Elizabeth Heger Boyle
In 1958, the Economic and Social Council of the United Nations formally requested that the World Health Organization (WHO) study FGC [female genital cutting]. WHO refused, claiming the practice was outside the organization’s competence because it was of a “social and cultural rather than medical nature.” Three years later, African women attending a UN seminar in Addis Ababa reiterated the request to study FGC, but WHO’s response was the same. The organization had a policy of not intervening in domestic politics without an explicit invitation from a state, and invitations were not forthcoming.
By the mid‐1990s, the situation had changed completely. The international community was centrally involved in eradicating FGC. Amnesty International included private abuses in its annual country reports for the first time, specifically referring to the practice. The International Monetary Fund and the World Bank (with impetus from the United States) linked aid to reform efforts. Four other prominent international governmental organizations (IGOs, including WHO) issued a joint statement condemning the practice as a violation of women’s rights. In a short span of decades, the ancient practice of FGC had become the target of unified international action. How did this change come about? […]
In the early years of the UN system, international intervention into local politics was highly circumscribed. The cherished right of each nation to govern its own people was heralded as nation after new nation threw off the bonds of colonialism and claimed independence. In this context, the international community defined the domestic jurisdictions of nation‐states broadly. In addition, international organizations did not define FGC as a health risk at this time, perhaps because the practice was passed on “voluntarily” from generation to generation. Furthermore, the negative consequences of early attempts to eradicate the practice in Kenya and Sudan might have made members of the international community reluctant to take up the issue. These factors combined to keep the international community out of the FGC controversy in the decades following World War II.
Western feminists, including Fran Hosken, Mary Daly, and Gloria Steinem, and women’s international organizations were critically important in raising international interest in the practice. (African opponents to the practice had been present for some time but had been unsuccessful at getting IGOs such as WHO involved in eradication efforts.) Initially, Western women and groups were vocal and confrontational. Advocates of sovereign autonomy continually raised the question of whether the West and international organizations should be involved in the eradication of FGC. Feminists responded by arguing that FGC was a serious problem requiring immediate international attention. Feminist mobilization in the 1970s spurred the international system to take a new look at FGC.
Early second‐wave feminists argued that FGC was a tool of patriarchy and a symbol of women’s subordination. These feminists argued that FGC was sadistic and part of a global patriarchal conspiracy. Seeing sadism in FGC actually predates feminist mobilization. For example, in one early account, Worsley claimed that the women who performed FGC “always” did so with a “sadistic smile of delight.” In adopting this explanation for FGC, Western women were implicitly assuming that no one would voluntarily choose to undergo the practice. African women were portrayed as victims who made “incorrect” choices because they were burdened by patriarchy. […]
Many African women found the discourse offensive. For example, at the international women’s conference in Copenhagen in 1980, African women boycotted the session featuring Fran Hosken, calling her perspective ethnocentric and insensitive to African women. Often, individuals in cultures where FGC is practiced were offended by their characterization in anti‐FGC discourse. Seble Dawit and Salem Mekuria criticized Alice Walker for failing to treat African women as efficacious and self‐aware individuals: she “portrays an African village, where women and children are without personality, dancing and gazing blankly through some stranger’s script of their lives.” Occasionally these individuals claimed that anti‐FGC rhetoric was exaggerated, but more typically they argued that African women were not assigned the attributes of modern individuals. In other words, they were not assumed to be self‐directed, autonomous, and efficacious.
Feminist arguments were also criticized for being ineffective at the local level. Melissa Parker, who lived with a tribe in Sudan while conducting medical research, argued that this type of discourse was doomed to fail locally:
Of course women do not circumcise their daughters to create problems for them later on. They do so to protect them. An uncircumcised girl is unmarriageable and would bring undying shame to her and her family. People would call her kaaba (bad), waskhan (dirty) and nigsa (unclean). Her life would be intolerable, as she would be taunted by friends and relatives wherever she went. In brief, the practice of circumcision is bound up with beliefs of honour, shame, purity and cleanliness. It is these beliefs which need to be examined and interrogated if any headway is to be made in bringing an end to such a custom. It seems almost comical that Western and Sudanese feminists have spent so much time tackling it simply at the level of female oppression when it is rooted in so much else as far as those women who experience it are concerned.
Parker’s perspective was essentially acknowledging that FGC was institutionalized in some areas. In these areas, history could not be ignored and “interests” had to be understood as including not only those defined by “universal” standards but also those important to the local context.
Despite the criticism, the feminist rhetoric captured the attention of the global community. By 1979, UN subcommittees had begun to study and provide outlets for national governments to discuss FGC. This occurred despite explicit opposition from some women in practicing cultures. Nevertheless, perhaps because the feminist rhetoric was so controversial, when IGOs finally decided to intervene to stop FGC around this time, they did not explicitly rely on the feminists’ arguments.
Instead, IGOs relied on scientific arguments about women’s health to justify their initial intervention to eradicate FGC. WHO and nongovernmental organizations were already intervening in national arenas to assist in birth control programs. Programs to eliminate FGC fit well within this mobilization. For example, international actors placed FGC in a category termed Traditional Practices Affecting the Health of Women and Children. This was also the title given to a 1979 WHO seminar held in Khartoum and the term used to describe FGC in the UN annual reports. African nation‐states also tended to root their eradication policies in a scientific health discourse. The major joint effort of nations was named the Inter‐African Committee on Traditional Practices Affecting the Health of Women and Children. Health problems were a universal concern, affecting every nation. By placing FGC within this framework, international actors did not appear to be singling out African nations for reform. Health rhetoric permitted a compromise between rights and sovereignty.
Thus, FGC became a health issue despite WHO’s early assessment that it was not. This reframing of the practice may reflect the increasing importance assigned to medicine (and science in general) in the international system. Because health issues were universally applicable to all nation‐states and yet narrowly tailored to easily identifiable “problems,” they were viewed as apolitical. Intervening for medical reasons did not threaten sovereignty because medicine was seen as neutral and existing apart from politics. Further, medicine was intimately linked with modernization and progress. It would be irrational and hence inconceivable for a culture to reject modern medicine. […]
Initially, feminists were willing to reframe their arguments in the terms adopted by IGOs. Themes of human rights and medicine began to appear in the feminist literature. For example, in her 1981 report, Hosken reframed her arguments justifying Western involvement, locating them in notions of human rights and health. She cited a letter she had sent to the secretary‐general of the United Nations, Kurt Waldheim, which had been signed by “many thousands of concerned women and men from all over the world”: “The mutilation of genital organs of the female body for any reason whatsoever is a fundamental offense against the human rights of all women in general, and specifically against the female children and women who are mutilated. The RIGHT TO HEALTH is a basic human right that cannot be abridged.” (Ironically, even the “neutral” medical discourse became the basis for distinguishing a hierarchy of values. For example, Hosken asserted in the same report that although Africans continued to call the practice “female circumcision,” the “medically correct” term was “genital mutilation.”) In the 1980s, feminists and other international actors reached consensus through an implicit agreement to focus on the medical consequences of FGC. FGC was a violation of the right to health, and therefore it was appropriate for the international community to intervene in local politics to reduce the occurrence of the practice.
In sum, radical feminists prompted the international community to take action against FGC. Realizing that they must act but unwilling to embrace the caustic feminist discourse, community leaders had difficulty developing their own justification for intervention. Science, in the form of medicine, became a seemingly neutral basis for invoking the human rights frame and intervening in national politics. In fact, however, the worldwide adoption of this perspective without debate was a monumental step toward global homogeneity. Individualism carried through medical science was acceptable to international actors; individualism in the form of assertive arguments about gender relationships smacked of bias and was initially too provocative for these same actors.
Once adopted, medical arguments were the sole basis for international intervention against FGC until 1990. A number of medical organizations were at the forefront of mobilization, including WHO, the Sudanese Obstetrical and Gynecological Society, International Planned Parenthood Federation, the International Organization of Gynecologists, and Doctors without Borders. Thus, from the late 1960s until 1990, the primary goal of international organizations was to reduce the negative health consequences of the practice.
A review of the literature suggests that the medical discourse was somewhat effective in making individuals aware of health problems associated with FGC. For example, Demographic and Health Survey data show that in Kenya only 31 percent of circumcised women aged forty‐five to forty‐nine were circumcised by trained medical personnel, but 57 percent of circumcised women aged twenty to twenty‐nine were. Likewise, only 9 percent of Egyptian women aged forty‐five to forty‐nine were circumcised by trained medical personal, but 50 percent of those women had their daughters circumcised by trained medical personnel. This trend is not universal, however. In some countries, such as Mali and Tanzania, medicalization has been, and continues to be, minimal. Ethnographies suggest more subtle forms of medicalization as well – changes that might not be picked up in official statistics. For example, over time, ethnographies increasingly refer to the use of antiseptics to clean the wound after FGC. Regardless of whether the medical discourse actually reduced the incidence of FGC, in many areas it had the overall favorable effect of making the procedure medically safer.
Given the success of the medical mobilization against FGC, it is easy to imagine mobilization around the practice diminishing. This did not happen. Instead, mobilization increased in the 1990s – but under a rights model rather than a medical model.
Although the international community in the postwar era had been hesitant to address gender issues, a relationship between gender equality and human rights had been developing; gender equality was becoming an appropriate basis for international action. In the 1950s, 1960s, and 1970s, the United Nations and its various subunits proposed many conventions and declarations relating to gender and human rights. (Conventions are binding for the states that have ratified them; declarations are non‐binding statements of aspirations.) During this time, women came to be defined less in terms of their familial role as mothers and more in terms of their rights as individuals. Most countries in the modern world have signaled their receptivity to these various conventions and declarations. The conventions and declarations provide a backdrop for understanding the policy development related specifically to FGC.
Thus, the increased attention to FGC coincided with greater attention to women’s issues in general. The international system had begun to create formal mechanisms for dealing with gender inequality around this time. The Convention for the Elimination of All Forms of Discrimination against Women (CEDAW) is a case in point. The history of CEDAW goes back to 1963, when twenty‐two countries introduced a resolution at the eighteenth UN General Assembly calling for international cooperation to eliminate discrimination against women. The resolution noted that discrimination against women still existed “in fact if not in law” despite the equality provision of the UN Charter and the UDHR [Universal Declaration of Human Rights]. On December 18, 1979, the CEDAW Convention was adopted by the General Assembly, and it came into force on September 3, 1981, when twenty countries had ratified it. As of June 2002, 170 countries had ratified the convention. Within the international treaty system, CEDAW stands distinctly as the symbol that women’s rights are human rights.
The preamble to CEDAW reaffirms faith in fundamental human rights and respect for human dignity. Article 1 defines discrimination against women broadly to include both intentional and de facto discrimination in human rights and fundamental freedoms. Article 2 mandates that states parties pursue, “by all appropriate means and without delay,” a policy of eliminating discrimination against women. Articles 2 through 5 set out the kind of measures to be taken by the state – legislative, judicial, administrative, and other measures, including affirmative action and modification of social and cultural patterns of conduct. Articles 6 through 16 address specific issues as they relate to women: sexual slavery, political and public life, nationality, education, employment, health care, economic and social life, rural life, equality in terms of civil law, and marriage and family relations. […]
By the mid‐1990s, feminist arguments concerning women’s rights as human rights and violence against women became the dominant basis for action by IGOs. A critical component of the feminist argument was to expand the idea of human rights to incorporate a positive requirement on states to protect individuals against harmful actions that occur in the “private” realm. MacKinnon argued that the privacy doctrine undermined gender equality generally: “The very place (home, body), relations (sexual), activities (intercourse and reproduction), and feelings (intimacy, selfhood) that feminism finds central to women’s subjection form the core of the privacy doctrine. But when women are segregated in private, one at a time, a law of privacy will tend to protect the right of men ‘to be let alone,’ to oppress us one at a time.” This laid the groundwork for later arguments that the idea of human rights should be expanded to encompass private abuses.
Once “privacy” became contested terrain, human rights activists were able to transcend cultural boundaries by grouping a number of private actions and practices under the broad title “violence against women.” At the international level, activists who promoted this idea were successful in increasing attention to issues such as FGC, wife beating, marital rape, child abuse, and sexual harassment. […]
FGC was featured prominently among these “new” human rights abuses, and feminists also began to pressure states directly about the practice. Dorothy Stetson suggested that governments in countries where FGC occurred represented only male interests. Priscilla Warren stated the case even more strongly: “Often the victim’s own government cannot or will not control the perpetrator; the state then also becomes a perpetrator.” Ultimately, national governments succumbed to the pressure. This is evident, for example, in the Egyptian state’s abrupt turnaround on the practice. In its 1996 report to the CEDAW Committee, the Egyptian state implicitly acknowledged its responsibility in the fight against FGC.
By the mid‐1990s, the transition from a medical model to a human rights model was complete. The FGC issue skipped from committee to committee in the organization, assigned first to a committee dealing with slavery, then moving on to a committee dealing with discrimination. Ultimately, the issue settled within the jurisdiction of the committee responsible for protecting human rights. By the time the issue reached the committee on human rights, the framing was complete: the international community had to eradicate FGC because the practice violated fundamental human rights. FGC offended the institutionalized construction of individuals as efficacious promoters of their own self‐interest.
In even more dramatic terms, the joint statement of WHO, UNICEF [United Nations Children’s Fund], UNFPA [United Nations Family Planning Association], and UNDP [United Nations Development Program] in 1995 labeled the medical basis for anti‐FGC policies a “mistake.” The reasoning of the joint statement suggested that much of the medical discourse – at least as it was applied locally – was exaggerated and consequently counterproductive. The second problem with the medical reasoning was more surprising. Essentially, medicalization had been too effective. By making FGC safer, the international community had undermined the urgency that originally motivated the eradication of the practice. The organizations attempted to recapture some of that urgency in their repackaged message: FGC had negative health consequences, but – more importantly – it was a violation of women’s rights.
Thus, in the mid‐1990s, responsibility for eradicating FGC was once again reassessed. At that time, the right to health took a backseat to the human right to be free from abuse – including abuse from intimates.