Female genital cutting (FGC) is the standard international terminology for the cutting away of part or all of the female external genitalia. The World Health Organization estimates that 100-132 million women and girls living worldwide have been subjected to FGC. In Sudan, it affects almost 90% of women and girls. Since 1985, the Sudan National Committee on Traditional Practices (SNCTP), a grassroots-oriented NGO working on women's and children's human rights issues, has been working to eradicate FGC and other harmful traditional practices, such as early marriage and non-spaced pregnancies.

Each year, some two million girls worldwide are at risk of clitoridectomy or excision – the most common type of FGC – where the clitoris, as well as parts of the labia minora, are removed. Infibulation is the most extreme and damaging type of FGC, where the clitoris and labia minora are removed along with all parts of the labia majora. The sides of the wound heal together, leaving a very small opening. At each childbirth, women are cut and re-infibulated after delivery. Infibulation is most prevalent in Sudan, Eritrea, Somalia and parts of Ethiopia and Mali (see Map).
Research in Sudan and elsewhere has shown FGC's negative impact on women's and girls' physical, psychological and sexual wellbeing, affecting male–female relationships, sexual intercourse, menstruation and childbirth. In addition, FGC negatively affects girls' general performance in school, work and domestic affairs.

A deeply rooted cultural practice

FGC is a deeply rooted traditional cultural practice, passed on from generation to generation. Archaeological findings show that infibulation dates back to before Christianity and Islam. Originating in Egypt and northern Sudan, it spread to East, Central and West Africa. FGC types and prevalence differ from country to country. The highest rates are found in East Africa (Somalia and Djibouti: 98%; Sudan 89%; Ethiopia 85%; Eritrea 80%; Kenya 50%), West and North Africa (Mali 80%; Gambia 79%; Burkina Faso 70%; Chad 60%; Egypt 55%; Liberia and Mauritania 50%; Nigeria 40%; Benin 30%; Sierra Leone 9%).

Research by SNCTP in Sudan shows no agreement among religious leaders on FGC. Though often mistakenly associated with Islamic law, FGC is not mandated by the Holy Qur'an, nor by the Hadith (Sayings of the Prophet Mohammed) and has been condemned by Egypt's highest religious institute, Al Azhar. The only consensus among Muslim jurists is on the need for male circumcision. In fact, FGC is hardly found in Arab and Muslim countries outside Africa.

FGC in Sudan

Sudan's 1990 Demographic Health Survey reported that 89% of ever-married women in northern Sudan's 16 regions had been infibulated. FGC is usually performed by midwives and traditional birth attendants (TBAs) living in the heart of local communities. The ritual and associated festivities are exclusively a women's affair, dominated by grandmothers and carefully concealed to avoid legal action, as mandated by the Sudan Penal Code since 1946.
The custom has long been ignored as an issue infringing upon women's and girls' human rights, as it is firmly rooted in Sudanese culture, and those opposing it risk social exclusion. In traditional society, it is almost impossible to discuss reproductive and sexual affairs openly and frankly. Even those who are aware of the harmful effects of FGC consider it important to maintain moral and religious standards by controlling female sexuality and preventing promiscuity, thus ensuring cleanliness and virginity. The fight against FGC is further hampered by a lack of information and high illiteracy rates. Nevertheless, a slightly declining trend is seen, especially among the urban elite, while recent research also shows a trend from infibulation toward excision.

SNCTP's fight against FGC

SNCTP aims to eradicate traditional harmful practices, notably FGC, and is active in the fight against HIV/AIDS. SNCTP also tries to contribute to solving Sudan's internal conflict, in order to create a supportive environment for women's and children's development. It has branches and community-based units in 14 states, mainly in northern Sudan, and is part of the Inter-Africa Committee (IAC) network, which covers 30 African countries. SNCTP works with a variety of stakeholders, including religious and political leaders, policy-makers, women's and community-based organisations, TBAs and midwives, health and social workers, police, educational institutes and teachers, youth and children, and households. Its main strategies include:

• awareness-raising and sensitisation of communities, religious and community leaders
• dissemination of information and publications
• mobilisation of the media
• advocacy and lobbying toward political leaders and policy-makers
• supporting the development of appropriate legislation
• including FGC education in programmes and curricula of community organisations, formal and informal education and health-worker institutions
• alternative employment programmes for midwives and TBAs as a substitute to loss of income when stopping FGC.

Cautiously positive trends

A recently held survey by SNCTP revealed interesting facts and trends regarding FGC. Overall knowledge on sexual health was low: only 34% had correct knowledge about the function of the female external genital organs. Outsiders and friends are the main source of information (53%), with school curricula (37%) and the family (10%) playing a minor role.
FGC is concentrated in rural (97%) and semi-urban areas (88%). In Muslim communities, infibulation is practised more widely than less extreme forms of FGC. However, 91% of recently married women mentioned a negative impact of FGC on their sex life, mainly associated with women's negative attitudes to sexual intercourse due to acute FGC-related health complaints and their husbands' subsequent aggression.
Results show a gradual, positive trend in attitude changes toward less severe types of FGC. Overall, only 27% supported infibulation, while 73% favoured clitoridectomy. The strongest support for infibulation is found among mothers (88%), while 42% of fathers and 46% of male students still support it. Only 11% of female students support it, reflecting a growing awareness among young women. Nevertheless, a large majority of the sample opinion (84%) expressed support for the total eradication of FGC for girls. A growing number of men prefer marrying uncircumcised women (56% of fathers and 44% of male students), while a majority of those who still prefer marrying a circumcised woman preferred clitoridectomy.

A higher level of education seems to have a positive influence. Among illiterate people, infibulation was more prevalent (91%) than clitoridectomy (9%); among university graduates this ratio was 50-50. Among younger women, the less radical type seems to be more common. Among female pupils, prevalence of infibulation versus clitoridectomy was 57% and 43% respectively, while this was 85% and 15% among their mothers.

Remaining challenges

Despite certain positive trends, many challenges remain. Existing legislation against FGC is not suited to deal with complete eradication, as Sudanese authorities are not yet ready to enforce the law and deal with resistance from cultural tradition. On 22 May 2002, a panel organised by the Ministry of Religious Affairs and the Women's Centre of the Omdurman Islamic University recommended the so-called "shar'ai excision". Thus, 60 years into the fight against all forms of FGC, a new type was simply proposed, stressing its – supposedly – beneficial religious and health effects, and proposing the training of medical staff in the procedure. In this context, the general lack of interest in eradicating FGC among health staff and the surgical excision by some health staff has even helped FGC acquire an aura of respectability. In addition, two types of "repair-FGC" or "re-infibulation" – believed to improve FGC after delivery – have been introduced by midwives without informing the health authorities.

Communication between men and women is a vital step in the process of eradicating FGC. However, it is difficult to achieve, as men are not yet ready for change, especially in rural areas. Awareness materials on the negative consequences of FGC are needed mainly for the illiterate people. Lack of financial support makes it difficult to reach rural people throughout the country.

One of the lessons learned so far is that elimination of illiteracy is one of the most important strategies to eradicate FGC, as it facilitates education and communication with communities. Other important communication strategies include using theatre and drama, songs, exhibitions and mobile media. Other priority areas include skills building in lobbying, advocacy and leadership; monitoring and evaluation; as well as attitude and behaviour change. Multiple strategies should be combined in a community-based approach with focused national messages and International NGOs programmes.