Interpreting female genital cutting: Moving beyond the impasse

Interpreting female genital cutting: Moving beyond the impasse

Leonard, Lori

Female genital cutting has been practiced in many parts of the world but is now most prevalent in sub-Saharan Africa. Particularly in the last half-century, genital cutting ceremonies have attracted significant scientific and media attention. I review some of the most frequently referenced interpretations of female genital cutting and suggest that ways of explaining such practices are limited. I indicate that the study of genital cutting practices is at an impasse-with absolutists arguing that intervention to stop the procedure is required and relativists asserting that outsiders have either no right or no ability to impose such change upon others. Data from fieldwork conducted among the Sara, an ethnic group from the south of Chad, highlight the diversity in genital cutting ceremonies that is not currently represented in the literature or acknowledged in popular discourse. Some of the Sara subgroups have only recently adopted female genital cutting. Young girls have been at the forefront of this movement, and parents, village elders, and religious and traditional leaders have been vehement opponents. The usual explanatory concepts-religion, tradition, patriarchy-are not referenced in participants’ descriptions of their reasons for undergoing the procedure. Strategies for approaching the study of female genital cutting are presented as ways to bring fresh perspectives to the literature and to move discussion of female genital cutting beyond the current impasse.

Key Words: female genital cutting, circumcision, female sexuality, subSaharan Africa, Chad

The cutting of women’s genitalia has been done for millennia (Joseph, 1996; Lane & Rubinstein, 1996; Mackie, 1996; Meniru, 1994), but widespread discussion of cutting practices is far more recent. The burgeoning literature on female genital cutting, summarized in a number of reviews (Fox, de Ruiter, & Bingham, 1997; Kouba & Muasher, 1985; Obermeyer, 1999; Wright, 1996), dates from the feminist movement of the late 19608 and early 1970s. In the last 30 years, there has been an outpouring of study, commentary, and debate on the subject. Female genital cutting has become a legitimate topic of scientific inquiry and of popular discussion, cutting across disciplines, media, and audiences in reach and appeal. Terms of reference for genital cutting practices have proliferated, and the appropriateness and accuracy of different expressions continue to be widely debated (Shell-Duncan & Hernlund, 2000). Female genital cutting is the term used in this review. Although unwieldy, it is used because it is descriptive, to a greater or lesser degree, of the practices discussed without being as blatantly judgmental as female genital mutilation. Nor does it suggest, as does the term female circumcision, that the practice can be equated with the one carried out on boys.

This growing body of literature is characterized by several curious traits. Although there are notable exceptions to these claims, in general, the texts are remarkably constrained and predictable, bearing signs of an almost standardized discourse. Many contain homogenized descriptions of the global distribution of female genital cutting, the different forms of genital surgeries performed, the various types of instruments used, and large-concept reasons for the practice (e.g., religion, tradition, patriarchy). The literature is also characterized by a moralizing tone and judgmental language. Female genital cutting is a “deeply emotional and brutal human drama” (DeMeo, 1997, p. 1), “an inhuman practice” (Annas, 1996, p. 331), a “tradition that has mutilated too many innocents for too many years” (Dirie & Miller, 1998, ), “strange and disturbing” (Lightfoot-Klein, 1997, p. 131), “a harrowing rite” (Dugger, 1996, p. Al). Those who do it or have it done to their children are “mutilators” and “child abusers” (Beyene, in Abusharaf, 2000, p. 31).

A stance is frequently taken and action, or inaction, is urged. Indeed, discussion and debate about what we should do, and, more fundamentally, whether we should do anything at all, are prominent in the writing on female genital cutting. On these questions, we seem to have arrived at an impasse (Martinez, 1999; van der Kwaak, 1992). Absolutists, who argue that this is an issue on which we must take a stand, are pitted against relativists, who argue that genital cutting must be understood in context and that “outsiders” have little right to intervene in the matter. The former argue that we should “draw the line” at female genital cutting (Konner, as cited in Gordon, 1991, p. 4), that “its morality transcends national boundaries and cultural beliefs” (Annas, 1996, p. 326). The latter say we should keep our “hands off clitoridectomy” (Tamir, 1996, p. 1), or let those who practice it “argue [it] out for themselves” (Scheper-Hughes, 1991, p. 26).

How did we arrive at such an impasse? The first half of this review is devoted to a discussion of the ways female genital cutting has been interpreted and the resulting ways in which we talk about cutting women’s genitals, and about intervening or not intervening to stop the practice. I focus on how and why we got stuck. In the second half of the paper, I discuss approaches that might be used to generate new perspectives, broaden the debate, and move us beyond the current impasse. Research on genital cutting among the Sara, an ethnic group from the Moyen-Chari region of southern Chad, and on the recent adoption of genital cutting practices among some of the Sara subgroups, is used to illustrate how these approaches might be applied.

Female Genital Cutting in Africa

More women undergo genital cutting in Africa than on any other continent (Caldwell, Orubuloye, & Caldwell 1997). Some form of female genital cutting is reportedly practiced in at least 28 and perhaps as many as 30 African countries (Dorkenoo, 1996; Kiragu, 1995; Toubia, 1998; World Health Organization, 1992). The prevalence of genital cutting practices within most of these countries is unknown. It varies, and sometimes widely, among regions and ethnic groups. Global estimates of the numbers of women who have undergone some form of genital cutting range from 20 to over 200 million (Dorkenoo, 1996; Hosken, 1976; Kiragu, 1995; Kouba & Muasher, 1985; Ruminjo, 1992; Toubia, 1994), and an additional two to four million girls are thought to be “at risk” of having their genitals cut each year (Dorkenoo, 1996; Kouba & Muasher, 1985; Ruminjo, 1992). However, nationally representative surveys to estimate the prevalence of genital cutting practices have been conducted in only seven African countries. Therefore, most estimates are based on extrapolations from much smaller-scale studies or from other data of questionable validity (Obermeyer, 1999).

The age at which girls are cut varies widely as well. Although most are probably cut between the ages of 4 and 10, there are reports of genital cutting shortly after birth and just prior to marriage or the first birth (Dorkenoo, 1994; Ruminjo, 1992). In most societies where female genital cutting is practiced, these procedures are not confined to members of particular socioeconomic, religious, or cultural groups but are carried out by a broad cross-section of the population.

There are a variety of ways in which women’s genitals are altered, though the diversity has most often been simplified by classifying cutting operations into three or four broad categories. A Technical Working Group convened by the World Health Organization (WHO) adopted a four-part classification system (Dorkenoo, 1996). Type I procedures, often referred to as “sunna circumcision” (Toubia, 1994), are the least extensive, and involve the removal of the prepuce or clitoral hood in addition to some or all of the clitoris. In Type II procedures, which Dorkenoo (1996) claims are the most common and account for as much as 80% of all instances of genital cutting, all or part of the labia minora is removed in addition to the clitoris and clitoral hood. Type III procedures, known as infibulation and comprising approximately 15% of all procedures (Kiragu, 1995), involve removal of all the external genitalia, including the clitoris, clitoral hood, labia minora, and a portion of the labia majora, which is then stitched together, leaving, in most cases, only a small opening for the passage of urine and menstrual blood. Toubia (1994) subdivided this category, differentiating complete infibulation from a procedure she termed “intermediate infibulation” in which a larger posterior opening is admitted. The Technical Working Group included a variety of alternative genital manipulations under Type IV procedures; these include stretching, pricking, piercing or cauterizing the clitoris and/or the labia, and cutting the vagina (e.g., gishiri cuts) or altering it through the introduction of herbs or other substances.

Female genital cutting procedures are a public health concern because of the physical complications associated with these practices (Toubia, 1994). Possible short-term effects include severe pain, hemorrhage, anemia, shock, infection, and even death. Longer-term problems, which are more frequently associated with infibulation than clitoridectomy, include scar formation, keloids, or cysts; infertility; urinary tract infections; kidney problems; and problems in childbirth (Arbesman, Kahler, & Buck, 1993; Dirie & Lindmark, 1992; Ebong, 1997; Fox, de Ruiter, & Bingham, 1997; Kiragu, 1995; WHO, 1992; Wright, 1996). The impact of genital cutting on psychological and sexual well-being is less well researched (Toubia, 1994).

Converging on the Truth: Interpreting Female Genital Cutting

Throughout the last century, social scientists offered a range of interpretations of female genital cutting practices. Social theories, and the most notable examples are psychoanalytic theory, functionalism, feminist theories, and notions of universal human rights, were applied to the practice of female genital cutting in an effort to understand it and to explain its occurrence. Others drew conclusions about the meaning of female genital cutting from observations of the co-occurrence of cutting ceremonies and various social, economic, or religious practices or arrangements. Empirical data, derived mostly from survey research conducted with men and women in regions where cutting was carried out, on the reasons for the practice have also been used to make sense of this phenomenon.

From Theory to Practice

Adherents of particular theoretical perspectives, stances, or schools of thought have trained their particular lens on the world on the practice of female genital cutting. Female genital cutting serves as an illustration, an example, or a case study; its examination is used to shore up or, more rarely, to call into question the writer’s pre-existing view of the world and of how things work. Several examples of sense-making of this sort follow. As is evident from the summaries, multiple and divergent interpretations of female genital cutting are possible even amongst those claiming the same theoretical orientation, while there is some degree of blurring and overlap between the various perspectives.

Functionalist interpretations. Arnold van Gennep studied religious beliefs and ceremonies from a wide range of cultures and authors and, in particular, the ceremonies that surround “life crises”-events such as births, deaths, marriage, and initiation-in order to extract the common elements of these ceremonies and their order or patterning. His study of initiation ceremonies-one of several types of status passage treated in The Rites of Passage (Van Gennep, 1960)-included the study of rituals surrounding events as diverse as the enthroning of a king; the consecration of monks, nuns, and sacred prostitutes; the ordination of priests or magicians; and the admission of individuals to age groups and secret societies. Van Gennep argued that the circumcision of boys and the “excision of the clitoris” (p. 72) among girls are used to mark the transition from childhood to adulthood and can only be properly understood when analyzed in that context. Although Van Gennep did not specifically mention infibulation, he did equate many Type IV genital alterations-perforation of the hymen, stretching of the clitoris, and cutting of the perineum-with circumcision and “excision.” When practiced as part of a rite of passage, genital cutting simultaneously separates initiates from the asexual world of childhood and incorporates them into the sexual and sex-segregated world of adulthood. In such contexts, genital cutting is construed as having little to do with sex, per se. Rather, its function is to prepare young men and women to occupy a preordained social role within the community and to serve as a potent reminder, to them and to others, of their place in the society.

Van Gennep argued that the act of genital cutting, therefore, has little intrinsic meaning; its function in the context of the initiatory process is to “modify the personality of the individual in a manner visible to all” (Van Gennep, 1960, p. 71). As such, it can be equated with any number of ritual acts that are used to the same end. Van Gennep compared male circumcision and female genital cutting to the removal of teeth, scarification, tattooing, the amputation of fingers or ear lobes, the perforation of the ear lobe, septum, or hymen, and the cutting of hair, and noted that “circumcision is among the simplest and least serious of all these practices” (Van Gennep, 1960, p. 72). While explicitly acknowledging the role of the clitoris as an “erogenous center” (p. 73) whose removal “diminishe[s] sexual excitability” (p. 73), he glossed over this attribute, contending that it was of little import to members of circumcising populations:

Actually, semicivilized peoples did not look that far; they cut those organs which, like the nose or the ear, attract the eye because they project and which can, because of their histological constitution, undergo all sorts of treatment without harming an individual’s life or activity. (Van Gennep, 1960, p. 73)

Critics have accused Van Gennep of not paying sufficient attention to the sexual aspects and implications of genital cutting ceremonies (Daly, 1978; Vizedom, 1976). His supporters have countered by placing Van Gennep’s de-emphasis of the sexual aspects of circumcision and genital cutting in historical context. The geographic distribution of genital cutting practices, and notably the prevalence of circumcision among Jews, Africans, and Australian aborigines, whose sexuality was both caricatured and feared, had previously focused attention on the possible sexual connotations and implications of these practices (Lyons, 1981). Lyons argued that Van Gennep’s perspective, by placing these acts in context and highlighting their social significance, offered a much-needed corrective.

Elements of Durkheim’s analysis of religious practice and ritual also echo throughout current discourse on female genital cutting, even though he never explicitly addressed this practice in The Elementary Forms of Religious Life (Durkheim, 1912/1995)-his examination of “primitive” religion and, in particular, Australian cults and beliefs. His objective in this work was to delineate the functions of religion: to prepare men for social life, to reinforce social solidarity, to transmit group values across generations, and to provide a sense of confidence and well-being. Like Van Gennep, his contemporary, Durkheim de-emphasized the corporeal aspects of ritual; the processes set in motion by the enactment of rituals are described as internal and cerebral-“act[ing] on minds, and on minds alone” (p. 379)-rather than physical. Ritual activity, such as genital cutting, is again framed as an instrumental practice, but this time in the service of the collective, rather than the individual, consciousness-a point on which Durkheim and Van Gennep disagreed (Vizedom, 1976). For Durkheim, rituals served not only to periodically remind individuals of the importance of the collective, but to ensure its continued existence by engaging members in common efforts to reshape, renew, and re-energize the group. Informants’ claims that they carry out a particular ritual because their ancestors did were taken by Durkheim as evidence for his thesis.

Psychoanalytic interpretations. In contrast to anthropologists’ functionalist interpretations of female genital cutting, psychoanalytic explanations centered on the psychological needs, desires, and impulses of individual actors. Although this lens, like others, has more frequently been trained on male than on female ceremonies, a handful of influential psychoanalytic accounts relating to female genital cutting dot the literature. These include two volumes by Felix Bryk, Voodoo-Eros (1964) and Circumcision in Man and Woman (1934), both drawing on fieldwork conducted in East Africa, and chapters by Marie Bonaparte (“Notes on Excision”), a student of Freud, and Bruno Bettelheim (“Girls’ Rites”) at the conclusions of their longer works, Female Sexuality (Bonaparte, 1953) and Symbolic Wounds (Bettelheim, 1955). Each author favored a different interpretation of female genital cutting.

Bryk (1934), echoing Freud’s theory of the dual nature of female sexuality (1931/1963), argued that female genital cutting has the purpose of “helping along the shifting of the erogenous zone” from the clitoris to the vagina-the sine qua non of “normal” (p. 297) sexual development and “mature” sexuality in women. According to Bryk, removal of the clitoris, “the organ most sensitive for the libido sexualis,” (p. 295) serves as both a facilitator and a symbol of the shift in women’s sexuality that occurs around the time of puberty. This shift involves a “change of possession” (p. 295) or the privatization of women and their sexuality. Once “common property,” (p. 295) the young, uncircumcised, sexually-unrestrained, and “clitoridal” (p. 295) girl becomes the “private possession” (p. 295) of her husband. As such, her sexuality-now vaginal-comes under social control, with reproduction as its intended aim.

Others, including psychoanalytic writers, have challenged Bryk’s thesis. Bettelheim (1954), for example, noted the implausibility of “primitive” men (p. 140) knowing about the dual nature of women’s sexuality and, in addition, questioned whether removal of the clitoris effectively shifted orgasmic response from the clitoris to the vagina. Bonaparte (1953) also expressed reservations. She noted that although male partners of women who had undergone removal or ablation of the clitoris, and even male partners of Somali women who had been infibulated, reported that these women could achieve orgasm, their reports needed to be interpreted with caution. In her opinion, men are easily “deluded by women in such matters, helped by their vanity and their indifference” (p. 192). Bonaparte nevertheless explored the question of the effect of genital surgeries on women’s orgastic response. On the basis of interviews with European and Egyptian women who had undergone genital surgeries of various forms and degrees (some of which were visually verified by Bonaparte) and retained clitoridal sensation, Bonaparte concluded that female sexuality was not likely to be altered by ablation of the clitoris, and that the operation did not achieve the objective of “feminizing” or “vaginalizing” (p. 204) women. Rather, she saw female genital cutting as equivalent to the mental or “psychical intimidations” (p. 203) imposed on European girls in response to masturbation; the objective was to thwart adolescent sexuality. Although such a goal was accomplished using verbal tactics in certain settings, more “primitive” peoples, whose instincts are “stronger” and “harder to curb,” (p. 203) resorted to physical violence to attain the same end.

Bettelheim’s (1954) analysis broke from previous psychoanalytic accounts in its emphasis on positive, ego-based motives for the practice rather than on the destructive and, at times, vengeful id-based arguments put forth by his predecessors. Although acknowledging the interpretive challenges posed by the practice of female genital cutting, he nevertheless offered two interrelated explanations. The first had to do with men’s ambivalence toward female sexual powers; the second was simply that women copied men’s initiation ceremonies. In Symbolic Wounds, Bettelheim’s thesis was that boys, lacking a physical marker of sexual maturity, such as the onset of menstruation, seek, through ritual circumcision and subincision, to acquire the reproductive powers of women. For women, however, Bettelheim argued that the actual physical changes occurring around puberty are far more remarkable than the rites concocted to mark them. In fact, he questioned whether the rites might not be an afterthought, a reaction to men’s awe, anxiety, and even envy, in the face of women’s mystical metamorphosis. That girls’ ceremonies are almost universally described as less complex and less important than those of boys was taken by him as further evidence in support of the notion that female rituals sprang up as parallels or copies of male rituals. Others (Eliade, 1958), although agreeing that female ceremonies appear to be less widespread than male ceremonies-as well as less “developed,” (p. 41) and “dramatic” (p. 42)-suggested that at least part of the explanation is that female rites were less accessible to (mostly male) ethnographers.

Feminist interpretations. Feminist scholars have generally interpreted clitoridectomy and other female genital operations as attempts by the patriarchy to control women, their bodies, and their sexuality. This work often portrays the operations as violent, cruel, and oppressive, and highlights the physiological significance and consequences of the practice. In Gyn/Ecology, radical feminist Mary Daly (1978) cataloged “African genital mutilations” (p. 153) alongside Indian suttee, Chinese footbinding, European witchburnings, and American gynecology (including “radical mastectomies and hysterectomies,” “carcinogenic hormone therapy,” and “psychosurgery”) in her list of “Sado-Rituals” (p. 131). Her analysis of genital cutting is laced with descriptors that signal a stance distinct from those occupied by functionalist or psychoanalytic writers. Women’s genitalia are “mutilated” (p. 158)-not circumcised, excised, or cut. The practice is “barbaric,” an “unspeakable atrocity,” (p. 153) a “massacre inflicted” (p. 155) on women. Female genital cutting is constructed as both a reflection and reinforcement of a social and moral order-the “phallocracy” (p. 155)-in which women are expected (or, in this case, physically forced) to be silent, subservient, virtuous, faithful, and pure.

The fact that women themselves are most often the ones to carry out the cutting poses, at least on the surface, a problem for feminist analysis. Daly (1978), however, argued that women’s involvement is made possible through a process of mental numbing; indeed, a common feature of the Sado-Rituals described by Daly (part of what she terms the “Sado-Ritual Syndrome,” p. 158) is to silence the mind, to distract women from reflective activity or contemplation of “Self” (p. 159). Circumcision deadens and deflects critical thinking by keeping women preoccupied with the pain of their mutilation. Daly characterized women’s role in ritual genital cutting as a “passive, instrumental” (p. 164) one. Men are the real, though hidden, perpetrators. Substantiating evidence includes male refusal to marry uncut girls, and the “reconstruction” (p. 160) of the female vagina to conform to the shape and size of the future partner.

Daly (1978) attacked both functionalist and psychoanalytic writers-among them Van Gennep, Bryk, and Bonaparte-accusing them of producing “patriarchal scholarship” (p. 171). Indeed, another feature of the Sado-Ritual Syndrome is the use of “objective” (p. 170) research to obfuscate what Daly calls “the facts” (p. 133)-the patriarchal underpinnings of the practice-and, in doing so, to legitimate and “misname” “atrocities” (p. 133) like female genital cutting. She depicted Bonaparte, in particular, as having fallen victim to the phallocracy; like women who have been cut, she has been “mentally castrated” (p. 164) and is therefore unable to see female genital cutting for what it really is. Critics, however, countered that Daly and other feminist scholars and activists interpret female genital cutting out of its socioeconomic, political, and historical context; use inflammatory and distancing language; approach poor women and women from different cultures as different, or “other”; and thereby effectively alienate precisely those women whom they purport to help (Abusharaf, 1995; Gruenbaum, 1996; Lyons, 1981; Robertson, 1996).

Human rights approaches. Female genital cutting is frequently cast as a human rights issue and a form of child abuse. Recent asylum cases in the United States, in particular, have drawn attention both to the practice and to this stream of interpretation, and the influx of African immigrants to the United States and to other Western nations from regions of the world where female genital cutting is currently practiced has made the issue more visible. In 1996, the United States Board of Immigration Appeals decided to grant Fauziya Kasinga political asylum on the grounds that if she returned to Togo she would be compelled to undergo ritual genital cutting. Although the case marked a watershed in United States immigration law, political asylum has long been granted by Canada to women who seek to evade genital cutting (Roberts, 1996).

Responses to these perceived human rights violations have generally been in the form of policy or legislative change. A proliferation of statements, proclamations, and pledges has recently been issued by national and international bodies in support of efforts to curb female genital surgeries, often under the human rights banner (Ras-Work, 1997). The United Nations encouraged government action to prohibit female genital cutting under the Convention on the Rights of the Child, which states that “[n]o child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment” (United Nations, 1989, Article 37a). Bodies such as the World Medical Association, the International Federation of Gynecology and Obstetrics, and the American Medical Association have all voiced opposition to the practice on ethical grounds commenting that, at minimum, female genital surgeries are medically unnecessary. A resolution named for Ashley Montagu was sent to heads of state, the President of Amnesty International, and the United Nations Secretary General for forwarding to the World Court for a ruling that would recognize female genital cutting as a violation of the Universal Declaration of Human Rights and of the United Nations Convention on the Rights of the Child (Prescott, 1997).

Anticutting laws have been passed in a number of countries, not only on the African continent, but also in Europe and the United States. The practice is illegal in Britain and France, where cases are treated and prosecuted as instances of child abuse (Black & Debelle, 1995; Gallard, 1995; Ortiz, 1998), as well as in Belgium and most of the Scandinavian nations. In 1996, the United States Congress, ratifying legislation introduced by Congresswoman Patricia Schroeder, made the practice of female genital cutting a felony, though several states had independently outlawed the practice years earlier. Existing data suggest that the effect of such legislation has not been to eradicate female genital surgeries– although criminalization may in some instances have had a deterrent effect (Bashir, 1997)-but rather to force the practice underground or to compel parents to send their daughters away to be cut (Gallard, 1995; Williams, Acosta, & McPherson, 1999).

From Practice to Theory

Others have taken a less explicitly theoretical approach, drawing conclusions about the reasons for, and the meaning of, female genital cutting from empirical evidence. Perhaps the best known and most widely cited work of this sort has been conducted by Fran Hosken (1976, 1978, 1981, 1982, 1993), who, over a 25-year period, has collected and compiled a vast array of material on female genital surgeries. Her database includes information drawn from medical reports, questionnaires mailed to health departments in regions of Africa where female genital cutting is practiced, and interviews with medical personnel in African hospitals. Some of her work has been published in Women’s International Network (WIN) News, a journal she founded in 1975 and continues to edit. Although criticized for its lack of methodological rigor and its forceful anticutting bent (Boddy, 1982; Gruenbam, 2000; Obermeyer, 1999; Shell-Duncan & Hernlund, 2000), Hosken’s work remains one of the most ambitious attempts to estimate the global prevalence of the practice and to map its distribution.

In presenting her data, Hosken produced a wide range of explanations for the practice provided by her informants. These include making women marriageable and enhancing their ability to reproduce; restraining women’s sexuality and keeping them faithful; honoring one’s family and perpetuating a custom approved by the ancestors; and carrying out an initiation ritual or rite-of-passage. Many of these assertions appear to lend support to the arguments of theorists described earlier, or at least to echo important themes in their analyses. The conclusions that Hosken has drawn from her data-that female genital cutting is “the castration of female sexuality,” (Hosken, 1981, p. 429) and “the denial of one of the most important of human rights-the right of all persons to control their own bodies and their own lives, free from outside interference, without threat or fear” (Hosken, 1981, p. 429)-seem most closely aligned with the feminist and human rights perspectives summarized earlier.

Using data on over 1,000 different social groups drawn from the Human Relations Area Files (Textor, 1967), James DeMeo (1997) examined the geographic distribution of the practice to draw inferences about the meaning of genital cutting rituals. DeMeo is with the Orgone Biophysical Research Laboratory, a group devoted to examining and testing the theories of Wilhelm Reich, and, through his own work, DeMeo argues for the recognition of geography as an important determinant of human behavior. According to his analyses, social groups that practice female genital cutting (labeled “painful female initiation rites”) share an “extreme patrist-dominator culture” (p. 11) with a range of tendencies that include the “abusive/neglectful treatment of children,” (p. 11) the “harsh treatment of women,” (p. 11) the “segregation of adolescent boys,” (p. 9) “male genital mutilations,” (p. 9) and “killing, torturing, and mutilation of the enemy” (p. 9). On the basis of these empirical associations, he concluded that female genital cutting “exist[s] within an hierarchical, sex-repressive and child-repressive cultural complex” (p. 9) and interprets the practice this way:

The underlying psychology of both male and female genital mutilations is anxiety regarding sexual pleasure, mainly heterosexual genital intercourse, as indicated by the associated virginity taboos and ritual absolutions against vaginal blood. In the final analysis, these mutilations say more about predominant sexual attitudes than anything else. The genital mutilations of young males and females are major examples of cultural “traits” or “practices” which, on deeper analysis, reveal roots in severe pleasure-anxiety, with sadistic overtones. (p. 10)

Ericksen (1989) conducted a study using methods similar to those employed by DeMeo (1997), but consulted a wide range of materials available on the cultural clusters listed in Murdock and White’s (1969) Standard Cross-Cultural Sample (SCCS). Ericksen found that 42 of 115 African clusters contain cultures in which female genital cutting is practiced, and that clear evidence of female genital cutting was available for 132 of the 295 distinct cultures identified in Murdock’s Ethnographic Atlas (1967). On the basis of all available secondary sources, she concluded that female genital operations in Africa were associated with male circumcision, as well as with “strong fraternal interest groups, virginity tests, and conservative premarital sex norms” (p. 182). Her interpretations of these findings were, however, expressed more cautiously and provisionally than those of DeMeo (1997). Ericksen used the data to establish a set of hypotheses for future research, including explorations of the use of female genital cutting to establish or enhance gender differentiation or to control and monitor marriage agreements between kinship groups, and as a concomitant of the spread of Islam and enslavement of women.

At an Impasse

Interpretations of female genital cutting, whether driven by theory or empirical data, have been relatively narrowly focused. The limits of the existing approaches became apparent to me while I was conducting fieldwork in southern Chad. The first of two studies on female genital cutting among the Sara was carried out in 1993 and 1994 with women in the urban center of Sarh, the capital of the Moyen-Chari region, as part of a larger survey related to infertility and reproductive health (Leonard, 1996). Interviews, conducted in French or in Sara, were completed with a systematic sample of 129 women who were approached as part of a door-to-door survey conducted in conjunction with a female research assistant from Sarh. All women were asked whether they had been cut, and those who responded affirmatively were asked their age at the time of the ceremony; the location of the ceremony; the type of care they received following the cutting procedure and from whom; the nature and extent of any problems or complications experienced; and whether their mother, sisters, and daughters were cut. The data were self-reported and were not corroborated by physical exams or other types of individual-level data collection.

Of the 129 women interviewed, 81% had undergone some form of genital cutting-mostly described as some degree of clitoridectomy. The results of two additional surveys conducted in the Moyen-Chari region, including one population-based survey (Chaine & Saidel, 1992), were similar. Thirteen percent (n = 12) of the 91 women who responded to questions about the care they received and problems they encountered postcutting reported hemorrhaging or bleeding excessively, and 8% (n = 7) reported an infection, high fever, or complication other than bleeding that required some form of intervention. Included in the latter category were problems (e.g., stomach ailments, psychological problems) that may or may not have been linked to the cutting ceremony (Leonard, 1996). When asked about their own experiences with genital cutting, as well as those of other family members, a number of respondents indicated, as an aside to the survey questions, that they were the first women in their families to have been cut. Others, who had not been cut, indicated that female genital surgeries were not practiced in their natal village. Subsequent interviews with elders in villages throughout the Moyen-Chari corroborated their reports; female genital cutting was indeed a recent phenomenon in many parts of the region and had not been adopted in others.

To follow-up on these leads and to learn more about the recent adoption of female genital cutting in Sara villages, I returned to Chad in 1998 and 1999 (Leonard, 2000a, 2000b). What emerged from this research were stories of female genital cutting that contradicted the theoretically and empirically based explanations for the practice available in the literature, as well as popular notions of why African girls are cut, who promotes it, and for what ends. The stories told by Sara men and women in the villages of Myabe and Bakum (both pseudonyms) simply did not fit within the available frameworks. The disjoint between the portrayals of female genital cutting in the scientific literature and the media and the stories told in Sara villages highlighted the narrow spectrum covered by existing interpretations, as well as the dearth of alternative stories of female genital cutting currently circulating. It also suggested that questions about female genital cutting other than those about the appropriateness of action and the type of action to be taken remain. In the second half of this paper, I focus in more depth on the experience of female genital cutting among the Sara and on ways to make sense of the practice.

Alternative Tales of Female Genital Cutting. The Case of the Sara of Southern Chad

The first complete census of Chad, conducted as recently as 1993, counted 1.7 million Sara (Bureau Central du Recensement, 1995a). The Sara are the largest ethnic group in the country, making up somewhere between one quarter and one third of its total population. Though lumped together for most purposes, the Sara are actually an amalgamation of at least 12 smaller ethnic subgroups that share a similar culture, language, and history (Chapelle, 1986; Fortier, 1982). The Moyen-Chari region of Chad, one of 14 administrative divisions in the country, is home to most Sara. It is located in the south-central part of the country, and borders the Central African Republic. The region is largely rural, and its economy is based almost entirely on agriculture, with cotton as the chief export crop.

The Sara are both patrilineal and patrilocal. Extended families, descended from a common ancestor (called the gir ka), constitute a village (Magnant, 1977). Marriage is exogamous and polygamy is practiced; women are acquired as marriage partners through the payment of a brideprice. Both Catholic and Protestant missionaries have been in the region since the middle of the 20th century, and in the intervening years have exerted substantial influence; the 1993 census indicates that 85% of the Sara describe themselves as Christian. Animism remains the exclusive religion of only 5% of all Sara, though many blend previously practiced beliefs and rituals with more recently acquired ones. The literacy rate among the Sara is estimated at 15%, and 58% of Sara children are enrolled in primary school, although the government has not made enrollment compulsory (Bureau Central du Recensement, 1995b).

Male and female initiation ceremonies are a prominent feature of Sara life. Male initiation, called yo-ndo, is a rite of passage from childhood to adulthood that is practiced by all of the Sara subgroups. Ethnographers have speculated that Sara men have been initiated for at least 2 centuries, and perhaps for as many as 4 or 5 (Fortier, 1982; Jaulin, 1967). However, the history of female genital cutting in the Moyen-Chari region is much more recent. Available evidence, though scant, suggests that female genital cutting was probably first practiced in the region in the mid 1800s. According to older Sara men and women, female genital cutting originated in the village of Boy, in the western Moyen-Chari, and among members of the Sara Nar subgroup (Leonard, 1996; Negue & Kemoral, 1997). Girls from surrounding communities were brought to Boy to be cut, an event captured in the lyrics to a song sung by older women in the nearby village of Peni. Female genital cutting is now the centerpiece of female initiation ceremonies, and indeed the two practices-initiation and genital cutting-are synonymous. Prior to the introduction and adoption of female genital cutting, female initiation among the Sara was-with one notable exception described below-nonexistent.

Some (Negue & Kemoral, 1997) have speculated that circumcision was introduced in the course of the razzias or slave raids conducted by the Arab empires to the north; however, there is no evidence to either confirm or dispute the link. Oral accounts and linguistic evidence suggest the possibility of multiple, simultaneous influences from the south, as well as from the north. Certain of the Sara subgroups, notably the Ngama, refer to female genital cutting as gadja, and say they “copied” it from their neighbors in the Central African Republic, who use a similar term, ganza, for the procedure (Eustache, 1952; Maran, 1921). Other subgroups refer to female genital cutting by the term bagne and indicate that it was copied from the Sara Nar. In practice, there is no distinction between the two types of ceremonies.

In many parts of the Moyen-Chari region, female initiation ceremonies are conducted annually on the outskirts of the village. Groups of girls, who range in age from approximately 8 to 12, attend the ceremony together and are segregated from the rest of the community for a period ranging from several weeks to several months. They are often accompanied by an older woman, who has previously been cut, who is known in some villages as the koondo, or the “mother of the initiation.” With few exceptions, women’s descriptions-“they took off a lot” or “they say the clitoris will grow long and so they have to cut it”-lack the detail required to neatly categorize the procedures. A woman from the northern Moyen-Chari who was interviewed in Sarh said, “for me, they took the whole clitoris.” Another woman, whose father was Sara and whose mother was a Muslim from the north of Chad, contrasted her experience with that of most Sara girls: “For the Muslims it’s just the tip. For the Sara it’s also the ‘lips’ and they cut more of the clitoris.”

Nabia (1991) reported that the only type of cutting practiced in southern Chad is clitoridectomy, though noting that the extent of the cutting varies. It can be “deep” (“cutting of the ‘root'”) or “superficial” (“cutting the tip” and sometimes the “petites levres” or labia minora) (p. 3). Physicians practicing in the Moyen-Chari region report seeing infibulated patients only very rarely, and they indicate that those they do see are not Sara women but are women from the Ouaddai region of Chad, on the Sudanese border.

The extent to which genital cutting rituals are accompanied by some form of training or education also varies widely across the Moyen-Chari region. In some villages, the emphasis on instruction is intense. Sara girls are taught to behave as adults, to take care of children, and to cook and clean; they also learn songs, folk tales, and dances specific to their subgroup (Leonard, 1996). In other villages, women report that little or no education goes along with the cutting ceremonies. A woman in Myabe, who had been cut in Sarh, described the instruction she received this way: “There is supposed to be education that goes with it, but I didn’t learn anything in particular. They took us to the river, told us to respect our mothers, not to talk too much to strangers. All of these things I had heard before.” The period of healing and seclusion is followed, in most of the region, by a coming-out ceremony that draws the attention of the entire village. The girls are painted with kaolin, a red, clay-like substance, and karite oil to give their bodies a reddish sheen. They wear heavy, copper bracelets and brightly colored beads around their necks and waists, and their faces are covered by masks. The initiates perform dances for their relatives, who reward them with money or small gifts. In some parts of the Moyen-Chari, the coming-out ceremony takes place over a prolonged period of time (sometimes lasting as long as 1 month) and includes more elaborate procedures, such as re-naming the initiate, constructing a new dwelling for her inside the family compound, or discarding all of her material belongings and replacing them with new ones.

Since its introduction in the mid 1800s, female genital cutting has gradually diffused across the Moyen-Chari region. However, a few areas, including some of the Sara Kaba villages in the northeastern Moyen– Chari and a handful of Mbaye villages in the south, have not yet begun to perform genital operations on women. The stories of female genital cutting in Myabe, a Sara Kaba village in the eastern Moyen-Chari where girls were first cut around 1980, and in Bakum, a Sara Madjingaye village in the center of the region, where girls were first cut about a half– century earlier, are briefly recounted below. Both were the focus of fieldwork conducted in 1998 and 1999 on the Sara’s adoption of female genital cutting. Myabe and Bakum are villages of similar size, with populations of 1,069 and 948, respectively. They are also approximately equidistant from the regional capital of Sarh, with Myabe located to the north and east and Bakum situated to the south and west.

Female Genital Cutting in Myabe

Female genital cutting in Myabe is a purely first-generation phenomenon. The village has no history of initiating girls, and genital cutting, as practiced there, is not part of an initiation ceremony. Keketa was the first girl from the village to be cut, and she did it around 1980, with a small group of girls from the neighboring village of Kemkiyaa. Only one genital cutting ceremony has been held on the outskirts of Myabe; because there are no women in the village who know how to do the cutting, the girls are forced to attend ceremonies in other villages. Estimates of how many girls have undergone the procedure since 1980 vary from approximately 30 to 100, although, based on informal counts, the lower number seems likely to be more accurate. Participation in the genital cutting ceremonies is by no means universal, and a minority of the girls eligible to attend-based on age-do so. Since the girls started going to the cutting ceremonies, residents report that only one has experienced a problem-“she bled a lot”-requiring the intervention of the local secouriste, or rescue worker.

Village residents uniformly report that the impetus for the adoption of female genital cutting has come from adolescent girls, who organize the ceremonies, obtain the resources required to participate (e.g., money to pay the excisor, sugar, tea, body oil, razor blades), and find and “hire” the excisor. Village authorities, traditional leaders, and parents are not involved in the planning or execution of female genital cutting ceremonies, and with few exceptions, are vocal in their opposition to the practice. The chef de terre or “chief of the land,” who is the supreme religious and spiritual leader in Myabe, has forbidden girls to get cut, has levied fines against those who do it, and has refused to attend the dances that are part of the girls’ coming-out ceremonies. In response to the ceremony held on the outskirts of Myabe, he prohibited the girls from re-entering the village until their wounds were completely healed, and, in addition, expelled the excisor, who was the wife of a village resident, from the community for “ruining the village.”

Mothers, none of whom have been cut, are not allowed to participate in the ceremonies, and in general, they neither understand nor support the decisions of their daughters. A mother of seven girls, only one of whom went to a cutting ceremony, said she “rejected [her] daughter for a while,” but “finally had to accept it.” Her daughter came back from the cutting ceremony and “didn’t explain herself.” Against the wishes of their mother, two daughters of a subchief in the village attended the cutting ceremonies. Their mother said she didn’t know “what was removed” from her daughters; the procedure puzzled her, both because she found her own clitoris “very small” and because the excisor wouldn’t let her see her daughters while they were recovering.

The girls attribute their desire to participate in the cutting ceremonies to pressure from peers and to the spectacle of the coming-out ceremony that follows the period of healing. The event draws a great deal of attention in the village.

People have a chance to see us after we come out and dance and dress well. We had to organize it ourselves. Girls who have done it won’t let you dance with them.

The dance, the beauty, and the sound is good. People appreciated the dance a lot and that is also what pushed us to go.

We did it for pleasure only. For new clothes and oil on our bodies and people pay us. I was happy.

Many of the girls in Myabe reported receiving no material aid or compensation for their participation in the cutting ceremony.

Those girls who plan and attend the ceremonies describe their participation as entirely voluntary.

If it hurts you or not that’s your problem because you’ve gone voluntarily You don’t have the right to say anything to your sister because you yourself went voluntarily so you shouldn’t come back and say anything.

Everything is voluntary. I didn’t go, and if my friends make fun of me it means little to me. I’m already old. Maybe my daughter will go, but I won’t force her.

When asked why they chose to participate, girls underscored their sense of agency, saying “it was my will,” and the cutting ceremonies were “something that interested me.” They also talked about girls who arrived at the site where the cutting was to take place and fled in fear or chose not to follow through with their plans. Although they admitted to teasing friends who opted not to attend, they also acknowledged that there are few enduring consequences of the decision to participate or not participate. One woman, whose parents didn’t allow her to attend, said

I was preparing to go with a group of girls and my parents told me I couldn’t go with my friends So I didn’t go. . . . I have no regrets. My husband didn’t care and now I have one child. My friends used to come by and say that my clitoris is long, but they don’t do that anymore.

In Myabe, female genital cutting is not a prerequisite for marriage, and, in fact, the majority view is that men prefer uncut women as sex partners.

Women rarely mentioned sexual desire or response when talking about genital cutting, and when asked directly they often responded by talking about fertility and childbearing rather than sexual gratification. One woman who had been cut said she “felt nothing” when she had sex with her husband; another, who had not been cut, thought those who attended the cutting ceremonies could only experience pleasure “after a lot of effort.” None of the girls in Myabe reported having sex prior to being cut and were, therefore, not able to make comparisons of their experiences pre- and postcutting.

Interviewer: And how is sex? Do you think it is any different after girls go to get their clitoris cut?

Kumsite: Men get a lot of pleasure from uncircumcised women first.

Orial: Both circumcised and uncircumcised women give birth so I don’t see the difference.

In fact, most had heard that the clitoris hardens after a woman’s sexual initiation, making the cutting difficult for the excisor as well as more painful for the girl. Women in Sarh, when asked about problems associated with cutting, frequently talked about the need for episiotomies when giving birth, but did not mention concerns or problems associated with sexual performance, responsiveness, or sensation.

Female Genital Cutting in Bakum

Residents of Bakum are members of the royal family, and are descended from the mbang, who is the king, or the grand chief, of all the Sara people (Fortier, 1982). In years past, women from the family of the mbang took part in a ceremony called gor that was an integral part of the annual celebration of the harvest. These ceremonies were a means of thanking the ancestors for a bountiful crop and of ensuring the continued prosperity of both the land and the lineage. The mbang called upon young girls in his lineage to participate in the gor, which involved, among other things, preparing offerings for the ancestors and dancing throughout the week-long celebrations. The gor was also an occasion for publicly cementing alliances. During the dances, boys placed sugar cane next to the girl they wanted to marry; if the girl accepted the offering, she was carried back to her mother’s house by the boy’s-now her fiance’s-family.

Although not serving the same functions as the gor-which was described by village residents as the only form of female initiation they practiced-female genital cutting has gradually usurped it. The gor was last celebrated in Bakum in 1966. The first girls from Bakum to attend cutting ceremonies did so around 1930, nearly 50 years before the practice appeared in Myabe. Some of the first women from Bakum to be circumcised are now around 80 years old, though birth dates for members of their generation are not documented and are approximations. Villagers, including these women, say that genital cutting was “copied” from the Sara Nar and the Sara No, subgroups located further to the west. As part of their coming-out ceremony, girls from the Sara Nar and Sara No subgroups came to Bakum to dance for relatives and were admired and subsequently imitated.

In some respects, stories of the adoption of female genital cutting in Bakum sound remarkably like the stories told in Myabe. At the outset, small groups of girls, attracted by the site of the coming-out ceremonies, banded together, sometimes singly or in twos and threes, and went to neighboring villages to find a woman who would cut them. Later, women who had been cut and who married into the village aided young girls in accessing excisors; however, genital cutting was not practiced in the village of Bakum proper until as recently as 1973. Girls were once again the stimulus for the adoption of genital cutting.

I don’t know what people thought of me going. It was my will. Before there was no excision for the Sara. We copied it. After me they went in a big group. The mbang was angry and said that we couldn’t do [the coming-out ceremony] here, but we didn’t listen to him. This is the village of the mbang and he said we should be doing the gor.

As in Myabe, the introduction and gradual adoption of female genital cutting did not proceed without opposition. Older residents reported that the mbang, the chiefs, and the parents of the girls who started the practice were enormously displeased at this turn of events, and treated girls who got cut as if they “didn’t belong to the family anymore.”

The parents here weren’t happy because it wasn’t their custom, but the young girls saw the dance and organized themselves. They thought it was beautiful and they wanted to take part in this dance, wear the clothes.

Najal and Namde, who are cousins and were among the first to be cut in Bakum, recalled being threatened by the mbang-their uncle-who told them they could not dance the gor and “did everything to stop [the cutting ceremony].” Enticed by their friends “on the other side of the river,” and subjected to their taunts of “koy,”- a term of derogation reserved for the immature, unformed, and uninitiated of either sex– Najal and Namde “disobeyed,” chose to organize their own cutting ceremonies, and ran away from the village to have the operations carried out. Both were known as “hard-headed” and rebellious daughters, as well as beautiful and highly sought after young girls.

When I wanted to go my father didn’t want me to go. My mother wasn’t excised. None of our parents were happy with us going but the two of us organized ourselves and ran away to do it. When we came back they couldn’t abandon us like that, but after we came out our parents didn’t give us anything.

My parents were very angry but I did it anyway. When I came out they didn’t give me anything The two of us came back and danced in Bakum and lots of people came and watched.

For a number of years following the introduction of female genital cutting, the gor and cutting ceremonies were conducted in parallel. Girls could attend either the gor or get cut, but the ruling mbang strictly forbade participation in both, for reasons that were not entirely clear to current-day residents of Bakum. In the past, a woman’s cutting status seems to have had little impact on her standing with her age– mates or on her ability to marry.

For us it was the same value-or and excision. We only respected each other. No one called anyone “koy.” That’s a new thing.

Everything depended on the man-if he liked a woman who did gor or if he liked a woman who did excision he married them.

Over time, more young women opted to be cut, so as not to be teased or marginalized by their age-mates and, increasingly, to be marriageable.

Girls thought it was pretty and the parents were forced to accept it. Now it is already generalized. Now they can’t get married without being excised and they will be called “koy.” Now it’s rare to find a young girl who isn’t excised.

In our time there wasn’t excision, so men married women who were excised or not excised. Now if a girl doesn’t go she can still marry but her friends will make a lot of fun of her and call her “koy” and so she’ll be obligated to go. The principal objective for going is not to be called “koy.” When others are in a conversation they won’t listen to you; they’ll say you are talking like a koy. When you’re married to someone who has another wife who is excised she won’t sleep with her husband or she’ll say that it isn’t good to sleep where a koy has slept.

Within a span of 30 to 40 years, all of the girls in Bakum were attending the genital cutting ceremonies, leaving none available to participate in the gor. Even the daughters of the current mbang-as residents of the village were quick to point out-have been cut. At the time of the harvest, the mbang is now obligated to call on older women to perform the dance that is part of the gor ritual, as young girls have entirely abandoned the practice, much to the dismay of some members of the older generation.

The gor disappeared after us. A Sara girl doesn’t even know what the gor is.

We like the gor because it is our tradition. The new generation focuses on koy-that’s why they all do it. They got excision from the Nar and then the No from around Koumra.

Opposition to genital cutting has mellowed over time in Bakum– some would argue of necessity-and female genital cutting has, in many respects, become institutionalized and almost bureaucratized in the village.

The chief of the land, parents, none of them were happy because it wasn’t our custom. Because now it’s all the girls who do it. The mbang did everything to stop it, but now he is obligated to accept it because everyone does it.

Where once the mbang, the chiefs, and girls’ parents strove to prevent it, now they participate in virtually every step of its organization and execution. Parents ask permission of the chief of the village to organize the cutting ceremony; their request is transmitted to the chief of the canton (county), who, in turn, seeks the approval of the mbang. The mbang requires that both the excisor and the parents of participants obtain permission to hold the circumcision ceremonies, and failure to obtain official sanction is punished by a fine. In fact, one excisor produced a typed and stamped letter of authorization delivered to her by the chief of the canton to carry out her work in the area.

Making Sense of Female Genital Cutting in Myabe and in Bakum

How do we understand the practice of female genital cutting in Myabe and in Bakum, particularly in light of current narratives that so dominate our thinking about these types of procedures and in relation to the absolutist-relativist impasse to which these narratives have led? The Sara’s experience of female genital cutting presents a clear challenge to the scientific literature on the topic and to popular ideas of what the practice means. The frameworks-from psychoanalytic models to human rights approaches-that have been widely used to make sense of female genital cutting seem misplaced when considering the scenarios unfolding in these villages and offer explanations that are simply less than compelling when held up to the evidence.

The ways in which female genital cutting is practiced by the Sara in at least some parts of the Moyen-Chari region not only represent a clear break from the existing narratives, they flatly contradict them. For the Sara, the cutting of women’s genitals is not a “traditional practice,” an “ancient rite” or a “cultural relic” (Dugger, 1996; Ebong, 1997; Gallo, 1985; Ogiamien, 1988; Ruminjo, 1992; World Health Organization, 1992). Rather, it is a recent innovation-an example of “modernism” according to more than one village resident. In some villages, like Myabe, it is a first-generation event, and in many more, like Bakum, first-hand accounts of the introduction and adoption of female genital cutting can still be obtained.

These accounts also suggest that in Myabe and Bakum female genital cutting was not imposed on young girls by their parents, mothers, grandmothers, or village authorities. In fact, in both of these settings those typically assumed to be responsible for the practice were those who fought hardest to prevent young girls from being cut. Parents and village authorities got angry, fined the girls, banned them from participating in other ceremonies, punished their excisors, forbid them to return to the village until fully healed, prohibited them from celebrating in the village, and “disowned” them. Young girls, described both by themselves and others as “hard-headed,” stubborn, rebellious, and disobedient, were the driving force behind the adoption of female genital cutting. They were its instigators and organizers; they acquired the needed resources, engaged an excisor, and, in some cases, ran away from home to be cut.

The practice of female genital cutting has not served to perpetuate the Sara’s traditions or culture or to promote group cohesion. In Myabe no form of female initiation existed prior to the infiltration of genital cutting, and in Bakum genital cutting superseded the gor-the only form of female initiation known to the Sara nobility-within two generations, or less than 40 years. In fact, female genital cutting was and is a substantial threat to the existing social order and is interpreted as a sure sign of its disintegration. In Myabe the chief of the land openly acknowledged his loss of control and mourned for the order of the past, saying: “I tell [the girls] not to go somewhere else and do it. . . . I get angry all by myself There is nothing I can do. The older people obeyed me and the younger people don’t. It hurts me.” Najal and Namde, in response to multiple decrees from the mbang not to attend the cutting ceremony or celebrate their coming-out ceremony in the village, said, simply, “we didn’t listen to him.” The most powerful of all the Sara chiefs was unable to stop the introduction and adoption of female genital cutting in Bakum and to prevent the eventual demise of the gor.

The diversity of ways in which female genital cutting is practiced and the challenges of interpreting it are at least partially illustrated by these two villages, separated by no more than 100 kilometers. At present, female genital cutting in Myabe is a sporadic, unorganized, and largely clandestine event of girls, many of whom act in open defiance of their elders, whereas in Bakum it is now a well-accepted and almost routine part of life, formally sanctioned and regulated by village and county authorities. If there are multiple, diverse stories of female genital cutting for the Sara, a people who number 1.7 million, share a common culture, language, and history, and inhabit a territory measuring 45,000 square kilometers (Decalo, 1987), then what must be the diversity of experience and meaning globally?

The absence of diversity in the stories of female genital cutting is not limited to the scientific literature or to the popular press. The stories of female genital cutting circulating in the Moyen-Chari region are also foreign to many Chadians, including those of Sara ancestry, living in the capital city of N’Djamena. Government ministries, international aid organizations, civil servants, university students, and the local press discuss female genital cutting in ways that resemble coverage in the West. Articles in the national newspapers describe “female genital mutilation” as a practice that is “still alive” in Chad, as an “obligation” of young girls who have to “submit” to being cut, and as a practice that “deprives the girl of her physical integrity” (Mbaininga, 1995). UNICEF and the Ministry of Planning include it among their list of “traditional practices” dangerous to the health of women and children (Nabia, 1991). In fact, young men and women in the village of Bakum, including the male research assistant who accompanied me for many of the interviews, knew little or nothing of the history of the gor and female genital cutting in the village, and were surprised by the stories narrated by their elders. At one point the research assistant remarked: “People will say you are someone from Bakum, but you don’t even know the history of Bakum.”

Moving Beyond the Impasse: Approaches to the Study of Female Genital Cutting

What is the way forward? The answer to this question depends on identifying the factors that drive the current debate and assessing their relative importance in discussions of genital cutting.

Shifting Boundaries: The “Known,” the “Unknown,” and the “Unknowable”

Obermeyer (1999) suggested that opposition to female genital cutting is fueled, in large part, by perceptions of its prevalence and its health consequences and advocates an empiricist approach to the study of “genital surgeries.” On the basis of an exhaustive review of more than 400 articles, she concluded that empirical evidence relating to the magnitude or the severity of female genital cutting procedures is surprisingly limited. Systematic, national surveys of the prevalence of female genital cutting have been conducted in only seven African countries, and many of them quite recently. Although smaller-scale surveys are often used to estimate the prevalence for larger groups, the hazards inherent in such extrapolations are apparent when considered in the context of extreme regional variation such as that found in the Moyen– Chari. Moreover, in only 30 studies have the health effects of genital cutting been examined, and in only eight have complications been systematically assessed. No evidence was produced for excess mortality attributable to cutting procedures and medical complications were “the exception rather than the rule.” In sum, Obermeyer was left to conclude that much of the tremendous output on the topic resembles “advocacy” work more than “science”; that the emphasis on intervention and action so evident in these texts, is largely value-rather than data-driven; that more empirical research is needed, with the objective of shifting the balance in favor of “the known” relative to “the unknown.”

Relatively few empirical data are available on female genital cutting in the Moyen-Chari region, although it has perhaps been more thoroughly studied than many other parts of sub-Saharan Africa. Neither the 1993 census nor the recent Demographic and Health Survey conducted in Chad (Ouagadjio et al., 1998) included questions about female genital cutting. Prevalence estimates from three surveys-each of which used different sampling frames and methodologies-consistently estimate the proportion of Sara women who have been cut at around 80% (Chaine & Saidel, 1992; Leonard, 1996; Negue & Kemoral, 1997). Reports on female genital cutting in the Moyen-Chari uniformly assert that Type I and Type II procedures are carried out on girls, and the narratives of girls and health care providers lend support to these claims. However, there have been no systematic studies of the extent to which women are cut or the variation in cutting practices present in the region. Data on the health and other consequences of the practice for Sara girls and women are also sketchy. The only systematically collected data on problems and complications come from a small (N = 91) sample of women in the urban center of Sarh who were asked to provide self– reports, sometimes many years after the event had occurred (Leonard, 1996).

In theory, additional empirical data of the type that Obermeyer (1999) advocates could contribute to establishing the relative placement of female genital cutting as a public health priority and as a focus of potential intervention, and on these terms it could inform the absolutist-relativist debate. The empiricist argument is that this ordering or prioritization should be done and that action should be taken on the basis of objective evidence rather than on the basis of sentiment, ideology, or some other criterion. But what impact is the collection of more empirical data on the distribution, extent, and consequences of female genital cutting likely to have in practice? To what extent does objective evidence actually inform the absolutist-relativist debate? And how much empirical evidence would be required to make a difference? If we knew, for example, that 30 million rather than 200 million women had been cut, or that 1 million rather than 4 million girls would be cut this year, would it change the debate? What would be the implication of finding that Type I procedures, rather than more extensive operations, are performed on Sara girls?

The questions that are, arguably, at the heart of the current impasse are those that relate to meaning, and Obermeyer (1999) acknowledged that the collection of more empirical data will do little to further our understanding of genital cutting practices. Phenomenologists and others whose emphasis is on understanding rather than description or explanation would likely agree and, further, have argued that in the absence of understanding, the appropriate foci for empirical investigations remain unclear (Dukes, 1984). Are the distribution and consequences of genital cutting practices in fact their most salient, compelling, or informative features, or the ones most useful to discussions about intervention? Martinez (1999), for example, suggested that it might be more appropriate to look at the ability of women in a particular context to leverage power to do something about cutting practices, should they so desire. His suggestion was prompted by study of Amartya Sen’s work and his concern with people’s ability to achieve what he calls “functionings”-context-specific values that may range from “elementary things” such as nutrition and good health to more abstract states or goals such as happiness, self-respect, and a sense of belonging. According to Sen, a just society is one in which people have achieved or can achieve those functionings that are valued. Whether women have the political or procedural power to do so in a particular context thus becomes the focus of empirical inquiry.

Obermeyer (1999) suggested that our knowledge of female genital cutting is likely to remain incomplete, and that the answers to some of our questions, and notably those about meaning, cannot be sought within the “purely empirical ‘scientific’ framework,” and may be “unknowable” due to unbridgeable cultural differences between those looking in and those under study. Others take a different tack and suggest that meaning can be apprehended, though perhaps not fully or in a way that would permit as definitive of a classification as the category “known” suggests.

Against Interpretation

In Susan Sontag’s (1964) essay, “Against Interpretation,” she advocated one approach to knowing that might be particularly suited to the study of female genital cutting. She argued for the need to suspend interpretation when approaching a work of art or, more generally, a “text.” Part of her thesis is that to approach a text with prefabricated categories of meaning, or even with the intent to interpret, is to “impoverish” the work, to “tame” it, and to make it “manageable, conformable.” In doing this, we succeed only in adding to the “thick encrustations of interpretation.” Interpretation, she argued, signals a fundamental dissatisfaction with the text, and a desire to remake it or to replace it with something else. In its place she advocated an “erotics of art”-an attempt to “resonate” with the work through the use of all of our senses. It is about seeing, hearing, and feeling more in order to understand.

This stance has been taken up, sometimes with direct reference to Sontag’s work, by some social scientists (Stephenson, 1983), and one part of its basic message-not to jump to conclusions-is in fact reflected in the scientific method. Stephenson, in his essay by the same title, differentiated between explication and understanding as types of interpretation, and referenced scientists and philosophers who argued that understandings form in feeling, and that feeling is the ultimate “raw material” (p. 76) of mind. Using data from a study of illicit affairs and their impact on individuals and relationships, he argued for the application of what he called “the Sontag Rule” (p. 103) to an examination of the factors derived from the use of Q methodology.

“to see more, hear more, feel more” of what is manifest before delving into dynamic, sociological, or other interpretations. A factor is not always what it may appear at first glance, and to feel more of it can offer something of the “pure, untranslatable, sensual immediacy of some of its images,” and this is the primary objective of understanding, as antecedent to explanation. (p. 103)

Given the ease with which researchers, journalists, writers, politicians, and the public have affixed meaning to genital cutting practices, this approach seems simultaneously appealing and problematic. How do we suspend interpretation or explanation, and seek instead to understand female genital cutting? Qualitative methodologists from a variety of disciplines advocate “bracketing”-or setting aside personal frameworks and assumptions (Maxwell, 1996)-when collecting, analyzing, and interpreting data; yet, practical advice on how to develop and use this skill is scarce. In the case of the Sara, and the happenings in the villages of Myabe and Bakum, suspending interpretation might mean setting aside the portrayals of circumcising peoples and groups and the “thick encrustations of interpretation” regarding female genital cutting that pervade the literature and the popular press. There is an intuitive appeal to this approach. It is not hard to understand that viewing the Sara as members of a “patrist-dominator culture,” or young girls as “victims” of atrocities inflicted upon them by a “phallocracy,” sets us up to see certain aspects of female genital cutting and to see the practice itself in a particular light.

There are important implications for the research process if understanding rather than explanation is the aim, and if feeling rather than framework is to drive, at least initially, our study of female genital cutting. (It should be noted that constructionist approaches offer other ways of understanding female genital cutting and would have similar implications.) Specifically, this approach would seem to demand the use of particular types of methods-notably those that call for immersion, intense human interaction, and reflection-and to call others (e.g., analysis of data from secondary sources) into question. This approach would also seem to preclude at least the immediate application of grand narratives or over-arching theories-such as those laid out in the first half of this article-to an instance of female genital cutting, and to argue, instead, for understandings that are derived from and are firmly anchored in a familiar and well-explored context. Stephenson (1983) argued that the type of “subjective science” (p. 121) he advocated was a needed, but not as yet accepted, antidote to the dominance of “objective science” (p. 121).

Conclusion

The recent adoption of female genital cutting by some of the Sara subgroups suggests that genital cutting, like most social practices, is more complex than the existing body of literature suggests. It is carried out in a variety of ways, by a variety of different peoples, for a variety of different purposes-even in places that appear quite similar. This diversity of experience has not been fully acknowledged; female genital cutting has been, as Winkel (1995) asserted, a “shibboleth that does not admit the possibility of complexity” (p. 2). As a result, articles in the scientific and lay press alike sound repetitive and standardized, and discussion and debate on the topic circle around the questions of whether action to stop the practice is justified and how best to intervene. To move beyond the current impasse, the master narratives that pervade not only the literature but also the popular imagination need to be de-centered, although not necessarily discarded. The stories about female genital cutting told by residents of Myabe and Bakum, two villages in the south of Chad, are examples of narratives that the dominant explanatory frameworks have difficulty accommodating. Indeed, the stories provide such a striking contrast to those available in the literature and to those that we expect to hear based on widely accepted explanations for genital cutting that they force us to acknowledge the inadequacy of current frameworks and to seek new ways of understanding and of knowing.

Two general approaches to the study of female genital cutting are discussed as possible ways to reinvigorate the current debate. Empirical data on female genital cutting are scarce and more are needed. At the same time, the potential contribution of empiricist research to resolving or changing the nature of the absolutist-relativist impasse is unclear and is questionable. More central to that debate is an understanding of what female genital cutting means in settings where it is practiced– knowledge that studies based on an objectivist epistemology are unlikely to yield. Sontag and social scientists inspired by her essay caution against interpreting too quickly, and advocate for a larger role for subjective experience in art and in science. When the subject of study is female genital cutting this caution is perhaps particularly apropos, given the ease with which interpretations and judgments have been rendered. These approaches-the collection of more empirical data and the injunction to seek understanding prior to attempting to explain or interpret-are not mutually exclusive and are only two of many possible options. The utility of these and other approaches need to be considered in light of the context, existing knowledge, and the intended aims of the inquiry, among other relevant factors.

Current understandings of female genital cutting practices suggest that what we know about these procedures is intimately linked to how we know. The case of the Sara exemplifies the diversity of experience associated with female genital cutting, reveals the shortcomings of existing interpretive frameworks, and points to the need to develop new ones. Understanding female genital cutting, rather than simply explaining it, may also require an expansion of our thinking-in this instance to include approaches and methods that are not part of the tradition of “objective science.”

References

Abusharaf, R. M. (1995). Rethinking feminist discourses on female genital mutilation: The case of Sudan. Canadian Woman Studies, 15(4), 52-54.

Abusharaf, R. M. (2000, March). Female circumcision goes beyond feminism. Anthropology News, 41, 17-18.

Arenas, C. L. (1996). Irreversible error: The power and prejudice of female genital mutilation. Journal of Contemporary Health Law and Policy, 12, 325-353.

Arbesman, M., Kahler, L., & Buck, G. M. (1993). Assessment of the impact of female circumcision on the gynecological, genitourinary and obstetrical health problems of women from Somalia: Literature review and case series. Women & Health, 20(3), 27-42.

Bashir, L. M. (1997). Female genital mutilation: Balancing intolerance of the practice with tolerance of culture. Journal of Women’s Health, 6(1), 11-14.

Bettelheim, B. (1954). Symbolic wounds: Puberty rites and the envious male. New York: Collier Books.

Black, J. A., & Debelle, G. D. (1995). Female genital mutilation in Britain. British Medical Journal, 310, 1590-1594.

Boddy, J. (1982). Womb as oasis: The symbolic context of Pharaonic circumcision in rural Northern Sudan. American Ethnologist, 19, 682-696.

Bonaparte, M. (1953). Female sexuality. New York: International Universities Press.

Bryk, F. (1934). Circumcision in man and woman: Its history, psychology and ethnology. New York: American Ethnological Press.

Bryk, F. (1964). Voodoo-Eros: Ethnological studies in the sex-life of the African aborigines. New York: United Book Guild.

Bureau Central du Recensement. (1995a). Recensement general de la population et de (habitat 1993. Tome 2: Etat de la population. [General census of the population 1993. Book 2: State of the population]. N’Djamena: Author.

Bureau Central du Recensement. (1995b). Recensement general de la population et de (habitat 1993. Tome 6: Alphabetisation-scolarisation-instruction [General census of the population 1993. Book 6: State of the population]. N’Djamena: Author.

Caldwell, J. C., Orubuloye, I. O., & Caldwell P. (1997). Male and female circumcision in Africa from a regional to a specific Nigerian examination. Social Science and Medicine, 44, 1181-1193.

Chaine, J. P., & Saidel, T. (1992). The child survival baseline survey (Technical report). Washington, DC: Devres.

Chapelle, J. (1986). Le peuple Tchadien: Ses racines et sa vie quotidienne [The Chadian people: Their origins and daily lives]. Paris: Editions L’Harmattan.

Daly, M. (1978). Gyn/Ecology: The metaethics of radical feminism. Boston: Beacon Press.

Decalo, S. (1987). Historical dictionary of Chad. Metuchen, NJ: The Scarecrow Press.

DeMeo, J. (1997). The geography of male and female genital mutilations. In G. C. Denniston & M. F. Milos (Eds.), Sexual mutilations: A human tragedy (pp. 1-15). New York: Plenum.

Dirie, M. A., & Lindmark, G. (1992). The risk of medical complications after female circumcision. East African Medical Journal, 69, 479-482.

Dirie, W., & Miller, C. (1998). Desert flower: The extraordinary journey of a desert nomad. New York: William Morrow.

Dorkenoo, E. (1994). Cutting the rose. London: Minority Rights Publications.

Dorkenoo, E. (1996). Combating female genital mutilation: An agenda for the next decade. World Health Statistics Quarterly, 49, 142-147.

Dugger, C. W. (1996, September 11). A refugee’s body is intact but her family is torn. The New York Times, pp. Al, A8-A9.

Dukes, S. (1984). Phenomenological methodology in the human sciences. Journal of Religion and Health, 23, 197-203.

Durkheim, E. (1995). The elementary forms of religious life (K. Fields, Trans.). New York: The Free Press. (Original work published 1912)

Ebong, R. D. (1997). Female circumcision and its health implications: A study of the urban local government area of Akwa Ibom State, Nigeria. Journal of the Royal Society of Health, 117, 95-99.

Eliade, M. (1958). Rites and symbols of initiation: The mysteries of birth and rebirth. Woodstock, CT: Spring Publications.

Ericksen, K. P. (1989). Female genital mutilations in Africa. Behavior Science Research, 23, 182-204.

Eustache, P. (1952). Notes sur l’initiation dans les groupe Oubangui: Mandjas, Banda, Gbaya, Banziri [Notes on initiation among the groups of Oubangui: Mandjas, Banda, Gbaya, Banziri]. Unpublished manuscript.

Fortier, J. (1982). Histoire du pays Sara [The history of Sara]. Sarh, Chad: Centre d’Etudes Linguistiques.

Fox, E. F., de Ruiter, A., & Bingham, J. S. (1997). Female genital mutilation. International Journal of STD and AIDS, 8, 599-601.

Freud, S. (1963). Female sexuality. In P. Rieff (Ed.), Sexuality and the psychology of love (pp. 184-201). New York: Simon and Schuster. (Original work published 1931)

Gallard, C. (1995). Female genital mutilation in France. British Medical Journal, 310, 1592-1593.

Gallo, P. G. (1985). Female circumcision in Somalia: Some psychosocial aspects. Genus, 41(1-2), 133-147.

Gordon, D. (1991). Female circumcision and genital operations in Egypt and the Sudan: A dilemma for medical anthropology. Medical Anthropology Quarterly, 5, 3-14.

Gruenbaum, E. (1996). The cultural debate over female circumcision: The Sudanese are arguing this one out for themselves. Medical Anthropology Quarterly, 19, 455-475.

Gruenbaum, E. (2000). Is female “circumcision” a maladaptive cultural pattern? In B. Shell-Duncan & Y. Hernlund (Eds.), Female “circumcision”. Culture, change and controversy in sub-Saharan Africa (pp. 41-54). Boulder: Lynne Reinner Publishers.

Hosken, F (1976). Female circumcision and fertility in Africa. Women and Health, 1, 3-11.

Hosken, F. (1978). The epidemiology of female genital mutilations. Tropical Doctor, 8, 150-156.

Hosken, F. (1981, Summer). Female genital mutilation and human rights. Feminist Issues, 1, 3-23.

Hosken, F. (1982, 1993). The Hosken report: Genital and sexual mutilation of females. Lexington, MA: Women’s International Network News.

Jaulin, R. (1967). La mort Sara [Sara death]. Paris: Plon.

Joseph, C. (1996). Compassionate accountability: An embodied consideration of female genital mutilation. The Journal of Psychohistory, 24(1), 2-17.

Kiragu, K. (1995). Female genital mutilation: A reproductive health concern. Population Reports, 23(3), 1-4.

Kouba, L. J., & Muasher, J. (1985). Female circumcision in Africa: An overview. African Studies Review, 28(1), 95-110.

Lane, S. D., & Rubinstein, R. A. (1996). Judging the other: Responding to traditional female genital surgeries. Hastings Center Report, 26(3), 31-40.

Leonard, L. (1996). Female circumcision in southern Chad: Origins, meaning, and current practice. Social Science and Medicine, 43, 255-263.

Leonard, L. (2000a). The adoption of female circumcision in southern Chad. In B. Shell-Duncan & Y. Hernlund (Eds.), Female “circumcision”. Culture, change and controversy in sub-Saharan Africa (pp. 167-191). Boulder: Lynne Reinner Publishers.

Leonard, L. (2000b). “We did it for pleasure only”: Hearing alternative tales of female circumcision. Qualitative Inquiry, 6(2), 212-228.

Lightfoot-Klein, H. (1997). Similarities in attitudes and misconceptions about male and female sexual mutilations. In G. C. Denniston & M. F. Milos (Eds.), Sexual mutilations: A human tragedy (pp. 131-135). New York: Plenum.

Lyons, H. (1981). Anthropologists, moralities, and relativities: The problem of genital mutilations. Canadian Review of Sociology and Anthropology, 18(4), 499-518.

Mackie, G. (1996). Ending footbinding and infibulation: A convention account. American Sociological Review, 61, 999-1017.

Magnant, J. P. (1977). Quelques grands types de systemes fonciers traditionnels au Tchad [Features of traditional systems in Chad]. Unpublished manuscript.

Maran, R. (1921). Batouala. Paris: Albin Michel.

Martinez, S. (1999, December). Rights, capabilities, and political culture in the study of female genital surgeries. Paper presented at the Annual Meeting of the American Anthropological Association, Chicago, Illinois.

Maxwell, J. A. (1996). Qualitative research design: An interactive approach. Thousand Oaks, CA: Sage.

Mbaininga, D. (1995, October 19). Mutilation sexuelle feminine: Line pratique difficile A enrayer [Female genital mutilation: A practice difficult to check]. N’Djamena Hebdo, p. 11.

Meniru, G. I. (1994). Female genital mutilation (female circumcision). British Journal of Obstetrics and Gynaecology, 101, 832.

Murdock, G. P. (1967). Ethnographic atlas. Pittsburgh: University of Pittsburgh Press.

Murdock, G. P., & White, D. R. (1969). Standard cross-cultural sample. Ethnology, 329369.

Nabia, A. (1991). L’excision feminine [Female circumcision]. N’Djamena, Chad: UNICEF.

Negue, F. K., & Kemoral, J. (1997). Initiation feminine: Resultats des recherches sur les possibilites d’amelioration de l’initiation feminine dans le Moyen-Chari [Female initiation: Results of research into the possibility of improving female initiation rites]. Sarh: Cellule Regional CONA-CIAF de Sarh.

Obermeyer, C. (1999). Female genital surgeries: The known, the unknown, and the unknowable. Medical Anthropology Quarterly, 13(1), 79-106.

Ogiamien, T. B. E. (1988). A legal framework to eradicate female circumcision. Medicine Science and Law, 28, 115-119.

Ortiz, E. T. (1998). Female genital mutilation and public health: Lessons from the British experience. Health Care for Women International, 19, 119-129.

Ouagadjio, B., Nodjimadji, K., Ngoniri, J. N., Ngakoutou, N., Ignegongba, K., Tokindan, J. S., Kouo, O., Barrere, B., & Barrere, M. (1998). Enquete demographique et de sante, Tchad 1996-1997 [Demographic and health survey, Chad 1996-1997]. Calverton, MD: Bureau Central du Recensement and Macro International, Inc.

Prescott, J. W. (1997). The Ashley Montagu resolution to end the genital mutilation of children worldwide: A petition to the World Court, the Hague. In G. C. Denniston & M. F. Milos (Eds.), Sexual mutilations: A human tragedy (pp. 217-220). New York: Plenum.

Ras-Work, B. (1997). Female genital mutilation. In G. C. Denniston & M. F. Milos (Eds.), Sexual mutilations: A human tragedy (pp. 137-152). New York: Plenum.

Roberts, J. (1996). US grants asylum to woman fleeing clitoridectomy British Medical Journal, 312, 1630-1631.

Robertson, C. (1996). Grassroots in Kenya: Women, genital mutilation, and collective action, 1920-1990. Signs, Spring, 615-642.

Ruminjo, J. (1992, September). Circumcision in women. East African Medical Journal, 69, 477-478.

Scheper-Hughes, N. (1991). Virgin territory: The male discovery of the clitoris. Medical Anthropology Quarterly, 5, 25-28.

Sen, A. K. (1992). Inequality reexamined. Cambridge, MA: Harvard University Press.

Shell-Duncan, B., & Hernlund, Y. (2000). Female “circumcision” in Africa: Dimensions of the practice and debates. In B. Shell-Duncan & Y. Hernlund (Eds.), Female ‘circumcision” in Africa: Culture, controversy, and change (pp. 1-40). Boulder, CO: Lynne Rienner Publishers.

Sontag, S. (1964). Against interpretation. New York: Doubleday

Stephenson, W. (1983). Against interpretation. Operant Subjectivity, 6, 73-103, 109-125.

Tamir, Y. (1996). Hands off clitoridectomy: What our revulsion reveals about ourselves. Boston Review [On-line]. Available: http://www-polisci.mit.edu/bostonreview/ BR21.3/Tamir.html.

Textor, R. B. (1967). A cross-cultural summary. New Haven, CT: HRAF Press.

Toubia, N. (1994). Female circumcision as a public health issue. The New England Journal of Medicine, 331, 712-716.

Toubia, N. (1998). Female circumcision/female genital mutilation. African Journal of Reproductive Health, 2(2), 6-8.

United Nations. (1989). Convention on the Rights of the Child, G.A. res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49. (Entered into force September 2, 1990)

Van der Kwaak, A. (1992). Female circumcision and gender identity: A questionable alliance? Social Science and Medicine, 35, 777-787.

Van Gennep, A. (1960). The rites of passage. Chicago: The University of Chicago Press.

Vizedom, M. (1976). Rites and relationships: Rites of passage and contemporary anthropology. London: Sage.

Williams, D. P., Acosta, W, & McPherson, H. A. (1999). Female genital mutilation in the United States: Implications for women’s health. American Journal of Health Studies, 15(1), 47-52.

Winkel, E. (1995). A Muslim perspective on female circumcision. Women & Health, 23(1), 1-7.

World Health Organization. (1992). Female circumcision. European Journal of Obstetrics and Gynecology and Reproductive Biology, 45, 153-154.

Wright, J. (1996). Female genital mutilation: An overview. Journal of Advanced Nursing, 24, 251-259.

Lori Leonard

Johns Hopkins University

Funding for data collection in Chad was provided by a grant from the National Science Foundation (SBR-9811074) and by a J. William Fulbright Fellowship from the Institute for International Education (IIE).

Correspondence concerning this article should be addressed to Lori Leonard, Assistant Professor of International Health, Johns Hopkins University, School of Public Health, 615 N. Wolfe Street, Room 7142, Baltimore, MD 21205. (lleonard@jhsph.edu)

Copyright Society for the Scientific Study of Sex 2000

Provided by ProQuest Information and Learning Company. All rights Reserved