Axes of Difference

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.

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).

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.

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. 204) – 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.

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.

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.