Female Genital Mutilation & Child ‘Marriage’, Covid-19, Climate Change – and War: an Economic Perspective (CSW66)

The sixty-sixth session of the Commission on the Status of Women (CSW66), a part of the United Nations organisation, takes place (largely via Zoom) from Monday 14 to Friday 25 March 2022. 

My colleagues Dr Lori Post, Dr Tobe Levin von Gleichen, Lorraine Koonce-Farahmand Esq and I presented a session moderated by WUNRN manager Lois Herman on Tuesday 15 March at 12 noon EST.   Our theme was ‘The Impacts of Climate and Covid on FGM and Child Marriage‘. 

My own contribution, entitled Female Genital Mutilation & Child ‘Marriage’, Covid19, Climate Change – and War: an Economic Perspective (below) focuses on the economics of these situations – an aspect not often so far examined, but one which I am convinced is critical to all serious endeavours to eradicate FGM, Child, Early and Forced Marriage and other harmful ‘traditional’ practices.

My particular paper follows below:

Female Genital Mutilation & Child ‘Marriage’, Covid19, Climate Change – and War:

an Economic Perspective

Female genital mutilation (FGM) is more than one thing.  It is an act which comes in many forms from the almost undetectable to the grimly lethal, it is one of the many so-called ‘harmful traditional practices’ – some of them actually very much contemporary – which are inflicted on girls and women (and some boys and men), and it is by any measure also an example of patriarchy incarnate, the imposition of (some) men’s will quite literally onto women’s and girls’ bodies.

Quite rightly, much attention has been paid to challenges around how to prevent FGM from occurring, and how to ameliorate the physical harm if it has occurred.  There are numerous projects and programmes at every level, from the most insular and local to the international and global.  Almost all these interventions have been instigated and led by some combination of community activists, health and education workers, policy-makers and civic leaders and politicians. Sometimes other concerned observers, writers, academics, perhaps anthropologists, have also become involved.

The costs in pain, human energy and other resources of FGM

Less frequently however are economists engaged in deliberations about FGM. 

It is routinely observed that the fathers of ‘cut’ girls can command a higher bride price than if these young women had evaded the knife. It is sometimes noted that girls who don’t have FGM are more likely to complete their education and achieve an autonomous, self-financing adulthood.  And some calculations have now been made to determine the costs of medical attention for victims of FGM. 

None of these considerations can be said seriously to comprise an economic analysis of FGM.  But as a global phenomenon – 30 million girls and women may experience it over the next decade – FGM  must surely be a significant factor in the financial and fiscal situations of many economies both local and national.

There is often clear economic motivation to deliver FGM from the perspectives of the family (especially the father, if he sells his daughter for more cows, cash etc if she is cut), and of the cutter him/herself (when this is done as a ‘professional’ service). And there are also others who benefit commercially in some instances, e.g. those who sell celebratory products such as food and clothing if  – where enforcement of prohibition even now remains weak or non-existent – the procedure is conducted with traditionally due ceremony.

I have argued elsewhere that the severe economic costs and consequences of FGM (and other harmful practices) must not be overlooked. The impact of the harm is seen in the funds required where medical treatment is available – an expenditure increasingly explored for instance by the World Health Organisation (WHO), which has recently (2020) developed an FGM Cost Calculator. To quote:

‘The FGM Cost Calculator combines data on health risk associated with FGM, health costs and national FGM prevalence to analyze the economic impact on national health services of treating the consequences of these harmful practices.

Health risk data were taken from a WHO database created for this analysis, pooling all available information from systematic reviews of health consequences of FGM. The following categories were used, each with a biological link to FGM: gynaecological, obstetric, urological, mental and sexual, as well as the immediate health complications that can result following the cutting.

To be included in the calculator, a health condition needed to show evidence of increased risk when comparing women with and without FGM. It also needed to have a treatment which could be implemented and costed in the health sector.’

Wider assessments, beyond the direct economic impacts of ill-health, of lost production and other economic opportunities are however hard (though just occasionally not impossible) to come by.

Amongst the costs of FGM which may be further incurred are those associated with the perennial suboptimal well-being of the woman herself.  She may be less able to tend adequately to her children, to the duties she has in her community, or even to the production of crops, other food and any items which comprise her small business if she has one.

Similarly, a woman who has had ‘the cut’ is likely to have received less education than one who has evaded it.  If such a woman cannot easily read and write, or conduct formal business, her capacity to earn a living, to support the education of her children, and even her everyday access to and negotiation of contemporary life may be severely compromised, wherever she lives.  She will likely find herself experiencing a life constrained by little autonomy, social capital or knowledge of how to cope with the wider world.

Much the same applies to the children of some women who have undergone FGM.  One of the greatest perils which young children face is maternal mortality, an outcome perhaps twice as likely after FGM as in intact women (see eg this report on maternal mortality in Sudan). The chances of infant mortality or death in the first few years is much higher for children whose mothers die soon after their children are born: in one study of maternal mortality (which focused particularly on HIV) it was found that children who experienced an early maternal death were at 15 times the risk of dying compared to children whose mother survived.

Another study in Kenya found that some 37% of live births to women who died of child-birth related causes survived their first year, compared to 65% of live births to a matched sample of women who died of non-child-birth causes, and 93% of live births to surviving women.

Presumably similar risks, whilst not quite as high, apply proportionately to children whose early years are blighted by invalid and unwell mothers, however much these women try to care for their infants.  It need hardly be said that infant and early years morbidity and mortality, like maternal death and ill-health, is a heavy burden both directly on the distressed families and communities affected, and on the economic welfare of those groupings.

On a larger and less personal socio-economic scale, even the production of food and the ownership of property and land may be predicated on FGM.  In some communities ‘uncut’ women are not permitted to handle food, or, for instance, to own land or benefit from inheritance; without FGM they have forever only the status of a child.  It seems that only those who have experienced intentional genital harm may engage fully with their families or in their societies.

Assessment of the ‘cost benefits’ of attaining adult status via FGM is beyond the scope of this current discussion, but there is here something of a conundrum: without FGM some women may not ever achieve recognised adulthood; but with it the functioning of their lives may be perpetually sub-optimal. 

The cost of property ownership to a cut adult woman may be a lifetime of pain and ill-health.  

The cost to societies of excluding uncut women may be the loss of their healthy and active engagement in their communities.

Further, disengagement can come at different levels. One emerging consideration in regard to FGM is that it can cause post-traumatic stress disorder (PTSD). This complex condition, usually arising from some sort of personal experience or assault, almost certainly affects many ‘victims’ or ‘survivors’ of genital mutilation; and one aspect of it is that such survivors are often highly suspicious of anyone who has not had their particular experience. Studies have shown, for instance, that US ‘vets’ (armed forces personnel) who have incurred PTSD are often unwilling to admit to their group anyone untouched by the condition. 

If the same exclusionary positioning of women who have experienced FGM is also the case, this may go some way, along with the matrilineal custom itself, to accounting both for the enduring strength of FGM sororities (‘sisterhoods’) in some communities, and for the active resistance to efforts towards eradication.

But there is also another, very unpleasant consideration in this exclusionary vein. Whilst there was for some while a debate about causation, it is now widely recognised that FGM is associated with one of the most distressing conditions a woman can experience: gynaecological and obstetric fistula may result either directly from their genital mutilation or from the early childbearing, by girls married off before their bodies have matured, which often accompanies that mutilation.

However such fistulae arise, they are, left unrepaired, amongst the most devastating ways to abandon a woman to a life quite likely broken by prostitution, destitution, despair and wretched pain.

Covid-19 and climate change amplify the personal and societal costs of FGM

In the light of the difficulties considered above, it might be thought there is little which could make the practice of FGM even worse; but a range of situations can do just that. These situations include epidemics, climate change – and war, which sometimes follows these other calamities; and all of these awful matters are more likely than ever before to have large-scale impact in our contemporary global world.

Covid-19

In alignment with this view, The Lancet summarises the impact of Covid-19 on FGM bluntly:

‘Worryingly, as the Covid-19 pandemic rages on, it is deepening inequalities, and it could soon have catastrophic effects on women and girls, as previous experience in responding to humanitarian crises and outbreaks has shown. The Covid-19 pandemic could exacerbate existing gender inequalities and increase the risk of gender-based violence.  School closures, movement restriction, and confinement hamper access to prevention, protection and care services…..

…. With less than a decade to go to achieve SDG 5.3 – to eliminate all harmful practices, such as child, early and forced marriage and FGM – we need annual monitoring and annual reviews to ensure that countries are held accountable for their progress….’

But will such monitoring and reviews actually happen? A look at the availability of data in the ‘global South’ simply for Covid-19 suggests probably not; and the chances of SDG 5.3 reaching its objective – the erasure of FGM by 2030 – seem to be diminishing rapidly.

It is widely accepted that the coronavirus (Covid-19) pandemic comprises a global catastrophe.  Although we cannot yet know the final toll, reports as at the end of February 2022 say that almost 6 million people across the globe are known to have died, and around 460 million people have had the disease.  Both these figures are thought to be severe underestimates

The global ‘excess death’ rate for 2021 shows that more people died in that year than can be explained even by Covid-19 mortality reports.  Some of this excess (real people, dying) can be accounted for by poor , or even zero, mortality reporting in various countries; and we have no way of knowing how much this has skewed the figures.  There is also however the issue of ‘Covid-19 related’ deaths, those whose actual cause of death was not Covid-19, but whose immune systems and general health were weakened by the virus, when another aspect of ill-health was also present. 

We know already that FGM probably has an impact on the health of many who have undergone it. One research programme which suggests that actual life expectancy is a few weeks less for women (mothers) with FGM indicates that genital mutilation is one contributory factor which influences morbidity rates. 

Whilst initial reports suggested that Covid-19 has had a lesser impact in the global South than in first world countries, it is more likely that this observed lesser incidence is due to under-reporting than to actually lower rates.  The WHO suggests that mortality rates for infectious illnesses generally are hugely under-reported in ‘resource poor settings where [there is] limited diagnostic capacity’.  Given this is so, it seems reasonable to suppose sub-optimal health because of FGM is also a contributory factor in the ‘excess deaths’ statistics. 

In short, FGM can give rise to lives blighted by ill-health (or at least sub-optimal health), which in turn may make for reduced capacity to survive infections such as Covid-19.

It is also possible that the psychological impacts of FGM sometimes give rise to defensive responses to illness. It is now widely acknowledged that veterans of violence / trauma in war are likely to bond in a way which precludes ‘outsiders’.  Whilst it seems there is as yet no specific research to confirm this supposition, it is quite possible that similar psycho-social dynamics apply also in some ‘FGM communities’.  The upshots of such bonding and exclusionary positioning in combination may well amplify the impacts of both FGM and Covid-19.

People under immediate threat tend to turn towards their own.  The pandemic leaves girls and women even more marginalized and vulnerable, particularly given that international travel restrictions have severely limited contact with external aid agencies.

We know already that, as schools are closed and protection from FGM reduces, as the need for income spurs the sale of girls for the child abuse which is early marriage (‘cut’ girls bring a higher price), as families struggle to feed their children and girls are married off (often as second or even more junior wives) to reduce the number of stomachs to fill, increasing numbers of girls are undergoing FGM. 

The rearing of girls is reverting to a ‘cash in hand’ business.  The prospect of a better income stream beckons if a girl’s education is put aside for immediate bride-price returns. In some areas FGM has become an even more signal event because, in the face of isolation from the wider world, the cutter provides an opportunity for families to meet up and get their daughters all ‘done’ together.

The upshot of all these damaging factors is this judgement by UNICEF of the increased incidence of FGM resulting from Covid-19:

‘Two million additional cases of female genital mutilation may occur over the next decade as COVID-19 shutters schools and disrupts programmes that help protect girls from this harmful practice.’

….. and that was the view back in March 2021.  The extended duration of the pandemic, and of the extended reversion to traditional ways, make it quite possible that UNICEF’s initial estimate now understates the pandemic-induced probable further harm of FGM, including a greater tendency to child / early ‘marriage’.

The commodification of girls as a source of family income continues apace.

Climate change

Like Covid-19, climate change as a result of global warming is already massively disrupting in many parts of the world. As we all know, the fundamental issue here is that ecological systems are becoming destabilised by temperatures rising almost everywhere, with the annual result that the natural ebb and flow of regional environments and the creatures and vegetations living in them are often now failing adequately to support that life.

The disruption of environments has many dimensions, but amongst the most immediately significant are flooding, drought, violent storms and failures of crops and food – all of which harm humans and other inter-dependent living creatures in a multitude of different ways.  Any one of these climate change upshots would be enough to cause chaos, but now they often come one after the other, affecting regional and local environments in many and unpredictable ways.

Fundamentally, however, the truth is that all these climate change phenomena are damaging, and all of them have the potential further to exacerbate and amplify the risk for girls and women who live in areas where FGM is practised.  Additionally, it is in locations such as – though not exclusively – parts of Africa that the dangers of climate change and FGM are both stark.  (It is a cruel irony that in regions such as Africa the impacts of climate change are currently most severe, but those responsible for causing the damage live far away.)

So how do climate change and other environmental crises affect FGM and child marriage?  The answer once again lies primarily in the economics of the situation. 

One aspect of food production of the global South such as some parts of Africa is that, whilst men and women alike may be farmers, a larger proportion of those women in employment outside the home are agricultural workers. Women often own much less land, and their ownership can be precarious, but they are thought to be more focused than men on the production of food for their families and communities. Nonetheless, women have less incentive, exacerbated sometimes by poor(er) education, than men to introduce methods of farming which increase production or mitigate against climate change: they have less access to finance for such improvements, and they also often have access to the land only whilst men permit it.  There is a constant risk for many women that if they do introduce improvements (such as terracing or fruit tree planting) that will be the trigger for men to reclaim ownership.

Inevitably environmental disruptors make it harder to produce food and other necessary products. Indeed, repeated severe draught or flooding can result in calamity: the ruination of agricultural businesses and even in no food at all. As The State of the Climate in Africa 2020 report tells us,

‘During 2020, the climate indicators in Africa were characterized by continued warming temperatures, accelerating sea-level rise, extreme weather and climate events, such as floods, landslides and droughts, and associated devastating impacts. The rapid shrinking of the last remaining glaciers in eastern Africa, which are expected to melt entirely in the near future, signals the threat of imminent and irreversible change to the Earth system…..

Africa is witnessing increased weather and climate variability, which leads to disasters and disruption of economic, ecological and social systems. By 2030, it is estimated that up to 118 million extremely poor people (i.e. living on less than US$ 1.90/day) will be exposed to drought, floods and extreme heat in Africa,  if adequate response measures are not put in place.’

As ever, women and children are in the greatest peril. Everyone is at risk, but women have fewer resources to draw upon and less authority to determine their futures than do men. Whole populations may find themselves under duress to migrate; but how, if you are a woman with children, can this be managed?

In such situations, with almost unthinkable obstacles to surmount, some women use the only commodity they have – their bodies. Prostitution and other exploitation and trafficking are situations arising from economic desperation but are sometimes the only means available to procure essential goods and services such as food and shelter.

At the same time, however, parents may consider the sale of their daughters in (early) marriage – another way to raise funds.  It is a sad irony that whilst women may be seeking to commodify their bodies in order to survive, they may also choose to commodify their daughters’ bodies for a higher price by inflicting FGM on them. Thus are women and girls reduced to chattels, items for sale at a price dictated by the market. 

Alternatively, if parents are afraid their daughters may be raped in destabilized times, FGM can become an attempted strategy to prevent (usually unsuccessfully) that risk. 

It seems there are few situations, in traditional thinking, where FGM is not at some level appropriate.

War

And so, via rape, we come to war. All the factors above which amplify the risk of FGM are relevant also in any combat situation.  Schools may close; paid work is hard to come by so other ways of raising funds must be found; food and other necessities may be scarce or insecure; enforcement of the laws which supposedly protect the vulnerable becomes difficult; previously productive land may be rendered unworkable; people may seek ways to signify their adherence to the group; and many people – often more women and children than men – will flee.  In such contexts the likelihood is that, if FGM has been an aspect of community life in earlier times, it may again come to the fore.

Even all this is not however everything that changes in hostilities. Beyond the ‘facts’ of war are the psychologies at play.  The desire of aggressors and instigators of war to ‘win’ at all costs almost predicates a machismo very dangerous to women and girls.  At such junctures FGM may become a resort of preference even where it had not been before; we have already noted that girls may be subjected to FGM as a way to ‘save’ them from rape. 

Beyond that however there is yet another hazard.  Whilst most female cutting is undertaken for ‘reasons’ around tradition and economic value, overt control and discipline is also a factor in some FGM events.  There are examples of this eg in the 2019 kidnapping by armed men of girls in Uganda, followed by forced FGM inflicted by traditional ‘cutters’. Likewise, we read the story of Karima Amin in Yemen, who, aged just seven, tried twice to escape FGM before a man and woman came very early one day to deliver the procedure:

‘The man told me he would punish me for all those times I ran away. He performed the worst type… (and) closed everything. I couldn’t even pee. He had to come back the next day to poke a hole so I could pee…  There were no repercussions. The man who did it to me was paid and he went on with his life.’

The claim that FGM is an ‘act of love’ [p.8] is by no means always true.  Combined then, as it may be, with actual conflicts or other contexts which are overtly hostile, FGM becomes very overtly an act of patriarchy incarnate, a matter of direct and violent subordination as well as of financial consequence within a wider patriarchal economy.

The economics

There are no easy answers to any of these matters.  One study which takes us a fair way is however the Building Bridges to End FGM publication Preventing and Responding to Female Genital Mutilation in Emergency and Humanitarian Contexts (December 2020). Along with important reports on the FGM situation in various parts of the world, it addresses its recommendations for action to a number of different interests and agencies, such as humanitarian actors, development actors, governments and donors, acknowledging as it does so that these various interests may have different timescales and objectives.

Even this report however brings more focus to the direct costs of EndFGM programmes than it does to the underlying truth, sometimes albeit in part acknowledged, that FGM is at base a matter of economics – often nonetheless most effectively lead by bespoke programmes of Public Health, which in its ideal form addresses all bases.

All the scenarios we have examined above require a degree of financial analysis much greater than simply direct costs.  The diktat ‘follow the money’ will be a critical and central element in finding ways at last to make FGM history.

We need to know far more about the full financial costs of FGM in each of the complex scenarios in which we have examined it: the damage to local and national economies in each case is surely much greater than ‘just’ the costs of medical treatment, schools to support girls fleeing FGM, exacerbated ill health where FGM combines with Covid-19, lost food production or providing places of safety for those who have to migrate because of climate change.

The first step must be to recognise all the factors involved in the inter-twining threads of FGM and other misfortunes; and after that real attempts must be made to put figures to the actual, inclusive economic costs incurred. 

I have suggested elsewhere that one step in this direction might be to instigate an Economic Deficit Index for FGM, incorporating measures relating to human capital, sustainable development and land.

Only after such indices and measures are developed can we turn with real evidence of socio-economic harm to decision-makers who have many other matters as well as FGM to concern them; only then can we show that – ‘even’ humanitarian concerns apart – neither  our communities and society, nor the women and girls so gratuitously harmed, can afford to tolerate FGM any longer.

This isn’t just a matter of earnest campaigning, absolutely vital though that is.  It’s also an issue which strikes at the heart of how we make the future better for us all.  Ending FGM is a challenge of the utmost urgency for the most senior politicians and opinion-leaders in the places it blights.

Female genital mutilation is now widely and rightly recognised as a fundamental national issue of health, well-being and human rights. 

But it is also necessarily a pressing matter of high fiscal policy – the use of government spending and taxation to influence the economy, typically to promote strong and sustainable growth and reduce poverty. 

There are few intentional actions by real people, influences on the human condition of hundreds of millions of others, which could improve lives as much as the eradication of FGM.

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Read more about FGM and Economics 

and about Child, Early and Forced Marriage (CEFM)

 

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

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Books by Hilary Burrage on female genital mutilation

https://orcid.org/0000-0002-6684-2740

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.

FURTHER INFORMATION AND ACTION

There is a free FGM hotline for anyone in the UK: 0800 028 3550, or email: fgmhelp@nspcc.org.uk

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.

Twitter accounts:          

@NoFGM_UK  @NoFGMBookUK   @FemaleMutlnBook  @FGMStatement   @NoFGM_USA @NoFGM_Kenya and @StopMGM.

Facebook page: #NoFGM – a crime against humanity

Email contact: via Hilary