Introduction
Lotte Hughes, Mark Lamont, Katy Newell-Jones and Damaris Parsitau
The issue of female genital mutilation/cutting (FGM/C) has become a cause célèbre in recent decades, both within regions of the world where FGM/C is practised, and globally. While it is primarily practised in Africa, the Middle East, and Asia, it is also practised in Western countries in some immigrant communities, and girls are sometimes sent briefly back to Africa to undergo FGM/C. Global migration has made it an international phenomenon. This is why, in a book on African issues, we also include discussion of FGM/C in the diaspora.
At least 230 million women and girls alive today have undergone FGM/C.
1WHO 2025: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation [Accessed 16 August 2025]. It is known to reduce the life chances of substantial numbers of girls and women, and to cause significant harm and sometimes death. While FGM/C sparks public outrage and shock among a wide range of actors, with zero tolerance levied towards these practices and even attempts to rationalise or explain them, some take the position of cultural relativism (see the textboxes on zero tolerance, p. 00, and cultural relativism, p. 00). An example of this is anthropologist Richard Shweder, who calls this public ‘disgust and anxiety’ over FGM/C a ‘mutual yuck response’ (Shweder 2000:216).
Blanket condemnation of FGM/C is not helpful; some would argue that it is counterproductive. To understand why people continue practising FGM/C, and find ways of ending or reducing it, one must first understand what it means to those who practise it. Furthermore, one must also understand what it means in the context of different ethnic communities. With so much emphasis placed on the physical cut in anti-FGM/C campaigns and interventions, deeper nuanced socio-historical-ethnographic contextualisation can sometimes be lost. We are more concerned in this volume with examining the social relations in which FGM/C is embedded, and the discourses around the practice and campaigns against it. Overall, we take a holistic approach to FGM/C that includes many different viewpoints, not least those of community members. Where possible, their voices will be featured. Some readers may find some of our authors’ views controversial. As editors we are aware of the likelihood of generating controversy (see ‘Axes of Difference’, towards the end of this Introduction, which identifies and discusses some of the main areas of contention). Controversy, though challenging, can be used to create an important space for open dialogue and the respectful exchange of views, which is what we intend here.
We do not discuss the origins of FGM/C; this has been speculated upon by many other authors (e.g. Boyle 2005; Gruenbaum and Ahmed 2022; Lightfoot-Klein 1989; Mackie 1996; Shell-Duncan and Hernlund 2000). Suffice to say there is some evidence that points to female genital cutting having been practised in ancient Egypt as long ago as the second century BC, and that it spread from there to Sudan, where the term pharaonic circumcision refers to its pharaonic historical legacy (Boddy 1989:51; Gruenbaum and Ahmed 2022).
Terminology
Before we discuss the issue and wider debates, it is necessary to explain the debate about terminology and the contentiousness that surrounds it (e.g. see Boyle 2005; Gruenbaum 2001; Shell-Duncan and Hernlund 2000; Abusharaf 2006 on terms for FGM/C in local African languages). Several terms are used to describe the practice of altering female genitalia. Most commonly used are female circumcision (FC), female genital mutilation (FGM), female genital cutting (FGC), and the hybrid term FGM/C. ‘The cut’ and ‘cutting’ are often used colloquially. Some scholars (including some contributors to this book) prefer ‘female genital modification’ (FGMo). Those using the term FGM, i.e. labelling all FGM/C as mutilation, argue that it is important to be uncompromising in one’s opposition to a practice that causes considerable physical and mental harm to large numbers of girls and women, affecting their life chances and quality of life.
2Scholars are not agreed on who first coined the term. David Anderson writes that it was medical missionary Dr John Arthur of the Church of Scotland who first appears to have used the word ‘mutilation’ to describe clitoridectomy in colonial Kenya (2018:10). These missionaries would have examined genital cutting through a biblical lens, in particular the ways in which male circumcision became a divisive issue in the early church. The New Testament word peritomē (Greek) meant ‘circumcision’, but in Philippians 3:2 Paul contemptuously called those urging Gentiles to be cut as belonging to the katatomē, which the King James Bible translates as ‘concision’, meaning a destructive slicing. Later bible translations render ‘concision’ as ‘mutilation’. Those using the term FGC tend to argue that the word ‘cutting’ more accurately reflects changes in the type of cut undergone by many young girls, is less judgmental, consequently leads to greater dialogue in practising communities, and hence opens the space for movement towards abandonment. In communities in transition from infibulation (see the WHO’s classification of types, textbox p. 00) to other forms of cutting, the term FGM is sometimes seen as referring only to the most invasive forms. In this book the editors have chosen to use the hybrid term FGM/C, while recognising its limitations. Individual chapter authors have used their preferred terms, hence the range of terms used across this book. (For more on terminology, see ‘Axes of Difference’ towards the end of this Introduction.)
The World Health Organization (WHO) uses the term FGM and defines it in this way:
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice has no health benefits for girls and women and can result in severe bleeding and problems urinating, and later cysts, menstrual difficulties, infections, as well as complications in childbirth and increased risk of newborn deaths.
33 WHO Factsheet (see note 1), 31 January 2025.The WHO goes on:
The practice of FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against girls and women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity; the right to be free from torture and cruel, inhuman or degrading treatment; and the right to life, in instances when the procedure results in death.
The WHO has classified four major types of FGM (see textbox on p. 00), which it then further divides, reflecting the wide variation in the practice (WHO 2025).
The overwhelming majority of those who perform FGM/C have received no medical training in the practice. Traditional birth attendants (TBAs) and other traditional cutters have learnt from other cutters in the community, who in turn had the role passed down to them. Health workers, nurses, and midwives who perform FGM/C will usually have training in aseptic techniques, pain management, and infection control, but not in the actual clinical procedure of FGM/C. In Somaliland, Newell-Jones (2016) encountered calls from community midwives and TBAs for training in how to carry out FGM/C, as well as calls for FGM/C to be included in the midwifery curriculum, from senior figures including staff in the Ministry of Religious Affairs. Both these measures would normalise medicalised FGM/C.
The twenty-two African countries that had, by 2018, introduced legislation banning FGM/C do not, in all cases, outlaw all types. Four of these (Cameroon, Ethiopia, Nigeria, and Tanzania) do not include ‘any real definition of FGM in their current legislation’ (28 Too Many 2018:34). UNICEF points out that many girls and women are unaware of the type of FGM/C they have undergone, and ways of classifying it in communities often differ from the WHO classifications (2013:7). There is increasing evidence that non-cutting or ‘less severe’ alternatives are being developed by individual families and communities that have modified their practices over time (Crawford and Ali 2015; Newell-Jones 2016, 2017; Van Bavel 2021).
Variations in terminology and practice
FGM/C is complex, and the WHO types do not necessarily cover every variation performed. The WHO refers to the ‘ambiguity of language in relation to FGM’, recognising that the same term can refer to multiple types of cut, and the use of ‘euphemisms or other coded ways of referring to FGM’ (WHO 2021). Obermeyer (1999:84) has written about ‘the incomplete correspondence between biomedical categories and local terminology’, and stresses that the term FGM/C ‘poses a thorny issue in the local languages’ of practising communities. Other scholars have made similar points (e.g. Bjälkander et al. 2013; Boyle 2005; Crawford and Ali 2015; Elmusharaf et al. 2006; Gruenbaum 2001; Newell-Jones 2017). Opposition to FGM/C has tended to centre upon the most ‘extreme forms’, notably infibulation, which has come to represent FGM/C in popular discourse. Yet globally, infibulation only constitutes 10 per cent of FGM/C (Earp 2015, citing Ahmadu 2000), although in some countries, for example Somalia, it remains the most practised form. Gruenbaum, Earp, and Shweder (2023: 202–3) note that media and policy often highlight extreme cases of female practices while downplaying male practices such as medicalised neonatal circumcision in the United States. This leads to inaccurate generalisations and stereotypes about culturally diverse communities engaging in these practices.
The international movement against FGM/C
The international movement for the eradication of FGM/C has gained increasing momentum in recent decades, led by bodies including the WHO and United Nations agencies UNFPA and UNICEF, whose Joint Programme on the Elimination of FGM began in 2008 and currently operates in seventeen countries, all apart from Yemen in Africa.
44 UNICEF: https://www.unicef.org/protection/unfpa-unicef-joint-programme-eliminating-fgm [Accessed 4 August 2025]. Last modified March 2025. The WHO initially avoided studying or working on FGM/C, ‘claiming the practice was outside the organisation’s competence because it was of a “social and cultural rather than a medical nature”’ (Boyle 2005:41). There was ‘a widespread view … that the practice fell outside the jurisdiction of the international system’ altogether (ibid.:45). That position was to radically change. Shell-Duncan and Hernlund (2020:1) note that the ‘current resurgence of indignation’ about the practice can be traced to a series of conferences that celebrated the UN Decade of Women (1975–88). (See Chapter 1 for an account of these conferences, and the resulting resolutions and protocols. Chapter 2 also discusses these landmark resolutions and events, but takes a different approach analytically.)
Key changes in the discourse
The move towards framing FGM/C as a human rights issue, rather than a primarily health issue, is a major shift arising from the conferences and other developments discussed in Chapters 1 and 2. (See Shell-Duncan [2008] for a thoughtful discussion of the implications of this shift.) We have also seen increasing consensus that any action aimed at reducing or ending FGM/C can only succeed if it is led by women at the grassroots, and grounded in an understanding of the cultural and political contexts in which FGM/C is situated (Shell-Duncan and Hernlund 2020:2–3). Furthermore, there is growing recognition that cross-community engagement, including with boys and men, is crucial in strategies aimed at ending or reducing FGM/C, and that FGM/C should not be seen in isolation but as intimately linked with other aspects of women and girls’ empowerment.
Some other marked changes in the discourse in recent years include a shift away from blaming patriarchy for the continuation of FGM/C. In this context, patriarchy usually refers to a socio-economic-political system dominated by males, in which men are assumed to wield power over women’s bodies and lives. Akweongo et al. (2021) maintain that ‘the practice [sic] of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women’ (no page number, seen online). Osezua and Edobor (2021) also regard patriarchy as sustaining the practice. Many scholars, and non-scholars, would take issue with these views. Ahmadu (2000:284) refutes the idea that ‘patriarchy is assumed to be the culprit’. Gruenbaum, Earp, and Shweder (2023:203) write that ‘numerous interdisciplinary studies over the years have put pressure on the patriarchy hypothesis’. They argue that female rites are in fact ‘counter-patriarchal’ because ‘the women’s rite serves to promote female within-sex bonding and network building – as the men’s rite typically does for males – thereby counterbalancing gendered asymmetry in political power and weakening male dominance in certain spheres’ (ibid.:202). Gruenbaum devotes the first chapter of her 2001 book to patriarchy, and asserts: ‘patriarchy does not hold up well as a sufficient causal explanation, particularly because pervasive patriarchal social institutions exist widely, far beyond circumcising societies’ (2001:40). Mackie and LeJeune (2009) make the same point, but conclude that while ‘patriarchy is a supporting condition of the practice’, removing patriarchal institutions will not end it (ibid.:6).
Then there is what one may call the ‘barbarism’ trope. Another marked shift in the narrative (at least with regards to Africa; this narrative persists in the diaspora) has involved moving away from condemning FGM/C-practising communities as ‘backward’, and implying that their cultural customs are ‘bad’ or even ‘barbaric’ (the most notorious example being Fran Hosken [1979], see Chapter 2), to embracing the positive aspects of culture and trying to work with those. As UNICEF describes it: ‘The abandonment of FGM/C is framed not as a criticism of local culture but as a better way to attain the core positive values that underlie tradition and religion, including “doing no harm to others”’ (2013:iii). This is evident in Alternative Rites of Passage, whose educational components often include lessons for initiates on ‘bad’ versus ‘good’ elements of culture (see Conradi et al., Chapter 13). Agencies and NGOs now tend to say they are not trying to change culture, but social norms (see Hughes, Chapter 14). These agencies have not stopped talking about cultural factors altogether, just shifted the emphasis to changing social norms.
Interlinked themes
The subject of FGM/C and attempts to end it is a fascinating one, partly because it is (no pun intended) cross-cutting. It is not a subject that can be viewed or understood through a single lens, although the widespread public perception may be that it is solely a health and human rights issue. It touches on, and interweaves, issues pertaining to health, sexuality and reproduction, children’s and women’s rights, social status, identity, bodily integrity, education, gender violence, gender inequality, history, politics, race and ethnicity, religion, power, colonialism and neocolonialism, and no doubt other subjects too. We are acutely aware of the diversity of issues that FGM/C intersects with. In recognition, we gather together some of the most prominent discourses and debates in the scholarly, development, and public domains in a section, ‘Axes of Difference’, at the end of this Introduction.
There is nothing new about some of these discourses. There is a long history of and continuity in debates around FGM/C, notably within the context of colonial missionaries’ and governmental concerns about it. The subject of FGM/C remains steeped in neocoloniality.
There is a strong sense of moral outrage and moral panic in these debates, both then and since. The early campaigns were played out upon the bodies of African girls and women, and often dominated by non-Africans, including white European women. As Frederiksen (2008:25) describes the so-called female circumcision crisis in colonial Kenya:
For a while … African women’s bodies were the battleground on which colonial officials, metropolitan politicians, Protestant missionaries and differently positioned African men and women fought. Who owned women’s bodies – the missionary-medical establishment, the imperial government, African men, or perhaps African women themselves? In the general clamour the voices of African women, the experts on clitoridectomy, were rarely heard.
Some would say little has changed (e.g. Ahmadu 2000; Ahmadu and Kamau 2022; Njambi 2004; Shweder 2022). However, increasing numbers of African women and men are now working on FGM/C as scholars, practitioners, activists, and policy makers, and this greater representation has already changed the narrative.
Diasporic issues and debates around FGM/C also clearly interlink with those in Africa. Global migration and movement have made FGM/C a global phenomenon, and thrown into sharp relief debates around culture, multiculturalism, cultural relativism, and decoloniality vis-à-vis the Global North and South. Africans in the diaspora have played a key role in influencing approaches to and activism around the practice, both on the continent and in their adopted countries. A particularly strong body of critical scholarship on diasporic FGM/C and legislation against it has emerged from the Nordic countries (e.g. Johnsdotter 2020). Johnsdotter (2023), citing Karlsen et al. (2023), questions ‘inflated estimates of girls at risk of FGM/C and notions about illegal underground activities’, assumptions which have led to unhelpful and factually inaccurate public and media debate in many Western countries. (See Mogilnicka et al., Chapter 8 in this volume.)
We will now highlight other key issues in current scholarship and practice.
Medicalisation
There has been a sharp increase in the medicalisation of FGM/C in recent years. This means the involvement of health practitioners, including midwives, nurses, and doctors, who perform FGM/C in medical facilities (such as clinics and hospitals), in people’s homes, or other spaces. Parents arrange to have their daughters cut in this way in the belief that the practice of FGM/C by medical practitioners is less harmful and more hygienic than when it is performed by traditional cutters (Shell-Duncan
et al. 2017/18). Leye
et al. (2019) describe how the earlier focus on health risks in anti-FGM/C campaigns unwittingly led to increased medicalisation. The procedure can also include reinfibulation, which involves the closure of women’s external genitalia following childbirth. In 2017/18 Shell-Duncan
et al. (ibid.) estimated that 26 per cent of women aged fifteen to forty-nine, nearly sixteen million women, reported having been cut by a medical professional. Rates of medicalisation are, they report, highest in Egypt, Sudan, Guinea, Djibouti, Kenya, Iraq, Yemen, and Nigeria (ibid.:13). Since these figures were released, there is evidence of increased medicalisation in various countries.
5See WHO 2025: https://www.who.int/news/item/28-04-2025-who-issues-new-recommendations-to-end-the-rise-in--medicalized--female-genital-mutilation-and-support-survivors [Accessed 12 August 2025]. Leye
et al. (2019) identify and discuss four ‘hotly contested debates’ around the medicalisation of FGM/C. These are that: (1) the WHO definition of medicalised FGM/C is too narrow, allowing it to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of ‘do no harm’; (2) all FGM/C is human rights abuse with life-long consequences, no matter who performs it; (3) healthcare professionals who perform medicalised FGM/C are sustaining cultural norms that they themselves support and may also gain financially from; and (4) there is a contradiction between protecting cultural rights in legal constitutions versus human rights legislation, which criminalises FGM/C. They conclude, in part, that more attention needs to be paid to using healthcare professionals as change agents in anti-FGM/C work. The WHO has published a practical guide on integrating FGM/C into midwifery and nursing curricula (WHO 2022a), and also developed a toolkit for the training of health practitioners in using person-centred communication skills for the prevention of FGM/C (WHO 2022b) which has been piloted in three countries: Kenya, Somaliland, and Guinea-Conakry. Initial research findings indicate it has resulted in an increase in the knowledge, skills, and confidence of midwives and nurses in talking about FGM/C to mothers. Mothers confirm that these conversations are taking place (Ndavi
et al. 2024).
Parallels with male circumcision
We include a chapter on male circumcision as a closely-related issue to FGM/C, focusing on the role of mothers in managing their sons’ circumcisions. Together with other historical continuities, the false binary opposition between male and female circumcision has its roots in the colonial era. Scholars such as Earp (2015) have questioned the ‘moral and empirical basis for distinctions made’ between the two that label the one (female) ‘barbaric’, the other (male) ‘benign or beneficial’. He notes that the two phenomena overlap in significant ways.
There is also a large ethnographic literature on genital cutting, particularly in eastern African societies, where the complementary of FGM/C and male circumcision is recognised. Genital cutting is seen by some social groups as a pathway through which sexuality is made socially legitimate. Without an understanding of how these complementary forms of genital cutting interact and mutually define one another, the tendency to see one (female) solely in terms of harms and the other (male) in terms of benefits obscures the ways in which they are linked. Shweder (2013) argues that the problem stems from whether a community makes a ‘moral equivalence’ or not between customary male circumcision and female genital cutting. In the United States, Shweder tells us, the moral equivalence is denied, with public opinion largely in favour of non-therapeutic and neonatal male circumcision, but trenchantly proscribing female genital cutting as ‘mutilation’ (ibid.:348). Two contributors to this volume (Lamont, Chapter 3, and Kamau, Chapter 12) argue that bringing male circumcision ‘back into’ the debate will produce a more critical appreciation of the parallels and contradictions in how male circumcision and FGM/C are perceived, practised, and resourced.
Bioethics
Several contributors to this volume explore how bioethics might diversify discussions about FGM/C. Traditionally, mainstream bioethics focuses on human research, genetics, death and dying, abortion, vaccines, and organ transplantation. However, bioethicists can also contribute significantly to FGM/C debates by applying principles such as autonomy, beneficence, and justice to navigate moral conflicts and scholarly polarisation.
A notable bioethical contribution is the call for neutral terminology. Terms like ‘female genital mutilation’ and ‘female circumcision’ are seen as ethnocentric and divisive (e.g. Van Bavel 2023:382). Bioethicists often prefer ‘genital cutting’ for its neutrality, encompassing practices like neonatal male circumcision and cosmetic labiaplasty without judgment. These principles extend beyond academia to public debates, especially in regions affected by FGM/C policies. Critics challenge the universalist stance of organisations like the WHO and the UN by broadening the debate to include elective genital surgeries, non-therapeutic male circumcision, and intersex surgeries. The WHO calls for high-quality ethics in FGM/C research (WHO 2021), with growing recognition of the need to move beyond polarisation.
A key bioethical theme in FGM/C policy concerns bodily integrity and autonomy, fundamental to human rights. This raises debates about consent, particularly in social contexts where parental rights and hierarchies shape decision-making. Bioethicists highlight ethical discrepancies in WHO policies, which accept male circumcision but condemn FGM/C (Earp and Johnsdotter 2021). Critics argue that framing FGM/C as ‘Other’ ignores transnational migration and legal cases in the UK and US.
Different approaches to ending FGM/C
A range of different approaches have been used in attempts to end FGM/C over the years. Initially, the assumption was that women did not know the impact of FGM/C on their health and therefore needed to be taught about the health risks and complications. This assumption was only partially correct. Women unfamiliar with medical terminology were unable to describe what was happening technically, hence the assumption that they were ignorant. However, many women were aware of the pain, bleeding, infections, difficulties in childbirth, and other complications. The emphasis on the health complications had some effect on reducing the severity of the type of cut being performed and is thought to have contributed, in many contexts, to an increase in the medicalisation of the practice, i.e. health workers performing FGM/C. Approaches to the elimination of medicalised cutting include the introduction of anti-medicalisation legislation, or guidelines by ministries of health, and also the training of health workers to see their roles in relation to FGM/C as counselling mothers not to cut their daughters (WHO 2022a and b).
The strengthening of a rights-based approach and the increase in public campaigns to end FGM/C, along with the call for zero tolerance and the introduction of the annual UN Day of Zero Tolerance, has led to an increased drive towards criminalising FGM/C, and the more active involvement of law enforcement and legal systems as a means of ending it. (More on zero tolerance below. Also see the textbox on p. 00.) As the prevalence rate decreased in key countries, there was an increase in initiatives to provide alternative incomes for traditional cutters, whose incomes were severely hit by the decrease in prevalence. Alternative Rites of Passage (East Africa) and Bondo without cutting (West Africa) are community-based approaches aimed at maintaining cultural practices associated with transitioning from girlhood to adulthood, but without the cut. The recognition that social norms play a role in maintaining FGM/C stimulated a greater focus on listening to communities, and understanding the drivers of and barriers to FGM/C. This led to a stronger focus on community dialogue – engaging teachers, health workers, community leaders, religious leaders, youth and community groups. Attitudes have also changed towards the involvement of men and boys in anti-FGM/C interventions, with them being increasingly seen as agents of change, working in partnership with women. Community radio has been used to increase the reach of education programmes. The increased availability of the internet and social media has led to youth-led social media campaigns, encouraging the development of community-based movements for change. Rescue of girls has also been widely used. This involves removing girls from their families, usually at times of greatest risk of being cut, and keeping them ‘safe’ in a refuge for the duration of the cutting season, or in some cases much longer.
Social norms theory has had an enormous influence on approaches to ending FGM/C since at least 2009, when eleven UN agencies adopted this approach. They have been influenced primarily by the work of the American political scientist Gerry Mackie, who drew on ideas from game theory to develop this approach, and who has long advised UNICEF.
66 Information taken from Mackie’s profile: https://web.archive.org/web/20130425000207/http://dss.ucsd.edu/~gmackie/ [Accessed 4 August 2025]. Mackie is co-director of UNICEF’s Learning Program on Changing Social Conventions and Social Norms, with Cristina Bicchieri. He has also worked closely as an advisor to Tostan, the Senegal-based NGO. Put very simply, the theory posits that people conform to the normative behaviour of their social group, partly in order to be accepted socially and partly to avoid stigmatisation and rejection. The social norms of the group must be changed to bring about mass behaviour change. The community concerned needs to be given ‘credible new information’ that changes ‘self-enforcing beliefs’ and leads to abandonment (Mackie and LeJeune 2009:25, 27). Mackie, Moneti
et al. (2014:6) have further explained: ‘A social norm is held in place by the reciprocal expectations of the people within a reference group. Because of the interdependence of expectation and action, social norms can be stiffly resistant to change.’ These and other authors (e.g. Bicchieri 2017) predicted long ago that this process (as set out in social norms theory) would result in ‘rapid mass abandonment’. While the theory has helped to shape development thinking and policy in some positive ways, the question remains: if the theory worked in practice, why has FGM/C not been eradicated after all this time?
Social norms theory in relation to FGM/C has become highly contested and debate increasingly polarised. When originally introduced, social norms theory helped change the way practitioners, scholars, and policy makers perceived FGM/C. It provided insights into why community members did not simply abandon the practice when they were aware of the health risks, and it provided a new framework to understand some of the dynamics behind the decision-making dilemmas facing people as they grapple with deciding whether or not to have their daughters cut. Social norms theory encouraged practitioners, and scholars, to consider the drivers for and against FGM/C, how these might influence decision-making, and the ways in which they might act to maintain FGM/C in practising communities. At a practical level, the theory actively encouraged greater listening to communities, encouragement of dialogue about FGM/C within communities, and the promotion of community-led strategies to end FGM/C, all of which have contributed to reductions in prevalence and/or harm caused by FGM/C. However, social norms theory has not proved to be the magic bullet that was once anticipated, predicted to bring about the abandonment of FGM/C. It has been more useful in understanding community dynamics and less useful as a formula for rapid mass abandonment.
The
zero tolerance policy appears to have first emerged in February 2003, though it did not become enshrined as an official date in the UN calendar until 2012, with the introduction of an International Day of Zero Tolerance of FGM/C. The policy aims to eliminate all forms of FGM/C worldwide. However, it is questionable whether elimination is even possible, least of all within the 2030 deadline set in 2015 by the UN’s Sustainable Development Goals.
7Known in short as the SDGs, seventeen goals were agreed by 193 countries in September 2015 as part of the UN 2030 Agenda for Sustainable Development. FGM/C is mentioned in goal five, on gender equality and the empowerment of women and girls, as is child marriage. https://www.un.org/sustainabledevelopment/gender-equality/ [Accessed 16 August 2025].There are two main arguments against the zero tolerance policy. Firstly, as O’Neill et al. (2020:266) have pointed out, the socio-legal and ethical inconsistencies between FGM/C and cosmetic genital modification ‘pose concrete dilemmas for professionals in the field that need to be addressed and researched’. They ask whether the strategy is effective or even credible, and discuss the Eurocentric implications of showing zero tolerance toward genital mutilation in the non-Western world compared with the widespread acceptance of cosmetic genital modification in the Global North. The second criticism is that the zero tolerance policy only recognises the elimination of all types of FGM/C as success, and does not recognise a reduction in harm as a valid interim goal towards complete eradication. (See textbox on p. 00.)
Alternative Rites of Passage (ARP) is a strategy, developed by NGOs, that aims to transform or transition girls to women by replicating many of the cultural rituals that once accompanied ‘traditional’ initiation, but without the physical cut. It is important to note that other alternatives have been developed, some by communities, that are not necessarily called ARP. Since the later 1990s, ARP has become popular in Kenya and Tanzania in particular, but variations have also been pioneered in some countries outside East Africa, such as Sierra Leone. ARP is relatively under-researched (Droy et al. 2018) and there is as yet no firm evidence that it is effective in reducing the incidence of FGM/C, though some NGOs claim otherwise. Long-term monitoring of girls and more rigorous evaluation of this intervention is the only way to determine its effectiveness, and for the most part this has not yet happened (see Conradi et al., Chapter 13; Hughes, Chapter 14).
Colonial legacies
European colonialism in Africa casts a long shadow over approaches to FGM/C today, and in attitudes towards practising communities in Africa and the diaspora. This legacy is evident in neocolonial practices and attitudes; for example, in some external ‘development’ interventions; in the condemnation of Africans (or people of African heritage in the diaspora) who practise FGM/C; and, more broadly, in what Lisa Wade has described as ‘the cultural inferiority frame’ (2011:37). Colonialism was not simply about the conquest and rule of foreign lands and peoples; it was a mindset that persists in places, and has distinct historical continuities, some of which we mention below.
Colonial powers in Africa took great interest in African women’s fertility and reproduction, largely because they wanted plentiful local labour. Administrators were concerned about high maternal and infant mortality rates, which appeared to them to be linked to FGM/C. The concerns of British (and to some extent French) missionaries were different, though attitudes were not uniform (e.g. see Murray 1976). Protestant missionaries in Kenya saw FGM/C and related cultural practices as ‘backward’, unhealthy, indecent, and morally repugnant, and tried to stop them (ibid.; Thomas 2003). By the late 1920s, some Protestant missions in Kenya were expelling Africans who were pro-FGM/C; others chose to be more tolerant, leading to deep divisions between different missionary societies. The expulsions led many Africans to rebel, boycott mission-run churches and schools, and set up independent churches. The state, meanwhile, was more reluctant to ban FGM/C, preferring to leave it to Local Native Councils of elders (ibid.; Murray 1976). Though other factors including land hunger were key drivers of the Mau Mau rebellion, the so-called ‘female circumcision crisis’ (1928–31) helped to stoke this anti-colonial revolt that paved the way for independence.
8Mau Mau was the name the British gave to this rebel movement (1952–60). Its supporters called it the Land and Freedom Army. Clitoridectomy and attempts to ban it became intertwined with (largely) Kikuyu resentment over land loss, forced labour, and other grievances (e.g. Anderson 2018; Frederiksen 2008; Pedersen 1991; Thomas 2003).
In British-ruled Northern Sudan, some medical missionaries and midwifery trainers were in favour of medicalisation, as were some missionaries in Kenya (see Murray 1976 on the Reverend William Rapley; Thomas 2003).
9Thomas cites the case of a Methodist nurse who taught her Kenyan trainees how to make a small incision in the scar tissue of cut women who faced problems in labour, in order to loosen it. The development of this technique ‘attests to how colonial medicine adapted to excision. Within hospitals, amelioration made more sense than obstinate condemnation’ (Thomas 2003:74). Boddy (2007b:5, also 2008) describes how British midwives in Sudan in the 1920s and 1930s ‘devised an attenuated form of infibulation as a cautiously remedial first step’ toward eradication, which is mirrored in some medicalised practices today. By the 1940s, the colonial government tried to end pharaonic cutting, against the backdrop of a British parliamentary campaign against infibulation (see Carver 2024 for parliamentary debates on Kenya and Sudan from the 1920s to 1940s; for Kenya, Thomas 2003). But a 1946 prohibition was unenforceable and sparked a revolt (Boddy 2008; Garcia 2021:283; Gruenbaum and Ahmed 2022).
In French West Africa the practice was also a subject for concern and investigation. In August 1949 the British Colonial Office contacted its French counterpart to ask what measures France was taking to combat FGM/C in its colonies (Garcia 2021:278ff).
10There was a change of government in France in 1949, and an investigation into FGM/C was not followed up. Dr Léon Pales, based in Dakar, had proposed to government ‘a synthesis of numerous studies by scientists, doctors and ethnographers’ who had examined the issue. Pales was also a Professor of Anthropology (Garcia 2021:286). French medical and ethnographic studies, informed by racial and moral theories, influenced official thinking. But the authorities decided not to intervene. Doctors said that attempts to stop it did not work. The government sought to avoid a rebellion, while missionaries feared losing their converts. As in Kenya, Protestant missionaries in French colonies tended to be more virulently anti-FGM/C than Catholics. Leonard (1996:261) writes of Chad that ‘Catholic clergy have been more tolerant of local practices, preferring to integrate them, where possible, into the life of the church, and generally taking a less combative stance’.
What are the other historical continuities? The movement towards harm reduction is one, as is empowerment through encouraging access to education for girls and women. Some may see the intrinsic violence of colonialism mirrored in (some of) the narratives used in anti-FGM/C campaigning that explicitly promotes the use of violent language and graphic imagery to describe FGM/C. Actively encouraging moral outrage and condemnation might gain the attention of governments and international donors, but we should also question whether this is an appropriate approach and what impact it might have on different stakeholders. Furthermore, some Africans regard moves against FGM/C as a neocolonial attack on their cultural traditions and bodily rights, just as they did in an earlier era (see Kamau, Chapter 12). In addition, some African practitioners and activists working towards FGM/C eradication are sensitive to being told to ‘change’ their culture, and regard this as deeply offensive and neocolonial.
Axes of Difference
Scholars and practitioners, including the authors and editors of this volume, approach FGM/C from different perspectives. These differences arise from our beliefs, the local and global contexts in which we live and work, our disciplines, and our experiences. As editors, we have engaged in dialogue, with each other and with our contributors, to reflect critically on our views about FGM/C. We became aware of multiple axes of difference that shape debates in this field. These differences are often ideological in that they reflect deep moral frameworks, social and political commitments, and competing ideas about rights, culture, and power. And they are sometimes deepened by gaps in research evidence, or indeed, the use of radically different kinds of evidence.
Here we highlight the major points of contention in this debate in order to guide readers. Different positions arise from contrasting beliefs about harm, rights, gender, bioethics, and cultural authority. For example, liberal rights-based ideologies emphasise individual autonomy and frame FGM/C as a human rights violation, while communitarian or cultural relativist perspectives stress collective identity and local moral worlds. Feminist positions also diverge (see Fusaschi, Chapter 2). Some feminists adopt universalist critiques of patriarchy and gender violence, while others argue for greater sensitivity to women’s voices within their cultural contexts (see for example Mogilnicka et al., Chapter 8; Leye et al., Chapter 6; Ahmed and Newell-Jones, Chapter 5). Decolonial stances challenge interventions against FGM/C as extensions of imperial power or neocolonial intrusion, while others see such interventions as necessary to advance gender justice as a necessary response to historical injustices. Global health priorities, too, reflect ideological divides, and determine (for example) whether medicalisation is seen as harm reduction or complicity in harm. These varied positions are sustained by power relations, including the authority of states, religious or customary leaders, and global governance institutions. Those holding ideological positions inevitably tend to value data that supports their position over that which contradicts it.
Perceptions of harm
Perceptions of harm underpin the beliefs and judgments people form about FGM/C, as well as the intervention measures considered appropriate. Opinions differ on whether FGM/C is inherently violent, and whether all types of it are harmful to all girls and women. Early anti-FGM/C efforts focused on the bodily harm caused by the practice, although it is now more commonly framed as a human rights issue. Three rights are in tension here: the right to bodily integrity, the right to freedom from violence, and the right to choose, i.e. for a woman to make decisions about her own body. In theory, these rights have equal weight; however, different people prioritise them differently. FGM/C also impacts indirectly on many other rights, including the rights to access education and health.
Some see FGM/C as inherently harmful and argue that the right of girls and women to bodily integrity is a basic human right (see Patrício, Chapter 1; von Gleichen, Chapter 9). Any ‘interference’ with a girl’s genitalia without a clear medical benefit is seen as an infringement of this right, regardless of consent, age, religion, or social norms. Others prioritise the right of the individual to choose, or the right of parents or guardians to make decisions on behalf of a child, with the intention of minimising harm. The rationale is that women should have the right to make an informed decision to undergo FGM/C, even if that choice may result in harm or the loss of bodily integrity, recognising that women make other decisions about their bodies (see Van Bavel et al., Chapter 10; Kamau, Chapter 12).
The tension between these rights leads to differences in the ultimate goals of initiatives addressing FGM/C. For those who see FGM/C as inherently harmful and prioritise bodily integrity, the goal is to eliminate all forms. For those who prioritise choice, the focus is more likely to be on harm reduction, eliminating the most harmful types of FGM/C (see Kamau, Chapter 12; Gruenbaum, Afterword).
Perceptions of change
Another axis of difference concerns how change in relation to FGM/C is perceived and measured. FGM/C is often portrayed as a harmful cultural practice that persists in specific communities without change. The reality is that the situation is dynamic. Significant changes have taken place historically, with FGM/C eliminated in some countries, prevalence rates reduced drastically in others. Less harmful types of FGM/C have been developed and adopted. Importantly, change continues to take place now, including in countries where the prevalence is highest.
Data, both quantitative and qualitative, is never neutral, can be used selectively, and is open to interpretation. Perceptions of the extent of change vary depending on which indicators are used and how change is understood to be happening. Some people focus primarily on measuring prevalence rates, seeing them as the key indicator of change and the basis for comparison across contexts. But evidence of changes in attitude and behaviours can be masked, giving the impression of a lack of change. Other people, sometimes writing about the same region but perhaps more deeply embedded in the practice at community level, report a different picture (see Ahmed and Newell-Jones, Chapter 5; Leye et al., Chapter 6; and Conradi et al., Chapter 13). They identify positive shifts towards abandonment, using indicators such as a greater willingness to talk about FGM/C, and changes in beliefs and attitudes. These shifts often precede changes in the type of cut performed and are seen as critical steps towards eventual abandonment. These important changes at community level take time to filter through to national or regional prevalence data.
Community-driven versus legislation-driven initiatives
Another axis of difference concerns the role of legal frameworks and the relationship between legislation and community-driven initiatives. Anti-FGM/C legislation is strongly encouraged by international institutions, although opinions differ on its impact. Legislation provides a statement of commitment by governments that can inform policy across governmental departments and set expectations for civil society. However, it can also be seen as an external intervention, potentially undermining local practice, infringing on the rights of women and girls to choose what happens to their bodies, criminalising already marginalised and poor communities, provoking backlash, and driving FGM/C underground (see Njenga, Chapter 11; Kamau, Chapter 12; Hughes, Chapter 14). This difference reflects deeper ideological divides between universalist rights-based strategies and respect for cultural rights, autonomy, self-determination, and participatory change.
Linked to this is whether change is seen as most legitimate and effective when driven by external authorities or by communities themselves. Some see global governance, international networks, and national campaigns – often linked to formal development goals and zero tolerance to FGM/C (see textbox p. 00) – as essential for establishing moral authority, unambiguous norms, protecting rights, and driving programmatic change at scale (see Patrício, Chapter 1). Others argue that change must come from within practising communities if it is to be sustainable (see Ahmed and Newell-Jones, Chapter 5; Leye et al., Chapter 6; Alassad, Chapter 7; Van Bavel et al., Chapter 10; Kamau, Chapter 12). They highlight that community-driven initiatives, often shaped by indigenous theories of change, relationships and dialogue, are more likely to shift norms, reduce harm, and create sustainable pathways to abandonment, without backlash or stigma. These reflect different theories of change: one grounded in long-term social transformation through dialogue and norms change, the other in immediate, authoritative, top-down action to trigger behaviour change.
Intersectionality
There is increasing agreement among community-based practitioners, researchers, and policy makers that FGM/C cannot be dealt with in isolation but should be seen as an intersectional issue, cutting across health, education, and societal roles. Practising communities face a range of challenges, such as food security, health inequalities, poverty, and marginalisation. FGM/C is a significant issue, but not necessarily the most urgent facing these communities. Consequently, there is a call for FGM/C initiatives to be integrated into practical programmes aimed at improving quality of life, including income generation, food and water security, health, and education (see Ahmed and Newell-Jones, Chapter 5; Leye et al., Chapter 6; Conradi et al., Chapter 13).
Integration brings its own set of challenges. For example, when integrating FGM/C into health-awareness programmes, health workers are variously seen as sustaining FGM/C through medicalisation, supporting abandonment by counselling mothers against cutting their daughters, and/or as skilled clinicians able to reverse some of the harm of FGM/C through reconstructive surgery. These different perspectives are found in this volume.
FGM/C is not required by any major religion. Religious leaders are strong influencers in practising communities, engaged in many of the community-based initiatives. While some see their involvement as essential to changing norms (see Thomson and Callaghan, Chapter 4), others critique the effectiveness or appropriateness of this approach, recalling the negative impact of early Christian missionaries, or the perceived links between Islam and FGM/C.
Choice of terminology
Readers will immediately notice differences in the terminology used for FGM/C, both in this volume and in the global discourse more broadly. Choice of terminology is rarely neutral. It can help establish safe spaces for open exchange, or trigger defensiveness and limit dialogue. These differences can be ideological, reflecting contrasting perceptions, or they may be adaptive, reflecting the intended audience at a particular time.
The term FGM is typically chosen to signal a clear judgment: it labels the practice as mutilation, irrespective of the type of cut performed, and explicitly frames it as a form of violence, abuse, or even torture of women (see von Gleichen, Chapter 9). Some feel that the term ‘mutilation’ is inappropriate, and prefer to use terms like ‘cutting’ or ‘modification’, which they see as better reflecting the cultural and social contexts in which the procedure is carried out (see Van Bavel et al., Chapter 10; Ahmed and Newell-Jones, Chapter 5). Clarity of terminology is crucial to avoid misunderstandings, particularly where several types of cut are being performed. Where infibulation is commonly practised, the term FGM, and sometimes FGM/C, is often used locally only to refer to infibulation. Many practitioners and staff of community-based CSOs or NGOs vary their terminology and language depending on their audience, recognising the decision-making dilemmas faced at the individual, family, organisational, and national levels. Equally, many activists tailor their terminology to attract the attention of the media, governments, and donors, using language and statistics to emphasise the urgency and importance of their messages. In this volume, we have generally favoured the use of FGM/C, while allowing contributors to use their preferred terms, often reflecting the spaces within which they work.
In conclusion, the social life of a controversy, such as FGM/C, depends upon being able to draw people into positions, often opposed, but sometimes adjacent, on issues that have no pathway towards being resolved. The axes of difference represented in this volume paint FGM/C as a wicked problem. As editors, we are resolved that no one position on FGM/C should be allowed to dominate, even though laws and sanctions have criminalised these practices in many countries and there is a long history of campaigning against them. We assert that in all the complexities explored in this volume, there is a need for different voices to be heard, while we keep our critical attention focused on the political and ethical outcomes of conversations, debates, and disagreements. Our hope is that some of the power relationships that mediate these discussions can be questioned and made more clearly visible. In doing so, we aim to disrupt conventional thinking on FGM/C and usher in new ways to disagree that will minimise harm and blame.
Our approach
In this volume we discuss some of the key contemporary issues around FGM/C, and campaigns against it, in historical perspective. Some of our chapters present new research findings; all present fresh perspectives on FGM/C. Several textboxes are included, which explain selected key issues concisely. These, and the discussion questions in the Appendix, can be used as teaching aids.
As editors we argue that FGM/C is not ‘just’ a health and human rights issue, but is multi-faceted and intersectional. While we recognise the global public health challenge of FGM/C and the human rights implications of the practice, we equally do not see elimination as either possible or necessarily achievable without greater focus on social relations, which are embedded in communities, mediated by social institutions such as schools, medical clinics, hospitals, churches, mosques, and courtrooms. Anecdotes gathered by contributors point to a fatigue, especially among communities, following years of campaigning and research, much of it externally driven, which often overlook the incremental, community-driven changes towards abandonment that have long been happening.
Throughout the book readers will encounter different perspectives. We feel that through listening to a wide spectrum of voices, including community-based voices, we gain greater insight into the complexities and challenges associated with FGM/C. Consequently, we have given our contributors the freedom to take different approaches and defend different positions, some of which may not necessarily agree with one another. Many of these differences are explored in the previous section of this chapter, ‘Axes of Difference’.
We hope that this book will stimulate wider debate, and be of interest to scholars, students, practitioners, and policy makers alike. Indeed, we believe that the debate is enriched and advanced when people from different backgrounds, working in different spheres, respectfully share their viewpoints, knowledge, and experience. Too often, they talk past one another, if they speak at all.