we will have meetings with scholars on circumcision of girls

we will have meetings with scholars on circumcision of girls

After announcing numerous reports through various associations and publishing materials, finally one of the provincial governors of Hormozgan was well informed:

Director General of the Office of Social and Cultural Affairs of Hormozgan Governorate has stated that we will have meetings with scholars on circumcision of girls.

Director General of the Office of Social and Cultural Affairs of Hormozgan governorate has stated that there is no definite statistics on the circumcision of girls, but the majority of the people of the province adhere to this issue. He has said that since this issue is based on religious principles, it is very difficult to get into this issue and it is opposed to this unless the attitudes of the scholars and religious leaders of these societies change. We have plans in this regard. One of the plans is to send advisers to have meetings with scholars and elders in these areas and say that female circumcision has a very negative psychological impact.

He remarked: At the meetings of the Social Security Staff, we opened the girls’ discussion about the circumcision, and the mindset was getting more prepared. We had meetings with advisers and talked, and now it’s better to have an interventionist approach in this regard.

This despite the fact that the director of public relations at Bandar Abbas University of Medical Sciences (Norouzian ) had said: Female circumcision is not routine and it is not known, and if it is done in the family, it is completely secretly, not in the doctor’s office. This action is a moral, legal, medical, and health mistake, and if we know who is doing these activities, we will surely avoid it, but because it is done in secret, it is unidentifiable. Because this is not common practice, public education cannot be provided, but in the past 20 years when this was done in Kong Bandar, one of the health center personnel at that time was able to educate and inform the inhabitants of the port about the progress of this action.

Also, Pari Sayyadi, Director General of the Office of Women and Family Affairs of Hormozgan Province has stated:

The statistics provided by some sites are far from reality. We have not seen such a case during the periodic trips we have to the provincial towns. I myself have witnessed cases of female genital mutilation in other provinces that I did not name, but about women 40 years ago. Of course, in the same provinces, that is not common.

A new announcement of a meeting with scholars shows that officials and practitioners have finally accepted the practice of circumcision in the province. It is hoped that such news will be heard in other provinces like Kermanshah, Kurdistan and East Azerbaijan.

Statistics show that with different distributions, about 60% of women living in Hormozgan Province tend to circumcise their daughters; this figure in other provinces is about 30%. In 1394 (2015), some news reported that a girl in Buchan was referred to the hospital due to the severity of the injuries caused by hemorrhage and severe hemorrhage. It was hoped that such an accident would alarm the authorities!

Female sexual abortion is prohibited in many countries of the world. In Iran, according to some current laws, Diyah (blood money) is also granted to female genital mutilation.

Article 664 of the Islamic Penal Code, adopted in 2013, also states that “the removal of either side of the woman’s genitals causes half of the woman’s full diyah (blood money), and the interruption and destruction of some part of the body has Diyah.”In this decree, there is no difference between virgin and non-virgin, young and adult, healthy and defective, such as rebellion and coronation.

In addition to this article, other provisions of the same law have addressed similar issues:

Article 704: Eliminating the power of ejaculation or reproduction of a man or pregnancy of a woman or destroying the pleasures of male or female intercourse leads to Arsh.

Article 708: Eliminating or permanent or temporary damaging other senses such as trickling, sleeping, and menstrual periods, as well as causing diseases such as tremor, thirst, hunger, fear and faint lead to Arsh.

Article 449: “Arsh” is a non-tangled diyah which amount is not specified in the Shari’ah. The court determined the extent of the crime in terms of the type and quality of the crime and its impact on the health of the innocent and the amount of damage incurred by considering the deceased and with the opinion of the expert. The rules of determined Diyah are subject to Arsh, unless otherwise provided in this law.

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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  5. Kaplan A, Hechavarría S, Martín M, Bonhoure I (2011). Health consequences of female genital mutilation/cutting in the Gambia, evidence into action. Reprod Health, 8:26.
  6. Reisel D, Creighton SM (2015). Long-term health consequences of Female Genital Mutilation (FGM). Maturitas, 80:48-51.
  7. United Nations (1948). Universal declaration of human rights. http://www.un.org/en/events/humanrights day/2007/hrphotos/declaration%20_eng.pdf
  8. Barstow DG (1999). Female genital mutilation: the penultimate gender abuse. Child Abuse Negl, 23:501-510.
  9. Bogale D, Markos D, Kaso M (2014). Prevalence of female genital mutilation and its effect on women’s health in Bale zone, Ethiopia: a cross-sectional study. BMC Public Health, 14:1076.
  10. Ouldzeidoune N, Keating J, Bertrand J, Rice J (2013). A description of female genital mutilation and force-feeding practices in Mauritania: implications for the protection of child rights and health. PloS One, 8:e60594.
  11. Berg RC, Denison EM-L, Fretheim A (2010). Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review of quantitative studies. http://www.kunnskapssenteret.no/en/public ations/psychological-social-and-sexual-consequences-of-female-genital-mutilation-cutting-fgm-c-a-systematic-review-of-quantitative-studies
  12. Andersson S, Rymer J, Joyce D, Momoh C, Gayle C (2012). Sexual quality of life in women who have undergone female genital mutilation: a case–control study. BJOG, 119:1606-11.
  13. Bjälkander O, Grant DS, Berggren V, et al (2013). Female genital mutilation in Sierra Le-one: forms, reliability of reported status, and accuracy of related demographic and health survey questions. Obstet Gynecol Int, 2013: 680926.
  14. Alsibiani SA, Rouzi AA (2010). Sexual function in women with female genital mutilation. Fertil Steril, 93:722-4.
  15. Fried S, Mahmoud Warsame A, Berggren V, et al (2013). Outpatients’ perspectives on problems and needs related to female genital mutilation/cutting: a qualitative study from Somaliland. Obstet Gynecol Int, 2013: 165893.
  16. Cook RJ,  Dickens  BM,  Fathalla  MF  (2002). Female genital cutting (mutilation/circumcision): ethical and legal dimensions. Int J Gynaecol Obstet, 79:281-7.
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  21. Rosen CB, J Heiman, S Leiblum, et al (2000). The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther, 26:191-208.
  22. Harper A (1998). Development of the World Health Organisation WHOQOL-BREF quality of life assessment. Psychol Med, 28:551-8.
  23. Malakouti SK, Fatollahi P, Mirabzadeh A, Zandi T (2007). Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians. Int Psychogeriatr, 19:623-34.
  24. Goldberg DP, Hillier VF (1979). A scaled version of the General Health Questionnaire. Psychol Med, 9:139-45.
  25. Werneke U, Goldberg DP, Yalcin I, Üstün B (2000). The stability of the factor structure of the General Health Questionnaire. Psychol Med, 30:823-9.
  26. Yasin BA, Al-Tawil NG, Shabila NP, Al-Hadithi TS (2013). Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city. BMC Public Health, 13:809.
  27. Jones SD, Ehiri J, Anyanwu E (2004). Female genital mutilation in developing countries: an agenda for public health response. Eur J Obstet Gynecol Reprod Biol, 116:144-51.
  28. Yirga WS, Kassa NA, Gebremichael MW, Aro AR (2012).   Female   genital   mutilation: prevalence,   perceptions   and   effect   on women’s health in Kersa district of Ethiopia. Int J Womens Health, 4:45-54.
  29. El-Zanaty F WA (2009). Egypt demographic  and
  30. Mahmoud MIH (2016). Effect of female genital mutilation on female sexual function, Alexandria, Egypt. Alexandria J Med, 52: 55-59.
  31. Berg RC, Denison E (2012). Does female genital mutilation/cutting (FGM/C) affect women’s sexual functioning? A systematic review of the sexual consequences of FGM/C. Sex Res Social Policy, 9:41-56.
  32. Vloeberghs E, van der Kwaak A, Knipscheer J, van den Muijsenbergh M (2012). Coping and chronic psychosocial consequences of female genital mutilation in the Netherlands. Ethn Health, 17:677-95.
  33. Behrendt A, Moritz S (2005). Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry, 162:1000-2.
  34. KoolaeeAK, Pourebrahim T, Moh-ammadmoradi B, Hameedy MA (2012). The comparison of marital satisfaction and mental health in genital mutilated females and non-genital mutilated females. Int J High Risk Behav Addict, 1:115-120.

 

 

 

 

 

 

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.”
________________________

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

what did Iranian Activists do during these years against FGM?

what did Iranian Activists do during these years against FGM?

FGM in Iran

Specific report of Stop FGM in Iran

This introduction sets out the context of FGM in the Islamic Republic of Iran and is included to enable a comparison to be drawn between the Indonesian FGM landscape and that in Iran.

In Iran, women who undergo FGM – often called Khatne or Sonat – primarily undergo Type I or rarely Type II FGM. Some local reports show that in the Khuzestan province, maybe, infibulation is performed (the activists are not sure). The type varies from one region to the next. While in some villages in Kermanshah and Kurdistan women believe that some small amount of bleeding from a cut is necessary, in other areas such as Hormozgan the genitals may be more extensively cut.[i] The vast majority of FGM procedures are carried out by traditional local female circumcisers, including Roma women passing through the villages, midwives sometimes known as dayeh or Bibis depending on the region, and family members (older women who are well respected in the villages).[ii] Generally it is a girl’s mother, grandmother, or other female relative that decides whether she will undergo FGM.[iii]

 

FGM is typically performed in the home. The clitoris is cut with a knife or razor blade and then ash, alcohol or local medicines (like Sorkhou) is used to clean and close the wound. In some areas, there is a trend toward medicalization where circumcisers use Betadine and bandages in an attempt to make the procedure more hygienic.[iv] FGM is typically performed when girls are very young and likely to forget the pain at

40 days or older, though the age varies depending on the region. In other areas girls range from ages three to six[v], and in some cases older girls undergo the procedure before marriage.[vi]  In Bandar Kong, a port city where some studies found that up to 70 percent of the women have undergone FGM (This study was about more than 12 years ago).[vii]

The practice of FGM has primarily been concentrated among the Shafi’i Kurds and Sunni minority of Iran primarily in rural areas such as Kurdestan, Hormozgan, Western Azerbaijan, Kermanshah, Lorestan and a handful of other regions.[viii] Hormozgan has the highest prevalence of FGM at over 60 percent.[ix] In West Azerbaijan, Kermanshah, and Kurdistan the rates range from 15 to 35 percent.[x] Kameel Ahmady, who recently published a study on FGM in Iran, found there was between an 8 to 15 percent decline in the rate of FGM between 2010 and 2014 in the provinces of Hormozgan, Western Azerbaijan, Kermanshah and Kurdistan.[xi] Interviews showed that 38% of women and men aged 15-49 still support the practice of FGM because of religion, tradition and culture.[xii] Another study which was written by Stop FGM Iran found that nearly half of respondents wanted their daughters to undergo FGM in the future.[xiii] Interestingly, more than half of respondents believed a legal ban on FGM would be effective to prevent it.[xiv]

 

A recent study shows that the rate of FGM has declined over the past ten years across Iran. In Piranshahr, West Azerbaijan, less than 10 percent of women and girls ages 15-29 have undergone FGM, compared to 43 percent of women ages 30-49.[xv] In Javanrood, Kermanshah, only about 6 percent of women and girls ages 15-29 have undergone FGM, compared to 41 percent of women ages 30-49.[xvi] FGM among women and girls aged 15 to 29 is 30 percent lower than the rate among women aged 30 to 49, and is lower than 8 percent among girls under 10 years old.[xvii]

 

FGM continues to be practiced in Iran for various reasons. Women are likely to have their daughters undergo FGM in order to improve their chances of marriage. FGM is viewed as a way to ensure the chastity of a young girl, reduce sexual desire, and keep her “pure” for her future husband. Girls who have undergone FGM may be viewed as more desirable than those who have not because of the high value placed on female virginity in Iranian and Islamic culture.[xviii] Some believe after birth clitorises become big and ugly, and cutting makes them more attractive, clean, and beautiful.[xix] Rural Kurds who are followers of “Shafi’i faith believe that a woman’s sexual desire is harnessed after being cut and whatever she does subsequently become halal, or acceptable to Islam.”[xx] In some regions, the food cooked by women who have not undergone FGM is not considered to be halal, and thus may not be eaten by others. In Bandar Kong, some believe “that women are evil creatures who can only be saved from the reach of the devil by being circumcised.”[xxi] For traditional circumcisors, their compensation for performing FGM may be their only source of income and therefore an incentive to continue the practice.[xxii]

 

“There is much debate on the issue and many Muslim scholars have provided evidence both for and against FGM.”[xxiii] Four Sunni Islamic schools of jurisprudence – Hanafi, Maliki, Hanbali, and Shafi’i – FGM is either preferred or considered obligatory.[xxiv] Some Supreme religious leaders have spoken out in support of the practice. They generally do not characterize it as mandatory in Islam, but do recommend it.[xxv] One Hadith in particular is frequently relied on. In this Hadith, “when Prophet Mohammad was migrating, a woman named Umma Habib who circumcised women came to the Prophet. The Prophet asked her whether she still did what she had been doing? She replied, yes, oh God’s Messenger unless you order me to stop. The Prophet replied: ‘No, it is permissible (halal). Just be careful not to cut deep. A little and that make the woman’s skin shining and smooth and dearer to her husband.”[xxvi]

 

FGM in the Islamic Republic of Iran, a majority Shi’a country, has lately been receiving more attention globally as a women’s rights issue. In 2014, Iran began to be recognized among the global list of countries in which FGM is present.[xxvii] But is not added in the list of UNICEF officially. For the first time Rayehe Mozafarian open special campaign to improving knowledge and by opening this campaign “stop FGM Iran”, all the efforts and field working are updating in the site and all information publish by using media. Then in the site of this campaign all news and recent activities publish in two languages, Persian and English.

 

The Law

 

While there is no specific anti-FGM law in Iran, the Islamic Penal Code prohibits bodily mutilation and can be used to combat FGM.

 

  • Article 664 of the Islamic Penal Code states “cutting or removing each of the two sides of the female genitalia leads to diya (compensation)[1] equal to half of the full amount of diya for a woman’s life.”[xxviii]
  • Article 386 criminalizes mutilation of the body. If the crime was intentional, it would be punished according to the retaliation (Qisas) law – the perpetrator shall be given a sentence that is equal to the crime committed.[xxix] If the crime was unintentional, the penalty may be either Diya (monetary compensation or blood money) as prescribed by Islamic law for that particular crime, or Ta’zir (where Islamic law does not prescribe a punishment for a particular crime, the punishment is left to the discretion of the judge).[xxx]
  • Article 706 makes it a crime to eliminate the sexual ability of a man or woman. Article 707 sets the penalty for that crime as full compensation (Diya or blood money).[xxxi]

 

Under Islamic law in Iran, girls reach the age of maturity at 9 years.[xxxii] A father or grandfather may appoint a guardian for their children in the event they may die.[xxxiii] In the event a child does not have a father, paternal grandfather, or guardian appointed by them, the court will appoint a representative to act on behalf of the child.[xxxiv] Any complaint brought on behalf of the child would have to be filed by the child’s guardian or court appointed representative.[xxxv] Since a parent or guardian would not file a complaint against themselves for FGM, the girl would have to wait until she reaches the age of maturity to file a complaint, and this would take tremendous courage to file a complaint against her family members.[xxxvi]

 

For general protections of their human rights, girls can also look to Articles 10, 20, and 21 of the Constitution (general protection of women’s rights); the Charter of Women’s Rights and Responsibilities (rights to life, physical integrity, protection against victimization, right to mental and physical health, and protection against family violence); and the Law on the Protection of the Rights of Children and Adolescents (criminalization of child abuse).[xxxvii]

 

Rayehe Mozafarian, for the first time wrote specific article about FGM and disability and mention these two subjects together and some articles which support these two subjects. Rayehe Mozafarian and Kameel Ahmady have also suggested that FGM may be characterized as a disability under the Iranian Protection Law for People with Disabilities, and the Convention on the Rights of Persons with Disabilities.[xxxviii] According to Mozafarian:

 

WHO defines Disabilities as an umbrella term, covering impairments, activity limitations, and participation restrictions, an impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. In 2014, the Islamic Consultative Assembly (parliament) of I.R. Iran passed a comprehensive bill on the right of persons with disabilities and the ministries of health and medical education were assigned to oversee its implementation. Under Article 1, the term person with disability is referred to ‘Those identified by the medical commission as having physical, mental or both disorders with a lasting effect on their health and general ability, limiting their independence socially and economically.’ … In 2002, the Islamic Republic of I.R. Iran assigned the Welfare Organisation to be responsible for the persons with disabilities. This organisation has various departments, such as cultural and social department which includes between all, the office of ‘family and women empowerment’ and also the office of ‘children and juveniles.’ The department of prevention and treatment of addiction includes a sub office on preventing disabilities. However the most important department working with persons with disabilities is the rehabilitation department and one of its offices is assigned to empowerment of persons with disabilities. The welfare organisation is responsible for the mutilation of women as all its departments have the power to prevent, empower, inform and eradicate FGM.”[xxxix]

 

Governmental Anti-FGM Interventions

 

While there have been close to no governmental efforts in Iran to eradicate FGM, Rayehe Mozafarian asked the Supreme Leader Ayatollah Khamenei`s view point. He has called FGM not acceptable and issued a fatwa stating that FGM is not obligatory.[xl] However, this does not go far enough, as he has characterized it as permissible. He has stated, “Today, female genital mutilation is not common among Shiites but the usage narrative show that it does not hurt if it can be done … [in certain] conditions, including compliance with health issues. But because the social norms have changed today, this action would not be acceptable…”[xli] In response to questions of whether a woman’s duty would require her to undergo FGM at her husband’s request the Ayatollah responded that, “implementation of husband’s order is obligatory for the wife if it does not have disadvantages or it is not harmful for the wife, she has to listen to her husband’s request.”[xlii]

 

In July of 2015, the University of Tehran (a public state-run university) and Iranian Campaign Stop FGM Iran held a conference on the subject of FGM, marking the first time that an official body connected to the government publicly remarked on this issue and governmental and official media cover the news and speak out about FGM in Iran for the first time. This event broke the silence after many years.[xliii] Experts discussed the harmful consequences of FGM, the underlying reasons for FGM, and an analysis of the linkage between FGM and Islam. DR. Bokharayee, Dr. Akbary and Mozafarian discussed that there was no religious precedent for the practice of FGM but that this was an antiquated practice simply given religious significance in order to remain pertinent.

 

Non-Governmental Anti-FGM Interventions

 

Education and Media

 

The prevalence of FGM in Iran has been successfully decreased in some parts through public awareness campaigns and with the help of religious leaders who have spoken out against the practice. In the western part where are near to Iraqi Kurdistan this issue decrease because Kurdish people use joint media but in the south, people talk in another language and accent and they do not have access to Kurdish media and other local media do not pay attention to this subject. By the other hand because of Iraqi-kurdish organization like wadi, Kurdish people know more about negative points of FGM. The media has been a useful tool in educating the public about FGM.

 

In 2014, Radio Farda in collaboration with Stop FGM Iran held the first broadcast in Farsi in which victims of FGM spoke out about the practice and its harms in their personal lives.[xliv] In the broadcast a woman tells of how her marriage ultimately failed because of her inability to enjoy sexual intimacy due to her having undergone FGM. Later, her mother was interviewed telling of how she regretted her decision to circumcise her daughter at a young age. The mother lamented that had she known about the detrimental impact of the practice on her daughter’s life she never would have done it. These emotional pleas were then interspersed with commentary from clergy and outside experts who warned of the detriments of the practice as well, further imploring the public to heed their warning.

 

Women’s rights activists such as Parvin Zabihi and Mehrangiz Kar have spoken out about FGM in media interviews.[xlv] Iraqi-Kurdish television stations have also aired TV specials about FGM in the Kurdish regions of Iran.[xlvi] An Iranian film released in 2014 also highlighted the issue of FGM. The film “Almond” tells the story of a Kurdish woman in Iran struggling with the consequences of FGM. This film brought increased attention to the issue of FGM in Iran, and was shown in the Growth Film Festival of Tehran as well as international film festivals.[xlvii]

Fatemeh Karimi has also written a book about this issues:  Tragedy of the Body, Violence against Women (2010).

 

The new book is recently published by H&S Media, written by Reyhaneh Zahiri and translated by Manavaz Alexandrian in the titled of “Mother of cloth dolls”. One of the story of this book is about Female Genital Mutilation in Iran[xlviii].

 

“For the first in Iran music video against FGM made by singer and artist Miss Chiman Rahmani, subtitled in English aired in most Kurdish TV and post on YouTube she tries to cover the issue of FGM and child forced marriage in her 6 minute long video music clip.”[xlix]

 

Researcher Kameel Ahmady found that using the media, including through interviews and online media of clerics and medical professionals speaking about the ill effects of the practice can influence attitudes toward FGM.[l]

 

Engaging Religious Leaders

 

Religious leaders who speak out against FGM can have a strong influence on changing attitudes toward FGM, particularly for those who believe FGM is a religious requirement. Religious leaders in Iran are divided on the issue, there are some religious leaders, including Sunni religious leaders in Iran, who have spoken out against the practice. The issue has been denounced by clerics in Iran who have denied that FGM is engrained in their brand of Islam.

 

FGM has been admonished by some clerics because, in addition to the physical harms that it causes women, they claim it causes a rift in the familial fabric because of the marital problems that decreased sexual desire and sexual dysfunction as a result of FGM can cause.

 

  • Ayatollah Khameneie: “It is permissible but not obligatory.”[li]
  • Grand Ayatollah Seyyed Hossein Fazlollah, 2010: “Our studies of the existing texts on this subject show that female circumcision is not of Islam’s doing and that it does not have an Islamic origin. Female circumcision was a ritual from the era of ignorance (the pre-Islamic era), when it was considered a way for a woman to make herself more attractive to her husband.”[lii]
  • Mala Seyyed Hasan Vazhi, West Azerbaijan: “FGM not only harms a woman’s health, but causes sexual problems in marriage which can lead husbands to ‘sin and adultery’. Female circumcision does nothing but hurt your daughter’s body. This practice must stop.’”[liii]

Rayehe Mozafarian wrote in her book the statements of these Ayatollahs:

  • Ayatollah Bayat Zanjani: “Women are not circumcised. Islam has been the subject of circumcision of the male penis. Because the women do not have this part of genital.”[liv]
  • Ayatollah Makarem Shirazi: “We have ordered a ban on it.”[lv]
  • Ayatollah Saanei: “Circumcision is a tradition and it should be done only for men. It is not Wajib for women.”[lvi]
  • Mullah Talib Mudizadeh, from Bandar Pol, Hormozgan province, 2010: “Regarding the proven medical and psychological arguments about the dangers of female circumcision and availability of concrete accounts testifying that female circumcision causes frigidity and sexual problems in marriage; and also considering the fact that religion always puts great emphasis on science and the Prophet of Islam has said ‘Go in quest of science, even to China’, and most sciences have proven the disadvantages of this act and insist that it shouldn’t be performed, so it is better not to be performed. My wife (Mulavi Amineh) and I have always strictly recommended people of this port and neighboring villages not to circumcise their daughters but circumcision is good and compulsory for their sons.”[lvii]
  • Mulavi Sheikh Salahedin Charaki, from Parsiaan, Hormozgan province, 2012: “There are good reasons that female circumcision is not necessary any more. It has many disadvantages and maybe leads to disloyalty of men and even having several wives. Imam Shafi’I has two different opinions about circumcision and other Sunni imams do not believe that it is compulsory. Therefore, I think now that it has been proven that it is not good for sexual relations and the amount to which the cutting should be done is not definite, not doing it would be better and more appropriate. I have not circumcised any of my three daughters because I am afraid of the dangers to their body and soul.”[lviii]
  • Ashara al-Mubasharîn Mosque in Piranshar West Azerbaijan: “Girls’ circumcision does not have many advantages for the girl and [he] has personally warned [his] family members, relatives and friends about it. [He] has also given advice and guidance about female circumcision in [his] sermons during Friday prayers and [he] has prevented this act to be carried out on [his] own family members.”[lix]

 

Interventions by Civil Society and the United Nations

 

It was not until 2014 that FGM was first publicly discussed in Iran as a human rights issue.[lx] Before this time some activists such as Parvin Zabihi, Fatemeh Karimi (author of Tragedy of body), Rayehe Mozafarian (author of Razor and Tradition) start talking about this issue. Several Iranian students have done small-scale research on FGM in Iran, including Homa Ahadi, Paisa Rezazadeh Jalali, Elham Mandegari, and Fahimeh Hassanian, Farzaneh Daneshkhah[lxi]  and etc.[lxii]

A few Iranian activists, Rayehe Mozafarian and Kameel Ahmady have more recently been instrumental in raising awareness in the country by publishing books on FGM in Farsi, notable in part because “Iranian authorities had let activists research FGM in Iran and had allowed those books to be published.”[lxiii]

 

As early as 2010, Rayehe Mozafarian collaborated with UNFPA, organizing a workshop on FGM in Shiraz.[lxiv] In 2014, she submitted a written statement to the UN Human Rights Council on FGM, and in 2015, presented on this topic at the 59th Session of the UN Commission on the Status of Women.[lxv] In this year she also participated as a guest speaker in Iraqi-Kurdish Parliament for the Day of Zero Tolerance to FGM[lxvi]. In 2011, Rayehe Mozafarian published the book Tigh o Sonat. She studied the relationship between FGM and various socioeconomic factors in hopes of finding correlations that might help to diminish the prevalence of the practice. She found that women who had undergone FGM and have received an education were much less likely than those who had not received any education to impose the same practice on their daughters. In addition, economic means were a strong signifier of the likelihood of being subjected to FGM with lower income being highly correlated with incidence of FGM, and families with more financial security being less likely to impose the practice on their daughters.

 

In her studies found that, “there were significant relation[ships] between Female Genital Mutilation and the following independent variables: job, education, experience of Female Genital Mutilation in the family, the use of using media by women, sexual control of women, attitude of women, age of the women and marriage.”[lxvii] The she continue writing articles and reports and open special campaign. For the first time she could attract governmental attraction and manage several meetings with ministry of women`s affairs, national reference of children`s rights of justice ministry.

 

Kameel Ahmady published a comprehensive study about FGM in Iran in English in 2015, based on surveys and interviews of around 4,000 women and 1,000 men in Iran over the course of six years. His research produced similar findings that “…a woman’s educational attainment is one of the important factors to influence whether the daughter would be genitally mutilated or not. …[H]ighly educated women prefer not to victimize their daughter in this way; the lower the educational attainment, the more likely a mother is to follow the tradition blindly, considering it a social norm or religious duty.”[lxviii]

 

He further found that the rate of FGM seemed to be declining each year, and attributed this to several factors: changing times and modern life, elderly traditional circumcisers not being replaced by a younger generation of practitioners, wider media coverage of FGM, greater access to media including through technology, migration from villages to towns, greater access to education among youth, less interest in religion among youth, and lack of willingness by younger generations to accept FGM.[lxix] Through surveys measuring attitudinal change of mothers toward FGM, he saw a big change in favor of ending FGM.[lxx] Ahmady attributed the decline of FGM in Iran in part to awareness raising campaigns.[lxxi] Educating each new generation about the harms of FGM was effective in deterring them from subjecting their daughters to FGM.

 

As part of his study, Ahmady also implemented small scale pilot interventions to address FGM. The pilot programs started out providing medical care, and increasingly used awareness raising campaigns, lobbying, and networking to build support for anti-FGM efforts especially among religious and community leaders, as well as men and women.[lxxii] They “used social events as a potential platform e.g. weddings, Quran lessons and funerals.”[lxxiii] Ahmady’s team conducted follow up visits to the villages twice annually to assess the impact of their interventions.[lxxiv] Effective communication with the local population and identifying local individuals from the communities to carry out the work were helpful to win support from the communities.[lxxv] Involvement of religious leaders was also influential especially for those groups insisting that FGM is a requirement of Islam.[lxxvi] He noted that religious leaders “need to be persuaded to make a proclamation against FGM in order to empower their communities in the struggle to end the practice. The pilot intervention has provided a platform for religious leaders to speak out against the ritual.”[lxxvii] His team also worked to “convince the public and especially mothers not to mutilate their daughters. We have been visiting and talking to clergymen, also important part of this work.”[lxxviii] As a result of these efforts, Ahmady concluded that awareness raising campaigns and advocacy are critical to change attitudes toward FGM and help eradicate the practice, though these must be part of holistic efforts to address FGM along with support by government officials and religious leaders.

 

Other grassroots efforts to address FGM are also growing in Iran. The Azarmehr Association of the Women of Kurdistan in Iran, an association working on women’s rights issues, recently started addressing the issue of FGM.[lxxix] Kurdish university students also started as association against FGM, and though they were not issued a permit to operate this association, this elevated the discussion on FGM in the Kurdish regions.[lxxx] A local campaign against FGM has also been launched in the Kermansheh and Kurdish provinces in Iran including trainings for women on the harmful consequences of FGM.[lxxxi] The Stop FGM Middle East campaign has also been active in publicizing and raising awareness about the issue of FGM in Iran and efforts to eradicate it.[lxxxii] At a family consulting center in Kermansheh in Iran, Elham Hosseini and Osman Mahmoudi hold educational classes for women and parents with young children about FGM. It is also training psychology students to educate others about FGM and combat the practice. The center offers psychotherapy for women who have undergone FGM, and couples who have marital problems due to FGM.[lxxxiii] At the Hamraz Consulting Center in Javanrood, service providers have provided life skills trainings for more than 1,300 housewives and educate women about the consequences of FGM in order to prevent future occurrences of FGM.[lxxxiv]2011 marked one of the first times FGM was publicly discussed in Iran, at a national congress on health education in Tabriz.[lxxxv]

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. [lxxxvi]

Following the English publication of Ahmady’s research, many international news outlets caught wind of the practice of FGM in Iran bringing international attention to this issue. The UN has also begun putting pressure on Iran to address FGM. In June 2014, the UN Human Rights Council placed international pressure on Iran to recognize the occurrence of FGM within its borders and to seek to abolish it.[lxxxvii] In response to submissions by civil society,[lxxxviii] the UN Committee on the Rights of the Child expressed concern about FGM, calling on Iran to “take measures to enforce article 664 of the Islamic Penal Code and to stop, effectively, the practice of female genital mutilation throughout the country.”[lxxxix] The primary mode of change has been brought about in Iran as a result of increasing public discussion, awareness, and grassroots movements.[xc]

 

Challenges to Ending FGM

 

While in Iran there are encouraging signs that the rate of FGM has steadily declined over the past few decades in some parts, there are challenges in addressing FGM that need to be overcome.

 

As a result, there is little institutional push to outlaw or address the practice or to support for civil society or activists combating FGM. Many Iranians remain unaware that it is practiced there, and there is little formal research about the practice in Iran.[xci]

 

Due to the aforementioned reasons, even though the Penal Code bans FGM and bodily mutilation, the provisions are not enforced to address FGM. No cases of FGM have been brought in Iran. In addition, because of the familial nature of the crimes, victims do not file charges against their own parents.[xcii]

 

While some religious leaders have spoken out against FGM in Iran, there is no consensus among all religious leaders in Iran. In addition, fatwas issued by local leaders have a limited reach – those issued in one area may not have an impact in other provinces or villages.[xciii]

 

In addition, while there has been some media coverage of FGM and media can be useful as a combative tool, many media outlets do not address FGM for fear of backlash or facing criminal penalties.[xciv] Stop FGM Iran published a letter to the media to speak out more and pay attention to FGM[xcv]. Nowadays most of local media which kept silence have started to speak out without previous considerations.

 

Recommendations

The experiences of Iran in addressing FGM can lend themselves to many lessons learned and best practices. Lessons learned and best practices which may be useful for civil society to address and prevent FGM in Indonesia include the following:

 

Using the Law

  • Utilize and advocate for holistic approaches to combat FGM.
  • Advocate for an anti-FGM law, or incremental bans on FGM.
  • Bring together women’s rights activists and lawyers to conduct an analysis of the legal framework in Indonesia and identify other laws that may be used to protect women and girls from FGM. For example, are there other laws relating to assault, bodily mutilation or child abuse that are not necessarily specific to FGM under which women or girls can nevertheless seek protections or legal redress? If such laws exist, consider whether strategic litigation would be useful and/or desirable to enforce those laws or raise awareness around the issue of FGM.
  • If other such laws exist, conduct educational training for prosecutors and police on how to address FGM in the context of those laws and to collect evidence.
  • If other such laws exist, advocate for changes in any law that may require a victim to file a complaint relating to FGM on her own behalf. A public prosecutor should file such claims even if the victim is not involved in the case, as victims may be afraid to file complaints against their family members.

 

Education

  • Advocate to ensure women and girls have meaningful access to primary, secondary, and tertiary education of women and girls.
  • Conduct education and awareness raising campaigns about the harms of FGM, and FGM as a human rights violation. Such campaigns should target various groups including women, men, youth, religious and community leaders, government officials, medical professionals, and other relevant stakeholders. Campaigns should be tailored to each target group, and address the beliefs and attitudes underlying the practice of FGM particularly including beliefs that FGM is a religious requirement. Campaigns should be implemented by members of the local community to ensure support by the target groups. These campaigns should not just be limited to the health complications associated with FGM, but should also address FGM as a human rights violation, in order to avoid inadvertently contributing to medicalization. Utilize social events as possible platforms to address FGM, such as weddings and Quran lessons.
  • Educate medical professionals, traditional circumcisers and birth attendants about the harmful consequences of FGM. Advocate for improved socioeconomic development and opportunities for medical professionals (and traditional circumcisers), so they do not need to rely on income from performing FGM. Train traditional birth attendants to obtain licenses to perform public health work and obtain gainful employment other than performing FGM.
  • Advocate for curricula in primary and secondary schools that address gender and human rights issues.

 

Engaging Government Officials

  • Advocate with the Ministry of Women and other relevant ministries that already work to address violence against women to incorporate FGM.

 

Engaging Religious Leaders

  • Advocate with and sensitize religious leaders to make proclamations against FGM and speak out against the practice. Highlight medical evidence that FGM is harmful, and link with Islamic principles that support the use of scientific evidence.
  • Share best practices from other countries such as Iran, including proclamations against FGM by religious clergy, with government officials and religious leaders in Indonesia.

 

Engaging the Medical Community

  • Advocate for medical associations to speak out against FGM.

 

Engaging the United Nations

  • Seek support from the UN Joint Programme on FGM/C to address FGM in Indonesia, particularly now that the UN has published data about FGM in Indonesia. Seek to leverage additional financial resources, such as through the United Nations system (e.g. UN Trust Fund to End Violence against Women).
  • Raise the issue of FGM in shadow reports to UN bodies.

 

Media Engagement

  • Train journalists and media houses to address issues of violence against women including FGM.
  • Use innovative media approaches to publicize and raise awareness about issues of FGM including traditional press and magazines; television and radio programs and interviews; social media; films including documentaries, short films, and web videos; songs and music videos; plays and theatrical performances; multiple platform advertisements; comics and infographics; and storytelling. Media approaches should utilize media that will most effectively reach populations that practice FGM, and should be culturally and contextually relevant. Media coverage involving religious clerics and medical professionals speaking out against FGM may be particularly effective in discouraging the practice.

 

Data Collection

  • Advocate for Indonesian government officials to collect more regular and comprehensive data on the prevalence of FGM, underlying beliefs, and trends, including in DHS surveys.
  • Capitalize on availability of new data on FGM in Indonesia, international observances such as the International Day of Zero Tolerance for FGM and other international platforms such as the Sustainable Development Goals to persuade government officials and religious leaders to address FGM, and to raise awareness about the issue.

 

Partnerships

  • Build a network of civil society organizations and other stakeholders to advocate against FGM.
  • Explore new partnerships to advocate against FGM such as with universities, and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

 

Community Level Interventions

  • Promote community driven interventions, and/or integrated socioeconomic development approaches.
  • Focus community interventions where FGM is most prevalent.
  • Target interventions toward young generations, newly married families with girls at risk of FGM, and pregnant females or new mothers with girls at risk of FGM to discourage them from subjecting their daughters to FGM and thereby prevent FGM. Promote positive family values.
  • Implement programs such as ‘safe space’ programs to empower women including through life skills training, and building social networks and support groups for women.
  • Encourage a coordinated effort on the part of the local government, civil society, religious leaders, health workers, and other stakeholders.
  • Incorporate anti-FGM messages into other services provided such as health services, rights education, or other work aimed at addressing violence against women.

 

Other

  • Advocate for improved socioeconomic development, especially for women and in areas where FGM is most prevalent.
  • Anticipate and plan how to address or respond to any backlash against efforts to eradicate FGM.
  • Establish an anonymous reporting hotline to deal with cases of FGM.
  • Identify champions or public figures who would be willing to speak out against FGM and champion advocacy against the practice.
  • Identify positive deviants – those who oppose FGM or refuse to subject their daughters to FGM – and interview them and encourage them to share their stories. Community or religious leaders who are positive deviants can be especially influential.
  • Connect religious leaders, journalists and media houses, and other positive deviants who oppose FGM or are friendly to women’s rights issues in order to build a social support network for them, that will reduce the possibility they may be stigmatized or face backlash individually for their actions. Provide a safe space and platform for them to safely speak out against the practice.

 

 

[1] Diya or blood money is the monetary compensation prescribed by Islamic law.

[i] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[ii] Id.; Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[iii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[iv] Written Statement Submitted by Verein Südwind Entwicklungspolitik, a non-governmental organization in special consultative status, UN Human Rights Council, U.N. Doc. A/HRC/26/NGO/92 (6 June 2014), available at https://documents-dds-ny.un.org/doc/UNDOC/GEN/G14/044/49/PDF/G1404449.pdf?OpenElement.

[v] Id.

[vi] Id.

[vii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[viii] Id.

[ix] Id.

[x] Id.

[xi] Id.

[xii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xiii] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xiv] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xv] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xvi] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xvii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran 45 (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xviii] Id.

[xix] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xx] Hajir Sharifi, Study Reveals Shocking FGM Prevalence in Iran, Rudaw (7 Mar. 2015), available at http://rudaw.net/english/middleeast/iran/030720152.

[xxi] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xxii] Id.

[xxiii] Id.

[xxiv] Id.

[xxv] Id.; Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xxvi] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xxvii] Stephen Schwartz, Female Genital Mutilation a Growing Problem in Iran, The Weekly Standard (20 January 2015), available at http://www.weeklystandard.com/female-genital-mutilation-a-growing-problem-in-iran/article/824155.

[xxviii] Tehran University organized First Conference about Female Genital Mutilation, available at http://www.stopfgmmideast.org/tehran-university-organized-first-official-conference-about-female-genital-mutilation/; http://tbinternet.ohchr.org/Treaties/CRC/Shared%20Documents/IRN/INT_CRC_NGO_IRN_19809_E.pdf; Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xxix] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xxx] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf; Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xxxi] Tehran University organized First Conference about Female Genital Mutilation, available at www.stopfgmmideast.org/tehran-university-organized-first-official-conference-about-female-genital-mutilation; Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xxxii] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf; https://www.crin.org/sites/default/files/iran_joint_submission_to_crc_committee_0.pdf.

[xxxiii] Id.

[xxxiv] Id.

[xxxv] Id.; https://www.crin.org/sites/default/files/iran_joint_submission_to_crc_committee_0.pdf.

[xxxvi] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xxxvii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xxxviii] Id.; Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xxxix] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[xl] Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/.

[xli] Id.

[xlii] Rayehe Mozafarian, The point of view of the Supreme Leader of the Islamic Republic of Iran on Female Genital Mutilation (7 June 2014), available at http://www.stopfgmmideast.org/the-point-of-view-of-the-supreme-leader-of-the-islamic-republic-of-iran-on-female-genital-mutilation/.

[xliii] Tehran University organized First Conference about Female Genital Mutilation, available at www.stopfgmmideast.org/tehran-university-organized-first-official-conference-about-female-genital-mutilation.

[xliv] FGM in Iran: Blade of Islam or patriarchal custom – an interview with scholars, activists and survivors, Stop FGM Middle East (4 December 2014), available at http://www.stopfgmmideast.org/fgm-in-iran-blade-of-islam-or-patriarchal-custom-in-interview-with-scholars-activists-and-survivors/.

[xlv] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf; https://www.youtube.com/watch?v=z_-QD4X6cSI

[xlvi] Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/.

[xlvii]  Rayehe Mozafarian and Hannah Wettig, Iranian Film tackles Female Genital Mutilation (15 December 2014), available at www.stopfgmmideast.org/iranian-film-tackles-female-genital-mutilation.

[xlviii] http://www.stopfgmiran.com/en/?p=84

[xlix] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf; https://www.youtube.com/watch?v=z_-QD4X6cSI

[l] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[li] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[lii] Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/.

[liii] Emma Batha, Anthropologist Reveals FGM Practised in Western, Southern Iran, Reuters (26 June 2015), available at http://www.reuters.com/article/us-iran-fgm-idUSKBN0P60OF20150626.

[liv] Id.

[lv] Id.

[lvi] Id.

[lvii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[lviii] Id.

[lix] Id.

[lx] FGM in Iran: Blade of Islam or patriarchal custom – an interview with scholars, activists and survivors, Stop FGM Middle East (4 December 2014), available at http://www.stopfgmmideast.org/fgm-in-iran-blade-of-islam-or-patriarchal-custom-in-interview-with-scholars-activists-and-survivors/.

[lxi] http://www.stopfgmiran.com/?p=449 and http://www.stopfgmiran.com/en/?p=110

[lxii] Id.

[lxiii] Saeed Kamali Dehghan, Female Genital Mutilation Practised in Iran, Study Reveals, The Guardian (4 June 2015), available at http://www.theguardian.com/world/2015/jun/04/female-genital-mutilation-iran-fgm.

[lxiv] Violations of Girls’ Rights Child Marriage and FGM in the I.R. Iran, Südwind (2014), available at http://www.stopfgmmideast.org/wp-content/uploads/2014/07/Iran-FGM-Child-Marriage-2014.pdf.

[lxv]  www.stopfgmmideast.org/press-statement-fgm-in-iran-needs-to-be-put-on-international-agenda (see original citations to human rights council and CRC); https://exilesactivist.files.wordpress.com/2014/06/g1404449.pdf

[lxvi] http://www.stopfgmkurdistan.org/html/english/articles/article099e.htm and http://www.stopfgmkurdistan.org/html/english/articles/article098e.htm

[lxvii] Rayehe Mozafarian, A survey on social-cultural factors related to Female Genital

Mutilation: A case study of age 15-49 in Qeshm Island, Shiraz University (2011).

[lxviii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[lxix] Id.

[lxx] Id.

[lxxi] FGM in Iran: Blade of Islam or patriarchal custom – an interview with scholars, activists and survivors, Stop FGM Middle East (4 December 2014), available at http://www.stopfgmmideast.org/fgm-in-iran-blade-of-islam-or-patriarchal-custom-in-interview-with-scholars-activists-and-survivors/.

[lxxii] Id.

[lxxiii] Id.

[lxxiv] Id.

[lxxv] Id.

[lxxvi] Id.

[lxxvii] Id.

[lxxviii] Kameel Ahmady, A Letter from Iran, Stop FGM in Kurdistan (January 2010), available at

[lxxix] Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/

[lxxx] Id.

[lxxxi]  New publication about FGM in Persian (13 February 2015), available at www.stopfgmmideast.org/new-publication-about-fgm-in-persian.

[lxxxii] Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/.

[lxxxiii]  Press Statement: FGM in Iran needs to be put on international agenda (9 June 2015), available at www.stopfgmmideast.org/press-statement-fgm-in-iran-needs-to-be-put-on-international-agenda.

[lxxxiv]  Osman Mahmoudi, Tackling FGM in Iran: Education about FGM during life skill classes for housewives (5 August 2014), available at www.stopfgmmideast.org/tackling-fgm-in-iran-education-about-complications-of-female-genital-mutilation-during-life-skills-classes-for-housewives.

[lxxxv]  Iran, Stop FGM Middle East, available at http://www.stopfgmmideast.org/countries/iran/ (citing link to congress on health education); see also T. Pashaei, F. Majlessi, A. Rahimi and A. Ghartappeh, Prevalence of Female Genital Mutilation and the Effects of Health Education Based on Behavioral Intention Model on Attitudes and Behaviors in Women Referring to Health Centers in Ravansar-Iran, in The First International and 4th National Congress on Health Education and Promotion (16-19 May 2011, Tabriz, Iran), Health Promotion Perspectives: An International Journal, Vol. 1, Supplement 2011, available at

[lxxxvi]  http://www.stopfgmmideast.org/iran-new-book-about-fgm-is-distributed-among-health-workers/

[lxxxvii] Hajir Sharifi, Study Reveals Shocking FGM Prevalence in Iran, Rudaw (7 Mar. 2015), available at http://rudaw.net/english/middleeast/iran/030720152.

[lxxxviii] http://tbinternet.ohchr.org/Treaties/CRC/Shared%20Documents/IRN/INT_CRC_NGO_IRN_19809_E.pdf

[lxxxix] https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/049/70/PDF/G1604970.pdf?OpenElement

[xc] In the Name of Tradition. Prod. Kameel Ahmady (2015), available at https://www.youtube.com/watch?v=RID4FnKf7oE.

[xci] Kameel Ahmady, A Letter from Iran, Stop FGM in Kurdistan (January 2010), available at

[xcii] Stephen Schwartz, Female Genital Mutilation a Growing Problem in Iran, The Weekly Standard (20 January 2015), available at http://www.weeklystandard.com/female-genital-mutilation-a-growing-problem-in-iran/article/824155.

[xciii] Kameel Ahmady, A Comprehensive Research Study on Female Genital Mutilation/Cutting (FGM/C) in Iran (2015), available at http://kameelahmady.com/wp-content/uploads/Kameel%20-%20EN%20Final.pdf.

[xciv] Id.

[xcv] https://valentinammaka.blogspot.com/2016/06/letter-to-media-in-iran.html