FGM in the Malian Context
keith harmon snow
Most families in Mali practice what is variously known as female genital mutilation (FGM), female genital cutting (FGC), female circumcision, or excision. FGM continues to devastate women and girls in Mali, in spite of efforts by many to convince parents to stop. The consequences include the unimaginable pain of the procedure, and many gynecological, urinary and obstetric problems, with all their ensuing psychological and marital anguish. Appendix B describes the four primary types of FGM, and details the potential consequences and medical complications.
The socio-cultural aspects of FGM vary greatly; no homogeneous practice, types of surgeries and rationales behind them are as diverse as the people that practice them. While FGM can clearly be defined as a patriarchal institution perpetuated to control women, women almost exclusively maintain the practice. Men's roles in its perpetuation cannot be dismissed however.
II. The Realities of Life in Mali
A former French colony with entrenched economic and political ties to France, Mali has suffered under acute conflict, in past decades, due to nomadic insurgencies in response to socioeconomic marginalization, discrimination and authoritarian government. Hundreds of thousands of refugees fled the government war on the Tuareg nomads, 1990-1995; most fled to Mauritania, Algeria and Burkina Faso. Repatriation and resettlement have been major issues. Thousands of refugees from Mauritania have contributed to internal security problems.
Centered in the Sahel and Sahara deserts, the temperature exceeds 100 degrees (F) for months at a time. Heat and poverty are overwhelming. Infrastructure and medical care is minimal. Decades of international programs aimed at economic modernization have not helped. Most of the economy is centered on farming and animal husbandry, and international mining cartels exploit the natural resources, especially gold, with little benefit to Malians. Cotton, cattle and fruit are major exports. The U.S. maintains ongoing cooperative military training, equipment and funding programs with Mali.
In Mali, 50% of girls are married at sixteen, and by seventeen 46 % are already mothers, or are pregnant. Women bear an average of 6.7 children. Educational opportunities are limited, with only one in five children attending school, and a major bias in favor of boys. Some 81 % of women (compared with 69.3 % of men) between the ages of 15 and 49 received no education. Illiteracy (over 76 %) remains a debilitating issue.
Violence against women, including wife beating, is tolerated and common. Numerous active women’s groups promote the rights of women and children, but women have limited access to legal services, and are particularly vulnerable in cases of divorce, child custody and inheritance rights. Women carry the bulk of the labor load, responsible for difficult farm work and childbearing, often under harsh conditions, especially in rural areas.
Forced early child marriage is a major problem in Mali: pre-pubescent and adolescent girls are frequently given away by parents in arranged, but unwanted, marriages. These girls risk forced sex with their husbands. Many child brides become pregnant, soon after marriage, and give birth in physical immaturity, increasing the risk of death from childbirth. Survivors often suffer adverse medical and psychological complications with severe and long-term health, social and economic consequences, including some of the same consequences as occur with FGM.
III. FGM in Mali 
There has been a movement against FGM in Mali for over 25 years. Many projects have been designed and conducted to convince parents not to have their daughters cut. Projects have also been carried out with excisers, themselves, to give them a start in a new line of work, or otherwise encourage them to stop excision. In recent years, the government has become involved and coordinates the efforts of the various groups addressing the problem. There has been some progress, but the lack of progress is perhaps more remarkable. Statistics are hard to find but the rate seems to have gone from about 97% to about 94% in the past two or three decades of campaigning against FGM. While the majority of people seem to believe that the practice is a bad thing, only a few are actually ready or willing to stop.
The vast majority of Malian women have been excised. Traditionally excision has been a rite of passage into adulthood, but in recent times, girls are subjected to it very early: 41% before the age of four; only 10% of girls survive unscathed to the age of ten. About half have their clitoris removed and the others have their clitoris and little lips (labia minora) cut. Only minor differences have been recorded between generations, or between rural and urban areas. All but a few ethnic groups practice FGM. Medicalization – FGM practiced by health service staff – is observed primarily in urban areas. Recently however, in the spring of 2002, television announcements were seen warning against the practice of FGM in hospitals. FGM is reportedly practiced throughout Mali, except for the regions of Gao and Timbuktu, and lower prevalence is seen amongst the Tamacheck (16 %) and Sonrai (48 %) people, who reside mainly in the Gao and Timbuktu regions. Education makes a surprisingly small difference, with 94% of women with no education or only primary education being cut and 90% of those with secondary education. FGM is practiced by Christians (85 %), by Muslims (94%) and by almost all other ethnic groups in Mali.
There is no federal legislation prohibiting the practices of FGM in Mali. Article 166 of the Penal Code prohibits voluntary cutting or injuring a person, or committing any violence against a person. Article 171 states that anyone who administers willingly any procedure or substance to an individual without consent, causing illness or disability, is punishable by six months to 3 years imprisonment. Many observers believe that these laws are sufficient to prosecute an excision case, if someone ever tried it, but no one has. The National Assembly discussed the matter last year and most legislators still felt that it wasn’t yet time for a law. While we hope the law will be enacted soon, this will certainly not be the end of the struggle. In Ghana, legislation promulgated without sufficient education and awareness has driven the practice underground.
In June, 1997, the Malian Government committed to total eradication of female genital mutilation. The Ministry for the Promotion of Women created a National Committee for the Eradication of Traditional Practices Harmful to the Health of Women and Children that links all NGO’s and government agencies active against FGM. In 1998, the Government instituted a two-phased plan to eliminate excision by 2008. Phase One, 1999-2004, focuses on education and dissemination of information. Phase Two, 2004-2008, is projected to adopt and legally enforce federal legislation.
V. Motivations for FGM 
The arguments used to perpetuate FGM range from fear for the daughter’s marriageability and honor, to conformity and insistence by older relatives and the community. In the past, women who underwent FGM as a cultural rite were often conferred with greater social and economic status – this in cultures where women were seldom honored, celebrated or recognized. Age differences and the related educational opportunities, in some parts of Africa, reveal changes in attitudes about FGM. More educated women in urban centers often, but not always, appear to oppose the practices. However, even mothers who do not favor FGM have had, or intend to have, daughters genitally cut, including, e.g., mothers in Egypt (23 %), Sudan (34 %) and Mali (65 %).
There are numerous reasons, rationalizations and justifications given for maintaining the practice of female genital cutting. A general list is provided below, followed by a discussion of specific cases most pertinent to the situation in the Saharan desert belt geographically comprised of Mali, Burkina Faso, Mauritania and Niger.
Į It contributes to women’s cleanliness and purity; and/or it keeps the vagina clean
Į It affects (increases) women’s fertility
Į It enhances femininity; asserts women’s indispensability as mothers of men (versus objects of sexual desire)
Į It prevents infant and child mortality
Į It is a rite of initiation into womanhood (though infant excision has almost replaced this in Mali)
Į It offers membership in a group
Į It increases marriageability
Į It is a tradition that must be maintained for religious reasons
Į It preserves virginity.
From an ethno-cultural perspective, practices among various cultural groups in the west Saharan region should perhaps be considered in total before any localized FGM campaign is undertaken. It is also important not to over-generalize information learned from one group, but to learn the significance of a practice from each community or culture.
Girls and women who have not been genitally cut are often ostracized from family and community, and they may at the very least be prohibited from various actions in their communities, and their status may affect the status and opportunities of other family members. Opposition to the struggle against FGM can also take the form of resistance to cultural imperialism or the promotion of cultural integrity. Thus reaction to sexualized western media has in some places prompted a fundamentalist backlash where FGM is seen as a necessity in the context of greater threats to cultural preservation and survival. Such influences, and perceptions, are often very real, and often only reinforce the resolve of groups and individuals to carry out FGM.
VI. Contradictions of FGM in Mali
Many people associate FGM with religious imperatives. In many places, including Mali, many Muslims believe that God ignores the prayers of uncut women. In the Sudan and in West Africa local sheiks and marabouts claim that FGM is a required or “preferable” Moslem rite. While male circumcision is an absolute command, it is generally conceded by Islamic authorities that there are no authenticated Islamic texts requiring the practice, and there are no final statements (fatwas) about FGM from an Islamic position.
Most of the statements made have stressed that FGM is only a “makrama” or “third or fourth order duty.” According to Sheikh Mahmoud Shaltout, former Sheikh of M-Azhar in Cairo, the most famous university of the Islamic world: “Islamic legislation provides a general principle, namely that certain issues should be carefully examined and if these prove to be definitely harmful or immoral, then it should be legitimately stopped, to put an end to this damage or immorality. Therefore, since the harm of excision has been established, excision of the clitoris is not mandatory nor a so-called ‘sunna’ (duty).”
More common among Muslims, FGM is also practiced widely in Africa by Christians and animists. Local African leaders of the Catholic Church generally have not opposed FGM; authorities of Protestant churches often have rejected it and other cultural traditions deemed inappropriate for Christian people.
In Mali, where most FGM takes place in infancy, the argument that FGM constitutes a valuable cultural rite (of passage) cannot be justified. As elsewhere, FGM occurs at an earlier age because girls increasingly protest FGM: younger girls are physically incapable of resisting FGM, and people claim it is more humane if the girl is young enough not to remember the procedure. In the interests of “tradition,” mutilations continue to be practiced even in families of government officials and political leaders where men have been to European or Western universities, even though these men have rejected most African traditions for their Westernized personal lives.
It is widely believed (e.g. in Mali and Burkina Faso) that the clitoris connotes maleness, and the prepuce of the penis, femaleness. Hence, both have to be removed before a person can be accepted as an adult in his/her sex and society. These beliefs can be addressed through education about human anatomy and development. The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, for example, in rural outreach, uses dolls, anatomical models and slides to show people that female genitalia have a purpose.
It is also believed that a girl who is not excised will run wild and disgrace her family. However, even though FGM often leads to discomfort or pain during intercourse, there does not appear to be a correlation between sexual activity and the practice of FGM. Evidence shows that extramarital sex is widespread: in Mali, with 94 % prevalence of FGM, 17 % of never-married women admitted to sexual activity in the month preceding the health and demographic survey, and 44 % had sexual relations in the past.
Undermining the schemas of belief can be achieved with education and clear articulation of the negative health and social consequences of FGM. For example, counter to popular perceptions, surveys have found that husbands (men more generally) prefer sexual experiences with uncut wives to those who have been cut. Research also reveals that marriages often suffer under the strain of FGM and its health consequences; many wives are abandoned when sexual or health problems are severe enough, and this often leads to greater ostracism, and hence social and economic isolation and loss.
Economic incentives also count among the factors supporting the perpetuation of FGM. The practitioners of FGM often gain considerable income for their services, and in a country as thoroughly impoverished as Mali, these incomes can mean the difference between life and death. Greater social status has also been conferred on practitioners, as they perform roles and services highly sought after on traditional or religious grounds.
The practice of FGM has come to be seen by many women as “natural.” Indeed, it is all they have ever known, and all they have ever seen among their familial and social groups. Many women may not link the many complications arising during childbirth, or later in life, to ‘surgery’ they underwent as children. This presents a unique and fundamental challenge to the opponents of FGM, who must confront and overcome the most basic and deep-seated misperceptions that women hold about their own bodies.
VII. Consequences of FGM
The health consequences of FGM include the unimaginable pain of the procedure, the many gynecological, urinary, and obstetric problems, and all the ensuing psychological and marital anguish. Chronic vaginal and urinary infections, painful menstruation, painful intercourse, and all kinds of gynecological problems plague many excised women. However, it is reported that only 15 to 20 percent of complications come to the attention of medical personnel due to the unavailability or remoteness of health care, ignorance, or the lack of priority given to women’s health and comfort. Most excisers “treat” complications themselves, sometimes with devastating results, and only the more serious complications are referred to the health sector.
The effects of FGM depend on the type performed (infibulation is even more hazardous than other types), the expertise of the exciser, the hygienic conditions under which the operation is conducted, the cooperation and the health of the child at the time of the operation. A detailed list of complications arising from FGM is included in Appendix B.
The extent of the psychological consequences has never been systematically investigated. It is often said that girls cut at an early age do not suffer any psychological trauma, but it is also reported that many remember their mutilation quite clearly. Common psychological problems, including anxiety, depression, nightmares, post-traumatic stress disorder, behavioral disturbances, psychosomatic illnesses, psychosis, neurosis, and suicide are due to the painful FGM procedures.
The social consequences of denouncing or evading, or protecting others against, the practice of FGM can be significant. It is women, primarily, who suffer the repercussions; families and communities have ostracized women who have evaded FGM. It is common for children, wives and mothers to be coerced or beaten into submission and complacency. There have also been cases of retribution against opponents of FGM; in Ghana an opponent was forcibly mutilated “to teach her a lesson.” Fear of ostracism, or direct violence, is significant.
On the other hand, and equally significant, some people are surprised that opposition is not as strong as they had thought. With so little discussion of the subject, in some families everyone assumes that the others support the practice, when it is not always true.
One of the greatest impediments to change is the belief by survivors of FGM that it was done in their best interests, and it is therefore in the best interests of others that FGM practices continue. The admission of one’s betrayal by parents and other respected elders, does not come easily. It must also be hard to accept that all the pain associated with the practice has been for no good purpose.
The economic costs and disadvantages of FGM often go unrecognized. For example, medical attention and surgery for complications, and the loss of productivity and working potential due to sickness and disease, are major factors that might be exploited in any educational campaign addressing FGM.
 On child marriage, see e.g.: Sarah Y. Lai and Regan E. Ralph, “Female Sexual Autonomy and Human Rights,” Harvard Human Rights Journal, Volume 8, Spring 1995: pp. 201-226.
 Most of the statistics in this section are based on a 1995/1996 National Demographic and Health Survey.
 Information for this section is taken liberally from the following significant and informative papers, which are heavily sourced and footnoted: Maria de Bruyn, Socio-Cultural Aspects of Female Genital Cutting, Royal Tropical Institute, Amsterdam, Netherlands; Lightfoot-Klein, H., Similarities in Attitudes and Misconceptions Toward Infant Male Circumcision in North America and Female Genital Mutilation in Africa, and Amna Hassan, Sudanese Women’s Struggle to Eliminate Harmful Traditional Practices, FGM Home Page, Internet website, 1998.