FGM: Geopolitics (Precarious Economies, Water), Fragile Contexts, And Child Stunting. Some Questions

FGM must be understood within wider geopolitical and ‘fragile’ contexts — especially poverty, rural economies, migration, and water scarcity — rather than as isolated cultural practices.  Consideration is required of how these conditions (including economic precariousness, limited education, and gender inequality) sustain the practice. There are potentially important under-researched intergenerational impacts, particularly possible connections between FGM, maternal health, and child stunting.  Interdisciplinary research and policies that integrate public health, economics, and gender analysis are needed.  Why, we must ask, do such critical structural factors remain largely overlooked?

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Much has been learned over the past half-century about the violence against women and girls which is female genital mutilation (FGM).  Less focus has been brought however onto the wider contexts of this harmful practice, or onto issues around the longer-term, inter-generational impacts on children born to women who have been ‘cut’. These are matters I examine in this paper, for the Colloquium on Female Genital Mutilation at Lady Margaret Hall, University of Oxford, on 5 June 2026.

The time has come to consider more closely geopolitical and ‘fragile’ or precarious contexts such as rural economies, and water, and inter-generational impacts such as likely child stunting.  Why have these matters been so little investigated?  And what might we learn if we delved further?

So, what is geopolitics, and why might we chose to consider it from a feminist perspective?

The case for adopting such a vantage point is well made by Dowler and Sharp (2025), who argue (in summary) that geopolitics can be seen in two main ways: the classical view, which centres state power, territory, and geography; or the critical view, which focuses on discourse and ideology in global politics. Both have often reflected masculinist and patriarchal priorities.  This is why a feminist geopolitics is needed to shift attention from state security to human security, especially for women, girls, and marginalised groups, focusing on gender justice and human security.

As Hyndman (2016) had previously explained, feminist geopolitics is not an alternative theory of geopolitics, nor the ushering in of a new spatial order, but is an approach to global issues with feminist politics in mind.  This perspective has generally been employed to consider large-scale political geographies (nation states etc), but could perhaps also be used to consider more specific aspects of geography and topography.

How the ‘land lies’ and how it is changing are, I’d suggest, often unremarked issues, especially for women and children with no power to influence (or even recognise?) how these critical factors shape their lives.

Translating the perceptions of such a geopolitic onto FGM in precarious or subaltern local economies (insofar as either of these terms adequately describes those economies), and then onto water as a commodity, brings a number of matters to the fore:

Rural (and sunken industrialised) precarious local economies

We know that FGM occurs mostly – but of course not always – in locations where people are poor and low levels of education are common.   This is true both for agrarian economies in the Global South, and for locations in otherwise advanced economies where poverty and isolation from the mainstream persist.

In these contexts much is made by EndFGM activists and others of the need for education; and indeed that is a critically vital requirement for ‘progress’.

What is less frequently acknowledged however is that ‘education’ should not be only an avenue to ‘better jobs’ in more advantaged towns and cities. Rural areas and other economically disadvantaged locations – including in the Global North – also need better educated, more formally informed citizens.  There must surely be a focus also on how to strengthen impoverished communities ‘at home’, as well as opportunities in the alluring metropolises.

It is likely that not all who seek better education want to leave the locations where they were born.  Local economies may also offer ways in which better literacy and business skills can be put to good use enabling women and girls in their traditional activities.  In agrarian communities, basic IT skills and proper access to the web (with e.g. money to charge appliances and not via husbands’ phones) can help improve agricultural practices and conservation, just as a better understanding of the law can help secure women’s rights to land.

Likewise, in disadvantaged Western communities it is important to ensure that no girl becomes lost to the system, disappearing into what some describe as an ‘enclave‘, perhaps an ‘underclass’ where school seems irrelevant and the future is limited by early marriage within a confined community, rather than by investment in learning, to benefit from future opportunities.

In both some rural and some disadvantaged urban contexts the focus may be on getting girls married, rather than ‘educated’; and that traditional-facing focus may in turn lead to FGM as a way of increasing the ‘value’ of girls as commodities for purchase as (young) brides.

Migrants and refugees:  Unfortunately however there is also another, increasingly large, group of women and girls who are severely under-served by education, economic opportunity and health care: these are migrants and refugees (women and men) who have had to flee their homes, often their countries, as a result of famine, war / hostilities or the global phenomenon of climate change.

The Health and Well-Being of Women and Girls Who Are Refugees: A Case for Action (2025) tells us that

Refugee women and girls face serious and interconnected health challenges due to forced displacement, limited access to healthcare, gender-based violence, exploitation, and other factors affecting their health and well-being, particularly social determinants of health. These experiences are often built upon intergenerational forms of abuse such as enduring colonial and patriarchal models where there are fundamental power imbalances and impediments to economic and political stability and as a consequence health and well-being. One in five displaced women and girls experiences sexual violence, which has lasting effects on their physical and mental health. Moreover, financial instability and uncertainty in migration status can further push women and girls into exploitative circumstances, such as modern slavery and survival sex.

A 2024 report focusing on the UK reinforces the message that FGM and its risks are not ‘only’ a problem in global regions such as central Africa:  Female genital mutilation, asylum seekers and refugees: the need for an integrated UK policy agenda tell us that

A group at particular risk, especially in largely monocultural areas outside London to which refugees are being dispersed, are girls and women who have undergone, or are at risk of undergoing, female genital mutilation (FGM)….   As a result of migration and refugee flows, the practice of FGM has now extended beyond the 28 African countries in which it is traditionally practised… 

The OECD (Organisation for Economic Co-operation and Development) is a forum and knowledge hub for data, analysis and best practices in public policy. Its Multidimensional Fragility Framework assesses a context’s fragility based on 56 quantitative indicators of risk and resilience across six core dimensions:  economic, environmental, human, political, security and societal, providing the analytical foundation for the OECD’s flagship States of Fragility reports.   The 2022 OECD Report addresses the ‘human’ dimension directly and examines How Fragile Contexts Affect The Well-being And Potential Of Women And Girls.  Key Messages are

• Adding the human dimension to the OECD multidimensional fragility framework casts new light on the determining role that health, education and other factors have on women and girls’ experiences in fragile contexts.
• Compared to other developing countries, women and girls in fragile contexts
> are more exposed to distinct health risks, such as maternal mortality, female genital mutilation and early pregnancies;
> tend to have lower educational outcomes –out of discrimination but also as a consequence of higher health risks– with significant impact on the health, cognitive and socio-behavioural development of their children;
> experience higher levels of gender discrimination, lower access to social protection, worse working conditions and lower pay, which further impedes translating their human capital into empowerment.
• The frequency of crises and conflicts in fragile contexts further exposes women and girls to forced / child marriage, unpaid economic participation, and sexual and gender-based violence.
• Fragility holds back women’s economic empowerment, and better human capital outcomes for the current and the next generation.

Fragility as a concept is probably very helpful in considering the vulnerabilities of girls and women who may experience FGM, but whilst FGM is, as above, occasionally referenced in respect of the OECD framework, it is not currently a prime focus of this perspective.  The present discussion has focused on refugees and asylum seekers, but these are not alone the people who experience contextual fragility, as our consideration of women and girls in difficult agrarian contexts, or in ‘excluded’ urban locations has shown.

In similar ways, the issue of water availability is at present only peripherally linked with FGM as a traditional behaviour, but there may be important reasons why it might overtly be so contextualised:

Water

The literature on water as a direct influence on the prevalence of FGM is at best thin.  It is considered in this blogpost World Water Day – And Why It matters For #EndFGM, which I wrote in 2024.  The hard evidence for a connection between water and FGM is slight, but it surely needs more attention?

Water is one of the most fundamental requirements for human life, but for many millions of people, most of them women, acquiring it continues to be an enormous expenditure of time and energy.  Women and girls around the world spend at least a collective 200 million hours collecting water each day.  (The United Nations World Water Development Report 2026 tells us that the estimated number of hours spent every day collecting water has now been increased to 250 million.)

Nonetheless, in June 2014 ReliefWeb published an intriguing news report entitled Improved Access to Water May Hold the Solution to Ending FGM in Africa, in which research by Ugandan Gwada Okot Tao, suggests that the incidence of FGM in Africa could be linked to water.

Gwada, who conducted research among 20 ethnic groups across Africa, including Kenya, Zimbabwe, Tanzania, Uganda, Ghana, and South Africa, says that ethnic communities that practice FGM in Africa can be found in areas where access to water supplies are problematic – and perhaps also where issues around personal hygiene are pressing.  He found that in Kenya, for example, only three of the East African nation’s 63 ethnic groups did not practice any form of ‘circumcision’. And these three communities were found in the Rift Valley region, where there are water bodies like lakes and rivers.

So where is the follow-up research on this potentially critical finding?

As The Lancet (2023) reports, the issues are in any case complex and relate closely both to women’s health and, importantly, also to the lack of value attached to their work:

In most countries, managing and safeguarding domestic water relies on women’s unpaid work. This is also true of many proposed solutions, allowing them to appear falsely low-cost, cementing existing inequalities, and blunting the potential for water research, policy, and practice to support both gender equality and safe drinking water for all.

It might seem that water is a matter relegated to women’s work, but not worthy of much enquiry in respect of their well-being.  To summarise the International Water Management Institute, 200 million hours is the equivalent of 100,000 people working full-time for an entire year.

… and that wasted time and energy is before any consideration also of whether easily available clean water is a factor in lessening the chances of FGM, and thereby also lessening the likelihood of poor health because of that damage.

Geopolitics is the context

Whether we consider the fragility of agri-enterprises run by vulnerable women, or, for some, their entrapment in isolated city enclaves, or the enormity of issues concerning water, the reality is the same.

Of course by no means all women and girls who experience FGM are in such precarious or fragile positions.  Some become proud survivors, working hard to stop FGM from harming any more women, and some just pursue their lives as ordinary citizens like anyone else; but perhaps many more simply continue to exist, silent and invisible, as best they can, their bodies damaged, and victims of a crime that should never have happened.

Whatever, we know that overall women and girls who experience FGM face the prospect of more ill-health throughout their lives than those, overall, who are not ‘cut’; and that condition has many costs, both personal and societal.  As the World Health Organisation report, Female Genital Mutilation Hurts Women and Economies (2020), tells us, “FGM is not only a catastrophic abuse of human rights that significantly harms the physical and mental health of millions of girls and women; it is also a drain on a country’s vital economic resources.”

This situation – damage to both persons and to their economies, with increased likely risk because of overlooked locational features – is surely geopolitics at its most basic?

Child stunting

We have considered child stunting and its measurement in previous posts on this website, e.g. Stunted Children: A Global Tragedy. Does FGM Amplify It?  (2024)

The World Health Organisation defines children as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median.   Stunting often indicates that a child’s nutrition is inadequate, and their likely prospects limited.  It’s about health, life experiences and expectancy, well-being and capacity to contribute to society – all vital issues in a rapidly changing world.

Inevitably, stunting condition affects many more children in the ‘Global South’ – those for instance in India (35.7% of under-5s) and Sub-Saharan Africa (33.6% of under-5s) – than in modern western countries; and it also occurs more frequently when a mother (or expectant mother) suffers from anaemia or other health disadvantage.  And, as the UNFPA reports, anaemia (alongside such horrifying damage as obstetric fistula – a condition to which (small and) child brides are particularly vulnerable) is one noted consequence of FGM.

A ‘footnote’ on child stunting in one Asian country may however be of relevance here, examining the practice of chhaupadi – the traditional requirement in Nepal (amongst other locations) that menstruating women seclude themselves away from their villages.

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A 2022 research paper tells us that

… the relationship between mother’s seclusion during menstruation and children’s health has not been previously evaluated. This is an important omission because children in Nepal are among the most vulnerable in the world. Under-five mortality is 25 deaths per 1000 live births, and 15% children are born with a low birth weight. The children are severely malnourished, with 36% children below five stunted and 10% wasted. The extent to which discriminatory practices against women, such as chhaupadi, worsen child health outcomes is [was] not known….

This study however suggests that mothers’ exposure to extreme chhaupadi seclusion during menstruation was associated with 0.18 standard deviation lower height-for-age z-scores (HAZ) and 0.20 standard deviation lower weight-for-age z-scores (WAZ) among children, and the negative association was stronger when women stayed in animal sheds—0.28 SD (standard deviations)  for HAZ and 0.32 SD for WAZ—than when they stayed in separate huts.

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The chhaupadi research paper also reports on several other factors which influence the health of infants, but for our current focus perhaps these data suffice.

Here was a study where various ‘accommodations’ of women during their menstrual cycles are measured against the longer-term well-being of their infants.  And a likely indicative correlation is found on this evidence to exist between these factors.  The basic reproductive functioning of women in these communities shaped, by common social understandings, their behaviours: although almost all probably did not wish to observe chhaupadi, they did so; and to an extent that enforced practice had a likely deleterious impact of their infants’ health.

Maternal anaemia and child stunting:  It may or may not be surprising that so little is known definitively about chhaupadi and its consequences, but another, large-scale study maternal and infant health (published in 2023) brings into focus a much more widely considered aspect of obstetrics and paediatrics: that of maternal anaemia and child stunting.

Nadhiroh, Michaela, Tung and Kustiawan, the authors of this paper, observed that the relationship between maternal anemia and stunting in children is (still) not well defined. Their systematic literature review therefore sought to determine whether maternal anemia was associated with height or length and stunting conditions in infants and children ages 0–60 months and measuring the physical dimensions and composition of the human body- outcomes for 195,024 children under five in India and 202,557 children under five in Sub-Saharan Africa.

Nine (of twelve) studies examined the correlation between maternal anemia and length or weight in children. Seven of the nine studies showed an association between maternal anemia and stunting in children; the others showed an association between maternal anemia and birth length. Nine out of 12 studies therefore showed that a mother with low haemoglobin (i.e. anaemia) was at risk of delivering a newborn with stunted growth.

Obstetric fistula and maternal height:  Another study also leads to matters of serious concern.  This research, reported in 2011, examined the correlations of obstetric fistula and maternal and infant outcomes in 19 selected studies, 15 reports from sub-Saharan Africa and 4 from the Middle East.  Tragically, many of the mothers were teenagers, and there was a very high incidence of infant mortality.

The authors of this research, Pierre Marie Tebeu et al,  observed that ‘the data on risk factors for obstetrical fistula are controversial‘ – this was before it was more widely acknowledged that FGM might be a cause of fistula – and in fact FGM as such is not actually mentioned.  But there is one potentially very significant specific finding;  many of the obstetric fistula patients were shorter than 150 cm tall.

And many of these ‘short’ women were from locations where the tradition of FGM has been observed for centuries. Which may lead us to ask if having FGM, being short and having very fragile babies are related?  We cannot know, from the data directly to hand, but it might be surmised that FGM is one causal factor in child stunting (and, so sadly, also in frequent infant death), and that this condition is handed down via generations of women who have experienced FGM and who were themselves stunted and fragile children?

And of course these infants born to ‘stunted’ mothers are both girls and boys – who likewise both grow up to be less able to engage in and contribute to their communities than would optimally be the case.  One study of stunting reported (2019) that it is associated with

…  significant long-term impact in adulthood in the form of reduced cognitive and physical development, higher risk of metabolic disease, and reduced work productivity that might potentially harm future economic growth at national level …. Globally, stunting affected 161 million children under five years old in 2013, mostly in low-middle income countries.

Another report (2016) tells us:

As for the economic impact, the World Bank estimates show that a 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in economic productivity.

Everyone loses when stunting occurs: infants and children, boys and girls, families, communities and even national economies are all negatively impacted.

We can ask questions galore about why and how? The specifics are however of less import in this particular debate than the general thrust of enquiry.

The big questions

After numerous important, well-funded, studies and such a long time during which the realities of FGM have been understood, it is difficult to understand why there are still so few clear answers to some fundamental questions.

As examples:

Why are there almost no studies of possible connections in relevant contexts between clean water availability and FGM?

Why are we still poorly informed about the likely criticality for women farmers of effective supported practices and autonomy – less need to depend on marriage and men – in their lives?

Why are the impacts of climate change on FGM practices mostly ignored?

Why are we not sharply alert to issues around girls ‘falling out’ of school in ‘deprived’ urban enclaves?

Why are the wider economic impacts of FGM not persistently considered?

Why are the perils of FGM to forcibly migrant / asylum-seeking women and their children so disregarded?

Why is there still a reluctance to acknowledge the highly probably connection between FGM and obstetric fistula?

Why (extraordinarily?) are there no definitive studies of inter-generational child stunting and FGM?

Why do politicians and policy officials (mostly men?) not insist on better insights?

Everyone can add their own particular questions to this list, but answers to all such queries are urgently required.

Even if ‘the evidence’ is not yet absolutely clear, should not the precautionary principle suggest we take note of, and cautions against, some of these factors?

Activists, campaigners and survivors on the ground are delivering everything they can, but by our inaction or lack of curiosity we are letting them down; their efforts, whilst essential, are, it seems on current ‘progress’, not enough alone and unsupported to end FGM forever.

A public health / socio-economic / political approach is essential if eradication is to be secured on a longer-term basis. As some of us have insisted for the past decade and more, such an approach must be built on a much wider and deeper understanding of how FGM and other violence against women and girls is sustained.

It is high time for the establishment of FGM Studies as a serious discipline, bringing together all aspects of this hideous global crime against quite literally hundreds of millions of women and girls.  So which institution, where, will be brave enough to step up?

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What Is Female Genital Mutilation (FGM)? The Enduring Data And Debates 

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Your Comments (see as below) on this topic are welcome.  
Please post them in the Reply box which follows at the very end of 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
Ashgate / Routledge (2015)  Reviews

A free internet version of the book Female Mutilation is available

here.

[It is hoped that putting all these global Female Mutilation narrations onto the internet will enable readers to consider them via Google Translate in whatever language they choose.]

Hilary has published widely and has also contributed two chapters to Routledge International Handbooks:

Female Genital Mutilation and Genital Surgeries: Chapter 33,
in Routledge International Handbook of Women’s Sexual and Reproductive Health (2019),
eds Jane M. Ussher, Joan C. Chrisler, Janette Perz
and
FGM Studies: Economics, Public Health, and Societal Well-Being: Chapter 12,
in The Routledge International Handbook on Harmful Cultural Practices (2023),
eds Maria Jaschok, U. H. Ruhina Jesmin, Tobe Levin von Gleichen, Comfort Momoh

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PLEASE NOTE:

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. ‘FGM’ is therefore the term I use here  – 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.

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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, except if in any specifics as discussed above.

Anyone wishing to offer additional comment on more general considerations around male 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.