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Joining The Dots: Why FGM Studies Must Be Part Of All Relevant Professional Curricula – As The Covid-19 Pandemic Shows

December 10, 2020

Thursday 10  December 2020 was the final event in the Kings College, London Autumn series of presentations on Patriarchal Inscriptions.  My own contribution that day concerned the urgent need for an academic field of ‘FGM Studies’.
It is a truism that ‘science’ sees only what it chooses to consider.  The current Covid-19 pandemic (70+m cases) has received many multiples of the resources available to address FGM (200+m cases). Further, subject disciplines (e.g. Public Health, if not Epidemiology as such) which illuminate disadvantage are  less likely to gain political favour. Reflecting on this, I called my talk

Going solo, passing the buck or joining the dots?
Why a multi-disciplinary curriculum is essential in professional training (and practice) to eradicate female genital mutilation.

The current Covid-19 pandemic offers an opportunity to explore and compare the differences in approach between an acute viral epidemic and an enduring, entirely human agency / socially activated one such as female genital mutilation (FGM). It is nonetheless vital that both be addressed.

There are several conclusions which may be drawn from comparing work to halt Covid-19 and FGM, not least that

  • some human health and socio-economic conditions receive more public recognition and resourcing than others;
  • laboratory scientific research is infinitely better geared and ready to tackle viral infections, than is so-called ‘social medicine’ to resolve dis-ease arising solely from intentional human agency;
  • cross-disciplinary laboratory research is of more interest to more people (workers, politicians and the public) than is the less dramatic issue-by-issue unpicking of ‘social agency’ problems by public health specialists;
  • research and other work by agencies (such as public health) which shine a light on inequalities and harm may find their discipline under-resourced, a ‘Cinderella science’; politicians rarely much appreciate consistent effort to disclose systematic disadvantage.

All these observations can be applied in respect of gender, ethnicity, age, status and location, if we compare global and national efforts to address Covid-19 and FGM.

It is time for those in different disciplines who are concerned with eradicating FGM to gear up effectively to joint working, and to insist that the suffering and socio-economic damage of FGM is as valid an area of endeavor as any other field of epidemiology and public health.

A discussion in The Economist is not the most likely place to start of a discussion about FGM),but that is where we begin today.  The 2020 November 14-20th edition of this magazine carries an article on the ‘rocky relationship’ between economists and epidemiologists as they seek to make sense of the current Covid-19 global pandemic.

‘… when economists venture into other academic areas,’ we are told, ‘their arrival often looks more like a clumsy invasion force than a helpful diplomatic mission.’

On the other hand, however, I have recently been exploring how to evaluate the economic impacts of FGM, and am keenly aware that economists can indeed add value to the real-life and urgent challenges which, just as in FGM, the Covid-19 pandemic presents us:

Confounding uncertainty [in the modelling of the epidemic] notwithstanding, and assessing how the pandemic is reshaping the global economy, scholars have worked at great speed, producing hundreds of papers evaluating policy measures, analysing the economic costs associated with outbreaks and lockdowns…’

But let us extrapolate from immediate questions around Economics and Covid-19, and agree that all contexts in which harm to health from a single identifiable cause occurs are in fact epidemics* – and thereby a concern of Public Health.  This is true whether the immediate cause of the harm is a virus (e.g. the coronavirus), or a tradition of gendered harm (e.g. FGM).
(*We will reserve a discussion about the extent to which ‘social diseases’ are perceived as medical ‘epidemics’ for another time.)

The above commentary however illuminates an important point: whilst there is nothing in the field of public health which can be resolved via the perspective of only one academic or scientific discipline, there are also some very important obstacles to be overcome before effective synergies between different approaches to complex public health challenges can be developed.


Many aspects, many levels
So at what levels can the understanding and eradication of FGM be approached?  Here are some of them:

  • Personal
  • Community
  • Medical
  • Health
  • Social
  • Faith / belief
  • Economic
  • Educational
  • Legal
  • Activist / campaigner
  • Policy
  • National (political)
  • International
  • Global / human rights

It is of course immediately obvious that some of these perspectives or approaches gel uneasily, if at all, with others; and whilst this discontinuity does not apply solely to FGM, the chasm between various understandings is exacerbated by the self-evident fact that FGM is a deeply personal matter, as well as a formal concern.

FGM is, after all, the epitome of the claim  that the ‘personal is political’ – it is one of the most literal and fundamentally harmful acts of patriarchy incarnate: the physical imposition of (some) men’s will on the bodies of girls and women.

Whilst, then, FGM is necessarily a matter for serious academic research, it is also an issue with very pressing and immediate consequences.   Bringing these disparate perspectives into alignment is not always easy.


But to begin at the beginning….
A girl (or sometimes woman) is subjected to FGM.  This can only happen when someone decides it must be done, i.e. via human agency; FGM never occurs because of ‘contagion’ or ‘accident’ in the infectious disease sense.  It is always a consequence of conscious choice – including, in some cases, that of the person on whom the FGM is inflicted.

All may not however be what it seems.  The likelihood that FGM can be stopped / prevented simply by asking people not to do it is often close to zero.  There are many and varied perspectives to consider:

Immediate stakeholders
The person actually implementing FGM has an important stakehold in the event – often personal financial and status, frequently community pressure, and sometimes also fear of relatives or others, alive or dead.

The person undergoing FGM often has some agency too – maybe just fear, community pressure or the promise of gifts, but also quite often a sense of duty and family loyalty, or desire to be accorded ‘adult’ status.

Others in the community may also have compelling reasons (alongside ‘tradition’), to permit or encourage continuation of the practice of FGM, for instance:  community identity (sometimes even stronger in diaspora communities), the place FGM has in the economic cycle of the community, the requirement for the girl to attain adulthood (without which she sometimes cannot own land or have any adult status, regardless of her age), the idea that FGM will ‘protect’ the girl from gendered violence in war zones, even the belief that FGM will somehow enhance fertility or provide ‘proof’ of virginity (which is so valued in agreeing bride price).

Any single one of these rationales to promote FGM – themselves only exemplar of the multitude of ‘reasons’ which crop up – requires thorough examination in the context of the many circumstances in which it may occur.  Furthermore, in each instance it is quite possible that the driving forces behind the act of FGM are will vary, perhaps over time as well as in different socio-economic and legal-political environments.

Already we have touched on personal, community and economic factors which may sustain FGM, with many more questions to ask, than clear answers and explanations to offer, concerning what FGM is actually about.

Health / care
Moving from direct engagement in FGM to issues around health care, we see another complex situation:

Here we have clinicians and other researchers world-wide who know with absolute certainty that FGM does not enhance health, or fertility, or any other medical condition.  FGM is harmful both physically and, often, also to resilience and psychological health.  It is damaging (and sometimes lethal) in the short, medium and long-term; and it can easily spill over in its consequences to hurting other family and community members as well.

Yet, on the one hand we have ‘traditional cutters’ who regard FGM as both a regular source of income and a requirement for girls to attain ‘purity’ and adulthood, and, on the other hand, clinicians – mostly but not always in nations transitioning from the developing world to the ‘modern’ world of hi-tech science – who sell their services as de facto mutilators who operate hygienically and provide pain relief… not to mention a small minority of first world physicians and other clinical staff who claim that ‘just a nick’ (by them) will prevent more substantial harm, and / or who (questionably) maintain that the procedure they deliver is ‘only’ genital cosmetic surgery and thereby permissible by law.

The rationales behind traditional ‘cutting’, as well as the complexities of modern apparent justifications for FGM, are myriad. As with much else concerning the eradication of FGM, the law and other formal EndFGM positions are largely disconnected from what happens on the ground…

…  which takes us to those who work to stop FGM in communities, whether in historically ‘cutting’ locations, or the variously located diaspora communities.

Approaches to end FGM may include parents, siblings (including brothers) and family, the ‘cutters’ themselves, community and faith / belief leaders, schools, the media at many levels, local and national politicians, and policy implementation, including NGOs (non-governmental organisations) which may control funding for a variety of beneficial or charitable programmes.

But whether the pressure to stop FGM is applied by local activists or by higher authorities, there is always the chance that what seems to be cessation is in reality just successful clandestine delivery of FGM away from ‘prying’ neighbourly or official eyes.  In any case that pressure may be half-hearted at best.

In some communities a girl’s loss of ‘purity’ will result locally also in the loss of bride price for the father and his family; or the higher-level political demand that FGM be stopped may be tokenistic because a politician wants to seem in favour of eradication so that s/he can draw down charitable funding, but they also don’t want to risk their political standing in pro-FGM communities.  Politics is in truth, they would maintain, the art of the possible.

How does a genuine campaigner, perhaps linking FGM eradication to more schooling for girls, and better health, cope with these significant disincentives to EndFGM?  How can the edict that only ‘cut’ women may own their own resources and land (for farming) be weighed against the implied prospect of a good education and future job, with self-determination for the adult woman?  What of the accusation that girls in the diaspora who remain uncut are defying their ancestors and their cultural identity?  How is the charge that white western women are permitted cosmetic genital surgery, but women of colour from other parts of the world are punished for FGM to be addressed?

The permutations of claim and counter-claim in this contested field are many, and the risks to those, often seriously under-supported and resourced, who campaign with commitment may be real.

We have already seen that politicians seeking the eradication of FGM may, in some places, be compromised by the ever-present need to keep their electorate onside.  Nonetheless, it is politicians who in the end make laws, and these laws are the rules by which the police and other enforcers then maintain order.

Like all other citizens, however, the police are instruments of their time and place. We know law enforcement action  may be shaped by perceptions of gender and ‘race’ everywhere, including in first world countries, so it is unsurprising that enforcing the law against FGM is also subject to particular understandings and varying levels of prioritisation – not to mention sometimes genuine concerns about the consequences, going forward, for others in the family or community when enforcement is severe; but it is also evident that the desire to enforce eradication is often solid and genuine.

What may be less clear is how (and which) various aspects of civic society must align in different circumstances for effective action on FGM eradication to emerge.


More questions than answers
Observations and commentaries such as above could keep coming, but perhaps the point is made: Female genital mutilation is a very complex issue and one for which every bit of knowledge gained gives rise to many questions still to be answered.

It is of course true that much has been learnt.  Indeed,  organisations such as UNICEF and UNFPA have produced impressive numbers of reports and data on FPA in many countries over recent years.  Just as examples:

Female genital mutilation (FGM)   (February 2020)

Accelerating Change – UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation Annual Report 2018  (September 2019)

UNFPA-UNICEF Joint Programme to Eliminate Female Genital Mutilation  (August 2019)
[49 Tweets / 458 Facebook posts  / 28  emails]

Similar work has been undertaken by the World Bank:

Female genital mutilation prevalence (%)   (August 2020)

Compendium of International and National Legal Frameworks on Female Genital Mutilation  (February 2020)

Ending FGM: The Role of Laws, Education and Social Norms  (February 2018)

Interventions to Prevent or Reduce Violence Against Women and Girls : A Systematic Review of Reviews  (2014)
[Abstract views 2,509 / Downloads 1,637]

…  and there are also scores of other significant international agencies, NGOs and similar organisations which also produce important reports and analyses of FGM incidence, trends and determining factors in many parts of the world.

But how much traction do these reports actually have?  Whilst we cannot know the extent of distribution of these documents in other formats, two of those above indicate show how often they have been shared on social media: the UNICEF paper has it seems been shared a total of 535 times, and the WHO one has been downloaded 1,637 times, with 2,509 views of the abstract.   To a very large extent, however, these exact figures of themselves are not important.: 200 million women and girls alive today have probably experienced FGM, yet just a relatively minute handful of people are reading the reports which tell us what is becoming known about this practice.

Similarly with the actual data.  The Accelerating Change – UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation Annual Report 2018report  (also above) tells us that

In 2018, the Joint Programme’s concerted effort to replicate and scale up proven interventions – as well as introduce innovations to enhance programme impact – paid off, as evidenced by the following accomplishments:

  • 131 arrests, 123 cases brought to court and 30 convictions and sanctions;
  • 2,455 communities made public declarations of abandonment of FGM;
  • 83,068 girls benefited from a capacity-building package and, in 4,258 communities, girls became agents of change after completing this package;
  • 560,271 girls and women received health services related to FGM, 231,375 receive social services and 83,812 receive legal services.

Every single contribution to an individual in the shadow of FGM is important, but at best these ‘accomplishments’ look in need of improvement against the enormity of the challenge.  And 30 convictions or sanctions across such a large programme leaves much to be still achieved (as, regrettably, does the sole successful prosecution in England, where perhaps 140,000 girls and women have been ‘cut’).  In the global context of 200 million women and girls with FGM who are currently alive, and the projected 3 million more who will have it in each of the next ten years, these kinds of figures for success look puny.

Nobody doubts the genuine desire for progress of all concerned with researching and producing these and many other reports.  Every publication tells us much that would help many people working to end FGM.

The problem is that perhaps not enough people ‘on the ground’ know that the information is there to be considered and translated into action.  This again is no-one’s ‘fault’; but it may be because there are particular challenges in disseminating knowledge about such a complex phenomenon across such a wide range of disciples and programmes.

And yes, there are numerous guides, handbooks, on-line courses and other resources to train professionals combatting FGM in hospitals, schools, courts of law etc, some of them even, like the WHO and UNFPA material, free to access at no cost.  But still progress on eradication is very slow.


Who needs to know … what?
As a whole efforts to eradicate FGM remain significantly disjointed.

Many of the agencies, organisations and activists sharing this objective are set in direct competition with each other, sometimes even in the same location.  Some of these agents of change are well resourced and powerful; some are effectively lone voices.  In some instances action is thoughtfully co-ordinated; in other cases there is barely even communication between different co-existing projects.  The underlying philosophies and frameworks of different programmes may vary substantially.

To a degree these disparities are not important.  The midwife delivering a baby whose birth is obstructed by FGM needs clinical skills, not a degree in anthropology.  The community activist has a much greater need to understand and have the trust of her/his community, than to have knowledge of international positions on human rights.  The teacher seeking to keep his/her girl students in school doesn’t require a degree in law – just as a police officer has no necessity to have a detailed grasp of de-infibulation.  Religious leaders require more rigorously valid insights into the scriptures than into strategies for the delivery of health care.

Each agent to their own expertise is the first step in tackling FGM; but that alone is not enough.  Even if FGM were easily comparable to a viral epidemic, and even if by some miracle that epidemic could be halted by production of a single vaccine, the currently disjointed collection of separate disciplines and endeavours around EndFGM would not be able to deliver the required resolution of the problem.

Contemporary clinical treatments arise only from the conjunction of multifaceted teams of highly skilled individuals, and even after that first stage strategies for delivering the treatment will require complicated teamwork bringing together many other practitioners with skills and resources in completely different, often non-clinical, fields of expertise.

FGM has a critical commonality when it is imposed – it damages the person concerned and is a fundamental abuse of her human rights – but it does not have a single genesis or vector for via which it ‘travels’.   The complexities of FGM are inescapable and the diversity of type and approach of the agents of change towards eradication are huge.

It is unsurprising that generalised entreaties by professional leads, politicians and policy makers to ‘work together’ to end FGM via ‘multi-agency’ guidelines have not alone been entirely successful.

In short, efforts to end FGM are increasing and commendably sincere, but they may fall short when it comes to coalescence.  The ‘multi-agency’ approach alone may be more an exercise in passing the buck, than in tackling the roots of the problem.


Joined up thinking – and questions
Much joined up thinking and enquiry remains to be done.  Not enough of us are looking to bring together the knowledge, expertise, insights and tools that between us all we have.

As I suggested in my paper of May 2019:  ‘End Female Genital Mutilation Programmes: Research And Evaluation’, it might even be said that not enough of us are asking the awkward questions:

  • Why did this work, but that didn’t?
  • Will this strategy or approach deliver a better outcome than that one?
  • Indeed, do we even have tools to tell us whether X or Y will have a greater impact, and on what elements of the challenge?
  • Are we actually clear about what factors in a given situation are most likely to be ameliorated by such-and-such an approach?
  • And have we actually identified which of the critical elements of any particular FGM scenario are most susceptible, and to what degree, if we use a given technique or approach?

Whist it is certainly the case that some researchers and programme leaders are asking these questions, their answers are not getting through to many ‘on the ground’.  Still too much is taken as given and not enough is routinely interrogated – not least because there may be no-one with the skills and resources available to do so.  No-one doubts that best intentions are evident, and that everyone is taking the actions to end FGM that they believe most effective in their specific contexts, but sometimes the action is grounded in little more than a hunch and / or whatever tools and expertise are available in that context at that time.

As we saw in a previous presentation today (Chappell et al, ‘Morbidity due to Female Genital Mutilation (FGM): A Scoping Review’), even questions such as the degree to which FGM of various sorts causes ill-health still remain to be answered definitely.  There are, as the UK Royal College of Gynaecologists 2015 Green-top Guideline No.53, ‘Female Genital Mutilation and its Management’, suggests, many matters which need to be resolved:

Recommendations for future research

  • The rates of stillbirth and neonatal death in women with FGM.
  • Interventional trials to assess the role of de-infibulation in improving pregnancy outcomes and the optimal timing of de-infibulation.
  • Clinical trials to investigate the safety and effectiveness of clitoral reconstruction.
  • The role of psychological assessment and treatment in the antenatal care of women with FGM. (p.18)

…  and these are ‘just’ the clinical questions, before we start to ask about the relative efficacy, in various contexts, of education, religious leaders, legal frameworks and socio-economic impacts etc.


Research: a help, not a hindrance
It can be claimed with some justification that the need to end FGM is urgent and there is little time, money or energy to spare immediately for research, evaluation and interrogation of action in hard-pressed communities.  Nor do I suggest that this as such should happen.

Rather, perhaps, the omissions I observe might be repaired if FGM became a subject or discipline in its own right, as many other aspects of academic and research study have done. Dialogue between the different aspects of FGM go along their own routes, almost in silos from other ways of seeing the issues; and where the interconnections do exists, they are more likely to be found in textbooks with a separate chapter on each:  Medicine; Education; Law; Sociology; Economics….

As I amongst others have argued, there needs to be a way to bring the logic and rigour of epidemiology to the service of community health – which I would suggest is in its public health guise the currently most promising way to bring together the various issues around FGM which we must address.

For sustainable progress we must ascertain not only what the various actors and agents should best do ‘on the ground’ at any given point, but also on what basis this ‘technical’ guidance is given, when it is appropriate, and how we can ensure the chosen action or technique will provide the most effective outcomes moving forward.

Yes, there are of course excellent summaries around FGM in many different places – the incidence and type of FGM, who deems (or does not deem) it necessary and why, the position of those in positions of power in the locale or country, availability of support for eradication and so forth…  but these critical items of information often lie in isolation to a wider framework drawing all available threads together.

The time is now well due for development of a framework or even paradigm into which can be fitted all that we know about FGM, how programmes to eradicate it are being conducted, to what degree they are currently effective, how the dynamics of any given community may change as FGM becomes history, and who decides what may or may not be done to this end.

In short, what is required is an additional level of FGM and its impacts and challenges.  Science, and academia generally, will not know what is not chosen to be examined; and the choices on the agenda are set by people who, like all of us, have particular concerns and motivations.  It is time to join the dots, to develop the field or discipline of FGM Studies, as both a research enterprise and, equally importantly, as a part of the curriculum, at whatever level is appropriate, in relevant training, undergraduate and post-graduate courses.


Bringing focus
As noted at the beginning of this discussion, an issue such as FGM requires action on many different levels, by different sorts of people, in many different modes.  All these ways of facing up to FGM are essential and every one of these approaches can easily be justified, at least on a case study basis.

Nonetheless, the absence of a dedicated academic field, FGM Studies (or however it is labelled), surely makes effective co-ordination and meaningful measurement of the impacts of the EndFGM enterprise more difficult?

To those on the ground in any context questions around comparative outcomes may be peripheral; the drive is simply to stop FGM as much as possible, and (often) to offer more positive and promising ways forward for (especially) the girls in that community.  Let us take as given that no-one wants to place any obstacles in the way of such ambitions.

Genuine and pressing efforts to eradicate FGM do however use resources, skills and goodwill of many sorts, so it would seem evident that freely available information about what works best in various situations and locations would be helpful.  It is here that the difference between approaches to research into specific discipline-defined (for instance, medical) questions, and research into wider context issues (such as the rationales for FGM) will diverge.  In the former example clinical expertise takes the lead; in the latter, a whole range of academic fields may come into play.

There is however little inter-disciplinary research around FGM.  Yes, professional and voluntary organisations in various countries may produce joint guidance on addressing particular aspects of FGM, but this guidance is on procedures and about e.g. information about legal requirements. Such knowledge at the technical level; it is not a route to exploratory and open-ended questioning of what happens and why, or even of the efficacy of the prescribed ways forward.

People dealing with FGM ‘on the ground’ cannot be expected to investigate and scrutinise everything they are involved in, but the need for such investigations and scrutiny is still there. At the moment such enquiries are generally conducted only by very high level bodies who may then publish weighty documents (in full, printer-ink-expensive, colour) on their websites. Propagation of information in the reports is likewise at a generally high level.  It tends to reach influential policy makers, but remains largely unremarked at the day-to-day level.

As work on FGM – with still 3,000,000 additional sufferers every year – develops, it is essential that what is known is better shared, and that research is likewise coherently developed and shared.  This can only happen when the required knowledge and research questions are brought into sharp focus through academic endeavour.

That is why the introduction of FGM Studies into relevant professional and training courses everywhere, probably within the wider framework of human rights and gendered violence, is so important.  To deal with an abuse as widespread as FGM clear focus is required, and that is what a named discipline can provide.


Questions for FGM Studies
So let us imagine that FGM Studies – or a subsection, re FGM, of Gender (not just Women’s) Studies – is introduced as a routine required / mandatory element of appropriate training, academic and professional courses.  What might it cover?

Others will ultimately decide, but I would include, at whatever level of detail is appropriate, all standard aspects of the issue: Health, Socio-economic, Legal, Educational etc.

But I would also include

  1. different perspectives on FGM eradication, and which ‘fits’ what situation,
  2. case studies which illustrate varied approaches to eradication in different contexts,
  3. formal information / guidance on how to find out more at a global as well as a local / national level,
  4. and, very importantly, guidance on the monitoring and evaluation of EndFGM programmes.

From all this I would hope, too, to see a much more active interest in identifying the gaps in our understanding and knowledge – not only bringing together what across the board is known, but also routine interrogation of that knowledge, to bring themes and threads together, and to learn more about the optimum ways to make FGM (and as far as possible other gendered violence) history.

Such interrogation will probably be largely the task of academics in many parts of the world.  Others on the front-line may well be involved, and perfectly capable of such research, but , whilst it is vital that their experience is shared and their perceptions understood, their time and resources are already stretched. At the very least, external support for any such ‘on the ground’ research will be required.

And this is in fact another reason for formalising FGM Studies: more academics, from more perspectives and more disciples, standing at a distance, may have the space to ask wider-ranging questions, to spend time to interrogate and piece together the evidence from different corners of the action…

There is an urgent need to create a paradigm for FGM which brings together the multiple layers and paradoxes of this most chameleon harmful practice – a practice which, in the words of the Kenyan prosecutor Christine Nanjala-Ndenga, ‘… is struggling to remain relevant and as a result [..] keeps on changing every single day.’


Comparison with Covid-19
It is worth noting once again that there are an estimated 200,000,000 women and girls alive today who have experienced FGM, and another 3,000,000 are expected to undergo the ‘procedure’ in each of the next ten years.

But whilst there is not, and should not be, any element of academic-disciplinary ‘competition‘  in comparing the proliferation of different sorts of threats to health, ‘virus versus intentional human agency’, one contemporary context might be that as we reach the end of 2020 the global incidence of Covid-19 is approaching 70,000,000 confirmed cases, with about recorded 1,600,000 deaths.

Thanks to anticipated vaccines the incidence of Covid-19 is in fact expected to reduce dramatically in the next year or two, and for most people across the globe a full recovery is expected.  The damage is not usually permanent and it will become a relatively controlled condition.  (Nonetheless, in both overall Covid-19  cases, and Covid-19 deaths, there are probably many more unrecorded instances, particularly in the developing world; and yes, some of the impacts of Covid-19 have also been gender-specific. In summary, more men die; more women are impoverished.)

Does this comparison between the epidemics of Covid-19 and FGM tell us anything?  Perhaps it does; for instance:

  • Covid-19 is a viral condition, easily contextualised by epidemiologists and clinicians; FGM results from a different sort of contagion – human agency (less easy to contextualise coherently). But nor is FGM much of a priority for leading public health practitioners.
  • Covid-19 has come from ‘nowhere’ (though virologists are less surprised than the rest of us); FGM is a perennial ‘plague’, for which vaccination c.f. Covid-19 cannot ever be the dramatic and (rightly) acclaimed response.  Despite contemporary debates about vaccination, changing minds about FGM requires much more effort to change cultures / traditions on a personal level.
  • Covid-19 can harm anyone, no-one knows if they are ‘next’; FGM harms ‘only’ generally defenceless girls and young women who (mostly) live in places ‘far away’ from first world locations, where a full medical response is in any case almost impossible. FGM is not a threat to many mainstream westerners.
  • Covid-19 is known to kill more older, minority ethnic minority men (and to cause most long-term harm to more older women), but initial effective reach of current vaccination programmes is likely to be less impoverished white people.  FGM rarely occurs in wealthier white communities.

These observations may lead us to conclude that, yet again, serious medical (and related) responses to major health crises will, at least initially, almost always serve certain sections of the community better than other sections.

We can debate at some later date the relative responsibilities of clinicians, researchers, commercial pharma companies and politicians for this uneven response, but what is immediately clear is that efforts to eradicate FGM – 200,00,000 sufferers, with another 3,000,000 more annually for the foreseeable future – have been far less well funded and supported than efforts to control Covid-19 – 70,000,000 sufferers so far, and expected to drop year-on-year.

Let me say again, this is absolutely not a competition.  All serious ill-health and suffering is a matter of valid concern.  But if we look we will see disparities in the way these different harmful conditions have been approached.  And we are entitled to ask ‘why?’.


Public Health
Nonetheless, along with the many obvious well-embedded biases in the responses by powerful people to different human conditions, there is another, albeit still connected, issue:

Covid-19 could be tackled immediately because every element of the required response was already available as an academic field – virology, epidemiology, big pharma development, economic, legal and social structures; all could be brought into play immediately.  But none of these fields has been geared up to provide synergy within a detectable framework to eradicate FGM. Virologists and epidemiologists expect to be part of a much bigger team. with partners they already know well.  FGM activists often have no such expectation.

There is however one academic / research field which has the capacity to address both conditions, but has not as yet been brought fully into play.  That is the ‘Cinderella’ science of Public Health.

In various first world countries (including Britain) Public Health has been significantly downgraded over recent years, and in many developing nations this field does not currently have the required capacity to be effective.  In the first world – which would ideally inform the work also of less advantaged countries – this has been a deliberate political choice: Public Health has the impacts of poverty and disadvantage as a major theme.

Perhaps we should ask if it is expedient for politicians to leave the ‘subversive’ focus of Public Health with as little real support and influence as possible?  Is this too cynical?


As we have seen, one difference between responses to, say, Covid-19 and FGM, is that there exists no previously existing academic field honed to consider FGM.  There is apparently little urgency where it matters when it comes to FGM.

Some of this is hesitancy about (or simple refusal to consider) FGM can be attributed directly to funding, but much of it is also around a lack of inter-disciplinary organisation to address the issues.  If it’s not asked for, it won’t be forthcoming. Funding will not arrive gratuitously.

FGM is an enduring and fundamental assault on human rights, for some a desperately sad life-changing experience, a practice which changes the dynamics of whole communities, and a massive economic cost at every level of society.

A meaningful challenge to FGM requires acknowledgement that it is a stark exemplar of patriarchy incarnate:  the imposition of (some) men’s will on female bodies. And it requires too as much concern for human rights in other parts of the globe, as in the first world.

The good news is that, if they wished, academics in (relatively) privileged positions could do much to make FGM the focus of concern to which 200,000,000-and-rising women are entitled.

Multi-agency ‘guidelines’, at whatever level of application, are no substitute for genuine enquiry and serious impact assessments. Despite best intentions, they may even result in turf wars.

Obstacles to genuine interdisciplinary collaboration such as those identified in the Economist commentary (above) must be recognised and addressed. Priorities for focus and academic prestige differ by discipline, but a field of study should not exist just to enhance the stature of those who subscribe to it.


FGM Studies as a clearly defined discipline
The time has come for the development, across boundaries of discipline and geography, of an academic discipline of impactful FGM Studies, to be shared across the relevant curricula and beyond that, to those who work so hard ‘on the ground’.

How should we do this? Who will join us?

If you would like to contact me directly about this paper, or are interested in development of an

                Association for Female Genital Mutilation Studies (AFGeMS)

please contact me via email here.

~ ~ ~ ~ ~

Read more about FGM and Economics

Read more about Public Health

Read more about Research 

Read Hilary’s published paper on Epidemiology and community health: a strained connection?

Your Comments on this topic are welcome. 
Please post them in the box which follows these announcements…..

~ ~ ~ ~ ~

Books by Hilary Burrage on female genital mutilation

18.04.12 FGM books together IMG_3336 (3).JPG

Eradicating Female Genital Mutilation: A UK Perspective (Hilary Burrage, Ashgate / Routledge 2015).
Full contents and reviews   HERE.
FEMALE MUTILATION: The truth behind the horrifying global practice of female genital mutilation  (Hilary Burrage, New Holland Publishers 2016).
Full contents and reviews   HERE.


There is a free FGM hotline for anyone in the UK: 0800 028 3550, or

Details of NHS Specialist Services for FGM here.

More info and posts on FGM here.

Activists, service providers and researchers may like to join the LinkedIn group Female Genital Mutilation (FGM): Information, reports and research, which has several hundred members from around the world.

The (free) #NoFGM Daily News carries reports of all items shared on Twitter that day about FGM – brings many organisations and developments into focus.

Also available to follow at no cost or obligation is the #NoFGM_USA Daily News.

Twitter accounts:          @NoFGM_UK  @NoFGMBookUK @FemaleMutlnBook  @FGMStatement  @NoFGM_USA @NoFGM_Kenya  @NoFGM_France  @GuardianEndFGM [tag for all: #NoFGM] and @StopMGM.

Facebook page: #NoFGM – a crime against humanity

Email contact: via Hilary


[NB The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, which has a primary focus on FGM, is clear that in formal discourse any term other than ‘mutilation’ concedes damagingly to the cultural relativists – though the terms employed may of necessity vary in informal discussion with those who by tradition use alternative vocabulary. See the Feminist Statement on the Naming and Abolition of Female Genital Mutilation,  The Bamako Declaration: Female Genital Mutilation Terminology and the debate about Anthr/Apologists on this website.]


This article concerns approaches to the eradication specifically of FGM.  I am also categorically opposed to MGM, but that is not the focus of this particular piece.

Anyone wishing to offer additional comment on more general considerations around infant and juvenile genital mutilation is asked please to do so via these relevant dedicated threads.

Discussion of the general issues re M/FGM will not be published unless they are posted on these dedicated pages. Thanks.

One Comment leave one →
  1. Von Gleichen, Tobe Levin permalink
    December 11, 2020 17:07

    Dear Hilary,
    Wonderful presentation and post. It was a perfect wrap-up. Thanks so much …
    Very warmly,

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