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Introduction

Grappling with the “Female Circumcision” Controversy

To outsiders, the practice euphemistically known as “female circumcision” is shocking. That people surgically alter the genitals of young girls and women, usually in painful and unhygienic procedures that can cause grave harm to their health, seems truly horrible. Why do loving parents allow such things to happen? How can they bring themselves to celebrate these events? How can they justify the practice when occasionally a girl dies from the injuries?

The horror female circumcision evokes is grist for outrage, electrifying a cry for urgent change. At the new millennium, there are still millions of girls and women in dozens of countries who bear the scars of cutting done to their genitalia early in life. Worldwide, it is estimated that an additional two million girls too young to give their consent undergo some form of female genital cutting each year. How can this be?

This book offers an exploration of the female circumcision practices themselves, the reasons they are done, examples of the social contexts, the health, social, and sexual consequences, and the controversies surrounding the process of change. It addresses many of the most frequent questions and challenges I have encountered in teaching and lecturing about these topics, with the intention to improve understanding, reduce simplistic denunciation, and provide a solid grounding for those who decide to support reform efforts. For people outside the cultural contexts where female circumcision is still practiced, developing understanding requires much more than merely knowing the facts or arriving at a philosophic position for or against. To allow readers more opportunity to consider the social contexts and the human experience, I include narratives and examples from my ethnographic research in Sudan.

The Practices Known as “Female Circumcision”

“Female circumcision” is one term used for the cutting and removal of tissues of genitalia of young girls to conform to social expectations. There is tremendous variation in the practices and their meaning. In some cultural contexts, these operations are done on very young children, including infants and toddlers (Shandall 1967, Toubia 1993, Abdal Rahman 1997). Anne Jennings has reported southern Egyptian girls undergoing the procedure at age one or two (1995:48). Most commonly, it is done to young girls between the ages of four and eight. But there are other cultural contexts (e.g., the Maasai of eastern Africa) where it is young teens, around the time of marriage (fourteen to fifteen or even older), who are circumcised.

While I consider it important to resist generalizing about the types of genital alterations around which the controversy unfolds, the variant forms can be differentiated and grouped. The least severe forms of the operations (excluding those that merely wash or prick the clitoris or prepuce without removal of any tissues) are those where a small part of the clitoral prepuce (“hood”) is cut away, analogous to the foreskin removal of male circumcision. Toubia asserts that in her years of medical practice in Sudan, Egypt, and the United Kingdom, she never saw any circumcisions that precisely fit this description (1996). Nevertheless, it is referred to elsewhere, at least as a theoretical possibility, and is discussed later in this volume. This form is grouped with those that include the cutting, pricking, or partial removal (or “reduction”) of the clitoris under the rubric of “sunna circumcision.” This term “sunna circumcision” is in fact applied to a wide variety of surgeries, and the term itself offers serious problems of interpretation of the meaning, propriety, and religious associations of the surgeries. The basic translation of the word “sunna” is “tradition,” and it usually connotes the traditions of Islam’s Prophet Mohammed, meaning those things that he did or advocated during his lifetime.¹ In Sudan, some use the term “sunna” for even more severe forms of female circumcision than the reductions just described.

Full clitoridectomies are termed “excision” or “intermediate” by most writers. These are more severe forms of surgery that include removal of the prepuce, the clitoris, and usually most or part of the labia minora, or inner lips. In Sudan this form is usually called sunna even though it is more serious than what some writers mean by sunna. The reason for this is that the folk classifications, in many areas at least, consist of only two forms, sunna and pharaonic circumcision, even though the operations vary a great deal from one circumciser to another and the sunna terminology seems to be applied to any circumcisions that are not “pharaonic.” Midwives and others also use an imprecise term, nuss (“half”), for some of the in-between forms.

Pharaonic circumcision entails the removal of all the external genitalia–prepuce, clitoris, labia minora, and all or part of the labia majora—and infibulation, or stitching together, of the vulva. Once healed, this most extreme form leaves a perfectly smooth vulva of skin and scar tissue with only a single tiny opening, preserved during healing by the insertion of a small object such as a piece of straw, for urination and menstrual flow. The extremely small size of the opening makes first sexual intercourse very difficult or impossible, necessitating rupture or cutting of the scar tissue around the opening. In a variation of infibulation that is slightly less severe, the trimmed labia minora are sewn shut but the labia majora are left alone. Reinfibulation is done after childbirth.

In short, the variety of operations defy easy categorization, and the descriptive terminologies that are comparative—generated from outside the frame of meaning of those who do them, to aid medical descriptions for example—cannot be expected to reflect categorizations that are meaningful from any specific cultural perspective. Whether a writer’s typology has three categories or some other number depends on the purposes of the study, whether it is for health education, ethnographic description, or medical analysis. I often use the two common Sudanese terminologies, sunna and pharaonic, because these are significant to the debates about cultural and religious authenticity discussed later, but I also discuss variations and innovations in these surgeries. These two categories parallel Sudanese physician Nahid Toubia’s dichotomous classification of “reduction” operations and “covering” operations (Toubia 1994).

What Should Be the General Term for These Practices?

The term “female genital mutilation” has become more widely accepted since the 1990s. “Mutilation” is technically accurate because most variants of the practices entail damage to or removal of healthy tissues or organs. But for most people, the term “mutilation” implies intentional harm and is tantamount to an accusation of evil intent. Some of my Sudanese friends have been deeply offended by the term, and it is their reaction as much as the connotations of that term that have influenced my preference for the term that is very commonly used when speaking or writing in English: female circumcision. “Female circumcision,” however, echoes the term for the removal of the foreskin in the male, which is generally considered nonmutilating (Toubia 1993:9). The term “female circumcision” is therefore rejected by many people because “circumcision” seems to trivialize the damaging act and the huge scale of its practice.

Neither term—mutilation or circumcision—is a translation of the Arabic word most commonly used for female circumcision in Sudan. Tahur (or its variations such as tahara) is usually translated as “purification” and connotes the achievement of cleanliness through a ritual activity. But in fact there is little about the rather matter-of-fact performance of the surgical act that one would associate with ritual in a religious or mystical sense. Thus using a term that connotes ritual seems both inaccurate and inadequate to the broad range of meanings and contexts of the practices. And some are offended by it, as it could give the impression that practitioners are unreflective or not rational.

“Clitoridectomy” and “infibulation” are somewhat more precise descriptive terms, but a term that encompasses both types of surgeries and other variations is also needed. “Female genital operations” or “genital surgeries” are accurate terms and can be used in some contexts, but they do not adequately differentiate these practices from therapeutic medical surgeries, whereas to call them “traditional female genital operations” evokes the simplified interpretation I challenge in this book. Shortening “female genital mutilation” to the more clinical-sounding FGM is an alternative now used widely by many, including Toubia, writing in the United States for an international audience. She adds, however, the eminently sensible thought that using the terms of reference of the communities where the practice occurs is a “starting point from which to initiate the process of change” (1993:9); she herself varies her terminology in her writing. The term “female genital cutting” (FGC) has been used by some writers and seems to be gaining greater acceptance.

The term “female circumcision” is often used here, despite its clearly euphemistic character, to avoid the connotations of evil intentions or wanton mayhem associated with the term “mutilation.” I am fully cognizant of its inadequacies.

Health Risks

All the forms of female circumcision share certain risks. First, the unhygienic circumstances in which circumcision operations are often carried out, together with the minimal training of many circumcisers, pose serious risks. Infection of the wound is common when unsterilized instruments are used or if cleanliness is not meticulously attended to. Hemorrhage (uncontrolled bleeding) is sometimes difficult to stop if the circumciser has cut too deep. Shock can occur, and septicemia (blood poisoning) can also result. In the days after the surgery, some girls experience retention of urine because of pain, swelling, fear of pain, or obstruction of the urethral opening. Problems such as adhesions of labial tissue (where not entirely removed), vaginal stones, and vaginal stenosis (narrowing) are also reported.

The forms that include infibulation offer additional serious health consequences. Obstruction of menstrual flow can occur in cases in which the scar tissue obstructs the vagina, and an adolescent girl may find menses prevented, with the unsuccessful discharge backing up and distending her uterus. El Dareer described a case in Sudan in which pregnancy was suspected, much to the shame and fear of the girl’s mother, until the true nature of the problem was discovered: the fifteen-year-old girl, who had never menstruated, had such a small opening she had difficulty passing urine and her menstrual discharge had been completely obstructed, perhaps because of vulvo-vaginal atresia (absence of an opening). An incision released the large quantity of fetid blood (1982:37). El Dareer also heard reports of a similar case in which the girl was said to have been killed for the sake of family honor. Even those whose menstrual flow is not obstructed often report painful menstruation, probably not only because of the usual cramps but also because of the tightness of the infibulation and frequent infections.

Later, first intercourse is complicated by infibulation because either painful tearing or unhygienic cutting (by the husband or a midwife called in to assist) commonly occurs. Obstructed intercourse resulting from a tight introitus or painful intercourse (dyspareunia) and chronic pelvic inflammation that might affect penetration or frequency can also result in infertility (Shandall 1967; Verzin 1975; for case descriptions, see El Dareer 1982).

During pregnancy and childbirth, the infibulated opening creates other difficulties. Infections of the vagina or urinary tract may contribute to miscarriage. Chronic pelvic infections are considered a major factor in infertility cases, and infertility is a socially disastrous condition throughout the regions where circumcision is practiced (see Inhorn 1994, 1996). The most severe, life-threatening, long-term complication of infibulation is obstructed labor. Fibrous, inelastic tissues of the vulva may require excessive bearing down during the second stage of labor, exhausting the mother and stressing the infant (El Dareer 1982:38). During childbirth, a midwife must be present to cut the inelastic scar tissue across the vaginal opening when the baby is in position for delivery (crowning) and sew the tissue together again after delivery. This cut is basically an episiotomy that is cut upward (anterior), rather than downward (posterior). Lateral or bilateral episiotomy to widen the vagina is also sometimes necessary (Abdalla 1982:26). Keloid scarring and cysts are not uncommon at the site of the infibulations, which can make the episiotomies themselves, as well as the restitching and healing, difficult. The risks of excessive bleeding and infections from all the cutting needed and the unavailability of medical facilities for emergencies in most rural areas of Africa pose survival risks for mothers. To reduce the risks of childbirth, some women greatly reduce their nutritional intake during pregnancy, a practice that may have the opposite effect.

Delays in the cutting during labor (e.g., if the midwife does not arrive in time or the traditional birth attendant lacks the experience to judge the timing), in addition to posing a risk to the survival of mother and infant, can also cause severe perineal lacerations or damage to vaginal tissue, often resulting in vasicovaginal fistulae, a serious medical problem wherein a passage is created between the vagina and the urinary bladder or other parts of the body cavity, including the rectum (see Shandall 1967, Mudawi 1977, Verzin 1975). For some women the result is a most embarrassing condition rendering her unable to retain urine and producing constant leakage. In rural areas where pads or absorbent cotton are not available in the market or are beyond the means of a family, the woman may be unable to preserve basic hygiene and may suffer the consequence of social avoidance, ostracism, or divorce (El Dareer 1982:38).

Infibulation is also related to an apparently high prevalence of urinary tract and other chronic pelvic infections. If urine cannot be passed easily and there is only a single pinhole-sized opening for both bladder and vagina, some women experience the backing up of urine into the vagina, which is particularly dangerous during pregnancy. One can easily imagine how a woman with such a condition—or any woman who finds it difficult, slow, or painful to pass urine—might be tempted to cut down on her fluids, drinking too little for good health in a hot climate. In many rural areas, latrines are nonexistent and hidden places, as well as opportunities, for uninterrupted urination may be few. When traveling by bus or truck, the lack of facilities at stops may force women to hide under their long veils and urinate in the open; many prefer the discomfort of holding their urine for many hours.

Such conditions and inadequate fluid intake could be contributing factors to the high rates of urinary tract infections reported: Shandall has reported a prevalence rate of 28 percent of northern Sudanese women affected by urinary tract infections (1967, see also Boddy 1998a:53).

The limited epidemiological information available on maternal mortality, stillbirths, and neonatal mortality in the countries affected by female circumcision practices gives cause for concern, though clear demonstrations of the relationship of these results to incidence of female circumcision await better data. Nevertheless, there is every reason to believe that reduction of the incidence and severity of female circumcision could contribute to improvement of the health and survival of women and children. (For more on medical consequences, see Abdalla 1982; Boddy 1982, 1989, 1998; Cook 1976; Dorkenoo and Elworthy 1992; Dorkenoo 1994; El Dareer 1982; Verzin 1975; Rushwan et al. 1983; Shandall 1967; Toubia 1993, 1994; Van der Kwaak 1992).

Psychological risks have also been discussed by some writers and depicted in fiction (e.g., Walker 1992, El Saadawi 1980a, Abdalla 1982). Abdalla states that psychological reactions range from “temporary trauma and permanent frigidity to psychoses,” and she hypothesizes an effect on the personality development of the young girls, a “totally neglected” topic (1982:27). There have been a few studies of mental health sequelae and the issue is being addressed in the literature (e.g., Baashar et al. 1979; Grotberg 1990, Toubia 1993). Baashir notes that the physical complications often produce psychological effects, for example, the “toxic confusional states” resulting from shock or tetanus, and there are also longer-term psychiatric sequelae to the physical complications, which can lead to “chronic irritability, anxiety reactions, depressive episodes and even frank psychosis” (quoted in Abdalla 1982:27). More research would be useful on female circumcision trauma in relation to later depression, fear of intimacy, and sexual dysfunction. Psychological consequences clearly can be expected to vary considerably, depending on cultural meanings that are taught and whether girls are prepared for the operations.

Reviewing the horrendous health risks, one can understand the intense outpouring of condemnation that ensued when the practices became more widely known by people outside the societies involved. That they have been nevertheless strongly defended and variously interpreted is the source of the intense controversy.

The Extent of Female Circumcision Practices

Various writers estimate that there are more than 100 million women and girls whose bodies have been altered by some form of female circumcision. Toubia estimates 114.3 million (1993:25). About 2 million are considered at risk for undergoing the procedure each year. Some form of female genital cutting is practiced in about twenty-eight countries in Africa.

But the procedure is not limited to Africa. Many more countries need to be concerned, as medical practitioners and social services providers find themselves dealing with circumcised women of immigrant populations now living in North America, Europe, South America, and Australia. Although new cases among immigrants are believed to be few, public health education of immigrants is needed and caregivers need preparation. Circumcision may also spread as people come to believe, however erroneously, that it is required by their religion, as in the case of Muslim populations in South Asia and Indonesia that have adopted circumcision. Several countries of Europe, south and southeast Asia, and North America, together with Brazil and Australia are said to have practicing populations that are “less than 1 percent” (Toubia 1993:34).

In Africa, statistics on prevalence of circumcision, its types, and the rates of new cases have been difficult to determine, as data are uneven (see Toubia 1993, 1995; Amnesty International 1997; Hosken 1978, 1982, 1998). According to data drawn from national surveys, small studies, country reports in WIN News, and anecdotal information, the affected countries have prevalence rates (i.e., the percentage of cases in the appropriate female age groups) that range from as high as 98 percent to as low as 5 percent. Some countries have none. The moderate rates of some countries may reflect an average of high prevalence in one area (perhaps certain ethnic groups) with low prevalence in another.

The countries with the highest total estimated prevalence are Somalia (98 percent), Djibouti (95–98 percent), Egypt (97 percent), Mali (90–94 percent), Sierra Leone (90 percent), Ethiopia (90 percent), Eritrea (90 percent), Sudan (89 percent for the northern two-thirds of the country), Guinea (70–90 percent), Burkina Faso (70 percent), Chad (60 percent), Cote d’Ivoire (60 percent), Gambia (60 percent), and Liberia (60 percent). Also very high, with estimates of 50 percent each, are Benin, Central African Republic, Guinea Bissau, Kenya, and Nigeria. Countries where fewer than one-third of women and girls are affected include Mauritania (25 percent), Ghana (15–30 percent), Niger (20 percent), Senegal (20 percent), Togo (12 percent), Tanzania (10 percent), Uganda (5 percent), and Zaire (5 percent). The remaining countries of northern Africa and southern Africa are considered “nonpracticing countries.” (See Map 1.)

Nearly a third of the cases in Africa are in Nigeria, not because of high prevalence but because of its large population; the country accounts for 30.6 million of the 114.3 million cases for Africa as a whole, according to Toubia (1993:25). Just seven countries of northeast Africa (Egypt, Sudan, Eritrea, Ethiopia, Djibouti, Somalia, and Kenya) contain half of the circumcised women and girls in Africa.

Infibulation, the most severe form of female circumcision, is most common in that same region of northeast Africa, including Somalia, Djibouti, eastern Chad, central and northern Sudan, southern Egypt, and parts of Ethiopia and Eritrea (see also Hicks 1993). The people of Djibouti have practiced infibulation almost exclusively. For Somalia, circumcision is virtually universal, and at least 80 percent are infibulated. For the northern two-thirds of Sudan, where El Dareer’s research team conducted interviews, 98 percent had circumcisions, but only 2.5 percent were sunna, while 12 percent were intermediate and 83 percent were infibulated. At the time of the interviews in 1979 and 1980, only 1.2 percent reported no circumcisions (El Dareer 1982:1). In Egypt the prevalence of infibulation is high mostly in the south near Sudan. Similarly, the areas of Eritrea and Ethiopia where infibulation is found are those near Sudan, Somalia, and Djibouti, where infibulation is predominant.

Although the amount of information is growing, mapping the areas where the various forms are practiced today and indicating prevalence is challenging, given the unevenness of data. Unfortunately, some of the maps that are being used in publications draw upon earlier efforts that incorporated anecdotal accounts that, at least for the areas of Sudan with which I am familiar, are not fully supported by ethnographic information. Because comprehensive epidemiological research has not been carried out everywhere and health data in general is often inaccurate in areas underserved by health care systems, all existing maps (including Map 1) must be understood as crude approximations of the pattern of prevalence; they do not reflect the increases or decreases in incidence (rate of new circumcisions in age groups at risk) that may or may not be occurring because of public health efforts and cultural change.

Clitoridectomy in the West

Damaging female genital surgeries are not limited to just a few countries of the world, nor have they always been linked to cultural traditions. A few years ago one of my European-American students told me that her grandmother had been circumcised as a child, growing up in the American South. She was not alone.

In a surgery performed in Berlin in 1822 (reported in The Lancet in 1825), a fourteen-year-old “idiotic” patient was said to have been cured of her “excessive masturbation and nymphomania” after being “declitorized” (Huelsman 1976:127). Not only did she discontinue “selfpollution,” but the “intellectual faculties of the patient began to develop themselves, and her education could now be commenced,” allowing her to begin to “talk, read, reckon, execute several kinds of needle-work, and a few easy pieces on the piano forte” (quoted in Huelsman 1976:127–28). According to Huelsman, the first four decades that The Lancet was in publication (i.e., after 1825), there were numerous case histories of patients “declitorized for a variety of medical reasons,” including hypertrophy, tumors, and “infantile, adolescent or adult masturbation regarded as excessive” (1976:128).

Elizabeth A. Sheehan offers a fascinating account of one of the European medical advocates of selective female genital cutting in the mid-nineteenth century, Isaac Baker Brown (Sheehan 1997), who was active during the period of greatest popularity of biomedical declitorization in England during the 1860s (Huelsman 1976:29). Although removal of clitorises in cases of disease was known in European medicine for centuries, Brown’s ideas emerged in an era of debate over whether the clitoris had any role at all in the female enjoyment of sex; some came to consider its removal as a “harmless operative procedure” (a phrase that was used in 1866, see Sheehan 1997: 328). An expert in various operations on the female sexual organs, Brown had founded the London Surgical Home for Women. From the observation that many of the female epileptics in his institution masturbated, Isaac Baker Brown developed a theory of causality that masturbation led to a progression of stages from “hysteria” to epilepsy and eventually “idiocy or death.” Particularly frightening in the long history of European understanding of women’s psychology is Brown’s assertion that danger signs of such possible degeneration might include becoming “restless and excited, or melancholy and retiring, listless, and indifferent to the social influences of domestic life.” “Often a great disposition for novelties is exhibited, the patient desiring to escape from home, fond of becoming a nurse in hospitals … To these symptoms in the single female will be added, in the married, distaste for marital intercourse” (Brown 1866, quoted in Sheehan 1997: 327).

Map 1. Types of Female Genital Cutting in Africa and Arabian Peninsula. Shaded areas indicate prevalence of some form of “female circumcision.” Darker shading indicates prevalence of infibulation. See Map Key on facing page.

Key for Map 1

COUNTRY

1 Benin

2 Burkina Faso

3 Cameroon

4 Central African Republic

5 Chad

6 Côte d’Ivoire

7 Democratic Republic of Congo

8 Djibouti

9 Egypt

10 Eritrea

11 Ethiopia

12 Gambia

13 Ghana

14 Guinea

15 Guinea-Bissau

16 Kenya

17 Liberia

18 Mali

19 Mauritania

20 Niger

21 Nigeria

22 Senegal

23 Sierra Leone

24 Somalia

25 Sudan

26 Tanzania

27 Togo

28 Uganda

29 Yemen

30 Oman

31 United Arab Emirates

Brown’s cure for such “feminine weaknesses” was removal of the clitoris. Recommending chloroform and scissors rather than a knife for the removal, Brown described cases of immediate improvement of his patients. There was widespread acceptance of his theories and some acceptance of his surgeries, both in Britain and North America. In modern times, even as late as the 1940s, biomedical physicians in England and the United States have done clitoridectomies for the treatment and prevention of masturbation and other “deviant” behaviors and psychological conditions such as “hysteria,” particularly for mental patients (Ehrenreich and English, 1973:34).

Ethnographic Research

Although this book is intended to offer breadth on the practices in their variant forms, I also offer data from my ethnographic research on rural women in communities in Sudan. This northeast African country is a valuable case because the most severe form of the surgeries—infibulation—is widely practiced there.

Over a period of more than two decades, I was able to spend about five and a half years in Sudan, which afforded me the opportunity to reflect on, and conduct ethnographic research on, female circumcision (see Map 2 for specific locations). My first trip to Sudan began in 1974, when my husband and I took teaching jobs at the University of Khartoum. The language of instruction at the university was English, but to delve into the society we studied Arabic and gradually became more proficient at speaking Sudanese Arabic. During the next several years, we lived in two urban contexts that afforded ample opportunities for participant observation: Khartoum, the capital city, and Wad Medani, the capital of Gezira Province, where my husband, Jay O’Brien, worked for a year at the University of Gezira. Some of my observations are drawn from these urban experiences, but I was fortunate to have opportunities for rural research in several parts of the country. (See Map 2, page 145.)

In 1975–76, I worked with the Economic and Social Research Council of the National Council for Research on the Jonglei Research Team that focused on the region in southern Sudan where the ill-fated Jonglei Canal was planned. Our multidisciplinary team collected data to enable us to analyze political, economic, and cultural patterns, local interest in development projects, and existing environmental adaptations and migration patterns of local herding, agricultural, hunting, and fishing practices. There I interviewed (with an interpreter) eighty women of the noncircumcising Nuer ethnic group on their work roles and reproductive histories (Gruenbaum 1990). We interviewed in a sample of Nuer communities clustered south of the confluence of the Sobat River with the White Nile in Jonglei Province, and I did participant observation in the village of Ayod, a Nuer community in Jonglei Province.

For the Sudanese Ministry of Social Affairs, I led a survey team to study the utilization of health and social services in Sudan’s premier area for irrigated agricultural development and cotton production, Gezira Province (located south of Khartoum in the peninsula formed by the Blue Nile and White Nile), and I conducted community case studies in Wad Sagurta and Abdal Galil villages. That 1977 research, together with archival research before and after it and additional research visits to Abdal Galil village, contributed to my dissertation on the impact of the Gezira Irrigated Scheme on health and health services in Sudan (Gruenbaum 1982).

In 1976–77, I also participated in research in two villages on the Rahad River, east of the Blue Nile, where my husband, Jay, and a colleague were studying economic organization and labor migration. The villages of Urn Fila and Hallali afforded a rich opportunity to compare ethnic differences in female circumcision practices, as well as patterns of family life (Gruenbaum 1979).

I went to Sudan for a short period of follow-up field research in 1989 that included work in the cities of Khartoum and Wad Medani and the villages of Abdal Galil in Gezira Province and a new village, Garia Wahid, where the families from Urn Fila and Hallali had been resettled for a development project, the Rahad Irrigation Project. Although I was only able to spend a few hours at the old Um Fila site with the families who had declined to relocate, the weeks of research in Garia Wahid afforded valuable insights into the process of change and the interethnic influences that were taking place.

In 1992, I returned to Abdal Galil in Gezira and Garia Wahid in the Rahad and also spent brief periods in the cities of Khartoum and Wad Medani. Although the time was short, just a little over a month, I was able to note the changes and to focus on interviews with people already well known to me.

Whenever possible, I have taken opportunities to continue discussing female circumcision and change efforts with Sudanese and other African women in international contexts. Most memorable was the Beijing Conference in 1995, when I had the opportunity to spend many hours over several days in the company of both northern and southern Sudanese women representing the whole political spectrum, including progovernment factions, internal dissidents, and exiles.

Taboo Subject?

It was not my intention to study the topic of female circumcision originally. In fact, I did not know about these surgeries prior to my decision to go to Sudan for the first time in 1974. It was not until the last few weeks before my husband and I were to depart that I learned of pharaonic circumcision. The wife of one of my graduate school professors, who had spent three years in Sudan in the 1960s, shocked me with the news. At our going-away party, she told me that most Sudanese women had undergone genital surgeries during childhood, that midwives removed the girls’ clitorises and all or part of their labia and then left them sewn shut, except for a very small opening for urination and menstruation preserved by insertion of a piece of straw during the healing process.

Kenana grandmothers with baby, Garia Wahid, Sudan.

A stark image. I recall feeling vaguely nauseous. Could she be mistaken? What a horrendous secret! Why hadn’t I come across this before? I had no reason to doubt her information, but I found myself unable to believe it completely, wondering if—and hoping—that it might by then be a thing of the past.

It is perhaps a similar experience of shock upon learning about female circumcision that has led outsiders to label this a taboo subject that cannot be discussed (e.g., Hosken 1982). After all, we wonder, why isn’t a fact of this importance generally known? One might conclude it has been kept secret, making the term “taboo”—associated with forbidden or secret activities—seem particularly apt.

But female circumcision is not a secret at all. In Sudan everyone knows about it. In 1994, I discussed this concept of circumcision as a secret or taboo with Sudanese legal scholar and change supporter, Asma M. Abdal Halim, who agreed: “It’s not a secret; we celebrate it!” (personal notes, Sisterhood Is Global Conference, Bethesda, Maryland, September 1994).

Why might a visitor conclude the topic is “taboo”? Probably because the subject is not likely to be brought up in conversations with outsiders. People have been reluctant to speak of it. First, it relates to sexual anatomy and sexuality, neither of which is a common conversation opener with people from outside one’s culture or social milieu. Indeed, sexuality is not a frequent topic of conversation among women in my Sudan experience and in the accounts of others. It is rarely mentioned in mixed company, though it is not suppressed among friends and in environments where people feel safe. Second, among people where circumcision practices and the reality of being scarred is part of everyday existence, it is unremarkable, taken for granted, and therefore unlikely to be spoken of among casual acquaintances visiting from foreign countries. In the United States, where until recently the circumcision of infant males was so general that doctors often performed it on newborns without even bothering to ask the parents, the fact that men are circumcised scarcely merits comment. Upon meeting a visitor from another country, an unlikely conversational gambit for an American to offer would be, “Oh, by the way, in our country we cut the foreskins off male babies. What about in your country?” Probably not. Does that mean it is “taboo”? I don’t think so. It is more or less the same for people from Sudan, Somalia, and other countries in which female circumcision is common.

There is another reason the subject has seemed hush-hush: the fear of outsiders’ condemnations. People dealing with foreigners were well advised to keep their female circumcision practices quiet or, when discussed, downplay their extent. Certainly during the colonial period (roughly the nineteenth and first half of the twentieth centuries), the attitudes of missionaries, colonial administrators, and medical workers were highly negative. European and North American attitudes that viewed many even less harmful indigenous customs in Africa as “barbaric” or “uncivilized” were not based on universally accepted values but are now understood to have been ethnocentric and often calculated attempts to justify actions and attitudes that were racist, ethnocentric, and exploitative. Were European activities in conquering and militarily “pacifying” African peoples, installing European-owned plantations and mines on their lands, destroying their cultures, and importing a new religion always beneficial to Africans? It would be naive to think so, though at the time these “white man’s burden” and “civilizing mission” ideologies were used successfully to gain support in Europe for conquest and exploitation.

From a contemporary, postcolonial perspective, such attempts at justification are transparent and can be confidently criticized. It should not be too surprising that external condemnations of female circumcision, like the old colonial ideologies, might be similarly criticized as being unjustified and offensive. In short, African societies have experienced European/North American ethnocentrism in its most cynical and destructive forms, and it should be no wonder that practices that diverge so markedly from European/North American values have not been advertised to Europeans and North Americans.

Where female circumcision is practiced, it has not been some hidden ritual of which people are guiltily ashamed, as some writers seem to suggest. Dr. Nahid Toubia has pointed out that critics have tended to mystify the whole subject and assume that female circumcision is “something inherited from an untraceable past that has no rational meaning and lies within the realm of the untouchable sensitivity of traditional people” (1985:150). In her interview by Terry Gross on the radio program Fresh Air (recorded in 1996), Toubia noted that the subject of female circumcision “is not taboo,” rather, “it is painful.” When women feel they are in a safe environment, they are “desperate to talk about it,” she has found.

The view that female circumcision is simply an irrational tradition suggests that the practitioners are somehow less rational than people in “modern” societies and justifies a heavy-handed approach that strives to teach (or preach to) people who are seen as “ignorant.” In my view, an elitist and ethnocentric attitude does not offer much hope for productive dialogue and mutual understanding. Female circumcision is neither a taboo subject—the fact that “we” didn’t know much about it does not mean it was secret—nor is it done without thought.

That said, I must also note that some people with insider status who are ardent activists against the practices do accuse those who allow complacency of succumbing to a taboo. For example, Somali activist Raqiya Haji Dualeh Abdalla comments, with reference to “the ancient custom of genital mutilation of women”:

Almost no one, so far, has had the courage to speak openly about it because of the taboo attached to sexual matters.

This taboo and secrecy surrounding the continuation of this brutal practice, the unwillingness of those involved in it to face reality, and the excuse that cultural practices are sacrosanct, are no longer convincing to many Somali women today. (Abdalla 1982:2)

Abdalla writes to motivate action, and the use of this word taboo seems intended to jolt her Somali sisters into action, lest they be branded as backward thinking. Others refer to female circumcision as a “silent issue.”

The Khartoum Context

After I moved to Khartoum in 1974, it took me many months to develop a perspective on my own horrified reaction to female circumcision. During those first months in Sudan’s capital city, the subject rarely came up with my Sudanese colleagues or students. The elegant Sudanese women at the university wore Western dresses covered by sheer, white, wraparound veils called tobes that modestly covered their heads and bodies nearly to the floor but did not conceal their hair, forearms, or faces. Women students in Khartoum generally spoke softly, carried themselves gracefully, walking in twos and threes, seldom alone, their high-heeled shoes or sandals clicking on the tiled corridors. Many wore bouffant hairstyles that lifted their tobes into impressive crowns framing their faces, and most wore some jewelry.

Their modest elegance was in stark contrast to women’s styles at the U.S. universities I had attended (Stanford and the University of Connecticut); I was used to jeans and sweatshirts or dressing up in pants suits or miniskirts. My friends and I seldom wore earrings, and my jewels in those days consisted of “love beads” left over from California in the 1960s. Our feminism emphasized health, outdoorsy looks, and a strong, witty intellectual style, with relatively little interest in, and even distaste for, what we saw as traditional feminine delicacy. By contrast, in this middle-class milieu of 1970s Khartoum, femininity was clearly marked, stylized, and valued. The women (about 10 percent of the students in those days) always sat in the front of the classrooms, a location that allowed them to concentrate on the lecture and afforded them the chance to discreetly rearrange and adjust their tobes after class without having to make eye contact with the male students while doing so.

It was difficult to imagine that it was these women who were the ones who practiced female circumcision. And could these affable, joking, confident men at the university be the fathers, husbands, and brothers who expected women to be circumcised?

I remember sitting with our friend and colleague Mohammed on one of those very hot, slow afternoons after lunch at the University of Khartoum Staff Club. Most offices closed about 1:30, and Jay and I usually drove our battered Volkswagen home by 2:30 or so, but we had decided to wait that day until the weather cooled off a little. We sat inside, away from the blinding tropical brightness outdoors and as close as we could get to the evaporative cooler that was built into the wall. Jay always complained that the ceiling fans—meant to circulate the cooled air—were so slow that the flies rode around on them. That day I believed him.

“Ya, Salim!” Mohammed called. He knew all the waiters’ names. The middle-aged man in a worn jalabiya, loose turban, and scuffed leather loafers took our order for another round of Pepsis and then returned with the heavy tray. “Sorry, no more ice,” he said as he set the thick, refillable bottles in front of us. They were barely cool to the touch.

Mohammed insisted on paying for all of them, treating us like guests again, even though we had been there for several months. More than once we had been accused of not respecting their cultural values if we tried to resist someone’s hospitality. Even after I learned the Arabic for “No, by God, it’s my turn,” and Jay could say “By the divorce!” (which meant “I’ll divorce my wife if you don’t let me pay,” which always got a laugh), we still did not often succeed in paying. To get a turn, one of us usually had to find the waiter in the corridor and pay him halfway through the meal before the others knew about it.

We learned much about Sudan from Mohammed. He often spoke passionately about politics, criticizing the latest policy of the minister of social affairs or passing on one of the many President Nimeiri jokes with which Sudanese expressed their dissatisfactions with the government. At first I was surprised that he would speak so frankly to foreigners. But he had spent several years as a graduate student in Britain and had traveled widely to international conferences, so he had numerous foreign friends and a cosmopolitan outlook. He was quite at home, however, in the small villages of Sudan. He was a man who combined a strong sense of cultural pride with a genuinely global view of humanity: we humans were all in this together, he seemed to be saying, so why bother hiding anything?

That day our conversation turned to the situation of women. His wife was a homemaker, though she had finished high school, had been abroad with him for part of the time, and spoke English fairly well. When we visited them, their home seemed very traditional to us. Several female relatives who lived nearby came and went through the women’s entrance and stayed on the private side of the house, while Jay had to stay with Mohammed on the formal side of the house, which consisted of the living room and courtyard by the main entrance. Although Mohammed’s wife, dressed in a colorful tobe, had ventured in to greet Jay, she seemed to prefer the company of the children and other women who were helping her prepare the meal while Mohammed relaxed with us. Did he prefer this division of labor and space, I wondered?

In fact, Mohammed was critical of the situation of women in his own culture. Many aspects of women’s roles didn’t matter much to him—separate entrances at the mosques and whether one wore a tobe or not—those were just traditional. “When people are ready to leave those things, they will. But for now they are comfortable with them.” He thought the division of labor in the family might also change.

But there were two things that Mohammed thought were real injustices: the limited educational opportunities for girls and female circumcision. As the father of several daughters, he wanted them to have excellent educations and good career opportunities. Since most schools—except for a few of the elementary schools—were sex segregated, there were far fewer schools for girls than boys. Whenever a village or town set out to build its first school, it was almost always for boys. Only many years later would the girls get a school. Mohammed’s urban residence and influential occupation meant that his daughters would get elementary school places, but the competition was very tough for the much smaller number of places available at each higher level.

Mohammed told us that he was also worried about female circumcision for his daughters. He had told the women of his family that he did not want them to be circumcised. I naively assumed that in a culture where the males are clearly dominant, his decision would be enough to protect them.

Not so. He was afraid that if he left the country to go to the conference he was planning to attend, the grandmothers would simply arrange everything and have the older two daughters circumcised in his absence. He was sure his wife would not oppose her own mother.

“Wouldn’t they be afraid you would be angry?”

Of course. But they just go along with me when I’m here. Among themselves they say it’s not men’s business.”

“But isn’t it illegal?”

“Oh, yes. Since the British law of 1946. But what difference does that make?” He laughed and shrugged. “I couldn’t have my own mother arrested, or my mother-in-law. If they do it, I’d just have to accept it.”

He took another sip of his Pepsi. “Anyway,” he continued, “I think I’ve figured out a way to take the family along for a vacation while I’m at the conference.”

Entering the Debates

I presented my first paper on the topic of female circumcision in 1980 and rapidly began to appreciate the intensity of this controversy. The fact that I had known little about female circumcision before my departure for Sudan in 1974 was not because it had never been written about. Indeed, in the British colonial period in Sudan, it was a topic of interest to policy-makers, government reformers, and activist groups. Nevertheless, it does not appear to have caught tremendous notice in scholarship, probably because most of the previous writing on the subject was to be found in medical journals that offered little social contextualization and this writing had not filtered into the consciousness of the women’s movement. With women’s studies only recently coming on the scene in the late 1960s and early 1970s, no one had yet undertaken the project to sort out for the public the information that was there to be gleaned from the medical articles and from existing ethnographic sources.

I would also note that during the early decades of the twentieth century, and to some degree even to the present, ethnographic writings usually were not written to be accessible to public policymakers. Instead, the image of anthropologists was that they cared only about obscure, “primitive,” “tribal” people and that such people were not of great interest to, or were seen as inferiors by, the dominant cultures of the developed countries, particularly in the period before the civil rights movement and the wholesale termination of overt colonial control of African countries. Anthropologists’ policy contributions often were directed to governing such people in colonial settings, offering insights into our evolution as a species, or at times assisting in cultural profiling to aid in war and counterinsurgency. Of course that is only one part of our history as a discipline. But although we and our forebears have been passionate about documenting cultural differences and have treasured the peoples whose stories we have come to know, we have not been immune from the use and misuse of our knowledge for less than lofty purposes.

Given that context, it is understandable that it was not until the momentum of the women’s movement that more information began to be available. In 1975 the American Ethnologist carried an important article by Rose Oldfield Hayes based on research in Sudan that linked the practice of “female genital mutilation” with fertility control, women’s roles, and patrilineal social structure. Here at last was an accessible argument that offered information and linked it to social context.

It was in this period, after I returned from my first research trip to Sudan, that I had been invited to present my paper. Like Hayes, my position was a feminist one that sought to explain the context and provide understanding of this as a women’s issue that was constrained by patriarchal relations and global inequality of opportunity. My paper evoked intense interest that led me to publish it (Gruenbaum 1982b). But I also encountered other reactions.

First, I found that several of the women scholars of Middle Eastern origin were intensely critical of this topic entering the Western discourse on the Middle East at that time. They considered it an inappropriate topic for outsiders because it tended to sensationalize and stigmatize their cultures. I agreed with them that the general public and scholars in the United States knew too little about Islam, the Arab-Israeli conflict, Arab cultural heritage, and the daily life of the many peoples of the Middle East/North Africa. They had a valid point: talking about this shocking practice could contribute to stereotyping, rather than promoting understanding.

The positions that Rose Oldfield Hayes (1975), Marie Bassili Assaad (1980), Janice Boddy (1982), and I (1982) had offered in our analyses recognized the value of the practices in their cultural contexts—not very pleasant or healthy, perhaps, but a significant element of the culture. Although Cloudsley (1983) gave the original version of her book the pointed subtitle Victims of Circumcision, she too documented its cultural significance.

None of these analyses was an apologist stance; anthropologists who wrote at that time recognized that change was happening and was likely to continue, perhaps at a gradual pace. We wrote as analysts rather than activists, but with an eye toward conditions that might lead to change (e.g., Gruenbaum 1982b). I strongly argued, as I continue to do, that there is a lengthy agenda of life struggles facing the poor people of the societies in question and we must not neglect to address their other dire problems like war, displacement, famines, high rates of disease and infant and child mortality, lack of educational opportunities, and economic exploitation (see also Morsy 1991). Harmful traditional practices are on the list, but from the perspective of rural women, they may not be at the top of the social change agenda.

Some of the Western feminist scholars who studied the affected countries made the decision to suppress this topic in their own writing and teaching. That was not only because Middle Eastern and African women asserted that it was not our place to bring it up, but also because many of us who had worked so hard in our teaching and writing to promote interest in and understanding of the cultures of Africa and the Middle East discovered that once this topic was mentioned, we could not discuss much else. The effect was, as Hale (1994) and Fleuhr-Lobban (1995) have discussed, a tendency to silence oneself on this topic, even among those who knew a great deal about it, leaving this issue to a footnote or not mentioning it at all.

Meanwhile, most social scientists from Egypt and Sudan rarely mentioned female circumcision in their work during the 1970s and early 1980s. Only a few Middle Eastern feminists wrote about it in English or translated works, with Egyptian novelist, doctor, and political activist Nawal El Sadaawi being a noteworthy example. The chapter entitled “The Circumcision of Girls” in her book The Hidden Face of Eve (1980) was particularly influential, as was the section describing her memories of her own circumcision, which was excerpted for Ms. magazine in the early 1980s. Its publication brought greater attention to the subject among North American feminists. But the most extensive and explicit analyses by Middle Eastern social scientists came later, for example, Morsy’s work on Egypt (1993) and her rejoinder to Gordon (1991).

Fran Hosken is credited with presenting the bombshell that generated much of the popular awareness of the seriousness and wide prevalence of these practices (discussed further in Chapter 8). In particular, her 1980 publication of The Hosken Report: Genital and Sexual Mutilation of Females (see also the third edition 1982) offered new information, a multicountry perspective, and an impassioned plea that aid missions, church groups, and international organizations should take a firm stand, including the withholding of aid, to require governments of the affected countries “to prevent the operations.” Hers was a take-no-prisoners approach that justified even forceful external interference.

While I differed with her analysis and tactics, Hosken did succeed in opening up to a broad audience a debate that was inevitable: how best to promote change. Her radical “eradication now!” position contrasted sharply with the gradualist program of medicalization that Sudanese reformers were pursuing in the 1970s—providing better hygiene and safety by performing these procedures in doctors’ offices, providing midwives with medical supplies to do them better, and trying to persuade people to do less severe forms. (Today public health programs refer to such approaches as “harm reduction,” pursued when eradication seems an impossible or distant goal.) Several other writers in the 1980s were also strongly oriented toward change (Sanderson 1981, Koso-Thomas 1987, Accad 1989, originally published in 1982 in French).

For impassioned change agents, however, reform programs are considered an obstacle and contextual analysts are viewed as apologists (a position I examine in the final chapter). From this perspective, we should stop using cultural “excuses” for human rights abuses of women and children. Gordon advocated that we anthropologists “draw the line” at female circumcision (1991), and increasingly anthropologists are willing to consider doing so (e.g., Fleuhr-Lobban 1995).

Novelists, journalists, other writers, and filmmakers joined the discourse in the 1990s. Hanny Lightfoot-Klein’s “Prisoners of Ritual” (1989) was just the first of many provocative titles that aroused tremendous public interest. Words like “crimes,” “pain,” “brutal ritual,” and “torture” figured prominently in titles; examples include “The Ritual: Disfiguring, Hurtful, Wildly Festive” (French 1997) and “Battling the Butchers” (Brownworth 1994). Alice Walker’s novel Possessing the Secret of Joy (1992) and Walker and Pratibha Parmar’s book and film Warrior Marks (1993) persuaded large numbers of people that a highly damaging, oppressive “ritual” was being inflicted without reflection, based on male domination and ignorance. With all of this awareness of the issue, anthropologists owe it to the public to offer their best ideas and analysis.

Recent analytical work and public education writing by anthropologists (and our kindred social scientists) has developed in a very gratifying direction, generally offering the contextualized analyses while accepting and contributing to ideas for change. Writers such as Scheper-Hughes (1991) and Gruenbaum (especially 1996) stress that circumcision practices are already changing and that the peoples affected are “arguing this one out” for themselves. Obermeyer (1999), Abusharaf (1998), Hale (1994), Hicks (1993), Lane and Rubinstein (1996), Boddy (1998b), Walley (1996), and the contributors to the new edited volume by Shell-Duncan and Hernlund (2000) all offer examples of contextualized analysis that neither condemns those who practice female circumcision nor endorses the continuation. This new body of literature could perhaps be characterized as being calm and optimistic about the prospects for change, while urging critics and reformers to make serious attempts to understand the contexts.

Feminist anthropologists who are committed to ameliorating the social injustices of the world and especially those based on women’s subordination must grapple with ethical dilemmas. Our respect for and analysis of the ways that humans have adapted culturally to many environments and social situations throughout our human past should not eclipse the fact that as human social actors, we are also engaged in the process of forming the human future. As feminist anthropologists, we should be involved in trying to find our way forward to a harmonious and sustainable future that allows autonomy for individuals and social groups but moves toward resolving conflicts in these differing world views and social practices.

No one has all the answers, but many fruitful avenues are being pursued. One area of possible dialogue is the expansion of the agenda of the human rights movement. In 1997, I became involved with the American Anthropological Association’s Committee for Human Rights. It was my hope that the human rights discourse might contribute to alleviating human suffering, but of course it is never easy to map such terrain. Human rights discourse requires anthropologists to consider conflicts between group rights and individual rights, between one group’s valued traditions and religious beliefs and the traditions and beliefs of others. The human rights movement internationally has at times allowed one set of cultures to be hegemonic, leaving it open to accusations of ethnocentrism, clearly counter to our anthropological tradition of cultural relativism (Messer 1993, Nagengast 1997, Walter 1995). Cultural hegemony cannot be the foundation if there is to be acceptance of universalist stances. But it will be even more difficult to resolve these issues as the human rights agenda expands into areas well beyond condemning oppressive actions of states, venturing into cultural practices and human rights to health and well-being (see Chapter 8).

The process of exploring the female circumcision debates is valuable in developing one’s own position and becoming able to contribute in some way to promoting understanding and working for better lives for women. To explore these issues in our writing is not the same as trying to “speak for” others or become their unauthorized “allies.” Nor is it intended to tell “them” what to do or pretend that some imaginary superior “we” has the answer to the questions of when and how to pursue change. Instead, grappling with difficult questions is a human moral imperative, or try to understand our world and to promote discussion and understanding across the boundaries that divide people.

Humanitarian Values and Cultural Relativism

Upon learning of these female circumcision practices, people from outside the cultures commonly conclude that the continuation of such harmful practices violates humanitarian values. Certainly, for those committed to improving women’s rights globally and for those working on international health, the agenda seems clear: we respond with an urgent desire to stop the practices.

Yet if these practices are based on deeply held cultural values and traditions, can outsiders effectively challenge them without challenging the cultural integrity of the people who practice them? Cognizant as we have become, at the dawn of the millennium, of the injustice of exercising cultural hegemony and of the greater insight achievable when multiple viewpoints are consulted and disparate voices heard, can we adopt a position that declines to challenge any cultural practices? Under what circumstances and through what means is it permissible to attempt to alter fundamentally the beliefs and practices of others? And even if the ethical justifications are found, how effective will condemnations of a cultural practice be, particularly if they appear to condemn an entire people and their cultural values?

Simplistic condemnations are not only ineffectual but can also stimulate strong defensive reactions. On many occasions, the pious pronouncements of outsiders against cultural practices deemed “backward” or “barbaric” have provoked a backlash, with people staunchly defending their traditions against criticism. Jomo Kenyatta, who was trained in anthropology and later became president of Kenya, wrote a book entitled Facing Mount Kenya (1959, originally published in 1938), in which he argued strongly in favor of female circumcision, viewing British colonial criticism of it as essentially cultural imperialism. More recently, at the 1975 international conference in Denmark sponsored by the United Nations for the International Decade for Women, female circumcision became a major focus of controversy at the conference when some of the African women present took umbrage at the denunciations of anticircumcision political activists such as Fran Hosken; non-African women such as Hosken were accused of inappropriate cultural interference. As this discussion has continued to flourish in international gatherings into the present, even African women who are activists against the practice do not usually welcome outsiders preaching pompously against their societies’ traditions.

Critical opposition is potentially experienced as hostile ethnocentrism. Ethnocentric assessments that view the practices of others through the perspective of one’s own culture are often innocuous misunderstandings. To see cultural differences naively from one’s own cultural perspective is neither preventable nor necessarily harmful. But frequently ethnocentric views lead not only to misconceptions but also to strongly negative judgments of differences. That sort of ethnocentrism has a different tone entirely, one of scolding, distaste, condescension, and condemnation. Insofar as it is unreflective, such ethnocentrism contributes to prejudices, particularly when the cultural differences concern strongly held values.

In the argument against female circumcision, people have too often latched onto some single cause that can be condemned. This may enhance one’s conviction of the need for change, but if it does not include an understanding of how the practitioners view the issue, it will not bring us any closer to seeing how change can occur. A sound analysis requires looking at female circumcision from many angles, listening to what women who do it have said about it, and trying to understand the reasons for resistance to change. Doing that does not make us advocates for the practices. It simply recognizes that without a more sympathetic “listen,” we miss the fundamental causes and the concrete obstacles to change.

The Prime Directive

Like the Hippocratic Oath to do no harm and Star Trek’s “prime directive” not to interfere with indigenous cultures of other worlds, cultural anthropologists have valued the rights of peoples to pursue their traditional practices and values.² This is not to say that in the past cultural anthropologists were not affected by ethnocentrism. Indeed there are many examples of disparagement and condemnation of customs to be found in earlier writings of cultural anthropologists. But anthropologists have struggled to clarify their perspective, recognizing the impossibility of totally “value-free” social science and yet pursuing a stance capable of greater objectivity than ethnocentrism affords. Any missionary zeal to change “the other” into a copy of the model of “civilized” culture offered by one’s own culture is understood to truncate one’s ability to understand.

Thus the anthropological antidote to ethnocentrism became cultural relativism—judging each culture within its own context rather than by the values of others. I regard cultural relativism not as an ultimate ethical stance but as a mental technique to assist people to avoid negative judgments of, say, food preferences, manners of greeting, or marital customs. Such a perspective is clearly necessary for carrying out ethnographic field research. While a cultural relativistic approach embodies certain ethical dilemmas, it is a beneficial starting point for promoting inter-cultural understanding. Although a useful mental exercise to free one from unreflective ethnocentrism, cultural relativism usually requires a degree of suspension of one’s ethical values. How far can or should one go with this?

Female circumcision offers a major test of whether it is possible to reconcile cultural relativist respect for cultural diversity with the desire to improve the lives of girls and women across cultural boundaries. It raises the question of whether the outsider’s desire to influence cultural practices constitutes ethnocentric interference or humanitarian solidarity. It demands consideration of how respect for cultural variation, which seems to imply noninterference, can be made to allow a constructive role for outsiders in social change.

The Limits to Cultural Relativism

One way to explore the issue of limits is to turn to some of the most extreme examples that can be imagined and see how individuals’ ethical values respond to these cases. Let us consider for a moment slavery. In slavery systems, one person owns and controls the fate of another, his or her freedom, work, sexuality, and well-being. In doing so, the owner may be following a socially permitted institution of another time and place, and he or she may consider slavery to be right and just. Applying cultural relativism would allow for better understanding and explanation of how that owner might manage to feel morally upright. An even more extreme example would be genocide. While it is jarring to think about it, those who have engaged in genocide or ethnic cleansing may have reasons for doing these things that they consider proper, such as perhaps a belief that it is God’s will or that racial/ethnic purity and homogeneity are the proper state of existence and the ancestral rights of inhabitants of a region.

But is it necessary to accept slavery or genocide as legitimate human institutions simply because certain cultures at particular historical junctures have justified them? Surely not. But to dismiss such views as purely crazy or “backward” is also to fail to appreciate the incredible complexity of the human mind, which can find justifications for behavior that in the light of a more general sense of human morality is clearly disgusting and outrageous. It is also clear that trying to understand the causes of such practices may prove valuable in preventing them in the future.

In my view, human beings should reflect upon and criticize historical events, whether they are directly involved in them or not. The exercise of understanding how those who practice slavery or genocide think about and justify the practices could be extremely valuable both to the understanding of humanity, a fundamental goal of anthropology, and to practical efforts to prevent these practices. For issues less likely to be altered by legislation or war, understanding why it may be in the interests of certain groups to continue practices judged harmful by others is a basic prerequisite for any efforts to convince others to change.

My point is that in order to benefit from the insights of the suspended judgment used in cultural relativism, individuals need not disavow all ethical considerations. And if an individual’s ethics are derived from a particular religious or cultural tradition, that does not automatically disqualify them as ethnocentric. Indeed, when there is dialogue, many of our culturally based human values can be seen to transcend cultures.

Genocide and slavery provide stark examples of cross-cultural ethical judgments; the response to other practices is not as clear to many of us. Consider infanticide. Although one might believe it is wrong to kill or abandon a healthy, unwanted infant after it is born, it is possible to arrive at understanding and sympathy for the moral position of a mother who has committed infanticide without oneself approving of infanticide as a customarily tolerated practice. In a situation of rural isolation, poverty, maternal malnutrition, cultural permission, and no apparent alternatives, a mother may be faced with a situation in which a new baby presents an unacceptable risk to the survival of her fourteen-month-old child who is also dependent on her milk. Early weaning of a toddler in a situation where other sources of milk or nutritious weaning foods are not available could easily lead to that child’s death through malnutrition and consequent infectious diseases. In fact, “kwashiorkor,” the name for a severe nutritional deficiency disease, means “second-child disease,” indicating that the disease is related to early weaning after the arrival of a new infant (Wood 1979:73). Faced with the risk of losing an older child to whom she and her family are already attached and in whom she has invested a great deal of effort, a mother might understandably consider protecting that child from the competition of a new, unwanted infant. If in addition the new infant has some disadvantage—a physical handicap, say, or being female in a social situation where sons are vital—the mother might make the difficult choice of infanticide, for which she would not be considered immoral in that society. (For one such example, see Chagnon 1983. See also Scheper-Hughes’s study of motherhood in the impoverished conditions of urban Brazil, Death Without Weeping, 1992.)

In the case of infanticide, pronouncing a moral judgment is really beside the point. What is to be gained by calling such a mother a murderer? Will an external condemnation serve as a deterrent to future such incidents? Or would changing the economic, educational, nutritional, and other social opportunities be a more effective route to change?

Where change is desirable and urgent, pronouncing moral judgments may have a place. But while it may be psychologically satisfying to pass judgment on the practices of others, it is not particularly useful unless the person is already in agreement with you. With issues like female circumcision, utilizing relativism is often more fruitful because it requires contextualization and inhibits crude ethnocentric prejudices that interfere with effective dialogue. Exploring the context produces clues about what changes would be necessary to allow for changes in the unfortunate practice and what factors might create obstacles to change. Infanticide can disappear when change occurs in the conditions that fostered it, as when economic conditions improve, allowing for more adequate nutrition. One can also expect that changes in cultural conditions, such as the strong preference for sons (which is itself frequently based on old-age security considerations of parents) found in many cultures where female infanticide has been accepted, could also help to reduce infanticide. If rural communities offered better opportunities for children and if a government introduced policies to allow girls the same educational and employment opportunities as boys, this could facilitate a cultural transition away from male-child preference. But under what conditions would a government introduce such policies? And is it acceptable for state power to interfere with cultural preferences? Can a state be assumed to represent the legitimate interests of the peoples it governs, even if some groups oppose the cultural standards imposed?

Strong cultural relativists question whether it is justified to strive to change the culture of others or whether a basic right of cultural self-determination prohibits external interference. In this view, to offer or impose changes rooted in the values and cultural traditions of powerful external forces constitutes cultural imperialism. Wasn’t this exactly the sort of justification used by European powers to conquer and subjugate other regions of the world?

The arguments that it was the “white man’s burden” to carry out a “civilizing mission” in Africa and other lands are now well understood as the ideological cover used to justify economic and social exploitation of subjugated peoples. The idea that “native” peoples should be Christianized and civilized served to garner public opinion in Europe for invasion and establishment of colonial domination around the world. With this justification, willful destruction of indigenous lifeways was carried forth for centuries as powerful countries imposed their economic systems and social values on peoples whose traditional cultures did not deserve the opprobrium they received. And Christianity, capitalism, and related governmental forms have been dogged by numerous economic, moral, and social problems of their own.

Thus it is appropriate to be cautious about the assumption that what seems self-evident and obviously “right” and “wrong” to a Western “us” is universally so. Shifting viewpoints can produce different understandings of the apparent purposes of social actions. Anthropologists, with their deep training in cultural sensitivity, may be more diligent in looking for ulterior motives and unforeseen effects of culture change initiatives undertaken by reformers, public health educators, and others working for change and development. Yet ultimately anthropologists, too, are affected by their own cultural backgrounds and beliefs.

Mahnaz Afkhami, a feminist activist with the Sisterhood Is Global Institute, has noticed that even those Western feminists who attempt to exercise cultural sensitivity at times display what she calls “arrogance”: “I have seen a lot more sensitivity from Western feminists in the last few years, but … sometimes their attempts at cultural awareness and sensitivity can go too far, as we see among those Western women who say that female circumcision … is just another cultural practice. But this cultural relativism is just another example of … arrogance…. It is as if Western feminists are saying ‘okay, a whole set of norms apply to us and our culture, and a whole other set of norms applies to these other cultures’” (Afkhami 1996:17).

Thus the analysis of the causality and roots of female circumcision practices is intricately linked to the need to assess and evaluate change efforts in terms of their intent and effect. Is an effort to change based partly on ethnocentric values? Or is it a response to human needs? Is it responsive to the priorities for change of the population affected by a policy? Can the policy be effective if it is perceived as ethnocentric?

There is no clear rule for how to decide when one is applying a universal moral standard and when one is seeing the world through the moral values of one’s own culture. Although there are philosophers who confidently assert universal moral principles, it is nevertheless quite difficult to persuade people with strongly held beliefs to accept any one set of “universal” values. Assertion, appeals to reason, or complex logical arguments cannot easily dislodge beliefs rooted in culture, faith, emotion, a different philosophical perspective, or lack of knowledge.

This dilemma is at the core of the female circumcision controversy. Although many people have achieved strong, clear views, others do not accept their reasoning or have strong views of their own. A fruitful dialogue requires a clearer understanding on all sides, not strongly stated moral judgments.

As immigrants have brought female circumcision practices with them to the countries of Europe and North America, and as the interconnectedness of the world’s peoples increases, the issue of the harm to the health of women and girls becomes a global concern. The insider/outsider differences in standpoint blur, intensifying the need to achieve some consensus on universal human rights to guide policy. It is incumbent upon North Americans and Europeans to become informed about female circumcision—to overcome misconceptions, to understand possible routes toward change, and to identify a constructive role in change efforts. But it is equally important to keep in mind the differing perspectives that people might hold from their own backgrounds because this is the substrate upon which the arguments, policies, and change efforts must grow.

Exploring the female circumcision controversy requires an investigation of ethnic, moral, religious, and gender role issues to promote greater understanding of the people who continue these practices and to consider how change is taking place.

Cultural Debates

Mohammed (in my earlier example) was not unique in his desire to foster improvements in the situation of women in Sudan. Indeed, a strong women’s organization, the Sudanese Women’s Union, has been politically active since the 1940s and includes many feminist, as well as nationalist, goals in its agenda (Hale 1996).

Yet in the 1990s, accusations that women’s rights advocates have adopted “Western values” are not uncommon. Nationalism in Africa often has included rejection of some elements of European culture and social structure, but this has intensified in certain contexts under the Islamist movement. Often referred to as “Islamic fundamentalism,” a term disliked by most Muslims, this Islamist movement is characterized by a desire to adopt what is thought to be a more authentic adherence to Islamic practice, including using Islamic law as the law of the state, and in some situations imposing Islamist understanding of proper dress and social rules on all members of society, or all Muslims at least. “Western” can then become an ideological stigma, symbolic for the Islamists of a rejection of the Islamic faith. In countries like Sudan, where an Islamist-oriented government came to power in 1989 and imposed many such policies and promulgated teaching and media efforts to gain popular acceptance, those who prefer to wear less restrictive clothing or otherwise challenge the legal initiatives of those in power have found themselves labeled “Westernized.” This label implies their views or practices are illegitimate for a Muslim or for any Sudanese and sets them up for discrimination and worse. In some countries where the Islamist movement has taken hold more as a social movement, there may be more tolerance for diversity of personal practice and opinions, as seems to be the case in Egypt. Many of the extreme elements of the movement do not accept this diversity as a final state of society, however, and are working toward the goal of an Islamist state.

Although European and North American feminists have strongly advocated equality for women, including social changes to allow them greater dignity and autonomy and the elimination of sharp social constraints on roles and behaviors, the labeling of these desires as “Western” is misplaced. Throughout the world, women’s equality has been a goal for reformers for decades, often predating the European and American movements. Indeed, Muslims frequently claim that the revelation of the Qur’an to Mohammed in the seventh century was a major boost to the status of women. In the past century, many Arab women (Muslim and otherwise) have written works that are clearly feminist in intent (Badran and Cooke 1990), and one of the first feminist “role reversal” novels was written in 1905 by Rogaia Sakhawat Hossain, a Muslim woman in what is now Bangladesh: Sultana’s Dream (Hossain 1988). And although there were contentious debates at the Fourth World Conference on Women held in Beijing in 1995 about whether equality for women should be a goal in the Platform for Action document, most Muslims who opposed the term “equality” could accept the compromise term “equity.” They argued that equity—with its implications of appropriateness to the context, allowing for a special role for each sex and different rules for men and women—rather than formal equivalency was preferable. According to their position, men should not have superiority, but men and women could have differing roles without preventing fair and equitable treatment of women. “Equality” to them implied that they would need to violate religious values such as male responsibility for support of family, the latter constituting the justification for such practices as giving women a smaller share of inheritance. The compromise on wording enabled people from all the participating countries to agree to promote women’s welfare without agreeing on the particular legal, religious, or cultural approach.

The drive for change in women’s roles and improvement in women’s status is not simply the result of external “Western” influences but is a consequence of the dynamic of the inherent cultural contradictions in each culture. Culture is always contested (Sanday and Goodenough 1990), rife with debates, and crosscut by the viewpoints of different classes, age groups, genders, and other social divisions. Individuals’ lack of behavioral conformity to cultural ideals offers evidence of this, as do the disagreements over ideas and the debates about how to interpret myths, traditions, rules, and religious teachings.

In posing a model of contested culture on these questions, I offer an alternative to the oversimplified “traditional/modern” or worse, “Western/non-Western,” dichotomies that have plagued the analysis of cultural differences. The ways in which dialogues take place across our imaginary “cultural boundaries” are structured by the contested nature of culture—which ideas are listened to, discussed, adopted, or rejected is influenced by the problems faced by individuals and groups and whether the ideas offer satisfying resolutions to existing social conflicts. The women and men of the societies in which circumcision is now practiced are arguing this issue out for themselves (see Gruenbaum 1996), and their ideas are as diverse and varied as the political discourse on women’s issues is anywhere. They are not dependent on the “West” for feminist ideas, nor can “traditional” and “modern” ideas be posed as monolithic alternatives. This book offers my understanding of the relationship between female circumcision and the status of women, from both a global perspective and more specifically as I have come to understand it in Sudan.

Why Do People Do It?

There is no simple answer to this question. People have different and multiple reasons. Female circumcision is practiced by people of many ethnicities and various religious backgrounds, including Muslims, Christians,³ and Jews,⁴ as well as followers of traditional African religions. For some it is a rite of passage. For others it is not. Some consider it aesthetically pleasing. For others, it is mostly related to morality or sexuality.

Understanding the diversity of reasons is the central issue if there is to be any hope for cross-cultural understanding, fruitful dialogue, or effective change efforts. Thus the central chapters focus on these questions.

Chapter 2 examines the cultural meanings associated with the practices, including beliefs about them and ritual aspects. Comparison with other forms of body alteration, especially male circumcision and subincision practices, is included. The main examples are drawn from my field research in one rural Sudanese community. Religion is often used as a justification for continuing or discontinuing a cultural practice, and circumcision is no exception. Because female circumcision is practiced by people of several religions, the issue requires an exploration of the relevant religious teachings and controversial interpretations.

In Chapter 3, I address morality and marriage expectations, including the significance of virginity expectations, the contribution of female circumcision to the preservation of virginity, and its role in the promotion of marital fidelity. The key question is whether circumcision status affects marriageability in the cultures where it is practiced.

If culture is so important in the perpetuation of female circumcision from one generation to the next, the cultural differences among ethnic groups might be expected to coincide with differences in practices, meanings, and ability to change. But insofar as ethnic identity might then be partially defined by the practices, we can also expect that tenacity to female circumcision practices based on ethnic identity might rival gender identity as an important obstacle to change efforts. Also, as people shift their ethnic identities through social class realignments, intermarriage, and migration, what happens to their circumcision practices? These are the issues pursued in Chapter 4.

One of the most salient issues about female circumcision in the writings of Western feminist authors is sexuality, which is the subject of Chapter 5. What are the effects of different forms of the surgeries on male and female sexual responses? Is the preoccupation with sexuality an indication of Western ethnocentrism?

Chapters 7 and 8 offer a perspective on the efforts to make fundamental changes in the practices. The first addresses grassroots change, while the second, the final chapter, looks at international covenants and social movements, current approaches to public health education, and practical suggestions for those committed to fostering change.

Dilemmas of Research and Reporting on Female Circumcision

Although one goal of this book is to consider the diversity of practices, contexts, and meanings, it cannot offer a comprehensive review of the full range of circumcision practices and their ethnographic contexts. I have drawn heavily on my own ethnographic research, however. I am fortunate that my examples from Sudan encompass a variety of ethnic, regional, and social class groups and span a period of years of significant social changes. From the diversity within one country and from selected comparisons with other areas, it will be evident that there is no single meaning or reason for female circumcision and there may be multiple routes to change.

In my field notebooks, I had jotted some thoughts on my frustration with fieldwork. How can anyone, I had written, ever achieve the level of confidence in their generalizations embodied in the style of the classic anthropological ethnographies, such as those of Evans-Pritchard? The old ethnographies give the impression that the researcher was omniscient, observing every detail of behavior, understanding every motive, able to generalize confidently about meanings and trends.

Contemporary anthropologists have been critical of that style, arguing that the knowledge is not authoritative, general, and timeless, but based on observations at one point in time. The strong postmodern critique of the study of the “other” recognizes that writing about culture is inherently interpretative and therefore influenced by the observer’s predispositions and opportunities.

But to write about female circumcision, which is considered inherently harmful and a violation of women’s and girls’ human rights, poses an additional dilemma for feminist anthropologists. The feminist commitment to giving voice to—but not presuming to speak for—the experiences of women, as well as the commitment not only to do no harm but also to contribute to empowerment, seems straightforward enough when dealing with many women’s issues. Domestic violence, children’s welfare, and equal opportunities and pay are all examples where giving voice to women’s dissatisfactions is usually supportive of a desire for change and improvement of the situation. But what about a harmful practice advocated by women?

The usual response in the 1960s and 1970s in the United States women’s movement was that women who accepted subordination might be said to have a “false consciousness” and that should not be considered morally blameworthy. Consciousness-raising groups were very popular as a means for providing a support group in which one could express one’s suffering, anger, difficulties, and doubts. The groups offered an opportunity to reflect on one’s analysis of the realities and one’s interpretation of fairness. What I always found significant about this process was that it relied heavily on open discussion, exploration of personal experience, and emotional support. It did not rely on preaching by an “enlightened” leader, passing judgment on other women, or demands for immediate changes in behavior. If a woman could not face the conflict over housework with her spouse, for example, she was not chastised, but offered sympathy, support, and suggestions by others who knew how difficult it might be. Personal growth, developing the courage to confront difficult changes, or just the release of knowing one is not alone were the results. Consciousness was raised by allowing one’s own insights and by listening to others to develop new perspectives.

For the most part, Western feminists have found themselves in a dilemma in dealing with female circumcision. To label women of a different culture as having a “false consciousness” for advocating circumcision sounds like a delegitimization of the culture or beliefs of others. And even if that criticism is restrained, there are major barriers to entering into a “consciousness-raising” process with advocates of circumcision, not the least of which are language, location, culture, and religion. Thus too often the result has been a pedagogy of missionizing, telling others what they ought to do differently for reasons justified only by the “enlightened” outsiders’ beliefs.

As I argue in this book, there is a role for anyone interested in contributing to the process of change. But the starting point is to work on understanding concrete situations in which female circumcision is practiced, as well as exploring and understanding one’s own reactions. I offer my experiences as one place to start.

¹ Muslims believe the Holy Qur’an to be God’s direct revelation and the first source of guidance concerning righteous living; the example set by the Prophet Mohammed in his lifetime and handed down in the writings known as the Hadith is a secondary source. Thus Muslims are expected to respect and follow these sunna of the Prophet as much as possible.

² The challenge that the female circumcision controversy poses to these values is deeply significant. For a short discussion of the topic in relation to Star Trek, see Anderson (1997).

³ According to Leila Ahmed, “in Egypt it [clitoridectomy] is as common among Christians as among Muslims” (1992:176). Nahid Toubia, as a Sudanese Christian, discussed the extent of the practice among Christians in the Arabic-speaking northern part of the country in her radio interview for Fresh Air in 1996, in which she commented on her own mother’s determination, as she matured, to prevent it for her younger daughters. See also Toubia 1993:31–32 on Islam, Christianity, and Judaism. Additional discussion of Islam and female circumcision is found in Chapter 2, below.

⁴ Mainly the Ethiopian Jews known as the Falashas, many of whom now live in Israel.