[6] Indonesia and Malaysia,^[8][9] as well as some migrants in Europe, United States and Australia.^[3][5] It is also seen in some populations of South Asia.^[13][14][15] The highest known prevalence rates are in 30 African countries, in a band that stretches from Senegal in West Africa to Ethiopia on the east coast, as well as from Egypt in the north to Tanzania in the south.^[5][16]

According to a 2013 UNICEF report based on surveys completed by select countries, FGM is known to be prevalent in 27 African countries, Yemen and Iraqi Kurdistan, where 125 million women and girls have undergone FGM.^[17] The UNICEF report notes FGM is found in countries beyond the 29 countries it covered, and the total worldwide number is unknown.^[18] Other reports claim the prevalence of FGM in countries not discussed by the 2013 UNICEF report.^[19][20] The practice occurs in Saudi Arabia,^[21] Jordan,^[21] Iraq,^[22][23] Syria,^[24] Oman,^[25] United Arab Emirates^[26] and Qatar.^[27] Earlier reports claimed the prevalence of FGM in Israel among the Negev Bedouin, which by 2009 has virtually disappeared.^[28]

As a result of immigration, FGM has also spread to Europe, Australia, and the United States, with some families having their daughters undergo the procedure while on vacation overseas. As Western governments become more aware of FGM, legislation has come into effect in many countries to make the practice a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter.^[29]

Data reliability

Much of the FGM prevalence data currently available is based on verbal surveys and self-reporting.^[30] Clinical examinations are uncommon. The assumption is that women respond truthfully when asked about their FGM status and that they know the type and extent of FGM that was performed on their genitalia. However, many FGM procedures are performed at a very young age, many cultures feel a taboo about such discussions, and a number of such factors raise the possibility that the validity of survey responses might be incorrect, potentially underreported.^[30][31] In Oman, for example, some do not wish to discuss FGM from the fear that such discussion is showing their culture's dirty laundry to the world, causing criticism of a practice that they believe is purely religious.^[25]

In countries where FGM has been outlawed, fear of prosecution of family members or self, and social disapproval from elders may cause women to deny that they underwent or were subjected to FGM.^[32] For example, the self-reported circumcision status of women aged 15–49 was verbally surveyed in 1995 in northern Ghana. The same women were interviewed again in 2000 after the enactment of a law that criminalized FGM and Ghana-wide public campaigns against the practice. This study discovered that 13% of women who reported in 1995 that they had undergone FGM denied it in the 2000 interview, with youngest age group girls denying at rates as high as 50%.^[33]

UNICEF has revised its data on the FGM prevalence rates in the Kurdistan region of the Middle East:

Where is FGM/C practiced? There are reports, but no clear evidence, of a limited incidence in (..) certain Kurdish communities in Iraq.

—UNICEF (2005), ^[34]

Female Genital Mutilation or Cutting (FGM/C): 1 in 2 young girls (15-24) has experienced FGM/C when they were younger in Erbil and Sulaymaniyah governorates (Kurdistan Region).

—UNICEF (2011), ^[35]

Africa

In July 2003, at its second summit, the African Union adopted the Maputo Protocol promoting women's rights and calling for an end to FGM. The agreement came into force in November 2005, and by December 2008, 25 member countries had ratified it.^[36]

As of 2013, according to a UNICEF report, 24 African countries have legislations or decrees against FGM/C practice; these countries are: Benin, Burkina Faso, Central African Republic, Chad, Côte d'Ivoire, Djibouti, Egypt, Eritrea, Ethiopia, Ghana, Guinea, Guinea-Bissau, Kenya, Mauritania, Niger, Nigeria (some states), Senegal, Somalia, Sudan (some states), Tanzania, Togo and Uganda (see page 9 of the report) and Zambia and South Africa (see page 8).^[3]

In 2014 The Girl Generation, an Africa-led campaign to oppose FGM worldwide, was launched.^[37]

General

Although estimates of the prevalence of FGM vary, sources have consistently found the practice to be undergone by the majority of women in the Horn of Africa, in the West African countries of Guinea, Sierra Leone, Gambia, Mauritania, Mali and Burkina Faso, as well as in Sudan and Egypt. Of these countries, all have laws against the practice, with the exception of Sierra Leone, Gambia, Mali and some states of Sudan.^[38] Infibulation, the most extreme form of FGM, known also as Type III, is practiced primarily in countries located in northeastern Africa.^[39]

Algeria

Female genital mutilation is present in South Algeria among Sub-Saharan African migrants.^[40][41][42]

Benin

Female genital mutilation is present in Benin.^[43] According to a 2006 survey, 13% of Benin women have been subjected to FGM. This is a decline over the 2001 survey, which reported 17%.^[44] The prevalence varies with religion in Benin; FGM is prevalent in 49% of Muslim women, 15% of Protestants, 12% of traditional religions and 7% of Roman Catholic women.^[45] A 2003 law banns all forms of FGM.^[46]

Burkina Faso

The WHO gives a prevalence of 72.5% for the year of 2006.^[47] A 2003 survey found FGM to be prevalent in 77% of women in Burkina Faso.^[44] An 1998 survey reported a lower rate of 72%. However, this was not considered as evidence of an increase in the practice, but as reflecting the worldwide fact that better and more information is increasingly available on FGM. The prevalence varies with religion in Burkina Faso; FGM is prevalent in 82% of Muslim women, 73% of traditional religions, 69% of Roman Catholics and 65% of Protestants.^[44][45] In a 2011 study on a wide range of variables, FGM prevalence characteristics in Burkina Faso was found to be strongly associated with religion, and age being the other important variable.^[48] A law prohibiting FGM was enacted in 1996 and went into effect in February 1997. Even before this law, however, a presidential decree had set up the National Committee against excision and imposed fines on people guilty of excising girls and women.^[36] The new law includes stricter punishment. Several women excising girls have been handed prison sentences. Burkina Faso ratified the Maputo Protocol in 2006.^[49]

Cameroon

Female genital mutilation is present in Cameroon.^[50] According to a survey on FGM in 2004, FGM prevalence rate was 1.4%. Even though national rate is low, there are regions with high prevalence rate. In extreme north Cameroon, the prevalence rate is 13% for the Fulbe people and people of Arab descent.^[51] The prevalence varies with religion; FGM is prevalent in 6% of Muslim women, less than 1% of Christians, and 0% for Animist women.^[45] Cameroon's national penal code does not classify genital mutilation as a criminal offence. However, article 277 criminalizes aggravated assault, including aggravated assault to organs. A draft law has been pending for over 10 years.^[51][52]

Central African Republic

WHO gives the prevalence of FGM in Central African Republic at 25.7% in 2008.^[47] A survey from 2000 found FGM was prevalent in 36% of Central African Republic women.^[45] This is a decline over the 1994 survey, which reported 43%. The prevalence in the 2000 survey varied with religion in Central African Republic; FGM was prevalent in 46% of Animist women, 39% of Muslim, 36% of Protestants, and 35% of Catholic women.^[45] In 1996, the President issued an Ordinance prohibiting FGM throughout the country. It has the force of national law. Any violation of the Ordinance is punishable by imprisonment of from one month and one day to two years and a fine of 5,100 to 100,000 francs (approximately US$8–160). No arrests are known to have been made under the law.

Chad

According to Chad's first survey on FGM in 2004, FGM prevalence rate was 45%.^[53] The prevalence varies with religion in Chad; FGM is prevalent in 61% of Muslim women, 31% of Catholics, 16% of Protestants, and 12% of traditional religions. The prevalence also varies with ethnic groups; the Arabs (95%), Hadjarai (94%), Ouadai (91%) and Fitri-batha (86%), and less than 2.5% among the Gorane, Tandjile and Mayo-Kebbi.^[53] Law no 6/PR/2002 on the promotion of reproductive health has provisions prohibiting FGM, but does not provide for sanctions.^[46] FGM may be punished under existing laws against assault, wounding, and mutilation of the body.^[36][46]

Comoros

Female genital mutilation is practiced only locally in Comoros.^[54]

Côte d'Ivoire

According to the WHO, in 2006, the prevalence of FGM was 36.4% among women aged 15–49 in Côte d’Ivoire.^[47] A 2005 survey ^[55] found that 42% of all women aged between 15 and 49 had been subjected to FGM. This is similar to the FGM reported rate of 46% in 1998 and 43% in 1994.^[45] The prevalence varies with religion in Côte d'Ivoire; FGM is prevalent in 76% of Muslim women, 45% of Animist, 14% of Catholic and 13% of Protestant women.^[55] A December 18, 1998 law provides that harm to the integrity of the genital organ of a woman by complete or partial removal, excision, desensitization or by any other procedure will, if harmful to a women's health, be punishable by imprisonment of one to five years and a fine of 360,000 to two million CFA Francs (approximately US$576–3,200). The penalty is five to twenty years incarceration if a death occurs during the procedure and up to five years' prohibition of medical practice, if this procedure is carried out by a doctor.^[36]

Democratic Republic of the Congo

Female genital mutilation is practiced in the Democratic Republic of the Congo.^[43][50] FGM takes place among some populations in northern parts of the country.^[56] FGM is illegal: the law imposes a penalty of two to five years of prison and a fine of 200,000 Congolese francs on any person who violates the "physical or functional integrity" of the genital organs.^[57][58] The prevalence of FGM is estimated at about 5% of women in the country.^[56][59] Type II is usually performed.^[60]

Djibouti

Estimates for FGM prevalence rate of FGM in Djibouti range from 93% to 98%.^[3][61] According to a UNICEF 2010 report, Djibouti has the world's second highest rate of Type III FGM, with about two thirds of all Djibouti women undergoing the procedure; Type I is the next most common form of female circumcision practiced in the country.^[62] Like its neighboring countries, a large percentage of women in Djibouti also undergo re-infibulation after birth or a divorce.^[63] Two thirds of the women claimed tradition and religion as the primary motivation for undergoing FGM.^[61] A predominantly Muslim country, Islamic clerics in Djibouti have been divided on the FGM issue, with some actively supporting the practice and others opposing it.^[64][65] FGM was outlawed in the country's revised Penal Code that went into effect in April 1995. Article 333 of the Penal Code provides that persons found guilty of this practice will face a five year prison term and a fine of one million Djibouti francs (approximately US$5,600). Djibouti ratified the Maputo Protocol in 2005.^[36]

Egypt

Egypt's Ministry of Health and Population has banned all forms of female genital mutilation since 2007.^[36] The ministry's order declared it is 'prohibited for any doctors, nurses, or any other person to carry out any cut of, flattening or modification of any natural part of the female reproductive system'. Islamic authorities in the nation also stressed that Islam opposes female genital mutilation. The Grand Mufti of Egypt, Ali Gomaa, said that it is "Prohibited, prohibited, prohibited."^[66] Egypt passed a law banning FGM.^[67] The June 2007 Ministry ban eliminated a loophole that allowed girls to undergo the procedure for health reasons.^[68] There had previously been provisions under the Penal Code involving "wounding" and "intentional infliction of harm leading to death", as well as a ministerial decree prohibiting FGM. In December 1997, the Court of Cassation (Egypt's highest appeals court) upheld a government banning of the practice providing that those who did not comply would be subjected to criminal and administrative punishments. According to a survey in the year 2000, a study found that 97% of the country's population still practiced FGM; a 2005 study found that over 95% of Egyptian women have undergone some form of FGM.^[69] In Egypt's first trial for committing female genital mutilation, two men were acquitted in November 2014; the doctor was ordered to pay the girl's mother compensation.^[70] However, in 2015 after an appeal the doctor was sentenced to more than two years in prison and the father was given a three-month suspended sentence.^[71]

Eritrea

The government of Eritrea surveyed and published an official FGM prevalence rate of 89% in 2003.^[72] About 50% of the women in rural areas undergo Type III with stitching to close vulva, while Type I and II are more common in urban areas. Overall, about a third of all women in Eritrea undergo Type III FGM with stitching.^[73] Most FGM (68%) are performed on baby girls less than 1 year old, another 20% before they turn 5 year old.^[72] About 60% of Eritrean women believe FGM is a religious requirement.^[3] The prevalence varies with woman's religion, as well as by their ethnic group; FGM is prevalent in 99% of Muslim women, 89% of Catholics and 85% of Protestants.^[45] Eritrea outlawed all forms of female genital mutilation with Proclamation 158/2007 in March 2007.^[36][74] The law envisions a fine and imprisonment for anyone conducting or commissioning FGM.^[75]

Ethiopia

The WHO gives a prevalence of 74.3% for FGM in Ethiopia (2005).^[47] According to a 2005 UNICEF report, Ethiopia's Regional statistics of the prevalence from the survey are: Afar Region – 94.5%; Harare Region – 81.2%; Amhara Region – 81.1%; Oromia Region – 79.6%; Addis Ababa City – 70.2%; Somali Region – 69.7%; Beneshangul Gumuz Region – 52.9%; Tigray Region – 48.1%; Southern Region – 46.3%. The prevalence also varies with religion in Ethiopia; FGM is prevalent in 92% of Muslim women, 72% of Protestants, 67% of Catholics and 67% of Traditional Religions.^[45] FGM has been made illegal by the 2004 Penal Code.^[76]

Gambia

Female genital mutilation is prevalent in Gambia.^[43][50] According to a 2013 report, an estimated 76.3% of girls and women have been subjected to FGM/C.^[77] A 2006 UNICEF survey found a 78.3% prevalence rate in Gambia.^[78] The age when FGM is done on Gambian girls ranges from 7 days after birth up to pre-adolescence.^[79] Gambia's predominant religion is Islam (90%), and it has many ethnic groups. Prevalence rates of FGM/C vary significantly between the ethnic groups: Sarahule (FGM rate of 98%), Mandinka (97%), Djola (87%), Serer (43%), and Wolof (12%). Urban areas report FGM/C rates of about 56%, whereas in rural areas, rates exceed 90%. A majority of Gambian women who underwent FGM/C claimed they did it primarily because religion mandates it.^[77] A 2011 clinical study reports 66% FGMs in Gambia were Type I, 26% were Type II and 8% Type III.^[80] About a third of all women in Gambia with FGM/C, including Type I, suffered health complications because of the procedure. Gambia has no law that prohibits FGM, and it does not prosecute it on the basis of any other criminal laws. The Gambian parliament and activists have been deliberating a law to address FGM.^[81]

Ghana

Female genital mutilation is present in Ghana.^[54] According to the WHO, its prevalence is only 3.8%;^[47] other sources put the prevalence at 5.4%,^[60] or much higher, at 30%,^[59] and at 40%.^[82] In 1989, the head of the government of Ghana, President Rawlings, issued a formal declaration against FGM. Article 39 of Ghana's Constitution also provides in part that traditional practices that are injurious to a person's health and well being are abolished. The Criminal Code was amended in 1994 to outlaw FGM, and the law was strengthened in 2007.^[46] Ghana ratified the Maputo Protocol in 2007.^[36]

Guinea

Guinea has the second highest FGM prevalence rate in the world.^[3] According to a 2005 survey, 96% of all Guinea women aged between 15 and 49 have been cut.^[83] That is a slight decline in the practice from the 1999 recorded FGM rate of 98.6%. Among the 15 to 19 year olds the prevalence was 89%, among 20 to 24 year olds 95%. About 50% of the women in Guinea believe FGM is a religious requirement.^[3] Guinea is predominantly a Muslim country, with 90% of the population practicing Islam. However, the high FGM rates are observed across all religions in Guinea; FGM is prevalent in 99% of Muslim women, 94% of Catholics and Protestants, and 93% of Animist women.^[45] FGM is illegal in Guinea under Article 265 of the Penal Code. The law sentences death to the perpetrator if the girl dies within 40 days after the FGM.^[52] Article 6 of the Guinean Constitution, which outlaws cruel and inhumane treatment, could be interpreted to include these practices, should a case be brought to the Supreme Court. Guinea signed the Maputo Protocol in 2003 but has not ratified it.^[36] Article 305 of Guinea’s penal code also bans FGM, but nobody has yet been sentenced under any of Guinea's FGM-related laws.^[83] In Guinea, instead of stopping FGM, the trend is towards medicalisation of FGM, where the mutilation is advertised under hygienic conditions by medically trained staff, who see FGM practice an additional source of income. Per the above 2005 survey, 27% of girls were cut by medically trained staff.

Guinea-Bissau

Female genital mutilation is present in Guinea-Bissau, and have been estimated at a 50% prevalence rate.^[50] A law banning the practice nationwide was made in 2011.^[84]

Kenya

Female genital mutilation is present in Kenya.^[50] The 2009 FGM survey^[85] in Kenya indicates that 27% of women aged between 15 and 49 have undergone FGM. By contrast, the 2003 survey reported a 32% rate, while 1998 rate was 38%. The statistical analysis of age group data confirms FGM practice is falling in Kenya. Of those women who have undergone FGM, the vast majority (83%) undergo Type II excision. In the Northeastern Province the prevalence is 98%, Eastern Province is 36% and Western Province 1%. FGM is common among the Kisii people (96%) and the Massai (73%), according to 2009 survey. Many other ethnic groups of Kenya practice FGM.^[85] The prevalence varies with religion in Kenya; FGM is prevalent in 50% of Muslim women, 33% of Catholics, 30% of Protestant women.^[45] In 2001 Kenya enacted the Children’s Act, under the provisions of which FGM was criminalized when practiced on girls younger than 18.^[85] The practice was made illegal nationwide in September 2011.^[86]

Liberia

Female genital mutilation is prevalent in Liberia.^[50] Genital mutilation is a taboo subject in Liberia. It is difficult to get accurate data on FGM prevalence rate. However, it is known that FGM procedure is mandatory for initiation of women into the secret Liberia and Sierra Leone society called the Sande society, sometimes called Bondo. A 2007 demographic survey asked women if they belonged to Sande society. It was assumed that those who were part of Sande society had undergone FGM. Based on this estimation method, the prevalence of FGM in Liberia has been estimated as 58%.^[87] Liberia has consented to international charters such as CEDAW as well as Africa's Maputo Protocol. Nevertheless, national legislation explicitly making FGM punishable by law has yet to be passed.^[52][87]

Libya

Female genital mutilation is practiced in Libya.^[54]

Malawi

Female genital mutilation is practiced in Malawi.^[54]

Mali

Female genital mutilation is prevalent in Mali.^[50] The WHO gives a prevalence of 85.2% for women aged 15–49 in 2006 in Mali.^[47] According to a 2007 report,^[88] 92% of all Mali women between the ages of 15 and 49 have been subjected to FGM. The rates of FGM are lower only among the Sonrai (28%), the Tamachek (32%) and the Bozo people (76%). Nearly half are Type I, another half Type II.^[88] The prevalence varies with religion in Mali; FGM is prevalent in 92% of Muslim women, 76% of Christians.^[45] About 64% of the women of Mali believe FGM is a religious requirement.^[3] In 2002, Mali created a government program aimed at discouraging FGM (Ordinance No. 02-053 portant creation du programme national de lutte contre la pratique de l’excision [Ordinance creating a National Program to Fight the Practice of Female Genital Mutilation]).^[89] There is however no specific legislation criminalizing FGM.^[52][88]

Mauritania

Female genital mutilation is prevalent in Mauritania.^[50] According to 2001 survey, 71% of all women aged between 15 and 49 had undergone FGM. A 2007 demographic cluster study found no change in FGM prevalence rate in Mauritania.^[52][90] Type II FGM is most frequent. About 57% of Mauritania women believe FGM is a religious requirement.^[3] Mauritania is 99% Muslim. The FGM prevalence rate varies by ethnic groups: 92% of Soninke women are cut, about 70% of Fulbe and Moorish women, but only 28% of Wolof women have undergone FGM.^[90] Mauritania has consented to international charters such as CEDAW as well as Africa's Maputo Protocol. Ordonnance n°2005-015 on child protection restricts FGM.^[91][92]

Mozambique

Female genital mutilation is present in Mozambique.^[54]

Niger

Female genital mutilation is present in Niger.^[50] According to 2006 survey, about 2% of Niger women have undergone FGM/C.^[3] In 1998, Niger reported a 4.5% prevalence rate.^[93] This survey data is potentially incorrect because, adjusted for age group, the women who claimed to have experienced FGM at the previous survey still are, albeit in a different age group. However, the 2006 survey implies more women had never experienced FGM than previously reported. The DHS surveyors claim the adoption of criminal legislation and fear of prosecution may explain why Niger women did not want to report having ever been circumcised.^[94] A WHO report estimates the prevalence rate of FGM in Niger to be 20%.^[95] Other sources, including a UNICEF 2009 report, claim FGM rates are high in Niger.^[96][97][98] A law banning FGM was passed in 2003 by the Niger government.^[99]

Nigeria

A 2008 demographic survey found 30% of all Nigerian women have been subjected to FGM.^[100] This contrasts with 25% reported by a 1999 survey, and 19% by 2003 survey. This suggests no trend, unreliable past or most recent survey data in some regions, as well as the possibility that a number of women are increasingly willing to acknowledge having undergone FGM. Another possible explanation for higher 2008 prevalence rate is the definition of FGM used, which included Type IV FGMs. In some parts of Nigeria, the vagina walls are cut in new born girls or other traditional practices performed - such as the angurya and gishiri cuts - which fall under Type IV FGM classification of the World Health Organization.^[100] Over 80% of all FGMs are performed on girls under one year of age. The prevalence varies with religion in Nigeria; FGM is prevalent in 31% of Catholics, 27% of Protestant and 7% of Muslim women.^[45] There is no federal law banning the practice of FGM in Nigeria. Opponents of these practices rely on Section 34(1)(a) of the 1999 Constitution of the Federal Republic of Nigeria that states "no person shall be subjected to torture or inhuman or degrading treatment" as the basis for banning the practice nationwide. A member of the House of Representatives has drafted a bill, not yet in committee, to outlaw this practice.^[36] Nigeria ratified the Maputo Protocol in 2005. As of 2010, 13 states of Nigeria had enacted laws against FGM.^[101] These states (including Abia, Bayelsa, Cross River, Delta, Ogun, Osun and Rivers State) are being mocked by excisers who conduct FGMs and who dare any law enforcement agent to arrest them.^[52]

Republic of the Congo

Female genital mutilation is practiced in the Republic of the Congo,^[50] and has been estimated at a 5% prevalence rate.^[50]

Senegal

Female genital mutilation is present in Senegal.^[50] According to 2005 survey, FGM prevalence rate is 28% of all women aged between 15 and 49.^[102] There are significant differences in regional prevalence. FGM is most widespread in the Southern Senegal (94% in Kolda Region) and in Northeastern Senegal (93% in Matam Region). FGM rates are lower in other regions: Tambacounda (86%), Ziguinchor (69%), and less than 5% in Diourbel and Louga Regions. Senegal is 94% Muslim. The FGM prevalence rate varies by religion: 29% of Muslim women have undergone FGM, 16% of Animists, and 11% of Christian women.^[45][102] A law that was passed in January 1999 makes FGM illegal in Senegal.^[103] President Diouf had appealed for an end to this practice and for legislation outlawing it. The law modifies the Penal Code to make this practice a criminal act, punishable by a sentence of one to five years in prison. A spokesperson for the human rights group RADDHO (The African Assembly for the Defense of Human Rights) noted in the local press that "Adopting the law is not the end, as it will still need to be effectively enforced for women to benefit from it. Senegal ratified the Maputo Protocol in 2005.^[36]

Sierra Leone

Female genital mutilation is prevalent in Sierra Leone.^[50] According to a 2008 survey, 91% of women in Sierra Leone between the ages of 15 and 49 have undergone FGM. The highest rate of prevalence is in the Northern Sieraa Leone (97%).^[104] Type II is most common, but Type I is known as well as Type III. In a 2013 report, researchers first conducted verbal surveys followed by clinical examination. They found that the verbal disclosure were not completely reliable, and clinical examination showed greater extent of FGM. These researchers report 68% Type II and 32% Type I in Sierra Leone women.^[30] Like Liberia, Sierra Leone has the traditional secret society of women, called Bondo or Sande society, which uses FGM as part of the initiation rite. 70% of the population is Muslim, 20% Christian, and 10% as traditional religions.^[104] Only Creole Christians of Sierra Leone are known to not practice FGM. There is no federal law against FGM in Sierra Leone; and the Soweis - those who do FGM excision - wield considerable political power during elections.^[52]

Somalia

According to a 2005 WHO estimate, about 97.9% of Somalia's women and girls underwent FGM. This was at the time the world's highest prevalence rate of the procedure.^[105] A UNICEF 2010 report also noted that Somalia had the world's highest rate of Type III FGM, with 79% of all Somali women having undergone the procedure; another 15% underwent Type II FGM.^[62] However, the prevalence rate varies considerably by region and is on the decline in the northern part of the country. In 2013, UNICEF in conjunction with the Somali authorities reported that the FGM prevalence rate among 1 to 14 year old girls in the autonomous northern Puntland and Somaliland regions had dropped to 25% following a social and religious awareness campaign.^[106] Article 15 of the Federal Constitution adopted in August 2012 also prohibits female circumcision.^[107]

South Africa

Female genital mutilation is present in South Africa.^[54]

Sudan

The prevalence of FGM in Sudan is 90%^[108]. Only some states of Sudan have laws against FGM;^[109] currently there is no national law forbidding FGM, although Sudan was the first country to outlaw it in 1946, under the British. Type III was prohibited under the 1925 Penal Code, with less severe forms allowed. Outreach groups have been trying to eradicate the practice for 50 years, working with NGOs, religious groups, the government, the media and medical practitioners. Arrests have been made but no further action seems to have taken place.^[36] Sudan signed the Maputo Protocol in June, 2008 but no ratification has yet been deposited with the African Union.

Tanzania

According to 2005 survey in Tanzania,^[110] FGM prevalence rate is 14.6% of all women aged between 15 and 49. In contrast, the 1996 survey reported 17.6, suggesting a drop of 3% over 10 years or unwillingness to disclose. Type II FGM was found to be most common. There are significant differences in regional prevalence; FGM is most widespread in Manyara (81%), Dodoma (68%), Arusha (55%), Singida (43%) and Mara (38%) regions.^[110] The practice varies with religion, with reported prevalence rates of 20% for Christian and 15% of Muslim women.^[45] Section 169A of the Sexual Offences Special Provisions Act of 1998 prohibits FGM in Tanzania. Punishment is imprisonment of from five to fifteen years or a fine not exceeding 300,000 shillings (approximately US$250) or both. Tanzania ratified the Maputo Protocol in 2007. As with Kenya, Tanzania 1998 Act protects only girls up to the age of 18 years. The FGM law is being occasionally implemented, with 52 violations have been reported, filed and prosecuted. At least 10 cases were convicted in Tanzania.^[52]

Togo

Female genital mutilation is practiced in Togo. According to a 2013 UNICEF report, the prevalence is only 4%.^[111] The WHO puts its prevalence at 5.8% in 2006.^[47] Other sources cite 12%^[60] and 50% ^[50] as prevalence. Type II is usually practiced.^[60] On October 30, 1998, the National Assembly unanimously voted to outlaw the practice of FGM. Penalties under the law can include a prison term of two months to ten years and a fine of 100,000 francs to one million francs (approximately US$160 to 1,600). A person who had knowledge that the procedure was going to take place and failed to inform public authorities can be punished with one month to one year imprisonment or a fine of from 20,000 to 500,000 francs (approximately US$32 to 800). Togo ratified the Maputo Protocol in 2005.^[36]

Uganda

Anyone convicted of carrying out FGM is subject to 10 years in prison. If the life of the patient is lost during the operation a life sentence is recommended.^[112] In 1996, a court intervened to prevent the performance of FGM under Section 8 of the Children Statute, which makes it unlawful to subject a child to social or customary practices harmful to the child's health. Uganda signed the Maputo Protocol in 2003 but has not ratified it.^[113] In early July 2009, President Yoweri Museveni stated that a law would soon be passed prohibiting the practice, with alternative livelihoods found for its practitioners.^[114]

Zimbabwe

Female genital mutilation is present in Zimbabwe.^[54]

Europe

In recent years the increase in immigration for individuals from countries which practice FGM, has led to the introduction of FGM in European and North American societies. However, FGM prevalence rate has been difficult to quantify among immigrants to European countries.^[115] A case study which investigated FGM in groups of migrant women from Northern Africa to European countries like Scandinavia, noted that a majority of these women had been circumcised before their migration to Europe.^[116] It also has been established that African communities in European countries continue the practice of FGM on their daughters after migrating to Europe. For instance in Sweden, a study by Karolinska Institutet concluded that about a third of families migrated from countries with a FGM culture wanted to continue mutilating in their new countries.^[117] The Council of Europe Convention on preventing and combating violence against women and domestic violence, which came into force on 1 August 2014, defines and criminalize the practice in Article 38:^{[118][119][120]}

Article 38 – Female genital mutilation

Parties shall take the necessary legislative or other measures to ensure that the following intentional conducts are criminalised:

1. excising, infibulating or performing any other mutilation to the whole or any part of a woman’s labia majora, labia minora or clitoris;
2. coercing or procuring a woman to undergo any of the acts listed in point a;
3. inciting, coercing or procuring a girl to undergo any of the acts listed in point a.

France

Between 1979 and 2004, a total of 29 FGM court cases were brought before criminal courts, mostly from the mid-1990s onwards and with aggravated sentences.^[121] By 2013, more than 100 people had been convicted of FGM.^[122] FGM is a criminal offense punishable by 10 years or up to 20 years in jail if the victim is under 15 years of age.^[123] The law requires anyone to report any case of mutilation or planned mutilation. In 2014 it was reported that about 100 people in France had been jailed.^[123] Not only the person carrying out the mutilation is sentenced, parents organising the crime face legal proceedings as well.^[123]

Germany

According to Terre des Femmes there are 25,000 victims in Germany and a further 2,500 are under threat of becoming mutilated.^[124]

Italy

After a few cases of infibulation practiced by complaisant medical practitioners within the African immigrants community came to public knowledge through media coverage, the Law n°7/2006 was passed on 1/9/2006, becoming effective on 1/28/2006, concerning "Measures of prevention and prohibition of any female genital mutilation practice"; the Act is also known as the Legge Consolo ("Consolo Act") named after its primary promoter, Senator Giuseppe Consolo. Article 6 of the law integrates the Italian Penal Code with Articles 583-Bis and 583-Ter, punishing any practice of female genital mutilation "not justifiable under therapeutical or medical needs" with imprisonment ranging from 4 to 12 years (3 to 7 years for any mutilation other than, or less severe than, clitoridectomy, excision or infibulation). Penalty can be reduced up to ²⁄₃ if the harm caused is of modest entity (i.e. if partially or completely unsuccessful), but may also be elevated up to ¹⁄₃ if the victim is a minor or if the offense has been committed for profit. An Italian citizen or a foreign citizen legally resident in Italy can be punished under this law even if the offense is committed abroad; the law will as well afflict any individual of any citizenship in Italy, even illegally or provisionally. The law also mandates any medical practitioner found guilty under those provisions to have his/her medical license revoked for a minimum of six up to a maximum of ten years.^[125]

Netherlands

FGM is considered mutilation and is punishable as a criminal offense under Dutch law. There is no specific law against FGM: the act is subsumed under the general offense of inflicting harm ("mishandling", art. 300–304 Dutch Criminal Code). The maximum penalty is a prison sentence of 12 years. However, the sentence can be higher if the offender is a family member of the victim. It is also illegal to assist or encourage another person to perform FGM. A Dutch citizen or a foreign citizen legally resident in the Netherlands can be punished even if the offense is committed abroad. Doctors have the obligation to report suspected cases of FGM and may break patient confidentiality rules if necessary.

Norway

FGM is punishable as a criminal offense under Norwegian law even if the offence is committed abroad.^[126]

Spain

The Criminal Code does state that sexual mutilation, such as FGM, is a criminal offense punishable by up to 12 years in jail.

Sweden

In 1982, Sweden was the first western country in the world to explicitly prohibit genital mutilation.^[127][128] It is punishable by up to ten years in prison, and in 1999 the Government extended the law to include procedures performed abroad.^[129] General child protection laws could also be used.^[130] The prevalence of FGM among immigrant groups in Sweden is unknown, but there have been 46 cases of suspected genital mutilation since the law was introduced in 1982, and two convictions, according to a report published in 2011 by the National Centre for Knowledge on Men's Violence against Women.^[131]

In June 2014, Norrköpings Tidningar published a story on genital mutilation,^[132] which was picked up by the foreign press, including The Independent and The Daily News. It was claimed that every single girl in one school class had been victims of genital mutilation.^[133][134] None of the newspapers said where and when the genital mutilation took place.^[135] It was later revealed by Sweden's national public radio that none of the girls had been subjected to the procedure, or had any procedure preformed on them abroad, while living in Sweden.^[127][136]

The National Board of Health and Welfare has estimated that up to 38,000 women living in Sweden may have been the victims of FGM. This calculation is based on UNICEF estimates on prevalence rates in Africa, and refer to FGM carried out before arriving in Sweden.^[137] In 2014, a Somali-born national coordinator at the County Administrative Board of Östergötland said the problem is not actively being pursued by authorities and the issue is avoided for fear of being perceived as racist or as stigmatising minority ethnic groups.^[138] The Ministry of Health and Social Affairs did however launch an action plan against FGM in 2003, which included giving courses to African women and men, who are now working as health advisors and influencing the public opinion among their fellow countrymen.^[128] The Government have also issued guidelines for officials in the social sector concerning actions and measures in a variety of situations.^[130]

United Kingdom

FGM was made a criminal offence by the Prohibition of Female Circumcision Act 1985.^[139] This was superseded by the Female Genital Mutilation Act 2003, and (in Scotland) by the Prohibition of Female Genital Mutilation (Scotland) Act 2005. Taking a UK citizen or permanent resident abroad for the purpose of FGM is a criminal offence whether or not it is lawful in the country the girl is taken to.^[140] Since April 2014, all NHS hospitals will be able to record if a patient has undergone FGM or if there is a family history of this, and by September 2014, all acute hospitals will have to report this data to the Department of Health, on a monthly basis.^[141]

The number of victims in 2014 was believed to be about 66,000.^[142] A July 2014 interim study carried out by City University London, jointly funded by Trust for London and the Home Office, reported that there were 137,000 immigrant women with FGM living in England & Wales. This figure includes approximately 103,000 women aged 15–49 and 24,000 women aged 50 and over. Additionally, approximately 10,000 girls aged under 15 and 24,000 women over 50, who have migrated to England and Wales, are likely to have undergone FGM. .^[143]

Middle East

Bahrain

Female genital mutilation is present in Bahrain.^[145][146]

Iran

Female genital mutilation is prevalent in Iranian Kurdistan. The estimated rate of mutilated girls and women varies between studies, ranging from 40% to 85%.^{[147][148][149]} A 2012 study in Kermanshah province of Iran suggests FGM is a common practice in Ravansars’ women, with over 55% of girls have been circumcised less than 7 years age.^[150]

Iraq

Female genital mutilation is prevalent in Iraqi Kurdistan, with an FGM rate of 72%^[151] for the entire region and exceeding 80% in Garmyan and New Kirkuk. In Arbil Governorate and Suleymaniya Type I FGM is common; while in Garmyan and New Kirkuk, Type II and III FGM are common.^[152][153] There was no law against FGM in Iraqi Kurdistan, but in 2007 a draft legislation condemning the practice was submitted to the Regional Parliament, but was not passed.^[154] A 2011 Kurdish law criminalized FGM practice in Iraqi Kurdistan,^[155] however this law is not being enforced.^[156] A field report by Iraqi group PANA Center, published in 2012, shows 38% of females in Kirkuk and its surrounding districts areas had undergone female circumcision. Of those females circumcised, 65% were Kurds, 26% Arabs and rest Turkmen. On the level of religious and sectarian affiliation, 41% were Sunnis, 23% Shiites, rest Kaka’is, and none Christians or Chaldeans.^[157] A 2013 report finds FGM prevalence rate of 59% based on clinical examination of about 2000 Iraqi Kurdish women; FGM found were Type I, and 60% of the mutilation were performed to girls in 4–7 year age group.^[158]

Jordan

Female genital mutilation is prevalent in some parts of Jordan.^[24][42] Southern Jordan residents of Wadi Araba near Aqaba are known to practice FGM. The practice is found in Muslim descendants of Bani Sinai tribes, and others living in Gaza and Beer Sheba.^[159][160]

Kuwait

Female genital mutilation is prevalent in Kuwait in the Maliki madhab of Sunni Muslims. A 2011 study finds 38% of women having undergone FGM, with Type II and III common.^[161]

Oman

The practice is prevalent in Oman;^[162] 78%^[163] of females have been mutilated. A 2013 article describes FGM practice in Oman, and claims the practice is very common in Dhofar.^[25] Type I is claimed to be common in southern Oman and typically performed within a few weeks of a girl's birth, while Type IV is observed in most parts of northern Oman.^[164]

Palestinian territories

Female genital mutilation is present in Palestinian territories.^[165]

Qatar

Female genital mutilation is present in Qatar.^[27][145]

Saudi-Arabia

Female genital mutilation is prevalent in Saudi Arabia.^[24][42] FGM is most prevalent in Saudi regions following Shafi'i school within the Sunni sect of Islam, such as Hejaz, Tihamah and Asir.^{[166][167][168]} In a clinical study, Alsibiani and Rouzi provide evidence of the practice in Saudi Arabia.^[169] Another 2010 report claims post-FGM medical complications are an indicator of widespread prevalence of the practice in Saudi women.^[170] A 2012 study finds, that of the Saudi women who had FGM, Type III was more common than Type I or II.^[171]

Syria

Circumstantial evidence suggests FGM exists in Syria.^[24][42] A 2012 conference confirmed that FGM is observed in Syria, particularly in its Kurdish, Shafi'i and minority Muslim groups.^[27]

Turkey

Circumstantial evidence suggests FGM exists in regions inhabited by Kurdish populations in Turkey.^{[24][172][173]}

United Arab Emirates

The WHO mentions a study that documents FGM in the United Arab Emirates, but does not provide data.^[145][174] The practice is reportedly prevalent in rural and urban UAE.^[175]) In a 2011 survey, 34% of Emirati female respondents said they were circumcised, and explained the practice to customs and tradition.^[26] FGM is a controversial topic in UAE, and people argue about whether it is an Islamic requirement or a tribal tradition. A significant number of UAE nationals follow in the footsteps of their parents and grandparents without questioning the practice. A 2012 report published by UAE government scores UAE at 31% on prevalence of Female Genital Mutilation.^[176]

Yemen

According to a 2008 UNICEF report, 30% prevalence^[177]; in addition to the adult prevalence, UNICEF reports that 20% of women aged 15–49 have a daughter who had the procedure in Yemen.^{[42][145][178]} In 4 of Yemen's 21 governorates, according to a 2008 report, the FGM prevalence rates exceed 80%: al-Hudaydah (97%), Hadhramaut (97%), al-Mahrah (97%) and Adan (82%); Sana'a Governorate, which includes the capital of Yemen, has a prevalence rate of 46%.^[144] Type II FGM was most common, accounting for 83% of all FGMs. Type I FGMs accounted for 13%.^[144] Yemeni tradition is to carry out the FGM on a new born, with 97% of FGM being done within the first month of a baby girl. In 2001, Yemen banned FGM in all private and public medical facilities by a government decree, but not homes. Yemeni government, however, did not enforce this decree. In 2009, conservative Yemeni parliamentarians opposed the adoption of a nationwide criminal law against FGM.^[179] In 2010, the Ministry of Human Rights of Yemen launched a new study to ascertain over 4 years if FGM is being practiced in Yemen, then propose a new law against FGM.^[180] A 2013 UNICEF report claims Yemen's FGM prevalence rate have not changed in last 30 years.^[181]

North America

Canada

There is some evidence to indicate that FGM is practised in Ontario and across Canada among immigrant and refugee communities.^[182] FGM is considered child assault and prohibited under sections 267 (assault causing bodily harm) or 268 (aggravated assault, including wounding, maiming, disfiguring) of the Criminal Code.^[183]

United States

The Centers for Disease Control estimated in 1997 that 168,000 girls living in the United States had undergone FGM or were at risk.^[184] Khalid Adem, who had moved from Ethiopia to Atlanta, Georgia, became the first person to be convicted in the US in an FGM case; he was sentenced to ten years in 2006 for having severed his two-year-old daughter's clitoris with a pair of scissors.^[185] Performing the procedure on anyone under the age of 18 became illegal in the U.S. in 1997 with the Federal Prohibition of Female Genital Mutilation Act.^[186] As of 2015, 23 US states have specific laws against FGM.^[187] States that do not have such laws may use other general statutes, such as assault, battery or child abuse.^[188] The Transport for Female Genital Mutilation Act was passed in January 2013, and prohibits knowingly transporting a girl out of the U.S. for the purpose of undergoing FGM.^[189]

Fauziya Kasinga, a 19-year-old member of the Tchamba-Kunsuntu tribe of Togo, was granted asylum in 1996 after leaving an arranged marriage to escape FGM; this set a precedent in US immigration law because it was the first time FGM was accepted as a form of persecution.^[190]

Oceania

Australia

In 1994 there were several anecdotal reports of FGM being practised amongst migrant communities in Australia.^[191] By 1997, all Australian states and territories had made FGM a criminal offence. It is also a criminal offence to take, or propose to take, a child outside Australia to have a FGM procedure performed.^[192] The incidence of FGM in Australia is unknown as it is unreported to authorities and is often only uncovered when women and girls are taken to hospital due to complications with the procedure.^[193]

New Zealand

Under a 1995 amendment to the Crimes Act, it is illegal to perform "any medical or surgical procedure or mutilation of the vagina or clitoris of any person" for reasons of "culture, religion, custom or practice". It is also illegal to send or make any arrangement for a child to be sent out of New Zealand for FGM to be performed, assist or encourage any person in New Zealand to perform FGM on a New Zealand citizen or resident outside New Zealand convince or encourage any other New Zealand citizen or resident to go outside New Zealand to have FGM performed.^[194]

South, Southeast and Central Asia

Afghanistan

Female genital mutilation is present in Afghanistan.^[195]

Brunei

Female genital mutilation Type IV is present in Brunei.^[196]

India

Estimates suggest 90% of females in the Ismaili Shia Muslim Bohra community in India undergo the trauma.^[14][197]

Indonesia

Female genital mutilation Type I and IV is prevalent in Indonesia;^{[198][199][200][201]} 97.5%^[201] of females from Muslim families (at least 85%^[202] of females in Indonesia) are mutilated by age 18. In certain communities of Indonesia, mass female circumcision (khitanan massal) ceremony are organized by local Islamic foundations around Prophet Muhammad’s birthday. Some FGM are Type IV done with a pen knife, others are Type I done with scissors. Two Indonesian nationwide studies in 2003 and 2010 found over 80% of the cases sampled involved cutting, typically of newborns through the age of 9. The surveys demonstrated that circumcision among girls and boys is a universal practice in the study sites, in all of which Islam was the primary religion. Across the sites, among all the children aged 15–18, 86-100% of the girls were reported already circumcised. More than 90% of families visited in the studies claimed they wanted the practice to continue.^[199][203] Historical records suggest female circumcision in Indonesia started and became prevalent with the arrival of Islam in the 13th century as part of its drive to convert people to Islam. In islands of Indonesia, where partial populations converted to Islam in the 17th century, FGM has been prevalent in Muslim females only.^[204][205] In 2006, FGM was banned by the government; however, FGM/C remained commonplace for women in Indonesia - the world’s largest Muslim nation.^[206] In 2010, the Indonesian Health Ministry issued a decree outlining the proper procedure for FGM, which activists claim contradicted the 2006 ruling prohibiting clinics from performing any FGM.^[207] In 2013, the Indonesian Ulema Council ruled that it favors FGM, stating that although it is not mandatory, it is still “morally recommended”.^[208] The Ulema has been pushing Indonesian government to circumcise girls, claiming it is part of Islamic teachings.^[209] Some Indonesian officials, in March 2013, claimed cutting and pricking type circumcision is not FGM.^[210]

Malaysia

Female genital mutilation Type I and IV is prevalent in Malaysia, where 93%^[211][212] of females from Muslim families (at least 57% of the female population^[213]) have been mutilated.^{[214][215][216]} It is widely considered as a female sunnah tradition (sunat perempuan), typically done by midwife (mak bidan). It is either a prick (Type IV) or cutting off a small piece of the highest part of clitoral hood and foreskin (Type I).^[217] Malaysian women claim religious obligation (82%) as the primary reason for female circumcision, with hygiene (41%) and cultural practice (32%) as other major motivators for FGM prevalence.^[214][217] Malaysia is a multicultural society, FGM is prevalent in Muslim community, and not observed in its minority Buddhist and Hindu communities.^[217][218] Malaysia has no laws in reference to FGM.^[219] The Malaysian government sponsored 86th conference of Malaysia’s Fatwa Committee National Council of Islamic Religious Affairs held in April 2009 decided that female circumcision is part of Islamic teachings and it should be observed by Muslims, with the majority of the jurists in the Committee concluding that female circumcision is obligatory (wajib). However, the fatwa noted harmful circumcision methods are to be avoided.^[220] In 2012, Malaysian government health ministry proposed guidelines to reclassify and allow female circumcision as a medical practice.^[221]

Maldives

Female genital mutilation is practiced in Maldives.^[15][222] Maldives' Attorney General Husnu Suood claims FGM was eradicated from Maldives by the 1990s, but the practice of female circumcision in Maldives is reviving because of Islamic fatwas from religious scholars in Maldives who preach that it as compulsory.^[223] Religious leaders have renewed their calls for FGM in 2014.^[224]

Pakistan

Female genital mutilation is practiced among some Pakistani communities.^[165] Gibeau reports, for example, FGM is widespread in Bohra Muslims of Pakistan^{[13][225][226]} The Sheedi Muslim community of Pakistan, considered to be of Arab-African origins, practice FGM.^[227] The practice is also found in Muslim communities near Pakistan's Iran-Balochistan border.^[228]

Philippines

Female genital mutilation is prevalent in parts of Philippines.^{[229][230][231]} The communities that practice FGM call it Pag-Sunnat, sometimes Pag-Islam, and include Tausugs of Mindanao, Yakan of Basilan and other Muslim communities of Philippines. FGM is typically performed to girls between few days old and age 8. Type IV FGM with complications have been reported.^[229][232]

Singapore

Female genital mutilation is practiced by the Malay Muslim community in Singapore.^[233][234]

Tajikistan

Female genital mutilation is present in Tajikistan.^[195]

See also

• Female genital mutilation
• Religious views on female genital mutilation

References

Further reading

• Ross, Susan Deller Women's Human Rights: The international and Comparative Law Casebook, Vantage Press, 2008. For the legal situation in the US as of 2008.

External links

• Laws on FGM in Africa (according to a 2013 document compiled by the African Child Policy Forum (ACPF) - an independent, non-profit, pan-African organization focusing on African children)

Female genital mutilation Issues Clitoridectomy Dysmenorrhea Dyspareunia Gishiri cutting Infibulation Keloid scars Pelvic inflammatory disease Rectovaginal fistula Vesicovaginal fistula By country Female circumcision controversy (Kenya, 1929–32) Female genital cutting in Sierra Leone Female genital mutilation in the UK Prevalence of female genital mutilation by country People Ayaan Hirsi Ali Waris Dirie Efua Dorkenoo Fran Hosken Gerry Mackie Molly Melching Layli Miller-Muro Comfort Momoh Nawal El Saadawi Marion Scott Stevenson Hulda Stumpf Nahid Toubia Alice Walker Opposition FORWARD Inter-African Committee on Traditional Practices Affecting the Health of Women and Children International Day of Zero Tolerance to Female Genital Mutilation RAINBO Tostan Tahirih Justice Center Books and films Desert Flower (book) Desert Flower (film) Moolaadé Possessing the Secret of Joy Woman at Point Zero Legislation Matter of Kasinga Prohibition of Female Circumcision Act 1985 Female Genital Mutilation Act 2003 2005 (Scotland) Act Categories Female genital mutilation Activists against female genital mutilation

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