Sexual Function, Mental Well-being and Quality of Life among Kurdish Circumcised Women in Iran

Sexual Function, Mental Well-being and Quality of Life among Kurdish Circumcised Women in Iran

Farzaneh DANESHKHAH 1, *Hamid ALLAHVERDIPOUR 1, 2, Leila JAHANGIRI 1, Tatiana ANDREEVA 3

  1. of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
    1. Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
      1. School of Public Health, National University of Kyiv-Mohyla Academy, Kiev, Ukraine

Abstract

Background: Female genital mutilation is an intentional inhumane procedure that threatens girls and women’s health. It is especially widespread in developing countries due to cultural, traditional and religious preferences. The aim of the current study was to investigate how circumcision affects women’s sexual function.

Methods: This cross-sectional study was conducted in the urban and rural area of Piranshahr County, Iran, in 2015 among convenience samples of 200 women, 15-49 yr old, who were applying to health care centers for receiving rou-tine health care services. Data collection was conducted with the use of a self-administered written questionnaire to assess female sexual function, mental well-being, and quality of life.

Results: Significant differences were found between circumcised and non-circumcised women in total score of female sexual function index (FSFI) in domains of desire, arousal, vaginal moisture, orgasm, satisfaction, and pain [(P<0.001), MD(95%CI)=5.64(3.64 to 7.64)] and based on Hotelling’s T-square, significant differences were found in dimensions of quality of life and FSFI.

Conclusion: The revealed sexual dysfunction among mutilated women gives ground to require that public health sys-tems take actions aimed at implementing special sexual education program to improve sexual functions of mutilated women and changing beliefs and social norms in the community level.

Keywords: Female circumcision, Circumcision, Sexual function, Women’s health

Introduction

Many girls born in countries of Africa and Middle East undergo inhuman procedure known as Fe-male Genital Mutilation/Cutting (FGM/C). “FGM/C refers to all the procedures that inten-tionally alter female genitalia including their partial or total removal for non-medical purposes” (1).

About 100–140 million girls and women have undergone FGM and are suffering FGM conse-quences globally. FGM currently occurs in 28 African countries affecting 67.7 million girls and women who are currently 15–49 yr old and more than three million girls have been estimated to be

at risk for FGM annually (1, 2). In addition to African countries, this phenomenon is seen in the East Asian countries such as Indonesia, Malaysia, and India as well as in the Middle East and among migrants from these areas to Europe, the USA, Australia and other countries where mi-grants carry along their own traditions (3-6). The described practices need to be terminated based on principles stated in the Universal Declaration of Human Rights article five saying that “no one shall be subjected to torture or cruel, inhuman or degrading treatment” (7).

History and the rationale why FGM is practiced in certain nations, religions, and cultures are not sufficiently understood except for the fact that female genital mutilation was known since an-cient Egypt (8). Current observations show that FGM is common in some Islamic countries (9). The prerequisites for female genital mutilation are related to a mix of cultural, customary, tradi-tional, religious and social factors within families and communities, perceived as ancestral socio-cultural roots (1). The rationale for performing FGM/C includes preservation of ethnic and gen-der identity, maintenance of ‘cleanliness’ and as-surance of women’s virginity, along with the con-trol of women’s sexuality. FGM/C is also consid-ered as a rite of passage from childhood to adult-hood (3, 10, 11).

FGM harms girls and women in many ways (1, 10, 12). In others words, FGM is a risk factor for several adverse health conditions among women, and all types of FGM procedures have immediate and long-term health consequences (13). Imme-diate complication of FGM includes severe pain, shock, hemorrhage, and infection that can lead to septicemia and acute urine retention, psychologi-cal consequences, as well as open sores in the genital region (3, 9, 11). In a long run, a range of traumatic consequences can arise including geni-tal ulcers, keloid scars, fibrosis, and chronic vul-var pain; inflammatory consequences include re-current bladder infections; menstrual difficulties which might manifest as painful and prolonged periods; and psychosexual consequences includ-ing dyspareunia and sexual dysfunction (3, 14). With three types of FGM being distinguished (1), most severe complications arise with types II and

  • procedures and especially type III that include repeated urinary tract and pelvic infections, urethra damage, infertility, an increased risk of childbirth complications, and natal deaths (15, 16). Additionally, various sexual dysfunctions as a component of FGM consequences affect wom-en’s emotional and sexual well-being (16-19).

The above-mentioned evidence of FGM devas-tating impact became the ground for the UN dec-laration on the elimination of FGM and the

WHO commitment to provide a “Global strategy to stop health care providers from performing female genital mutilation” (1), which calls all health professionals to act to prevent this harm-ful and violent practice which is inhuman and threatening to women’s human rights.

FGM is known as a traumatic procedure that can demolish and impair sexual functions of mutilat-ed women including altered desire/libido, pain/discomfort, and diminished arousal result-ing in inhibited orgasm(3, 14) while the British Medical Association concluded that little is doc-umented with regard to the psychosexual and psychological consequences of FGM (20). Addi-tionally, not much has yet been documented with regard to psychosexual outcomes of FGM specif-ic for different nations and regions. In Iran, with a great variety of national, racial, and religious groups, FGM predominantly occurs in the west and south of Iran where most of the people are Sunni (the largest branch of Islam) or belong to Kurdish nation.

Based on the above mentioned background, the aims of the current study were to obtain infor-mation about the consequences of female cir-cumcision on sexual function of circumcised women. We also aimed to acquire explorative information regarding the status of FGM, its prevalence, predominant method/type of female circumcision, and attitude to this practice among the Kurdish women in Iran.

Materials and Methods

Participants and Procedures

This cross-sectional study was performed in Pi-ranshahr County, Iran, near the border of Iraq where a part of Kurdish people is living there. Participants (n=200) were sexually active married women of child-bearing age 15-49. Convenience sampling was conducted through two urban and five rural health centers; all the women who ap-plied to health care centers for routine health care services during the data collection period and agreed to participate were recruited. Data were collected during Feb and Mar 2015 by means of in-person home-based interviews guided with a structured written questionnaire and clinical examination by a midwife. In case of needing to clinical examination, participants were examined by a midwife in the clinic. All participants were covered with governmental health care services. The age of women ranged between 15 and 49 yr; 9.5% of women were younger than 20 yr, 42% were 21-30 yr old, 37% were 31-40 yr old, and 11.5% were older than 41 yr.

Tabriz University of Medical Sciences’ Ethics Committee approved the study, and informed consent was obtained from all study participants before the interview and clinical examination.

Measures

Socio-demographic variables

Socio-demographic variables included age, dura-tion of marriage, employment status (employed, housewife), education (illiterate, primary, second-ary education, high school and higher), number of deliveries, place of living (rural or urban area) and parents’ education level.

History of FGM

This was defined as any partial or total removal of the external female genitalia during the child-hood age. In addition, for determining the type of FGM, participating women were asked about which parts of their genital organs were removed, cutting tool, circumcised, and age they have un-dergone FGM. In case of needing to diagnose the type of FGM, participants were under examina-tion by a midwife. Additionally, viewpoints of circumcised women about why they had been under FGM were obtained by a brief semi-structured interview.

Female sexual function index (FSFI)

The FSFI is a brief, multidimensional, validated tool for assessment of sexual function and con-sists of nineteen items for six domains of libido, arousal, lubrication, orgasm, satisfaction, and pain (e.g. ‘‘Over the past 4 wk, how often did you feel sexual desire or interest? Almost always or al-ways; Most of the time (more than half of the time); Sometimes (about half the time); On a few occasions (less than half of the time); Almost never or never”). Each item has six possible answers that describe the status of sexual function during the last four weeks (14, 21). Responses to each question related to the previous month were recorded and scored either from 0 (no sexual ac-tivity) or 1 (suggestive of dysfunction) to 5 (sug-gestive of normal sexual activity). The reliability coefficient for the scale was 0.95. Higher scores on the scale indicated normal sexual activity.

Quality of Life (QoL)

  • 26-item rating scale was used to gauge wom-en’s perception of their quality of life (QoL) in four domains of Physical health, Psychological,

Social relationship, and Environment (e.g. ‘‘How would you rate your quality of life? Very poor; Poor; Neither poor nor good; Good; Very Good’’). A 5-point Likert-type scaling (1=strongly disagree, 5=strongly agree and 1=never, 5=completely) was used (22). The relia-bility coefficient for the scale was 0.94. Higher scores on the scale indicated better QoL.

Mental wellbeing

The validated 28-item Farsi version of the Gen-eral Health Questionnaire (GHQ-28)(23)was used to measure the wellbeing of women. The GHQ refers to subjective symptoms of psycho-logical distress, somatic manifestations often as-sociated with anxiety and depression, relationship difficulties, and perception of social, family, and professional roles (24). The GHQ-28 is com-posed of four subscales used to measure somati-zation, anxiety, social dysfunction, and depres-sion. Both subscales and summated total scores were used (24, 25). All items had ordinal four-point Likert-type scales (0-1-2-3). A higher score on the GHQ-28 represents poorer mental health status. The reliability of coefficients of reliability of the subscales varies around 0.87 and the inter-nal consistency of the total scale is 0.90.

Statistical analysis

Information obtained from the two groups was analyzed using SPSS version 16 for Microsoft Windows (Chicago, IL, USA). The statistics used to describe the groups included mean, standard deviation, frequencies (number of cases) and percentages where appropriate. Comparison of quantitative variables between circumcised and non-circumcised women was conducted using Student’s t-test for independent samples. To compare categorical data, Chi-square test of in-dependence was performed. Exact Fisher’s test was used instead when the expected frequencies in some subgroups were less than 5. The Ho-telling’s T-square method was applied for simul-taneous comparisons of dimensions between FGM and non-FGM women and finally, bivariate analysis was performed to ascertain the associa-tion between the quality of life and general health with sexual function trait. The correlations be-tween low quality of life as well as low level of general health and low sexual function trait were assessed using Pearson correlation. In all anal-yses, P<0.05 was considered statistically signifi-cant.

Results

In our sample, the total rate of FGM was 70% (n=140). With 53.6% (n=75) among women of older than 31 yr age and 8.6% (n=12) in the less than 20 yr old group. Among the rural women, 93 (66.4%) were circumcised versus 13 (22.7%) among the women in the urban area. Among the uncircumcised women, 17 (28.5%) were em-ployed while it was true about 19 (13.3%) of cir-cumcised women (Table 1).

Table 1: Demographic characteristics of noncircumcised and circumcised women

Variables Non FGM (n=60) FGM (N=140) P-Value
n(%) n(%)
Age (yr) Less than 20 7(11.7) 12(8.6) 0.048
20-30 31(51.7) 53(37.9)
31-49 22(36.7) 75(53.6)
Occupation Housewife 43 (71.7) 121(86.4) 0.013
Employed (28.3)17 19(13.6)
Education Illiterate 1(1.7) 34(24.3) <0.000
Primary 7(11.7) 48(34.3)
secondary 13(21.6) 23(16.4)
high school 21(35.0) 21(15.0)
More 18(30.0) 14(10.0)
Mother’s education illiterate 37(61.7) 125(89.3) <0.001
primary 6(10.0) 10(7.1)
secondary 4(6.7) 5(3.6)
high school 9(15.0) 0(0.0)
more 4(6.7) 0(0.0)
Father’s education illiterate 45.0(27) 100(71.5) <0.000
primary 8(13.3) 29(20.7)
secondary 5(8.4) 2(1.4)
high school 12(20.0) 8(5.7)
more 8(13.3) 1(0.7)
Housing Owned 45(75.0) 123(87.9) 0.023
Rented 15(25.0) 17(12.1)
Residence Urban 47(78.3) 47(33.6) <0.000
Rural 13(21.7) 93(66.4)
Income Low 19(31.7) 28(20.0) 0.115
Middle 39(65.0) 100(71.4)
High 2(3.3) 12(8.6)
Mean)SD) Mean)SD)
Duration of marriage 6.66(0.85) 10.52(0.62(
Number of children 1.18(0.14) 1.88 (0.09)

In addition, 125 (89.3%) of participants with history of FGM reported that their mothers were illiterate versus 37 (61.7%) among uncircumcised women and participants who had literate mother were not circumcised. Table 2 shows the average scores for the participating women’s sexual func-tion: a significant difference was found (P<0.001) between circumcised (mean=18.25, SD=6.32) and non-circumcised (mean=23.90, SD=7.12) women. Additionally, significant differences were found between two groups in all the domains of sexual function scale including desire, arousal, vaginal moisture, orgasm, satisfaction and pain with circumcised women having lower sexual function scores. However, no significant differ-ences between the two groups were found in the quality of life score: (mean=52.73, SD=12.59) among circumcised women and (mean=53.39, SD=12.13) among those non-circumcised. Addi-tionally, average scores for all the domains of quality of life are brought in Table 2. The calculated scores for general health status did not re-veal significant differences between the two groups of participants (P-value: 0.935).

Table 2: Comparison of female sexual function index, quality of life, and mental wellbeing between two groups of circumcised and non-circumcised women

Variable Mean (SD) MD** (95%CI) P-Value
FGM* Non FGM
(n=140) (n=60)
FSFI Desire 2.67(1.07) 3.67(1.43) 0.99(0.63 to 1.35) <0.001
Arousal 2.85(1.30) 3.95(1.46) 1.09(0.67 to 1.50) <0.001
Vaginal moisture 3.02(1.18) 4.01(1.37) 0.98(0.61 to 1.36) <0.001
Orgasm 2.32(1.19) 3.64(1.32) 1.32(0.94 to 1.69) <0.001
Satisfaction 3.60(1.54) 4.34(1.45) 0.74(0.28 to 1.20) 0.002
Pain 3.78(1.56) 4.28(1.14) 0.50(0.06 to 0.94) 0.025
Total 18.25(6.32) 23.90(7.12) 5.64(3.64 to 7.64) <0.001
WHOQOL-BREF General Health 63.12(20.57) 64.16(17.14) 1.04(-4.92 to 7.01) 0.731
Physical Health 62.88(15.96) 61.48(15.22) -1.39(-6.18 to 3.39) 0.567
Psychological 56.96(16.52) 59.86(14.39) 2.89(-1.94 to 7.74) 0.240
Social Relationship 21.45(5.65) 22.60(6.44) 1.15(-0.64 to 2.94) 0.207
Environment 59.24(14.50) 58.85(15.06) -0.38(-4.85 to 4.07) 0.864
Total 52.73(12.59) 53.39(12.13) 0.66(-3.12 to 4.45) 0.731
GHQ-28 Somatic symptoms 5.99(3.71) 6.58(3.78) 0.59(-0.54 to 1.72) 0.307
Anxiety and insom- 5.98(4.17) 6.20(4.29) 0.21(-1.06 to 1.49) 0.742
nia
Social dysfunction 7.30(1.62) 7.21(1.15) -0.09(-0.54 to 0.36) 0.696
Severe depression 4.87(4.70) 4.30(4.27) -0.57(-1.97 to 0.81) 0.414
Total 24.16(10.90) 24.30(10.43) 0.13(-3.14 to3.41) 0.935
  • FGM – Female Genital Mutilation
  • MD – mean difference

CI : Confidence interval

P-Value based on independent samples t-test Assessment of sexual behavior in two groups (Table 3) showed that 68 (48.8%) of circumcised women had low desire for having a sexual rela-tionship while only 16 (26.7%) were similarly characterized among the non-circumcised. Re-garding women’s demand or offer for sexual contact, 15 (25%) of non-circumcised had history of offering sexual contact vs. four (2.9%) among circumcised women which constitute a statistical-ly significant difference. Additionally, 14 (10%) of circumcised women reported history of violence against them by their husband while only 2 (3.3%) reported so among the non-circumcised.

Table 3: Comparison of sexual function between two groups of circumcised and non-circumcised women

Variables Non FGM (n=60) FGM (n=140) P-Value
n (%) n (%)
Sexual status Low desire 16(26.7) 68(48.6) <0.001
High desire 23(38.3) 12(8.6)
Normal 21(35.0) 60(42.8)
Demand for sexual contact by Men 44(73.3) 130(92.9) <0.001
Woman 15(25.0) 4(2.9)
Both 1(1.7) 6(4.3)
Frequency of intercourse per month 4 ≤ 17(28.3) 20(14.3) 0.051
4-20 40(66.7) 117(83.6)
20 ≥ 3(5.0) 3(2.1)
History of Sexual violence by husband No 58(96.7) 126(90.0) 0.111
Yes 2(3.3) 14(10.0)

* FGM – Female Genital Mutilation

P-Value based on Chi-square/Fisher’s exact test

There were significant correlation between low quality of life (r=0.42, P-value<0.000) and low level of general health(r= -0.65, P-value<0.000) with low sexual function trait.

The common type of mutilation in Iran was type I or clitoridectomy and all the FGM participants were circumcised by removing a part or the whole of clitoris. Regarding viewpoints of cir-cumcised women about why they had been under FGM, 64 (45.7%) reported that religious beliefs, traditional rituals, and customs were the main factors of FGM while 58 (41.4%) of participants did not share any understanding of why they have been circumcised. Additionally, 80 (57.1%) of circumcised women reported that religious beliefs and traditional rituals were the main rea-son for their families and mothers to opt for the FGM procedure for their daughters while 45 (32.9%) reported that cultural beliefs about controlling sexual desire among women were main reasons for mothers to select FGM. Ac-cording to the women participating in the study, men including fathers had no role on FGM in the studied area. All women were circumcised with a razor; 118 (84.3%) of participants responded that gypsy women were responsible for cutting the girls’ genital organs; 15 (10.7%) responded that relatives did so, and 7 (5%) said that this was done by local women. As regards the age when study participants had been circumcised, 72 (51.4%) of women reported that they were circumcised before age 3 and did not remember this, 65 (46.5%) had been 4-12 yr old, and 3 (2.1%) were older than 12 yr and they could recall this unpleasant event. Additionally, partici-pants reported that they had been subjected to FGM based on their mothers and grandmothers’ request. As for the next generation (the daughters of study participants), none of the respondents reported having subjected their daughters to FGM.

Table 4: Simultaneous comparison of dimensions of FSFI,WHOQOL-BREF and GHQ-28 between FGM and non-GGM women

Wilks’ Lambda Value F df1 df2 P-Value
GHQ-28 0.980 0.983b 4.000 195.000 0.418
WHOQOL-BREF 0.934 2.720b 5.000 194.000 0.021
FSFI 0.732 11.795b 6.000 193.000 <.001

Results based on Multivariate Tests of Hotelling’s T-square

The results of Hotelling’s T-square use for simul-taneous comparisons of dimensions between FGM and non-FGM women showed that there were significant differences in QoL and FSFI scores while there was no significant difference in mental well-being score between the two groups (Table 4).

Discussion

The findings of the current study show that women with the history of genital mutilation happen in some parts of Iran similarly to other countries in the Middle East. In particular, it had been common previously between the Arab and Kurds because of cultural and religious beliefs of Sunni Muslims living in the west and south of Iran. However, these practices have dramatically decreased within recent years.

In this study, the proportion of women with FGM was as high as 70% among studied partici-pants in the previous years but it has seen a de-creasing trend of FGM among young women in compare of old women and none of the study participants reported FGM on their daughters. Although our study was not conducted on a community level, our findings are comparable with the results of the studies conducted in high prevalence communities such as 27 African coun-tries, Yemen and Iraqi Kurdistan (26-28). The prevalence that we estimated is in line with stud-ies from some ethnic and religious groups located in the west and south of Iran, where most people are Sunni (29).

One of the prominent facets and facts about cir-cumcising of young girls is the exclusive role of women and mothers in conducting circumcision of girls. In other words, men have no determin-ing role with regard to this practice. Similarly, to other nations and countries (3, 5), findings of the current study indicate that women are responsi-ble for FGM in the west of Iran. Fortunately, in the recent years, mothers in Iran are not request-ing that their daughters be subjected to circumci-sion. The rate of FGM is reduced considerably because when it was asked all participants, none of them reported history of circumcision on their daughters but it is needed to systematic research to measure the current rate of FGM among young girls.

Besides ethnic and religious factors, the likeli-hood of women undergoing FGM might be re-lated to low literacy level among the rural popula-tion. In this study, FGM was significantly associ-ated with some variables, including unemploy-ment and lower literacy of parents. Therefore, the practice of FGM is pertinent to certain social and ethnic groups, which is in line with findings in Ethiopia (30) and Egypt. More than 80% of the circumcised women were illiterate and unem-ployed and that the probability of FGM declined with educational level while being higher among women in lower social strata (31). Low education level and consequent lower level of health knowledge, unemployment and its related pov-erty in line with living in the deprived rural area might have posed these women at risk of becom-ing victims of FGM in the studied sample of Kurdish population in Iran.

Clitoris, which is a sexually sensitive tissue, is re-moved partially or totally in any type of FGM. There is increasing evidence that FGM damages sexual function (3, 14), and findings of the cur-rent study demonstrate that FGM was signifi-cantly associated with diminished female sexual function. In addition, all domains of female sexu-al function namely desire, arousal, lubrication, orgasm, satisfaction, and pain could be affected because of FGM; this is consistent with findings of a recent case-control study in Egypt (32). In contrast, in Saudi Arabia was reported no differ-ence in mean desire score or pain score between FGM and non-mutilated females; however, statis-tically significant differences were reported be-tween the two groups in arousal, lubrication, or-gasm, and satisfaction, as well as the overall sexu-al function score(14). Additionally, as a systemat-ic review and a meta-analysis have concluded, women subjected to FGM significantly more like-ly reported dyspareunia, the absence of sexual desire, and reduced sexual satisfaction (33).

Additionally, numerous studies have identified depression, anxiety and post-traumatic stress disorder (PTSD) as potential consequences of FGM (34-36). FGM has psychological and mental ef-fects, our study did not reveal discrepancies in mental wellbeing between circumcised and non-circumcised women, and thus, this hypothesis can be further tested in larger scale studies paying more attention to mental health of these women. Despite progressive improvement about health indices and quality of health care services, human society is facing phenomenon of female circum-cision, which threatens the health of girls where they become victims of inhumane practices based on certain cultural beliefs. Nowadays, two types of health promotive approaches are needed to overcome FGM phenomenon. First, preventing female circumcision among child girls and sec-ondly, supporting circumcised girls and women who are suffering consequences of FGM.

This study had a number of limitations. First, the cross-sectional study was conducted on a con-venience sample of women in Piranshahr County; as a result, our findings cannot be generalized to all Sunni and Kurdish women and other popula-tions of Iran. In addition, the study used self-reported measures that could lead to inaccurate recall and/or reporting. Furthermore, some measurements were conducted with the use of a researcher-designed questionnaire for collecting socio-demographic and health data, rather than using previously standardized instruments, which may have resulted in lack of comparability with other studies, inaccuracies, and misclassification. Nevertheless, this was the first study of this kind among the under-studied population of Kurdish women.

Conclusion

Many of the Kurdish girls in the county of Pi-ranshahr were circumcised in the past decades, and clitoridectomy was the most common type of mutilation impairing sexual function of muti-lated women. Nevertheless, no differences were found between circumcised and non-circumcised women in quality of life and mental wellbeing, which probably confirms that clitoridectomy, is a less harmful procedure in comparison to other types of FGM. Additionally, none of the mutilat-ed women allowed that their daughters be sub-jected to FGM which indicate a progressive re-duction in the rate of female genital mutilation in recent years.

Ethical considerations

Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or fal-sification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

Acknowledgements

The authors would like to thank Tabriz Universi-ty of Medical Sciences for financial support. The authors would like to acknowledge all partici-pants of the study.

Conflict of Interests

The authors declare that there is no conflict of interest.

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How a religious ruling seems to have stopped FGM in the 1950s in Ahwaz, Iran

How a religious ruling seems to have stopped FGM in the 1950s in Ahwaz, Iran

Two new studies shed more light on the practice of Female Genital Mutilation (FGM) in the Middle East. For the first time, a study explores whether FGM is practiced in Syria – and comes to the conclusion that no evidence of its existence can be found.

Another study explores the history of FGM in the region of Ahwaz in the South-Western Iranian state of Khuzestan. Through talking to older women the PhD-student Susie Latham found that FGM was common in this region but has been abandoned completely without any official program in place. Furthermore, she found that it was first replaced by a milder form before the practice was stopped entirely.

“Collectively, the information suggests that before about 1945, all girls around Ahwaz were routinely subject to Type II FGC. The pattern of cutting across the generations strongly suggests a transition to less severe cutting before the practice finally stopped, although individual families did not necessarily need to pass through each stage.”

Latham found that women in the beginning of the 1950s only underwent Type I FGM, while the practice stopped entirely by the mid to late 1950s.

Instructions against FGM came from a higher religious authority

The reason for abandonment seems to have been interference by religious authorities according to her interview partner. “Every single woman who gave a reason for the abandonment of FGC said that it was the result of an Islamic ruling. Some just knew that it had become haram, but others said that a religious authority had said so in the mosque and that this had been communicated through the men to the women. In my husband’s town, the current imam confirmed reports by three old women that his father had decreed FGC should end, saying the instructions came from a higher religious authority.”

Latham also discusses in her paper how her findings contradict common strategies against FGM. Rightly, she notes that the importance of religious rulings is underestimated by UN and international NGOs. Religious rulings she assumes may not only be of great importance for the practice in Iran, but also in Africa from where she cites examples from Senegal and Somalia proving her point.

Her further thoughts lead her to the suggestion that moving to milder forms of FGM may be a better option than the current Zero-Tolerance approach by the UN and others and could more successfully lead to a total abandonment.

This is an interesting reasoning and quite different from the usual defenders of medicalization who see it as the lesser evil. Latham does not defend more Sunna types as the lesser evil and points out that it is unclear what exactly Sunna female genital cutting is. She sees the promotion of milder forms as a strategy to total abandonment and stresses the importance of agency by local communities.

However, her suggestion must still be rejected as being too general and not applicable in most places. She does not take a closer look on the consequences of medicalization as her example from Iran was not based on medicalization but apparently on the decisions of traditional cutter “to cut less”.

Moving to milder forms as it is promoted today by defenders of medicalization, however, has the opposite effect: FGM becomes more acceptable and can even spread. Thus abandonment becomes less likely.

Nevertheless, Latham’s study gives valuable new insights into the topic and her thoughts about current approaches being too standardized are worthwhile discussing.

No evidence of FGM in Syria

Researchers Diana Geraci and Jaqueline Muslders, on the other hand, looked into the existence of FGM in Syria. Rumors existed that FGM was indeed practiced in the region of Homs and maybe even other places. Even though no evidence existed and no Syrian woman had ever spoken out on it its existence seemed plausible because the Syrian Sunni population adheres to the Sha’afi law school which officially considers female genital cutting a duty.

The researcher team applied a number of methods to verify or falsify these rumors scanning grey literature, asking refugees, midwives, gynecologists and NGOs working in the field. They did not find any evidence that FGM is practiced in Syria today or was in the last 60 years. The value of this research lies also in its discussion of ethnic and relgious correlation: “The possible relation between ethnicity (Kurdish) and law school (Shafi’i) and FGM is too precarious to draw any conclusions for Syria. The Kurdish people in Syria speak a different language than the Kurdish people in Iran and Iraq where FGM is a known practice. And not all communities where Shafi’i law school is dominate practice FGM.”
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The studies:

Susie Latham: The campaign against Female Genital Cutting: empowering women or reinforcing global inequity? In: Ethics and Social Welfare, Volume 10, Issue 2, 2016

Diana Geraci, Jaqueline Muslders: Female Genital Mutilation in Syria? An Inquiry into the existence of FGM in Syria, Pharos, April 2016

Survey: Majority of religious leaders pro FGM in Kermansheh, Iran

Survey: Majority of religious leaders pro FGM in Kermansheh, Iran

A recent survey among Sunni religous scholars in the Iranian province of Kermansheh shows that a majority of them (67%) believe that “female circumcision” is religiously obligatory or at least recommended for girls and women. In this province in the West of Iran, female genital mutilation (FGM) is practiced by Sunni Kurds who adhere to the Shafi’i law school. Many of them believe that Islam commands them to have their girls cut.

Mullahs opinionIn recent years, the issue of FGM has been raised in Iran by a number of activists through media (radio and internet) and a conference in Teheran. In the province of Kermansheh regular lectures for parents and couples were held and information material warning of negative effacts was distributed. Furthermore, educational programs in Iraqi Kurdish media (TV and radio) about FGM also reach an audience in the Kurdish speaking communities in Iran.

There is good reason to believe that these campaigns have let to a change in attitudes among the population towards FGM. Rates have dropped from 31% in 2010 to 18% in 2014 in the province of Kermansheh, according to a comprehensive study on FGM by Kamel Ahmady.

Yet, even tough educational programs have an effect on people’s attitutes, religious opinions (fatwas) play an important role as well. In reaction to the campaigns against FGM, a number of mullahs have voiced their opinion against FGM while others defended the practice. However, it was not at all clear which opinion the majority of mullahs tends to.

Now, the Hamraz counseling center of Javanrood (Kermansheh, Iran) has conducted a survey among 81 religious leaders and asked them about their opinion on FGM.

The results show that FGM is still justified by a majority of mullahs as a religious deed. Only a small minority of 4% believed that it is not an Islamic practice (not Sunna). The vast majority stated that it is Islamic. More than a third (35%) sees it as recommended or Sunna (the right path), but do not call it an obligation. Yet, almost as many (32%) say it must be done. To substantiate this view, a number of Hadiths (accounts of the prophet’s life and sayings) are referred to and a small number of mullahs even falsely believes that the Holy Quran itself calls for female genital cutting.

However, there is also a highly ambiguous group of 23% who take the seemingly contradicting position of calling it obligatory and Sunna, but say it is not necessary in their opinion. The author of the study, Osman Mahmoudi, interprets this “as a sign of change within the religious establishment or a reaction towards changing opinions in society.”

Mahmoudi points out, that “on the other hand, knowledge of negative consequences exists.” A majority (54%) have heard of different negative effects like psychological problems, infections and marital problems. He concludes that “awareness campaigns have at least partly reached their audience. This is also shown by the answers to question 7 where 34% answered that the decrease of FGM is due to awareness raising through media and research.”

He finds this contradiction highly alerting: “The results imply, that one and the same mullah may know about negative health effects and still defend the practice as a religiously good deed.”

Yet, the mullahs distance themselves from modern science as is shown by the results of question 6 where 46% chose one of the answers which prioritize religion over scientific research and medical studies. “Only 19% take the position that FGM should not be done if doctors and psychologists show that it leads to complications.”

The study concludes “that education about negative health effects of FGM does not lead to a rejection of the practice if strong religious beliefs stand in the way. Medical studies seem to be rejected by a vast majority of mullahs if they contradict their religious believes, thus scientific results are simply not believed.”

__________________________

Osman Mahmoudi: Survey on religious views on female genital mutilation: Religious justification and awareness raising in Kermansheh province, Iran, August, 2016

Iran: New book about FGM is distributed among health workers

Iran: New book about FGM is distributed among health workers

The practice of female genital mutilation (FGM) affects Kurdish women and girls in the Iranian province of Kermanshah and continues within a complex web of social, cultural and economic justification. It is medically unnecessary and has adverse physical, sexual and psychosocial consequences.

 

Many Kurdish health care practitioners have little knowledge or experience of the cultural and health issues relevant to FGM. The provision of appropriate health care for girls, women and couples victim of FGM needs to be based in an understanding of the issues and beliefs which have accommodated the continuation of the practices.

Health care and promotion for these population may involve addressing long held beliefs about FGM, including those related to health, hygiene, personal philosophy and traditional practices.

Prevention of the practice in Kermanshah must also involve education about the negative consequences. Health care professionals have an important contribution to make through the provision of health information and health promotion.

To reach out to health care professionals, Osman Mahmoudi and Muhammad Rauf Amini published a book on FGM in the first half of 2016. In the first step more than 1000 copies of this book were distributed during Ramadan month among doctors, midwives, psychologists and counselors who live in the cities of Javanrood, Paveh, Rawansar and Salas.

The booklet has been produced to increase awareness and understanding of some of the issues around FGM and includes these information:

  • Types of female genital mutilation
  • Local beliefs about female genital mutilation
  • female genital mutilation in Islam
  • Islamic scholars fatwa prohibiting female genital mutilation
  • Physical harms of female genital mutilation
  • The harms of female genital mutilation during pregnancy and childbirth
  • Sexual harms of female genital mutilation
  • Psychological harms of female genital mutilation
  • Experts to stop female genital mutilation.

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Committee on the Rights of the Child, Concluding observations on the combined third and fourth periodic reports of the Islamic Republic of Iran

Committee on the Rights of the Child, Concluding observations on the combined third and fourth periodic reports of the Islamic Republic of Iran

The Committee considered the combined third and fourth periodic reports of the Islamic Republic of Iran (CRC/C/IRN/3-4) at its 2055th and 2057th meetings (see CRC/C/SR.2055 and 2057), held on 11 and 12 January 2015, and adopted the following concluding observations at its 2104th meeting (see CRC/C/SR.2104), held on 29 January 2016.

Download the report here

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