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.
1 See WHO 2025: https://www.who.int/news/item/28-04-2025-who-iss ues-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.