Ablation of female genitalia: how should we talk about it?

Seated next to Efua Dorkenoo OBE for the regional Conference of the Inter-African Committee on Traditional Practices affecting the Health of Women and Children, 17-21 November 1997 in Dakar, Senegal, I reported on efforts in Germany to end FGM. At the time, my sponsoring association was (I)ntact, headquartered in Saarbrücken, born in 1996. At the urging of Efua Dorkenoo, FORWARD in Germany would be founded in Frankfurt am Main in 1998.


TODAY, October 19, from 5 p.m. to 7 p.m. CET, a webinar will find me sharing the podium with journalist Günter Haverkamp, director of FRIEDENSBAND and Round Tables in North-Rhine Westphalia that, at regular intervals, attract delegates from more than thirty anti-FGM NGOs in Germany. Our subject this afternoon? A point of incessant debate: how do we talk about FGM? What terminology is most effective? Is it mutilation in preference to circumcision, cutting, or, in any of the myriad tongues of practitioners, ‘sunna’, gudniin, tahur, bolokoli, halalays, megrez, khitan, and so forth, each term eliciting emotions, often conflicting, of accomplishment, pride, or horror, none easily conveyed in a foreign idiom.

Therefore, let’s acknowledge the elephant in the room. Disagreement occurs in former colonizers’ languages and owes a lot to English and French terminology. For instance, ‘Beschneidung’ is ‘circumcision’ in German, the same word for women and men though the procedures obviously differ. Many German-speaking campaigners even today prefer this generic — despite its inaccuracy vis-à-vis females–, to the concept mutilation, in German Verstümmelung, judged harsh or uncharitable, especially by survivors whose feelings count.

As a non-native speaker of German (I acquired it only in my mid-twenties), I’m unprepared to comment on the affective connotations of Verstümmelung. The French avoid the dilemma by agreeing to use the medical term for ablation: excision, which means slicing off flesh. (In Khady’s words: unable to slash it off in one go, the cutter was obliged to saw.)

Khady (Koita) published Mutilée in 2005. Within months the memoir was translated into a dozen languages but would wait 4 1/2 years before becoming available in English. UnCUT/VOICES Press was founded to bring this book and its impressive fight against FGM to Anglophone readers. Khady. Blood Stains. A Child of Africa Reclaims Her Human Rights. Trans. Tobe Levin. UnCUT/VOICES Press, 2010. You can find a German version on Amazon.


In English, ‘mutilation’, whose use I unequivocally support (i.e. in German Verstümmelung), is in fact, like the French, a medical term and is preferred by consensus of major global players, among them the UN and the IAC, even if context requires flexibility.

Concerning context(s), discussion is either private — between a survivor and her therapist, doctor or advisor — or public and formal.

In private, it should go without saying, tact dictates tone. It is recommended to use, at first, the word for the thing that comes naturally to the patient or client.

Public representations of the ‘event’ however do and, likely should, differ. Many who defer to courtesy in private wish in public to stress the resonance of medical accuracy. There is no gainsaying that amputating — chopping off, in the words of numerous survivors’ memoirs and novels — a healthy organ for cultural reasons is medically-defined as mutilation.

Here’s Merriam-Webster’s dictionary definition of ‘mutilation’: “deprivation of a limb or essential part especially by excision” [https://www.merriam-webster.com Accessed 18 October 2022].

Is the clitoris not an ‘essential part’?

How provocative in answering this (non-rhetorical) question is a headline in the New York Times published only two days ago. “Half the World Has a Clitoris. Why Don’t Doctors Study It?” [by Rachel E. Gross nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html]. For one thing, upwards of 200 million women have had theirs snatched (to use one of the less gruesome terms). The fact that such an article doesn’t mention FGM at all — has the author never heard of it? — seems to underscore the need to attract attention to an immorally-neglected transgression. Gross writes about a US physician billed as an exception to indifference: “Today, Dr. Rubin has appointed herself Washington’s premier ‘clitorologist’. The joke, of course, is that few are vying for the title — out of embarrassment, a lack of knowledge or fear of breaching propriety with patients.”  

Broadly speaking for the USA, Gross is right, but her research is dangerously narrow, even jingoistic despite a cursory glance at Australia. Had she merely looked eastward, she would have found a global movement to end FGM that includes institutions dedicated to the clitoris. Dr. Pierre Foldes and his Women Safe in Saint-Germain-en-Laye, for one; the Desert Flower Clinic in Berlin, for another; The Rose Clinic under Dr. Brenda Kelly in Oxford for a third, and the list goes on. Burkina Faso, for instance, also boasts successful clitoris restoration as does a student of Foldes, Dr. Marci Bowers, who performs reconstruction in San Francisco.

I mention these establishments under the microscope of terminology because they offer reparation for mutilation. They represent the institutional face of the debate.

My reasons for espousing, with vehemence, the accurate medical term are, however, admittedly subjective. I began working to end FGM in 1977. I therefore draw on more than four and a half decades of experience; have made many friends among campaigners over the long haul; and have been privy to private communication among experts that, to my knowledge, has yet to be made public concerning the evolution of vocabulary.

As a guest in the mid-1990s at FORWARD’s board meeting in London, I shot this photo of Adwoa Kluvitze, Efua Dorkenoo OBE, and Comfort Ottah. They advocate using the term FGM.

Briefly, in the mid-90s Efua Dorkenoo, with whom I began working in 1980, was head-hunted from FORWARD, the association against FGM she founded in 1982 (registered in 1983), by the World Health Organization in Geneva and tasked with writing the first global guidelines to end FGM. We had a long phone conversation in the late 1990s during which she told me she had left WHO (and was then working in S. Africa) in protest against pressure from an American woman of European descent at the UN in NY who threatened to cut off funding if she (Efua) persisted in using the term ‘female genital mutilation’ instead of calling it ‘cutting’. Extortion?

In 1985 at the UN End-of-Decade for women conference in Nairobi, the Inter-African Committee, newly founded in 1984, presented itself in a series of workshops. Here we see delegates (clockwise) authors Dr. Nawal el Saadawi, Awa Thiam, and Nawal again with her daughter Mona, also an author. Photo credits: Tobe Levin


The above example of neo-colonial interference is not hearsay for it is alluded to in the wording of the Inter-African Committee’s powerful statement on terminology.

As that institution describes it, the term ‘female genital mutilation’ was adopted in 1990 by the Inter-African Committee (IAC) on Traditional Practices Affecting the Health of Women and Children, and in 1991 the World Health Organization (WHO) recommended that the United Nations adopt it as well.  It has now been confirmed by the United Nations and the World Health Organisation.  The turning point in this debate was the Bamako Declaration of 6 April 2005, issued by the sixth General Assembly of the IAC, in Mali.

As Hilary Burrage reminds us, “it is important to acknowledge the Bamako message, an edited (abbreviated) version of which follows.” Equally of note, February 6th, now the day specifically dedicated to ending ‘female genital mutilation’, was initiated as an explicit reaction to efforts aimed at diluting terminology.

Wednesday 6 April 2005, Bamako, Mali

… An issue of concern at the 6th General Assembly … has been attempts to dilute the terminology Female Genital Mutilation (FGM) and replace it with the following: “Female Circumcision,” “Female Genital Alteration,” … “Female Genital Surgery,” and more recently “Female Genital Cutting” (FGC). … Female Genital Cutting (FGC) does not reflect the accurate extent of harm and mutilation caused by all types of FGM. This terminology has been adopted by some UN specialized agencies and bi-lateral donors … influenced by specific lobby groups largely based in western countries.

These changes trivialize the nature of female genital mutilation and the suffering of African women and girls[and] … made without  consultation, [they] override the consensus reached by African women in the front line of the campaign as well as the … millions of African girls and women who suffer in silence. 

We want the world to know that in 1990 African women … adopted the term FGM at the IAC General Assembly in Addis Ababa, Ethiopia. They took this brave step to confront the issue head on with their practicing communities.

[Why? To avoid confusion, to emphasize] the nature and gravity of the practice; to recognize that [only] a [continuing and painful] struggle [can alter] the mentality and behaviours of African people, [yet to insist] that this pain [is] integral to [empower] girls and women … to address FGM [and to take] control of their sexuality and reproductive rights. … 

Experience indicates that long-term change occurs [only] when change agents help communities to go through this painful process. Not to confront the issue is to [promote] denial of the gravity of FGM, thus resulting in mere transient change… .

We recognize that while it may be less threatening for non-Africans to adopt other less confrontational terminology in order to enter into dialogue with communities, it is imperative that the term FGM [be] retained. 

The term FGM is not judgemental. It is instead a medical term that reflects what is done to the genitalia of girls and women. It is a cultural reality. Mutilation is the removal of healthy tissue. The fact that the term makes some people uneasy is no justification for its abandonment.

We would highlight that … FGM was adopted [by] consultation and consensus [among …] African experts [at] the first technical working group meeting held in Geneva in 1995 and gained … world-wide currency and acceptance. The Beijing conference also adopted and used … female genital mutilation. … FGM has been adopted and endorsed by the European Union [and] the African Union; [it] is currently utilized in all their documentation including the most recent Additional Protocol to the African Charter on Human and Peoples’ Rights, on the Rights of Women [Maputo].

At the first general meeting of Terre des Femmes in the spring of 1983 in Frankfurt, another of my houseguests, Awa Thiam had been invited as keynote speaker. In the photo are, l to r, Ingrid Staehle, Terre des Femmes founder; Awa Thiam and Dr. Tobe Levin. Terre des Femmes also uses FGM.

While we appreciate the efforts made in response to FGM on the continent and the Diaspora, it is patronizing and belittling to African women and girls to have outsiders define their oppression. Indeed what gives anyone but Africans the right to change a term agreed upon by the largest group of African activists on this issue in the world? This is at best paternalism and is a sad reflection of how, after many years of African women working against FGM … when FGM was a taboo, the campaign has been high-jacked by others … not involved at the beginning and who do not appreciate the nature of the struggle.

  1. We, the participants at the 6th IAC General Assembly, demand a halt to this drift towards trivializing the traditional practice by adopting a subtle terminology.
  2. We demand that all organizations and international bodies revert to the terminology adopted by the IAC in 1990, and reinforced in 2002.
  3. We demand that international agencies recognize the right of NGO’s in the field to continue to use FGM and not to be denied funding because of this.
  4. We demand that the voices of African women be heard and that their call to action against FGM [be] heeded.

The word ‘mutilation’ is, therefore, employed in formal contexts, as the World Health Organisation Interagency Statement  explains, because by definition (as above) it emphasises the gravity of the act.

Dr. Asma el Dareer, an early pioneer against FGM with her 1983 book, predating action around preferable terminology, Woman, Why Do You Weep? Circumcision and Its Consequences (London, Zed Press) was my houseguest in Frankfurt in 1991.

In sum, I have supported the IAC since its inception in 1984, and the IAC, I’m convinced, is among the world’s leading authorities on the subject. My use of their terminology acknowledges — and honors — the sacrifices their members have made and, above all, the courage they show. To do otherwise would feel like betrayal, as though I supported those they describe as applying (neo)imperial pressure, as lacking longevity in the struggle, and as ‘patronizing and belittling’ their efforts. Moreover, many of those who inspire my agreement have been subjected to harassment and violence, as, for instance, related to me by Dr. Olayinka Koso-Thomas of Sierra Leone whose office was ransacked by FGM-supporters; Berhane Ras-Work, first IAC president who has been spat upon for her engagement as was her successor, Mariam Lamizana; or Awa Thiam, author in 1978 of La Parole aux négresses, a feminist manifesto against excision, who has been insulted as well. American author Alice Walker, whose novel Possessing the Secret of Joy (1992) and accompanying video (1993) also incurred opprobrium, in my view undeserved, which set the US movement back a generation — as we sense from the article in the New York Times quoted above from October 17, 2022 — and the date’s not a typo.

If you have witnessed clitoridectomy, excision or infibulation, I needn’t remind you that ‘torture’ covers it. And clearly, no matter what you call it, you want it to stop. Our disagreements concern strategy, not the end-game. But each activist must choose her (or his) alliances. Whose lead will you follow? Here are a few among my many mentors.

While Khady speaks at the HRC in Geneva in 2012, Alvilda Jablonko, Efua, and Berhane Ras-Work listen.
FORWARD in Germany, answering the phone in 2006, found Ambassador Fatoumata Siré Diakité on the line. She joined us, becoming one of our most active members and had a profound influence on me. In Bamako, I was her houseguest. She died on 14 October 2016 — much too soon, at 64.
As guests of the Embassy of Mali in Berlin, in 2011, I am with the Ambassador (right) and Dr. Pierrette Herzberger-Fofana MEP (left), co-founder of FORWARD in Germany (now FORWARD for Women, e.V.) and another of my mentors. Pierrette has just published a brochure titled Female Genital Mutilation (FGM) and Human Rights, — a ‘pre-book’ I call it, since we plan to turn it into a volume on FGM in Germany — a copy of which was presented to the President of Ethiopia during the recent visit by a European Union Parliamentary delegation (September 2022).
Dr. Morissanda Kouyaté at the Commission on the Status Women, March 2013, attending the EuroNet FGM panel. Before becoming the Minister of Foreign Affairs of the Republic of Guinea (he serves at present), he headed the IAC and, whenever asked to voice an opinion on terminology, he waxes eloquent in defence of calling it by its name, ‘mutilation’.
Finally, here is the EuroNet FGM General Assembly hosted by FORWARD for Women, e.V. in 2012, bringing together many of the activists who have inspired me. The German FORWARD’s managing director, also a dear mentor, is at right, kneeling in the first row, Dr. Mariame Racine Sow.

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