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Culture Clash: Designing Vaginas, FGM, and Dutch Policy

 

Introduction

Waris Dirie, United Nations Ambassador for the Elimination of Female Genital Mutilation, remembers her childhood “circumcision” in Somalia.  The following excerpt from her book, Desert Flower, describes her experience:

“The old woman looked at me sternly, a dead look in her eyes, then foraged through an old carpet-bag. She reached inside with her long fingers and fished out a broken razor blade… The next thing I felt was my flesh being cut away. I heard the blade sawing back and forth through my skin. The feeling was indescribable. I didn't move, telling myself the more I did, the longer the torture would take. Unfortunately, my legs began to quiver and shake uncontrollably of their own accord, and I prayed, Please, God, let it be over quickly. Soon it was, because I passed out.  When I woke up, my blindfold was off and I saw the gypsy woman had piled a stack of thorns from an acacia tree next to her. She used these to puncture holes in my skin, then poked a strong white thread through the holes to sew me up… My memory ends at that instant, until I opened my eyes… My legs had been tied together with strips of cloth binding me from my ankles to my hips so I couldn't move. I turned my head toward the rock; it was drenched with blood as if an animal had been slaughtered there. Pieces of my flesh lay on top, drying in the sun.”

Female Genital Mutilation (FGM) is a relatively recent issue in Dutch society.  While stories such as the one above at one time seemed distant to Europe, FGM is now considered a very serious human rights issue, and one which Dutch society has been forced to confront.  In the 1980’s and 1990’s, a mass influx of Somali refugees to the Netherlands caused an increased awareness about this deeply ingrained cultural tradition.  There are now an estimated 39,000 female immigrants in the Netherlands originating from FGM-practicing African countries.  However, Somali women tend to receive the most Dutch media attention, because 98% of the women in Somalia are “circumcised” under the most severe form of FGM, infibulation, and Somalis compose the largest African immigrant group in the Netherlands.  Integration in the Netherlands demands a certain degree of adjustment to Dutch cultural norms.  Immigrants struggling to adapt are forced to balance their own cultural identities with their new host country’s norms.  FGM is a cultural practice that persists in the Netherlands despite the government’s ban of it in 1993.  While the ban was a positive development, it is clear that the problem remains, and further governmental action is necessary.  FGM is globally accepted as a human rights violation.  Now, the question remains: How can the Dutch government and society eradicate a tradition that is over 2000 years old?

Definitions

The World Health Organization’s (WHO’s) definition of FGM is this: “FGM constitutes all procedures which involve the partial or total removal of the female external genitalia or other injury to the female genital organs, whether for cultural or any other non-therapeutic reasons.”  The WHO separates FGM into the following four categories:

Type I Excision of the prepuce with or without excision of part or the entire clitoris.

Type II Excision of the prepuce and clitoris together with partial or total excision of the labia 

minora.

Type III Excision of part or all of the external genitalia and stitching/narrowing of the vaginal 

opening (infibulation).

Type IV Unclassified: includes pricking, piercing or incision of clitoris and/or labia; stretching 

of clitoris and/or labia; cauterization by burning of clitoris and surrounding tissues; scraping (angurya cuts) of the vaginal orifice or cutting (gishiri cuts) of the vagina; introduction of corrosive substances into the vagina to cause bleeding or herbs into the vagina with the aim of tightening or narrowing the vagina; any other procedure which falls under the definition of FGM given above.

The most high-risk immigrant groups in the Netherlands that practice FGM are those originating from Egypt, Ethiopia, Eritrea, Somalia, and Sudan.  According to Amnesty International, in all of these countries over 90% of the female population is “circumcised” and infibulation, the most severe form of the four, is often executed.  The procedure is usually performed without anesthesia or sterile conditions, and crude cutting devices such as scissors or razors are used.  FGM has the tendency to induce serious short term and long term consequences including hemorrhaging, shock, urinary tract infections, reproductive tract infections resulting from obstructed menstrual flow, excessive scar tissue, keloids, lowered fertility, and sometimes sterility.  FGM can severely diminish a woman’s sexual stimulation and ability to achieve orgasm, and it can cause her pain during the course of menstruation, sexual intercourse, and labor.  Finally, the intense pain of the procedure can cause psychological damage and trauma.  

Before judging the female genital mutilation ritual, it is essential to develop an understanding of the significance of female “circumcision” to the people who practice it.  FGM is practiced for physiological, social, and symbolic reasons.  It is used as a sexual repressive device, in order to “protect” women from “their inherent sexual nature and behavior.”  It is also believed to protect a woman’s virginity and prevent adultery, as well as increase a man’s sexual pleasure during intercourse.  A “circumcised” female is also considered more beautiful.  Some societies view the procedure as a religious duty.  Anke van der Kwaak, an anthropologist at the Free University’s Medical Center in Amsterdam was commissioned by the Ministry of Social Affairs to research the occurrence of FGM in the Netherlands.  She refutes the notion of FGM as a religious duty: “Many think that it is prescribed by Islam, which it is not.”  Waris Dirie, before seeking asylum in the Netherlands, was “circumcised” in her native country, Somalia.  She describes the Somali cultural basis for FGM as follows:  “Since the prevailing wisdom in Somalia is that there are bad things between a girl's legs, a woman is considered dirty, oversexed and unmarriageable unless those parts--the clitoris, the labia minora, and most of the labia majora- are removed.”   In some societies, male and female “circumcisions” are purification processes in which a child’s sex is made unambiguous.  The removal of a woman’s male element, the clitoris, is believed to be necessary for reproduction.  Hence, the “circumcision” ceremony is not only a celebration marking her transition from child to adult, but also an important moment of “rebirth” in which the youth passes from the liminal state of androgeny to having a complete gender identity. 

The Campaign

In recent years, the Dutch government has been struggling to find new solutions toward combating female genital mutilation in the Netherlands beyond its 1993 ban.  In order to learn more about the practice abroad and in the Netherlands, the Dutch Ministry of Social Affairs commissioned research by several Dutch scholars, including two anthropologists at the Free University in Amsterdam, Anke van der Kwaak and Edien Bartels.  The researchers interviewed a broad spectrum of people and organizations in order to form a comprehensive report.  Among those interviewed were medical practitioners, judges, policy makers, gynecologists, and organizations like Pharos (a Dutch organization specializing in education on FGM), as well as “circumcised” Dutch African immigrants.  The report’s findings were submitted in November 2003 to the Ministry.  

As a result of this research and increased knowledge and awareness of the issue, Minister of Justice Piet Hein Donner has proposed new legislation against FGM.  Currently in the Netherlands, Dutch legislation prevents prosecution of Dutch nationals who have committed crimes abroad when the crime is not punishable in the country in which it occurred.  In other words, if a Dutch family travels to Somalia or Sudan, countries in which FGM is not legally prohibited, for the purposes of having their daughter “circumcised,” the Dutch government is unable to prosecute.  Minister Donner proposes dropping the current legislation’s dual criminality requirement, believing that this could ultimately act as a significant deterrent.  Anke van der Kwaak, an anthropologist and researcher of FGM in Holland, agrees with the change in legislation: “We should also be able to say to people, it is not only forbidden here, but also when you go to Somalia or any other country.  I think there is a fair chance that this proposal will go through parliament.”  The Netherlands has dropped the dual criminality requirement in the past in cases of sexual offenses involving minors.  The government was able to take this action, because the protection of children against sexual abuse is recognized as a basic universal right, even while it may still persist in some countries.  As FGM is mainly practiced on girls between the ages of six and twelve, Minister Donner argues that the protection of female minors from FGM under his new legislation is parallel to the action the Dutch government took with sexual abuse cases.  Furthermore, it would be an important step in preventing future human rights violations.

The right-wing VVD Party representative Ayaan Hirsi Ali has proposed additional anti-FGM legislation.  Hirsi Ali has been a vocal presence in the Dutch media on the FGM issue.  She has asserted: “During school holidays children are taken to their countries of origin, where female genital mutilation is not forbidden and than children are operated on without anesthetics.  It’s done with scissors; it’s done with razor blades; it’s done with broken glass, and that’s really very inhumane.” However, it is difficult to monitor the occurrence of FGM in Holland.  Anke van der Kwaak has stated on this issue of statistics that “it’s hard to say if it [FGM] is common practice.  We have no true idea of the figures. It could be ten girls a year, but it could also be 100.”  Therefore, Hirsi Ali’s proposed legislation would initiate a system of monitoring FGM occurrences.  A government program would examine girls between birth and age eighteen from high-risk countries.  Then the government would record and track which of these girls in the Netherlands have already been mutilated and those that remain at risk.  The girls who are not “circumcised” would continue to be checked by local consultation bureaus, such as the GGD, until their eighteenth birthday.  The consultation bureaus, especially the communal GGD’s, are public health organizations that provide local health care and information to most refugees and immigrants.  Under the proposal, if a consultation bureau discovered a case of mutilation, it would be obliged to report it to the authorities, and the parents and the individual who performed the “circumcision” would be prosecuted.  In cases where persons who performed the “circumcision” ritual did not reside in the Netherlands, their personal data would be recorded on a list of people prohibited from EU entrance.  Fear of prosecution under the suggested law could deter parents who are considering imposing the ritual on their daughters.  Hirsi Ali’s proposal is very controversial and heavily debated, though.  If passed, it would be the first Dutch law specifically prohibiting FGM, which currently falls under the law against child abuse.     

The Dutch medical community has also organized its own conferences and educational systems and guidelines for confronting FGM.  In 1992, for example, a conference was held in Leiden to discuss the issue and the medical community’s ethical obligations and responsibilities in dealing with a patient who is considering FGM, or who has been “circumcised.”  Among the three hundred people in attendance were representatives from the World Health Organization and the Chairman of the Inter-African Council Against Female Genital Mutilation.  At the conference, a suggestion by Koos Bartels and Ineke Haaijer, two researchers of FGM among Somali women in the Netherlands, was discussed.  Ultimately, their position that doctors be allowed to perform operations in which the clitoris is symbolically pricked was assailed in the media, and they were unfairly portrayed as being pro-FGM.  

Jos van Roosmalen is a leading Dutch gynecologist and obstetrician in the FGM debate.  After working in Eastern Africa for seven years, when van Roosmalen returned to the Netherlands, he became involved with African issues in Holland.  Van Roosmalen also finds fault with Bartels’s and Haaijer’s proposition.  Framing the issue in a cultural context, he questions whether a mere prick would be accepted as adequate by the groups practicing FGM, since with the rest of the genitalia intact, a woman could still be considered impure and unclean by those groups’ standards.  In an interview with van Roosmalen, he asked, “Where’s the line?”  

In his thirty years in medicine, van Roosmalen estimates that he has seen approximately fifty cases of FGM.  Usually he is confronted with a “circumcised” woman when she comes to him pregnant.  He follows accepted medical protocol as stated by the Nederlandse Vereniging voor Obstetrie en Gynaecologie (Dutch Association for Obstetrics and Gynecology) and speaks to the woman and her husband about her “circumcision,” and then about how it will affect the birthing process.  If a woman is infibulated, van Roosmalen must perform a procedure termed an anterior episiotomy, in order to allow a large enough passage for the baby.  The labour of an infibulated woman can be very painful and complicated because the scar tissue around the vagina lacks elasticity.  After the child is born, van Roosmalen then discusses with the patient the extent to which the episiotomy will be closed.  In African countries that practice FGM, the woman is usually reinfibulated.  However, performing this procedure is illegal in the Netherlands.  Van Roosmalen tries to keep the vagina as open as possible to prevent future health complications, but claims that usually there is some sort of compromise reached.  He asserts that many of the women say to him, “If you open it [the infibulated vagina], don’t open it too much.”  If the baby born is female, Van Roosmalen then speaks with the mother further about the health, sexual, and psychological consequences of FGM.  This type of counseling becomes an integral part of his job and ethical responsibility to provide his patients with informed medical advice.  The WHO releases guidelines for doctors on how to broach the subject with patients.  In addition, seminars on counseling women with FGM are incorporated into the medical training system.  This coming December, van Roosmalen asserted that there will be a special two-day special training offered to obstetricians and gynecologists on FGM.  Finally, in medical schools, the issues and procedures surrounding FGM are taught in various electives.

The First and Third Worlds

The Dutch government has made significant strides toward the eradication of FGM in the Netherlands.  In forming policy and addressing the issue in the media, though, the government must make considerable efforts to understand the sensitivity of this deeply ingrained traditional and cultural practice.  Cheryl Johnson-Odim’s article, “Common Themes, Different Contexts: Third World Women and Feminism,” is particularly enlightening in explaining the importance of inter-cultural understanding.  Johnson argues that the Feminist Movement is too narrowly tailored to a First World conception of female oppression.  Essentially, the western Feminist Movement must gain a greater understanding of intersectionality before it attempts to combat what it deems as Third World female oppression.  During the United Nations Conference in Copenhagen of 1980, the issue of FGM was raised in such a negative manner that it caused many African women to “resent what they feel to be the sensationalistic nature of the campaign by many First World feminists.”  It would be disrespectful to the cultures practicing FGM to categorize it inherently as inhumane without attempting fully to understand its cultural relevance.  Janice Boddy stresses this point in her 1997 article, “Womb as Oasis: The Symbolic Context of Pharaonic Circumcision in Rural Northern Sudan.”  Boddy researched the Hofriyat practice of infibulation in a Sudanese village.  She makes a strong statement for intercultural understanding before judgment: “I discuss my growing appreciation of its [infibulation] significance… the extent to which its meanings inform women’s sense of self and are embedded in the commonplace details of everyday life.”  She concludes: “Those who work to eradicate female circumcision must… cultivate an awareness of the custom’s local significances and of how much they are asking people to relinquish as well as gain.”  Intersectionality is vital to accomplishing change in any successful social movement.  In attempting to stop FGM altogether in the Netherlands, the Dutch government must proceed carefully in choosing effective legislative measures and in the language it uses in public statements so as to not alienate the groups which practice it.  It should be especially vigilant against placing a value judgment on this practice when a similar judgment could be made about certain surgical procedures performed in the Netherlands.  In the Netherlands, it is legal for a woman to pierce her clitoris or to undergo a surgical operation in which her vaginal labia are cut smaller to make them more aesthetically pleasing.  Perhaps in this context, the government should also allow K. Bartels’s and I. Haaijer’s suggestion of allowing a prick of the clitoris, limiting this freedom to women who are at least eighteen years old and who have discussed the procedure and its consequences extensively with a medical practitioner.  However, this legislation does not solve the problem of children being “circumcised” in secret and with improper medical equipment.

While Ayaan Hirsi Ali’s proposal of checking at-risk girls in schools is a possible way to monitor and deter the occurrence of FGM by Dutch nationals, ultimately, it is an example of an alienating policy.  It is disrespectful to single out all children of immigrants from FGM countries for such an intimate procedure.  In the social work system, a minor is only checked for child abuse when a person has strong reasons to believe that the child is being abused.  Hirsi Ali’s proposition is blanket legislation that disregards privacy in favor of enforced intrusiveness.  Her legislation is the type Cheryl Johnson-Odim would find alarming and insensitive, as discussed in the prior paragraph.  However, Hirsi Ali is correct in her assertion that the Dutch government must enforce stricter policies that aim beyond the future eradication of FGM to more pragmatic and current solutions.  The government has a responsibility to protect its children from real dangers like FGM.   If the Netherlands is seriously interested in protecting the female children of Dutch nationals with origins in FGM countries, they could consider instituting medical examinations for girls from birth until age eighteen, when they leave or enter the Netherlands from high-risk FGM countries.  Should a child return to the Netherlands “circumcised,” the Dutch government should pursue prosecution.  This recommendation provides a mechanism for the government to monitor FGM occurrences, and it is in line with Minister of Justice Donner’s proposed legislation.  While this policy would necessarily require a significant degree of intrusiveness into the privacy of female minors, it is less alienating and more focused than Hirsi Ali’s proposal.  When considering the moral balance between the long term and irreparable damage caused by mutilation versus a short-term medical check-up that could possibly protect a child from the former fate, the answer seems obvious.

The Challenge Ahead

Minister of Justice Donner’s legislative proposition is a positive step. However, the government must proceed beyond legislative action to encourage educational programs actively and to work with social and religious institutions.  Education is the government’s best tool for protecting future generations of girls and young women from FGM.  Often “circumcised” women are not aware that their physical complications and health problems are related to FGM.  In fact, the ritual has become such a societal norm in certain African countries that it is not recognized as being mutilation.  Increased funding should be given to Dutch organizations like Pharos, which work to combat FGM and provide educational materials to the groups practicing the procedure.  Furthermore, web pages, explaining FGM’s harmful effects and related Dutch law should be established in the native languages of all immigrants from FGM-practicing countries living in the Netherlands.  Additionally, a hotline should be established that women who are facing social pressures to have their daughters “circumcised” can call to speak with trained specialists.  Radio, television, and newspaper advertisements should be launched demystifying the practice and explaining the health, sexual, and psychological consequences.  Furthermore, clinics specializing in FGM counseling should be established near African immigrant communities.  The government must also address the problematic relation between Islam and FGM.  Many communities believe that Islam orders FGM, when in fact the practice predates Islam: “I will never forget the pain, but it is our faith.  It is written in our holy books.  That is why it should happen to our daughters as well” (anonymous quotation of Somali woman).  In order to combat this common misconception, the government should establish dialogue with local imams and encourage Islamic institutions in the Netherlands to educate their congregants on the true relation between Islam and FGM.  Finally, the government must begin its educational agenda in the asylum seeking centers.  It is at these institutions, where women are in a transitional state between entering a new society and maintaining their cultural identities that the strongest impact can be made.  In these institutions doctors and social workers must be situated to discuss with women from FGM countries the realities of FGM.

Ultimately, since sexuality is socially constructed, as the social structure is changed by effective grassroots work and governmental bans and legislation, FGM should dissipate.  A 1997 article by Ellen Ross and Rayna Rapp, “Sex & Society: A Research Note from Social History and Anthropology” explains the ways in which sexuality is socially constructed.  They assert that “Sex feels individual… but those feelings always incorporate the rules, definitions, symbols, and meanings of the world in which they are constructed.”  There are three main groups that provide social contexts for sexuality in societies: kinship, sexual regulations and definitions in communities, and national world systems.  Ross’s and Rapp’s arguments offer valuable insights into the social contexts in Gikuyu society in Africa that perpetuated FGM and those that discouraged it.  “The Gikuyu historically depended upon communal, social responsibility to monitor sexuality and control reproduction.”  British imperialism introduced the advent of Christian missionaries to Mutira.  Post-independence, many Gikuyu men and women converted.  The missionaries used the bible to discourage FGM.  Wanoi, a Gikuyu woman, attributes her change in opinion on the subject of FGM to the fact that the Virgin Mary was uncircumcised.  Here is an example of how a national world system, the Catholic Church, affected Gikuyu society’s construction of sexuality.  Gikuyu society also offers the example of how macro-level changes, like education, can have profound effects on the social groups in place.  As FGM fell apart in Kenya, so did the social institutions that had kept it intact for so long.  From the following quote from Shamsa Hassan Said, a Dutch woman of Somali origins who had been “circumcised,” it is clear how social institutions in Somalia maintain and encourage FGM: “It was one big party; in Somalia you only get to be a person when you are circumcised. The pressure is huge, even under children. All your friends are circumcised, so you want to get circumcised yourself. It is part and parcel of our culture. When you’re born and raised in Mogadishu, you don’t see how horrible it is.”  Women who immigrate from Somalia and other FGM countries are leaving behind the kind of social pressure and construct that Said describes.  Accordingly, as generations of immigrants from FGM practicing African countries become integrated into Dutch society, their ties to FGM will eventually diminish.  They will find ways to maintain their unique cultural identities, while becoming integrated into a society in which “circumcision” is not valued, nor considered beautiful.  Through effective and sensitive macro-level legislation and grassroots movements in the Netherlands, it can be hoped that FGM will eventually become a practice of the past.

 

References

 

Interviews

Zahra Abdi, Somali advocate against FGM, June 30, 2004.

Edien Bartels, Anthropologist at the Vrije Universiteit, co-writer of advisory report on FGM for the Dutch Ministry of Social Affairs, Strategieën ter voorkoming van besnijdenis bij meisjes, June 24, 2004.

Jos van Roosmalen, Gynecologist at the Leids Universitair Medisch Centrum and FGM expert, June 26, 2004.

Literature

Frances A. Althaus, Female Circumcision: Rite of Passage Or Violation of Rights?, in: Family Planning Perspectives, Volume 23, No. 3, September 1997.

Edien Bartels and Anke van der Kwaak, Strategieën ter voorkoming van besnijdenis bij meisjes, report, Vrije Universiteit, 2003.

Koos Bartels and Ineke Haaijer, ‘s’Lands Wijs, s’Lands Eer, Vrouwenbesnijdenis en Somalische vrouwen in Nederland, 1992.

Janice Boddy, Womb as Oasis: The Symbolic Context of Pharaonic Circumcision in Rural Northern Sudan, in: the Gender/Sexuality Reader: Culture, History, Political Economy, edited by Roger N. Lancaster and Micaela di Leonardo, pp. 309-324, New York: Routledge, 1997  (originally published in 1982).

Leon Buskens, Female Circumcision, Khitan, University of Leiden, 2004.

Central Bureau for Statistics; Absolute Numbers of African Population in Holland Where Female Genital Mutilation Exists in Country of Origin, 2003.

Jean Davison, Voices From Mutira: Change in the Lives of Rural Gikuyu Women, 1910-1995, 2nd ed., Boulder, Colo.: Lynne Rienner, 1996.

Cheryl Johnson-Odim, Common Themes, Different Contexts: Third World Women and Feminism, in: Third World Women and the Politics of Feminism, edited by Chandra Talpade Mohanty, Ann Russo and Lourdes Torres, pp. 314-327, Bloomington: Indiana University Press, 1991.

Bertine Kroll, Fighting Mutilation, May 12, 2004.

Ellen Ross and Rayna Rapp, Sex and Society: A Research Note from Social History and Anthropology.  in the Gender/Sexuality Reader: Culture, History, Political Economy, edited by Roger N. Lancaster and Micaela di Leonardo, pp. 153-168, New York: Routledge, 1997 (originally published in 1981).

Shamsa Hassan Said, Aren’t all women circumcised?, in: Opzij, July/August 2002.

World Population Fund Information Packet on FGM.

Websites

1. http://www.minvws.nl/kamerstukken/gvm/besnijdenis_bij_meisjes.asp; (Report on FGM written for Second Chamber from the Ministry of Health, Welfare, and Sports)

2. http://www.ministerievanjustitie.nl/b_organ/nhg/nieuws/wet_vrouwenbesnijdenis.htm (Statement of Ministry of Justice about FGM legislation)  

3.http://www.justitie.nl/pers/persberichten/archief/archief_2004/030304Minister_Donner_vrouwenbesnijdenis_vervolgen.asp?List=Y&ComponentID=45989&SourcePageID=4530; (“Minister Donner Wants to Prosecute Female Circumcision,” March 2004)

4.http://www.vvd.nl/index2.asp?ItemCode=NWS&SelectedItemID=40&ID=5004&DeepLinkSearch=TXT; (Ayaan Hirsi Ali on FGM)

5. www.vrouwenbesnijdenis.nl (Dutch website on FGM)

6. http://www.pharos.nl/Infd/Pp-infd2D.html; (Pharos, Knowledge-Centre for Refugees and Health)

7. http://www.wpf.org/vrouwenbesnijdenis; (World Population Fund, advocates against FGM)

8. http://www.amnesty.nl/downloads/boek_vrouwencampagne.doc, (Amnesty International  Netherlands information on FGM)

9. http://www.amnesty.org/ailib/intcam/femgen/fgm9.htm (Amnesty International, Human Rights Information Pack)

10. http://www.who.int/docstore/frh-whd/FGM/infopack/English/fgm_infopack.htm (Female Genital Mutilation Pack)

11. http://www.nvog.nl/files/standpunt_12-vrouwenbesnijdenis.pdf (Nederlandse Vereniging voor Obstetrie en Gynaecologie (Dutch Association for Obstetrics  and Gynecology) statement on FGM

12. http://www.fgmnetwork.org/html/modules.php?name=Content&pa=showpage&pid=11 (The FGC Education and Networking Project: Articles and Discussions: The Waris Dirie Story)

13. http://www.defenceforchildren.nl/nl/default.html. Defence for Children is an organization that protects children’s rights.

 

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