Female genital mutilation in developing countries: an agenda for public health response


      There is uncertainty regarding reasons for persistence of the practice of female genital mutilation (FGM) and the best strategies for intervening effectively. In spite of strong international condemnation, the persistence of FGM in many countries suggests that it can only be effectively eliminated when its practitioners are presented with a safe alternative that preserves their culture and, at the same time, protects the health and well being of women. Recognizing that there is no simple solution to the problem, this paper argues that interventions for preventing FGM should be non-directive, culture-specific and multi-faceted to be of practical relevance. Such interventions should not only motivate change, but should also help communities to establish practical means by which that change can occur. Potentially effective prevention interventions targeted at local practitioners of FGM, parents, at-risk adolescents, health and social workers, governments, religious authorities, the civil society, and communities are presented.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. World Health Organization. Female Genital Mutilation Report of a WHO Technical Working Group Geneva, 17–19 July 1995, WHO Document: WHO/FRH/WHD/96.10.

        • Koso-Thomas O.
        The circumcision of women: a strategy for eradication.
        Zed Books Ltd., London1987
      2. United States Agency for International Development. Female Genital Mutilation. Information Bulletin. Office of Women in Development. Washington, DC: United States Agency for International Development (USAID); March 1997.

      3. World Health Organization. Female genital mutilation information pack, Gender and Women’s Health Department. Geneva: World Health Organization; 1996. (accessed 6 April 2004).

        • Vissandjee B.
        • Kantiebo M.
        • Levine A.
        • N’Dejuru R.
        The cultural context of gender, identity: female genital, excision and infibulation.
        Health Care Women Int. 2003; 24: 115-124
        • Larsen U.
        • Okonofua F.E.
        Female circumcision and obstetric complications.
        Int. J. Gynecol. Obstet. 2002; 77: 255-265
        • Yoong W.
        • Shakya R.
        • Sanders B.
        • Lind J.
        Clitoral inclusion cyst: a complication of type I female genital mutilation.
        J. Obstet. Gynecology. 2004; 24: 98-99
        • Obermeyer C.M.
        Female genital surgeries: the known, the unknown, and the unknowable.
        Med. Anthropol. Q. 1999; 13: 79-106
        • Mackie G.
        Female genital cutting: a harmless practice?.
        Med. Anthropol. Q. 2003; 17: 135-158
        • Toubia N.
        Female circumcision as a public health issue.
        New Engl. J. Med. 1994; 331: 712-716
        • Okonofu F.E.
        • Larsen U.
        • Oronsaye F.
        • Snow R.C.
        • Slanger T.E.
        The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria.
        Br. J. Obstet. Gynecol. 2002; 109: 1089-1096
        • Balk D.
        To marry and bear children? The demographic consequences of infibulations in Sudan.
        Lynne Reinner Publishers Inc., Boulder, CO2000
      4. World Health Organization. Female genital mutilation: an overview. Geneva: WHO; 1998.

        • Jones H.
        • Diop N.
        • Askew I.
        • Kabore I.
        Female genital cutting practices in Burkina Faso and Mali and their negative health outcomes.
        Stud. Family Plan. 1999; 30: 219-230
        • Obermeyer C.M.
        The health consequences of female circumcision: science, advocacy, and standards of evidence.
        Med. Anthropol. Q. 2003; 17: 394-412
      5. Hyman J. Margaret Wambete’s healing scars. Global AIDSLink 83:23, December 2003/January 2004. Washington, DC: The Global Health Council; 2003.

        • Morison L.
        • Scerf C.
        • Ekpo G.
        • Paine K.
        • West B.
        • Coleman R.
        • Walraven G.
        The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey.
        Trop. Med. Int. Health. 2001; 6: 643-653
        • Gruenbaum E.
        The female circumcision controversy.
        University of Pennsylvania Press, Philadelphia2001
        • Toubia N.F.
        • Sharief E.H.
        Female genital mutilation: have we made progress?.
        Int. J. Gynecol. Obstet. 2003; 82: 251-261
        • Little C.M.
        Female genital circumcision: medical and cultural considerations.
        J. Cult. Diversity. 2003; 10: 30-34
        • Mandura M.U.
        Female genital mutilation in Nigeria.
        Int. J. Gynecol. Obstet. 2004; 84: 291-298
        • Magoha G.A.
        • Magoha O.B.
        Current global status of female genital mutilation: a review.
        East African Med. J. 2000; 77: 268-272
        • Mackie G.
        Female genital cutting: the beginning of the end.
        Lynne Reinner Publishers Inc., Boulder, CO2000
        • Shell-Duncan B.
        • Hernlund Y.
        Female “circumcision” in Africa: dimensions of the practice and debates.
        Lynne Reinner Publishers Inc., Boulder, CO2000
      6. World Health Organization. Female genital mutilation. Programmes to date: what works and what doesn’t. Geneva: WHO; 1999.

        • Herieka E.
        • Dhar J.
        Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.
        Sexually Transmitted Infect. 2003; 79: 220-223
      7. Population Council. Female genital mutilation: common, controversial, and bad for women’s health. Population Briefs 3:2. (accessed 6 April 2004).

      8. Population Council, Frontiers in Reproductive Health. Using operations research to strengthen programmes for encouraging abandonment of female genital cutting. Report of the consultative meeting on methodological issues for FGC research, 9–11 April 2002. Washington, DC: Population Council; 2002.

      9. Ben-Ari N. Villagers join campaigns against female genital mutilation. Africa Recovery, United Nations; 2003. (accessed: 23 December 2003).

        • Abdel-Tawab N.
        • Hegazi S.
        Critical analysis of interventions against FGC in Egypt.
        Population Council, Washington, DC2000
      10. Creel L. Abandoning female genital cutting: prevalence, attitudes, and efforts to end the practice. Washington, DC: Population Reference Bureau; 2001. (accessed 6 January 2004).

        • Mackie G.
        Ending footbinding and infibulation: a convention account.
        Am. Sociol. Rev. 1996; 61: 999-1017
        • Chelala C.
        An alternative way to stop female genital mutilation.
        Lancet. 1998; 352: 122-126
      11. PATH. Alternative rituals raise hope for eradication of female genital mutilation. Program for Seattle, WA: Appropriate Technology for Health (PATH). (accessed 5 January 2004).

        • Thomas L.M.
        Ngaitana (I will circumcise myself): the gender and generational politics of the 1956 ban on clitoridectomy in Meru, Kenya.
        Gender History. 1996; 8: 338-363
        • Mella P.P.
        Major factors that impact on women’s health in Tanzania: the way forward.
        Health Care Women Int. 2003; 24: 712-722
      12. United Nations. A world fit for children. Report of the twenty-seventh special session on children. New York United Nations General Assembly. UN Document: A/RES/S-27/2, 2002. (accessed 15 April 2004).