When it’s the doctors carrying out female circumcision
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In a surprise development, 2015 saw the conviction of a doctor for performing female circumcision after 13-year-old Soheir al-Batea died during the procedure.

Batea’s parents took the doctor to court, although they later withdrew their case. By this time, it had been taken up by rights groups and the doctor, Raslan Fadl, who, after an initial acquittal, received a two-year sentence, the first successful application of a seven-year-old law banning the practice. Less surprising, perhaps, is that the ruling was not actually applied, and Fadl was later tracked down by reporters and appears to be living freely and working in a government hospital.

Notably, the procedure was carried out by a doctor, countering a prevalent image of female circumcision as being conducted by non-medical individuals with rudimentary tools. Almost three quarters of female circumcisions in Egypt are carried out by medical staff.

According to a 2014 report by the National Health and Demographic (NHD), 92 percent of married women between the ages of 15-49 have undergone female circumcision, although these statistics are contested, with UNICEF recently releasing a report asserting that 70 percent of women were circumcised in 2015. In any case, the practice remains widespread and according to the NHD survey, 72 percent of the surgeries are performed by medical practitioners.

Infograph on female circumcision in Egypt

Infograph on female circumcision in Egypt

(Click to enlarge infograph)

May al-Sallab, the female genital mutilation (FGM)* coordinator for UNFPA, told Mada Masr one of the biggest struggles they face is the increasing medicalization of female circumcision.

“The latest data shows that 74 percent of girls have been cut by doctors and around 8 percent by nurses, so medicalization is something that needs to be combatted. Doctors often do it because there is financial compensation,” she says.

Dalia Abdel Hameed, head of the gender program at the Egyptian Initiative for Personal Rights, says part of the problem with medicalization is that the state has been inconsistent with its policies towards female circumcision.

In 1994, the Health Ministry issued a decree stating that female circumcision would only be legal when performed in certain state hospitals. They even encouraged citizens to undergo the procedure in hospitals by making the price of the operation a mere LE10. The Health Minister at the time, Ali Abdel Fattah, stated that the institutionalization of female circumcision would reduce health complications and eventually lead to the eradication of the practice altogether. Twenty-two years later, this is clearly not the case.

The institutionalization of female circumcision did not last long. Abdel Fattah’s decision faced widespread criticism from rights groups, and female circumcision was soon banned again from hospitals.

In 2007, the Health Ministry issued a decree banning all health professionals from performing female circumcision in governmental or non-governmental hospitals and clinics. But Sallab says this decree has been hard to enforce, as there is a need to strengthen the monitoring of private health clinics. She also adds that, unlike some countries, Egypt does not have a medical council to act as a regulatory body over medical professionals.

“If you look at the history, the state itself created its own state of discontent. For a while they would allow doctors to perform female circumcision, then they turned around and said, ‘oh we have a medicalization problem’,” Abdel Hameed explains.

Medicalization and combating female circumcision

There are a plethora of non-governmental organizations, international, national and state organizations currently combatting female circumcision.

The Coalition Against FGM includes 87 NGOs, who work in partnership with state and international bodies, like the National Council for Women and the United Nations. Maya Morsy, the newly elected head of the National Council for Women, said in one of her first statements, that one of her main priorities was combatting female circumcision.

The United Nations Population Fund (UNFPA), one the biggest international players combatting female circumcision, works closely with the Health Ministry, the National Population Council and Al-Azhar in its outreach programs.

Part of the problem with medicalization is that it builds on state policies of focusing on the adverse health effects of female circumcision. This is because the state is uncomfortable addressing some of the root problems behind female circumcision to do with female sexuality, Abdel Hameed asserts. “The state and medical approach ignores social motives. There must be a discussion about sexuality and sexual rights,” she says, adding that one of the reasons a focus on medical consequences doesn’t work is that so many people have been circumcised they merely have to glance around them to see examples of women living healthy lives afterwards.

“You convince communities that it’s a health hazard, and is better done by doctors, but they contradict themselves. They imagine people have no minds. Most of them have been circumcised,” Abdel Hameed explains. Women are largely victimized by the process of countering the practice, she adds, asserting that the state tends to focus either on religious motivations for female circumcision or adverse health effects, neither of which address social causes.

The religious orthodoxy has been consistently anti-circumcision in recent years, and in 2007, Al-Azhar Supreme Council for Islamic Research issued a fatwa stating that female circumcision has no basis in Sharia law, although it is not an Islamic practice and is also widely prevalent in non-Islamic communities. Abdel Hameed says the state’s focus on religious justifications for female circumcision led a to a politicization of the issue that, like the focus on the negative health effects of circumcision, distracted from the root causes of the practice.

Both Abdel Hameed and Sallab agree that many families use circumcision as a way to curtail sexuality in women and girls and as an attempt to limit promiscuous behavior. She asserts that a more effective way to tackle circumcision would be to focus on body integrity and take a more comprehensive approach by working with schools and convincing families not only not to circumcise their daughters, but also to let them finish their education.

While UNFPA does work with religious and health authorities in their efforts to limit female circumcision, they have found some of their most successful work has involved creative interactive projects with communities, like plays and musical performances, Sallab says. These initiatives make people more comfortable and willing to talk about more personal matters, like how female circumcision can affect a marriage.

“The marital issue is a sensitive issue. It’s hard to come into a community and talk about it. But we pair the theatre interventions with experts who can answer questions about marital problems and people react well,” she explains.

Anti-female circumcision efforts are bearing some fruit. Sallab says that recent statistics show rates of female circumcision among young women between the ages of 15-17 have decreased from 2008 to 2014.

In 2008, 74 percent of young women between 15-17 were circumcised. In 2014, that figure decreased to 61 percent. She also says fewer women are saying they want to have to their daughters circumcised, with the Demographic Health Survey showing that 57.8 percent of women believed their daughters should be circumcised in 2014, compared to 82 percent in 1995.

*N.B: Although Mada Masr uses the term female circumcision to refer to the practice, Female Genital Mutilation (FGM) has been used in this piece in official job titles and quotations.