• female genital cutting;
  • female genital mutilation;
  • circumcision;
  • human rights;
  • violence against women


  1. Top of page
  2. Abstract
  7. Acknowledgments

ABSTRACT  The international campaign to eliminate female genital cutting (FGC) has, since the early 1990s, actively attempted to divorce itself from a health framework, adopting instead a human rights framework to justify intervention. Several key questions emerge regarding the prominent placement of FGC in the international human rights movement: What are the ramifications of framing FGC as a human rights violation? What actions are mandated by a human rights approach? What perils and pitfalls potentially arise from the adoption of a rights-based framework, and how might they be avoided? In exploring these questions it becomes clear that, although a human rights approach is promising, careful deliberation is required to develop action strategies that offer both protection and respect for the culture and autonomy of those women and families concerned.

ALTHOUGH CAMPAIGNS to eliminate the practice of female genital cutting (FGC) can be traced back several centuries (Thomas 2000, 2003), the current wave of opposition was brought forcefully into the international arena by a series of conferences honoring the UN Decade for Women (1975–85; see Gosselin 2000), launching what Richard Shweder (in press) calls the “global campaign”: an international movement with the aim of creating and enforcing universal norms defining alterations of the female genitals as fundamentally intolerable. The initial phase of this campaign framed opposition to FGC as a health issue, and the Inter-African Committee classified FGC among other pressing health concerns, labeled a “harmful traditional practice.” The health approach has, however, gradually fallen from favor because of a number of unintended consequences. As a result, since the early 1990s, the global campaign has actively attempted to divorce itself from the health approach, adopting, alternatively, a human rights framework for justifying opposition to FGC. However, the classification of FGC as a human rights issue falling under the rubric of international law has not been unproblematic, owing to the fact that there are no international human rights instruments that specifically address FGC. Nonetheless, a growing consensus has emerged aligning FGC with other forms of violence against women, placing FGC firmly in the expanding global “culture of human rights” (Merry 2001).

Recently, though, a number of scholars have voiced critiques of the international human rights movement; in these—particularly in the context of debates about how to balance the universalization of human rights and multiculturalism—FGC has featured prominently (see, e.g., Okin 1999; Shweder 2002). Critiques that plague the human rights movement raise serious questions for the global anti-FGC campaign: What are the consequences of adopting a human rights framework? Does a human rights approach privilege legal action, and is such action an effective strategy for eliminating FGC? Is the seemingly apolitical human rights movement in essence a guise for imposing Western norms? Can a human rights approach undermine women's agency? In exploring these questions, it becomes clear that a human rights approach offers a potentially promising avenue for ending unacceptable forms of the practice of FGC, as well as a potentially promising avenue for forging consensus—however contextual and contested—on how to determine standards for what will be seen as unacceptable. However, as I discuss further toward the end of this article, it also becomes clear that careful deliberation is required to develop action strategies that offer both protection and respect for the culture and autonomy of those women and families concerned.


  1. Top of page
  2. Abstract
  7. Acknowledgments

The practice of FGC—also known as female circumcision or by activists as female genital mutilation (FGM)1—refers to practices involving a variable degree of alteration of the external genitalia (for a general overview of these practices, see Shell-Duncan and Hernlund 2000). The WHO (2008) has developed a recently updated classification of the practices as: Type I, partial or total excision of the clitoris or its prepuce or both (often referred to as clitoridectomy); Type II, partial or total excision of the clitoris in addition to labia minora or labia majora or both (commonly referred to as excision in English-speaking countries); Type III, excision of part of the external genitalia and adhesion of the labia minora or majora or both to enclose the vulva (also called infibulations); and Type IV, all other unclassified procedures, including pricking (sometimes referred to as symbolic circumcision), piercing, and stretching. All of these practices have been condemned by the international community as well as an increasing number of governments worldwide and have been targeted for elimination.

The initial phase of the global campaign framed opposition to FGC as a health problem: an “impediment to development that can be prevented and eradicated much like any disease” (Hosken 1978:85). Interventions to eliminate FGC initially centered on a community-based education approach of delivering a message on the adverse health effects, which assumed that as people were made aware of the risks, they would be motivated to abandon the practice (for an extended discussion, see Hernlund and Shell-Duncan 2007). As an intervention strategy, community-based education programs have, however, gradually fallen from favor for several reasons.

First, although these efforts succeeded in raising awareness of the practice and its purported consequences, health education campaigns have failed to motivate large-scale behavior change. In circumcising communities, people are often already aware of many, if not most, of the potential adverse health outcomes but feel that the risk is worth taking in light of the social and cultural importance of the practice (Obiora 1997; Sargent 1989, 1991; Shell-Duncan and Hernlund 2000; Toubia 1988).

Additionally, health information delivered in anticircumcision campaigns is often drawn from medical case studies of infibulation with extreme complications, resulting in perceived, and often real, exaggerations of health risks. In some instances, the discrepancy between well-meaning propaganda and the real-life experiences of affected women has been shown to undermine the credibility of such campaigns (e.g., Ahmadu 2000; Gosselin 2000; Johnson 2000; Morison et al. 2001).

Another problem is that closer scrutiny of scientific evidence on health problems associated with FGC shows that it is indeed difficult to establish the medical “facts” (see Shell-Duncan and Hernlund 2000). A laundry list of adverse health outcomes, often divided into the categories of short-term, long-term, and obstetrical risks, is repeated in the introduction of many papers in the voluminous literature on female “circumcision.”Carla Makhlouf Obermeyer (1999) and I (Shell-Duncan 2001) have emphasized that the location of original sources of the so-called “medical facts” is often elusive, and even when locatable is often found to be based on individual case studies or small, poorly designed studies. Although these factors ought to have limited generalizability of the findings, they did not do so, a point eloquently made by Obermeyer (1999). Obermeyer completed the first systematic review of the biomedical literature and found that despite the “vast literature on harmful effects of genital surgeries … evidence on complications is very scarce” (Obermeyer 1999:92). Her presentation of the available evidence launched a renewed debate over the interpretation of the medical evidence of harm. Interpretations on each extreme range from, on the one hand, the idea that operations are accompanied by risks deemed to be “nontrivial” (Mackie 2003:144) to, on the other hand, Shweder's assertions that “African genital modifications are not all that dangerous, and can in any case be done safely” (Shweder in press:8).

In June 2006, the WHO released findings from the largest and only, to date, prospective study of FGC and obstetrical complications (WHO 2006a). WHO issued a press release that proclaimed that “a new study … has shown that women who have had Female Genital Mutilation (FGM) are significantly more likely to experience difficulties during childbirth and that their babies are more likely to die as a result of the practice” (WHO 2006b). The headline of the story appearing in the New York Times stated: “Genital Cutting Raises by 50% Likelihood Mothers or Their Newborns Will Die, Study Finds” (Rosenthal 2006). What this alarming headline fails to disclose is the modest magnitude of risk. As Ronán M. Conroy notes, “for women with WHO type III mutilations (the most severe) there was a relative risk of 1.3 for both caesarean section and infant resuscitations, and 1.6 for stillbirth or early neonatal death, and there was not increased risk for the 32% of women who had WHO type I mutilation” (2006:106).2Conroy (2006) further notes that, in comparing risk factors in pregnancy, this places FGC somewhere behind maternal smoking. Consequently, the WHO study presents some complex findings that are not easily distilled into headlines. For this study, as well as others, the real issue comes down to interpretation of existing data and the contention between contested evaluations of what constitutes “acceptable risk” or “nontrivial harm” (see Obermeyer 1999, 2003, and Mackie 2003 for an extended debate on this issue).

A final problematic aspect of the health approach as a rationale for abandoning FGC is that the emphasis on health risks is believed by anticircumcision advocates to have inadvertently promoted the conceptualization of FGC as a health issue amenable to treatment through medical care. Opposition to all forms of medicalization has been and remains at the core of anti-FGC activities, despite the fact that evidence that it undermines intervention efforts is lacking (Shell-Duncan 2001). Resolute opposition to any form of medicalization and all transitional measures is shown, for example, in the Inter-African Committee's 2003 pronouncement of February 6 as annual “Zero Tolerance on FGM” day. Major international donors have also adopted unambiguous stances opposing FGC, as well as the medicalization of the practice.


  1. Top of page
  2. Abstract
  7. Acknowledgments

Since the early 1990s, the global anti-FGM campaign has actively attempted to distance itself from the health approach, largely adopting instead an alternative human rights framework for justifying opposition to FGC. In tracing these events, my methodology parallels what Sally Engle Merry (2006:28) calls “deterritorialized ethnography.” She writes:

The distinctive contribution of anthropology has been its focus on small-scale, more or less observable, social units and the cultural meanings and practices that constitute them. But is this model appropriate now? Where can we find these units as we look at the new political and cultural configurations produced by globalization and the flows of capital and culture across national boundaries? The challenge is to study placeless phenomena in a place, to find small interstices in global processes in which critical decisions are made, to track the information flows that constitute global discourses. [Merry 2006:28–29]

An ethnographic analysis of the growing “culture of human rights” (Merry 2001) and the placement of FGC in the international human rights movement involves examining the deterritorialized world of UN conferences, donor meetings, and forums for drafting international and national policy, and critically appraising these strategies.

I have been privileged to participate in meetings at the WHO in Geneva and UNICEF in New York, Kenya, and Ethiopia that were attended by representatives of numerous UN agencies and local and international NGOs. I attended two USAID-sponsored conferences in Washington, D.C., commemorating the first and fourth anniversary of the pronouncement of “Zero Tolerance on FGM” Day, and a congressional hearing that accompanied the 2004 symposium. Academic conferences, as well, have become sites of interaction and intellectual exchange among academics, policymakers, and representatives of local and international NGOs. In my role as an academic and as a UN “academic consultant,” I have adopted the role of participant-observer in the emerging global discourse of FGC as a human rights issue. Participation in these diverse forums has also afforded me access to an extensive “grey literature”3 produced by UN agencies, government offices, and international and local NGOs. Through the analysis of academic literature, media accounts, and grey literature, and by conducting deterritorialized ethnography, it is possible to trace the production of a human rights discourse that has come to frame the issue of FGC.

I argue that, in response to the unintended and unanticipated consequences of framing FGC as a health issue, the global campaign to eliminate FGC has alternatively embraced a human rights framework for justifying intervention. This shift occurred in tandem with pivotal historical changes in the global movement to fight violence against women through international law. Prior to the 1990s, violence against women was viewed as a private, domestic matter, and thus beyond the scope of international human rights law (Human Rights Dialogue 2003; Kapur 2002). The 1993 Vienna World Conference on Human Rights was a landmark event in which two important developments occurred. First, “female genital mutilation” became classified as a form of violence against women (VAW); second, the issue of VAW was for the first time acknowledged to fall under the purview of international human rights law. At this conference, a coalition of groups with diverse interests in domains of VAW joined efforts to seek judicial protection, uniting four previously separate gender-based issues: (1) victims of armed conflict, including rape and sexual abuse in war; (2) global trafficking of women; (3) domestic violence and rape; and (4) violence owing to customary practices and religious law (Coomaraswamy 2004). According to Radhika Coomaraswamy, the former UN Special Rapporteur on Violence against Women, violence owing to customary practices has been the hardest to address because culture comes under attack (Coomaraswamy 2004). Yet inclusion of FGC in this category firmly aligns the international campaign to eliminate FGC with the global movement to fight VAW. Activists have successfully challenged the traditional concept of “human rights issues” as perpetrated only by states and worked to expand the legitimacy of the human rights movement (Human Rights Dialogue 2003).

The classification of FGC as an international human rights violation under the rubric of international law has been subject to ongoing debate (Hernlund and Shell-Duncan 2007). Because there are no international human rights instruments that specifically address FGC, a “doctrinist approach,” as it was called by Karen Engle (1995), involved assimilating a right to protection from FGC into the dominant human rights framework. Several legal scholars (Boulware-Miller 1985; Breitung 1996; Gunning 1992) have argued that although different claims can be made, each approach carries with it potential problems or weaknesses. Major rights-based claims include the following: the rights of the child, the rights of women, the right to freedom from torture, and the right to health and bodily integrity.

The Rights of the Child

The Declaration of the Rights of the Child, adopted by the UN General Assembly in 1959, states that each child shall be given the opportunity “to develop physically, mentally, morally, spiritually and socially in a healthy and normal manner and in conditions of freedom and dignity” (UN General Assembly 1959). Because of the inability of children below a certain age to provide informed consent, their vulnerability provides a potentially compelling basis for denouncing the practice of FGC. As Kay Boulware-Miller (1985) and Barrett Breitung (1996) note, there are several problems with this approach. Parents who value the cultural, economic, and social benefits of the practice may view genital cutting as being in the best interest of the child's mental, moral, and spiritual development yet would be classified as “incompetent and abusive mothers [and fathers]” (Boulware-Miller 1985:166). Additionally, by focusing on physical harm to the exclusion of social acceptance, this approach overlooks the fact that in societies with a high prevalence of FGC, a child's right to develop “normally” includes being circumcised.4

The Rights of Women

The classification of FGC as a form of VAW raises the possibility of invoking the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which entered into force in 1981. CEDAW creates an obligation for the state to “modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of [gender inequality]” (UN General Assembly 1979). CEDAW, however, has limited international effectiveness because of all UN human rights treaties, it is subject to the greatest number of exemptions and exclusions of “traditional customs and practices” (Breitung 1996:683). Moreover, the fact that the decision to perform FGC is often firmly in the control of women weakens the claim of gender discrimination.

Freedom from Torture

Another approach to legitimizing opposition to FGC has considered defining the practice as a form of torture. Prohibitions against torture are most clearly delineated in the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. Article 1 defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person … for reasons based on discrimination of any kind” (CATCID 1984). It further requires that the torture be inflicted “with the consent or acquiescence of a public official or other person acting in an official capacity.” Although FGC is most often performed in private settings beyond the view of public officials, it has been argued that the failure of countries to ban the practice or to enforce existing laws satisfies the “consent or acquiescence of a public official” requirement (Breitung 1996; Gunning 1992). However, consent makes the process of defining the practice as torture difficult. Moreover, Breitung (1996) argues that applying the label of “torture” to a social custom valued by most practitioners may be viewed as an attack on culture and may be more likely to cause resistance than to help end the practice.

The Right to Health and Bodily Integrity

A number of scholars have reached the conclusion that the most promising rights-based claim for opposing FGC is the right to health and bodily integrity. Article 15 of the Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for the health and well-being of himself” (UN General Assembly 1948). Advantages of this approach are that it is less judgmental and more politically acceptable than other rights claims (Boulware-Miller 1985). Isabelle Gunning notes as well that, by adopting a tone that is not accusatory, “[such an approach] resonates [with] the concerns shared by African women on both sides of the surgeries debate, as well as by African men and governments” (1992:237). Despite the appeal of this approach, it is possible to identify numerous problems with it. For instance, a narrow focus on health complications does not exclude various forms of medicalization as solutions. In addition, several commentators note that a preventive health approach is not economically feasible in countries battling more acute health problems (Boulware-Miller 1985; Breitung 1996). Nonetheless, most scholars conclude that the health angle is the least problematic approach for calling for the elimination of FGC.

Therefore, in the end, attempts to divorce health and human rights concepts have been unsuccessful, and the alliance, no matter how fragile or contradictory, persists. For example, on September 1, 2000, USAID adopted an “official policy regarding female genital cutting … that recognizes that FGC as a harmful traditional practice that violates the health and human rights of women” (USAID 2004, emphasis added). Consequently, the fanfare that accompanied the release of the WHO six-country study is best understood not only in terms of its scientific contribution but also for its political ramifications. One activist who disseminated the WHO study findings on an e-mail distribution list wrote: “See below. Some sobering news for those who claim the practice isn't harmful” (personal correspondence, June 2006).

Moving Beyond the Doctrinist Approach

The tension between health and human rights has abated in recent years, because of several factors. First, despite problems with the doctrinist approach, in the past decade the concept of VAW, including FGC, has been integrated into expanding notions of human rights, resulting in acceptance of FGC as counternormative at the international level (Boyle 2002). The lack of clear doctrinal support from international human rights instruments becomes increasingly less problematic as an international consensus emerges with regard to supporting an expanded notion of human rights that includes FGC. Second, concerns that emerge from interpretations of international rights instruments are increasingly becoming moot as African nations become signators to regional human rights instruments that explicitly frame FGC as a rights violation (e.g., the Protocol on the Rights of Women in Africa, also known as the “Maputo Protocol,” ratified in 2005). Moreover, as a language of human rights becomes codified in the constitutions and statutes of African nations (e.g., the Children's Act passed in Kenya in 2001), it becomes apparent that the concepts and discourse of human rights has in these instances become enshrined in the canons of national law, although it is open to question as to whether it reflects value systems at the local level. Finally, this expanded human rights formulation has been used to justify state action to protect the rights of girls and women in the private sphere and may have encouraged the proliferation of national laws specifically banning FGC in the past decade.

In 2008, WHO published a policy statement on FGM, representing the views of numerous UN agencies (UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, and WHO). In this document, the stated reason for updating the 1997 joint statement was to highlight the “wide recognition of the human rights and legal dimensions of the problem” of FGM (WHO 2008:3). Although UN organizations have reached consensus regarding adopting a human rights framework (“mainstreaming human rights”), the implied course of action suggested by adopting this framework is under debate. Some argue that a human rights approach codifies the obligation of governments to eliminate the practice of FGC, primarily (although not solely) through legal measures and sanctions. An alternative perspective emphasizes education about human rights at the local level, focusing on women's empowerment to improve their economic and social status, as well as their ability to participate in a process of creating community consensus around norms upholding the protection of the rights of women and children. The latter approach is illustrated by Tostan, a NGO based in Senegal that provides a holistic human rights program intended to equip participants with the skills, knowledge, and resources to identify problems in their community, one of which is often FGC, and to develop problem-solving strategies to combat these problems (Tostan n.d.).5 The 2001 Resolution of the UN General Assembly on Traditional or Customary Practices Affecting the Health of Women and Girls, however, delineates a multipronged course of action that includes dissemination of information, training health workers, empowering women, and adopting and implementing legislation (UNICEF 2005:19). It remains unclear, however, how the breadth of measures outlined in the resolution can or should be implemented at the local level, and whether differing strategies will operate in a synergistic or complementary fashion.


  1. Top of page
  2. Abstract
  7. Acknowledgments

In recent years, a number of commentators have warned against viewing the human rights movement as a panacea for prevention of harm (Bell and Carens 2004; Coomaraswamy 2004; Kapur 2002; Shweder in press). David Kennedy, author of The Dark Sides of Virtue: Reassessing International Humanitarianism (2004), warns that unless those in the human rights movement operate with awareness of the potential pitfalls and perils, the human rights approach can create as many problems as it seeks to resolve. Similarly, Daniel Bell and Joseph Carens (2004) call for an examination of ethical dilemmas faced by international organizations promoting human rights, arguing that critical appraisal is needed to “avoid repetition of mistakes and counter-productive actions” (Bell and Carens 2004:302). Some potential problems with applying a human rights framework are, therefore, worthy of consideration.

The Human Rights Framework Views Problems and Solutions Too Narrowly

The human rights movement articulates problems in political terms and solutions in legal terms. Numerous commentators have emphasized that legal strategies are unlikely to work in isolation from other efforts to end the practice of FGC. However, Kennedy (2004) argues that the human rights movement privileges legal strategies over others and suggests that this serves to delegitimize remedies in the domain of nonstate action (e.g., religious, national, or local work). The health framework similarly narrows the perspective for problematizing FGC as well as conceptualizing solutions, and perhaps serves as a cautionary tale. In the early 1980s, anthropologist Ellen Gruenbaum warned that the health angle “implies not only that the practice is ‘pathological,’ but that its solution might lie in a sort of campaign-style attack on the problem. Social customs, however, are not ‘pathologies’; and such a view is a poor starting point for change, since it is not necessarily the one shared by the people whose customs are under attack” (1982:6). With legislative actions aimed at ending FGC taking increasing prominence, we need to remind ourselves again that this is a social issue that reaches beyond its political ramifications. As such, viewing protection from FGC as a right to be enforced, granted, recognized, and implemented by the state must not de-emphasize or delegitimize approaches recognizing the cultural significance of FGC and the potentially multiple and cascading social effects of ending the practice. Kennedy explicitly warns against the limits of shifting from one narrow framework to another: “We could think of it as sin and send the religious, as illness and send physicians, as war and send in the military. Or we could think of it as a human rights violation and send the lawyers. Doing so can be a way of doing nothing, avoiding responsibility, simultaneously individualizing the harm and denying its specificity” (2004:34).

To date, 15 African countries have passed legislation that specifically bans FGC, and other nations are under pressure to do so as well, despite the fact that there exist divergent views on the potential effects of legislative action.6 Supporters argue that legal prohibition of FGC has a general deterrent effect, whereas others argue that legislation, as a top-down approach, can be perceived as coercive and thus derail local efforts to end the practice. Questions regarding the effects of legislation are numerous: Does it deter the practice of FGC? Does it drive it underground? Does it incite mass reactions? Is it perceived as enforceable? How does it interact with other efforts aimed at ending the practice? With such questions unanswered, we might be prudent to heed Leslye Obiora's warning against a “naively idealized confidence in the law” (1997:352).

The Imposition of Western Human Rights Constructs

Several commentators argue that human rights is a Western construct imported, and in some cases imposed, on other cultures (e.g., Kennedy 2004; Mutua 2002; Shweder in press). Others counter that the conceptualization of a “human rights agenda” as Western and not African is overly simplistic (Cowan et al. 2001; Leary 1990; Welche Jr. 1995). Welche Jr. (1995) notes that in certain African cultures, human rights ideologies are embedded in indigenous values. However, Kennedy contends that although there are parallel developments in other cultures that provide interesting analogies, the ideas embraced by the human rights movement and codified in UN doctrines are the “product of a particular moment in place: [the] Post-Enlightenment West” (2004:18).

Makau Mutua (2002), along with Kennedy (2004), argues that although the human rights movement claims to be universal and seemingly apolitical and ahistorical, it is fundamentally Eurocentric and promotes the universalization of Eurocentric ideals. Several commentators further contend that the human rights movement has, in essence, become a rescue mission from outside (Kapur 2002; Kennedy 2004; Mutua 2002; Shweder in press), casting intervention as a virtuous and moral imperative. Mahmood Mamdani reminds us that this results in a power imbalance that is all too familiar:

The history of colonialism should teach us that every major intervention has been justified as humanitarian, a “civilizing mission”… Now, as then, imperial interventions claim to have a dual purpose: on one hand to rescue minority victims of ongoing barbarities, on the other, to quarantine the majority perpetrators with the stated aim of civilizing them. [2007:8]

The portrait of the human rights movement as a Western hegemonic civilizing mission often employs a static image of human rights, one cast with the creation of the Universal Declaration of Human Rights. Merry (2001:31) contests the image of human rights as a fixed and abstract conception and instead describes an evolving “culture of human rights,” one that develops and changes over time in response to a variety of social, economic, political, and cultural influences. She notes that in the past 50 years the concept of “human rights” has grown to include an expanded notion of collective and cultural rights. This is apparent in the evolving discourse on FGC; with the expansion of the conceptualization of human rights to include VAW, FGC has become firmly integrated into the emerging international culture of human rights.

A central question, however, is whether non-Westerners have provided meaningful cross-cultural input and influence in the human rights movement. A number of scholars (e.g., Glendon 2001; Welche Jr. 1995) have pointed to the role of non-Westerners in drafting UN doctrines as a basis for international law. Although acknowledging that the human rights movement has diffused throughout the globe and been embraced by diverse people, Mutua (2002) trenchantly argues that international organizations have resisted meaningful input from the Third World. In contrast, Leary contends that Western influence is now only one of a number of cultural influences on the development of international human rights standards, arguing that “other cultures are making significant contributions to our collective conception of human dignity” (Leary 1990:30).

Merry also maintains that the “human rights system is now deeply transnational, no longer rooted exclusively in the West” (Merry 2006:2). Along with other legal anthropologists (e.g., Cowan et al. 2001), Merry notes that, in the ongoing debate on how to balance the right to culture and human rights, commentators often employ a very narrow and essentialized view of culture. Among human rights activists, culture has often been cast as an “excuse for abuse,” with local custom conceptualized as harmful practices rooted in local culture (Cowan et al. 2001; Dembour 2001; Merry 2001, 2006; see also Hernlund and Shell-Duncan 2007). Merry (2001, 2006), along with Abdullahi A. An-Na'im and Jeffrey Hammond (2002), forward a more flexible and contested view of culture, suggesting that this perspective offers a better way to understand the transnational spread of human rights ideas and the transfer of human rights–based approaches to novel local settings. An-Na'im and Hammond (2002:13) offer the image of a “cultural tool kit” from which individuals construct strategies of action to meet their goals.7 They suggest that cultural variation, borrowing, and innovation create a range of options, allowing rights activists to support courses of action that best promote human rights. Consequently, Merry (2001) contends that culture can simultaneously be an opportunity as well as a barrier to change, helping to shape possibilities for action.

Undermining Women's Agency

A third potential problem with applying a human rights framework involves questions of undermining women's agency. In the decade since FGC became reconceptualized as a human rights issue, critiques have been leveled at developments regarding FGC, as well as more broadly at the movement working to eliminate VAW. Although acknowledging significant gains in protection of women's rights, several commentators (e.g., Coomaraswamy 2004; Kapur 2002) argue that the VAW movement has transformed the image of Third World women to one of powerless victims incapable of self-determination, self-expression, and reasoned decision making.

Kapur (2002) further argues that the VAW agenda has created a victim image that is ahistorical and essentializing, reinforcing the notion of a Third World “Other” who is civilizationally backwards, thoroughly disempowered, and helpless. At the same time, the victim image and the focus on violence invites protectionist measures from the state, remedies that have little to do with promoting women's empowerment or autonomy (Kapur 2002). Mutua expands on this view: “The grand narrative of human rights contains a subtext which depicts an epochal contest pitting savages, on one hand, against victims and saviors, on the other” (2002:10). Elaborating on this savage–victim–savior metaphor, Mutua contends that the savage is not the state per se but, rather, cultural “deviations,” whereas the savior is the “human rights corpus itself, with the United Nations, Western governments, INGOs, and Western charities as the actual rescuers, redeemers of a benighted world” (Mutua 2002:11). Radhika Coomaraswamy, former UN Rapporteur for Violence against Women, contends that this position sanctions a belief in the superiority and power of one culture over another and allows the human rights movement to acquire an arrogant tone that can create more obstacles than it eliminates (Coomaraswamy 2004; see also Kapur 2002).

Critiques have also emerged along this line specific to FGC. Corinne Kratz has charged that many writings on FGC fail to recognize differences in African women based on nationality, class, ethnicity, education, or age. Instead, what emerges is the image of a homogenized, essentialized African woman who is “powerless, constrained by tradition defined by men, unable to think clearly, and [has] only problems and needs, not choices” (Kratz 1999:108). She further argues that conceptually, women become classified and defined by shared victimization by FGC (see also Abusharaf 2000).

Obiora (2007) offers Tostan as a “best practices” example that may demonstrate how change in a human rights framework can avoid removal of women's agency. The Tostan mission statement describes their aspiration to provide leaders with the knowledge and skill to become confident, respectful actors in social transformation and economic development in their own communities, “equipping participants to tackle everyday realities, of which female genital cuttings are just a sample” (Obiora 2007:75). Pointing to the success of Tostan, Obiora counters that “voluntary abandonment constitutes an eloquent case for empowerment” (2007:81). Clearly, efforts to end FGC through a human rights framework, not just in Africa but across the globe, must carefully assess the ramifications of their actions on women's agency.

Unresolved Questions Concerning Consent

As noted above, since the early 1990s an increasing number of countries have passed legislation banning the practice of FGC. The level of restrictiveness, however, varies. In some countries such as Kenya and the United States, FGC is prohibited on minors but is permissible for consenting adult women. In other countries such as Sweden, the United Kingdom, Senegal, and Ghana, FGC is prohibited at any age. Variations in restrictiveness, ranging from none to total prohibition, reflect unresolved questions concerning consent.

In cases of minors, debates center on whether parents and guardians have decision-making authority regarding FGC for their minor daughters (Boulware-Miller 1985). Alison Slack (1988) has drawn as an analogy the example of consent for medical treatment. Children below a certain age have “diminished capacity” and are unqualified to make medical decisions on their own behalf. In most instances, medical decision-making authority is held by parents or guardians. Slack (1988) notes a crucial exception: in the United States, courts have ruled that parents cannot refuse medical treatment on religious or other grounds when their children's health would be seriously compromised. Slack contends that a similar situation exists with excision and infibulation and argues that “it seems unjust that the decision to have an operation performed on a baby girl—one that could risk her life or health, one that will permanently change her physical characteristics and may even harm her future children—would be made without her understanding or consent” (Slack 1988:470).

It is important to note that although Slack specifically addresses excision and infibulations, legal prohibitions do not restrict just these forms of FGC. Less severe forms of cutting, clitoridectomy, and nicking are banned in most instances as well. This has raised questions about what constitutes acceptable risk and how to decide when parents' rights to exercise their culture are outweighed by a child's right to protection. Alison Dundes Renteln has pointed to the tension inherent in this debate, noting that “according to the international law (The Convention on the Rights of the Child), children have both a right to practice their culture under Article 30 as well as a right to traditions prejudicial to their health under Article 24(3)” (2002:5). The new UN interagency policy statement recognizes the fact that parents “who take the decision to submit their daughters to female genital mutilation perceive that the benefits to be gained from this procedure outweigh the risks involved” (WHO 2008:9). Nonetheless, they forcefully conclude that “this perception cannot justify a permanent and potentially life-changing practice that constitutes a violation of girls' fundamental human rights” (WHO 2008:9).

The case of FGC appears to be held to exceptionally strict standards when compared to other body modifications such as piercing, scarring, tattooing, and, as several commentators note, male circumcision. Kirsten Bell, for instance, expresses concern over the “asymmetry in discussions of [male and female] genital cutting and the problematic assumptions they perpetuate” (Bell 2005:140). Robert Darby and J. Steven Svoboda also note that in the West “male and female genital alterations enjoy such strikingly different reputations. … The first is regarded as a mild and harmless adjustment that should be tolerated, if not actively promoted, and the second as a cruel abomination that must be stopped by law, no matter how culturally significant to its practitioners” (2007:305). Mary Fox and Michael Thomson (2005) oppose the permissive standard applied to male but not FGC, contending that both practices should be couched in terms of child protection. Although a growing number of organizations are involved in activism against what some refer to as “MGM” (male genital mutilation; see Silverman 2004), a human rights framework has not been as readily embraced for “MGM” as “FGM” (Darby and Svoboda 2007; Svoboda 2004). Shweder and colleagues question whether “unequal treatment of male and female circumcision demonstrate[s] hypocrisy, ethnocentricism, or unjustifiable limits to the tolerance granted ethnic minority groups in the United States and European nations?” (2002:1). Furthermore, only rarely in comparative analyses is the type of FGC considered. Should the same standards for consent apply to symbolic or nicking forms of FGC as to infibulations?

The issue of consent is contested not only for minor girls but also for adult women. Opponents of FGC have argued that it is impossible for adult women to provide informed consent because only someone who was “coerced, manipulated or highly irrational will agree to undergo female genital mutilation” (Sheldon and Wilkinson 1998:271). Such opponents of FGC therefore argue that the practice should be banned overall, irrespective of age. Sally Sheldon and Stephen Wilkinson (1998) suggest that the question of valid consent to FGC has been assessed in reference to varying standards for informed consent. A less stringent standard addresses pressure placed on women by friends and family to persuade a woman to undergo FGC. They suggest that safeguards to prevent such coercion for other decisions, such as organ transplantation, could be applied to the case of FGC, making valid consent a possibility.

A stricter standard for consent is more often invoked by opponents of FGC, addressing pressure to conform to “deep-rooted, internalized social expectations” (Sheldon and Wilkinson 1998:271). Adoption of this standard leads to the conclusion that, given social pressure to conform, it is impossible for a woman to ever rationally consent to FGC. Slack (1988:472) raises the question, “Can the decision to be circumcised even when all the facts and reasons are known, be considered truly voluntary when the only alternative is to be ostracized for such aberration?” She notes that, in addition to cultural pressure, women may experience social and economic pressure, particularly when FGC is considered to be a prerequisite to marriage, and marriage is the key avenue to economic security, social support, and legitimate childbearing.

Sheldon and Wilkinson (1998) point to perplexing and disturbing contradictions that arise in the United Kingdom when legislation banning FGC is applied to adult African women but not applied to cosmetic surgeries on Western women. They argue that “if the claim that consent to these procedures [FGC] can never be valid holds true, then it may also hold true for the many cosmetic surgeries where the decision to have such surgery results from overt or covert social pressure to conform to certain physical ideals” (Sheldon and Wilkinson 1998:272). The irony of differential treatment of FGC and cosmetic surgeries has become magnified with the growing popularity in Europe and the United States of female genital cosmetic surgeries (FGCS). Such surgeries include labia reduction, labia remodeling, clitoral reductions, and vaginal “tucks” (Altermd n.d.), procedures that are referred to by some as “designer vaginas” rather than FGM (Derrick 2001; Navarro 2004). The arrogance of the implication that Western, but not African, women can rise above the pressure of societal norms of ideal physical form to provide valid consent is disturbing, and perhaps evidences what Obiora refers to as the “persistence of orthodox racist ideology in … jurisprudence” (2007:69).


  1. Top of page
  2. Abstract
  7. Acknowledgments

The issue of FGC has not only become reconceptualized and reframed as a health human rights issue but also has achieved central prominence in debates arising on how to balance universalization of human rights and multiculturalism. Mutua identifies a key paradox: “The human rights corpus as a philosophy … can ironically be seen as favorable to political and cultural homogenization and hostile to difference and diversity …. Yet, strangely, many human rights instruments explicitly encourage diversity through the norm of equal protection” (2002:3). In the context of ongoing debates, FGC features prominently as a test case in which diverse conclusions are reached.

Philosopher Martha Nussbaum, for instance, addresses attacks on universalism in general and specifically on the claim that it advocates neglect or abrogation of women's autonomy. She argues that an “important way to answer this worry is to insist on the universal importance of protecting spheres of choice and freedom, within which people with diverse views of what matters in life can pursue flourishing according to their own lights” (Nussbaum 1999:9). However, she argues that this does not preclude limiting the range of choices offered to people. Instead, Nussbaum contends that the choices that should be protected “are those that are deemed of central importance in the development and expression of personhood” (1999:11). According to this perspective, restricting FGC protects autonomy over central human functional capacities, such as life, bodily health and integrity, and control over one's environment (both political and material). Her forceful concluding statement, however, echoes the zero tolerance stance: “We should keep FGM on the list of unacceptable practices that violate women's human rights, and we should be ashamed of ourselves if we do not use whatever privilege and power that has come our way to make it disappear forever” (Nussbaum 1999:129). One obvious question is: Who exactly is the “we” to which Nussbaum refers?

Mutua (2002), by contrast, emphasizes protecting human dignity and calls for the identification of societal structures through which dignity could be enhanced. He posits that “such an approach would not assume ab initio that a particular cultural practice was offensive to human rights. It would respect cultural pluralism as a basis for finding common universality on some issues” (Mutua 2002:8). Applying this logic to the case of FGC, he advocates for approaches that seek to investigate the social meanings and purposes of the practice and to develop an understanding of varied positions concerning the practice within the society. He suggests that “rather than demonizing and finger-pointing under the tutelage of outsiders and their local collaborators, solutions to the issue could be found through intracultural dialogue and introspection. Such solutions might range from modifying the practice to discarding it” (Mutua 2002:155). Although they do not share Mutua's willingness to entertain solutions short of abandonment, intervention projects grounded in local understanding and employing respectful community dialogue, such as the Tostan program, are making significant strides in ending the practice (Diop et al. 2003).

I join Mutua in welcoming the consideration of solutions that emerge through a process of dialogue and understanding, even if the proposed solutions fall short of the rigid “zero tolerance” mandate.8 Significant serious questions concerning consent remain unanswered: Should parents be precluded from providing consent to all forms of FGC, including forms such as nicking that are milder than male circumcision? Under what conditions, if any, are adult women capable of providing informed consent to undergo even milder forms of FGC? How is coercion defined and assessed, and what steps can be taken to reduce or eliminate coercion? With such questions unanswered, I find it difficult (1) to deny adult African women the decision-making authority granted to Western women and (2) to support a staunch zero-tolerance platform. At the same time, it is clear that situations exist in which protective measures clearly are warranted and urgently needed and in which a hands-off strategy would be equally unethical as a cultural imperialist approach.

The promising perspectives offered by Merry (2006) and An-Na'im and Hammond (2002) focus on the fact that culture is not static and homogenous but, rather, is constantly changing in response to innovation, cultural borrowing, and forces operating at various levels of society. Consequently, rather than being purely prescriptive, cultures offer a range of options that define acceptable and unacceptable courses of action. Seeing culture as open to change allows for the interpretation of cultural variation as an indigenous resource for change and cultural transformation (An-Na'im and Hammond 2002; Merry 2006). According to An-Na'im (1990), the central issue in the debate is whether looking at human rights from the various cultural perspectives that now coexist and interact across the globe promotes or undermines international standards.

The significance of the debate extends well beyond how a human rights perspective permeates discourses on FGC and how a human rights framework influences policies and interventions to end the practice. It contributes to a broader discussion of challenges faced as the human rights movement extends transnationally and as human rights principles are employed as a lens through which to assess and evaluate cultural values. As Richard Schwartz notes, “Every culture will have its distinctive ways of formulating and supporting human rights. Every society can learn from other societies more effective ways to implement human rights. While honoring the diversity of cultures, we can also build toward common principles that all can support” (Schwartz 1990:368). Consequently, Mutua grants a “plea for genuine cross-contamination of culture to create a new multicultural human rights corpus” (2002:8).

Raising a critical voice about potential unintended and unwelcomed consequences of the human rights framework for opposing FGC is not meant to dampen or quell an important movement. Instead, it is intended to raise awareness of potential problems to make it easier to engage and navigate these issues in an informed and pragmatic fashion. As Kennedy (2004) urges, it is important to move forward with the human rights approach while carefully assessing, anticipating, and attempting to avert the potential pitfalls and blind spots of this framework. We must, as well, further explore whether and how legislative measures contribute to changing norms and practices of FGC, as well as the broader social context of the practice, in either expected or unanticipated ways. And finally, we urgently need to improve our understanding of the way that state action and legal structure interact, either in complementary or contradictory ways, with grassroots or formal organized change efforts. Employing these means, it is hoped that we can best recognize, understand, and promote solutions for the practice of FGC that offer both protection and respect for the autonomy of those women and families concerned.


  1. Top of page
  2. Abstract
  7. Acknowledgments

Acknowledgments A draft of this article was presented as a paper at the USAID-sponsored symposium commemorating the fourth anniversary of Zero Tolerance Day held in Washington, D.C., in February 2007. I am thankful to the Population Reference Bureau for inviting me to speak at this event. While developing the ideas presented in this article, I benefited from input and discussions with many colleagues: Gabriella DeVita, Ellen Gruenbaum, Elise Johansen, Joel Ngugi, Richard Shweder, Lori Walls, and Joanna Wilson.

  • 1

    Recently, a few UN agencies—UNICEF, UNFPA, and USAID—have begun to use a compromise acronym: FGM/C (see, e.g., UNICEF 2005). The use of this term has been met with opposition by some African activist organizations, most notably the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC), who in 1990 formally adopted the term FGM. Although recognizing the ongoing contentious nature of naming the practices (see Shell-Duncan and Hernlund 2000; WHO 2008), I prefer the less value-laden term female genital cutting. I use the acronym FGM, however, when referring to the views and work of scholars and activists who strategically employ this term.

  • 2

    Further results of the study show that when broken down by parity, the risk of Caesarian section, in comparison to noncircumcised women, is elevated only for women with multiple births and type II circumcision (excision). An elevated risk was not found for infibulated women, regardless of parity. The risk of infant resuscitation was elevated for infibulated women only at first birth, and for excised women only at higher-order births. The risk of perinatal death was elevated for excised and infibulated women at first delivery but not higher-order births. Clearly, the study presents complex findings that require careful interpretation. One very important point raised by authors of the study is that the outcome measures in this study occur against an already high background rate of maternal morbidity. Therefore, the excess attributable risk from FGC would not be expected to be large and could only be detectable in a study as large as this one.

  • 3

    The term grey literature refers to documentary material that is not commercially published, including technical reports, briefs, working papers, conference proceedings, and policy statements.

  • 4

    Mackie (1996, 2000), in his account of social convention theory, describes how this norm can shift through coordinated abandonment of FGC.

  • 5

    The program promotes integrated nonformal education that helps participants determine their future goals and obstacles to overcome to achieve their goals. Although not originally designed to address FGC, the program led members of 13 villages to participate in a public declaration to collectively abandon FGC in 1997. A decade later, residents of more than 1,500 Senegalese villages have participated in similar declarations to abandon FGC.

  • 6

    This figure was true as of January 2008.

  • 7

    See Bell and Carens (2004) for examples of mediating conflict between human rights norms and local cultural norms.

  • 8

    Most activists firmly oppose any outcome short of total abandonment, even for adult women, because it “leaves the door open” and raises an issue of monitoring whether people have, in fact, abandoned more severe forms of cutting or are simply reporting that they have done so. I find this logic unsatisfying because documenting the veracity of self-reports is an issue even when people claim to have ended the practice. Moreover, in communities in which people are willing to replace infibulations with nicking or clitoridectomy but are unwilling to end the practice (as has been reported in northern Kenya and Somalia), the potential for reduction in medical risks is now clear.


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