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Issues at a Glance

Giving Up Harmful Practices, Not Culture

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… it is unacceptable that the international community remains passive (about harmful traditional practices) in the name of a distorted vision of multiculturalism. Human behaviors and cultural values, however senseless or destructive they may appear from the personal and cultural standpoint of others, have meaning and fulfill a function for those who practice them. However, culture is not static but is in constant flux, adapting and reforming. People will change their behavior when they understand the hazards and indignity of harmful practices and when they realize that it is possible to give up harmful practices without giving up meaningful aspects of their culture.

World Health Organization, 1996,
Female Genital Cutting: A Joint WHO/UNICEF/UNFPA Statement.

In every culture, important practices exist which celebrate life-cycle transitions, perpetuate community cohesion, or transmit traditional values to subsequent generations. These traditions reflect norms of care and behavior based on age, life stage, gender, and social class. While many traditions promote social cohesion and unity, others erode the physical and psychological health and integrity of individuals, particularly girls and women. Factors such as limited access to education, information, and services allow those that may be most harmful to persist.

Harmful traditions exist in many different forms, but they share origins in the historically unequal social and economic relationships between men and women. Female genital cutting, early marriage and childbearing, and gender bias have received global attention due to their severe, negative impact on the health and well-being of females. Efforts to alter or eradicate these practices are often met with suspicion or hostility from those communities practicing them, particularly when efforts originate from outside the community. For many members of these societies, ending their traditions is unimaginable, as such practices constitute an integral part of the socio-cultural fabric.

This document examines three harmful practices that have received global scrutiny. However, many other practices, such as nutritional taboos and birth practices, also have debilitating effects on the health and well-being of females.

Female Genital Cutting Is Widely Practiced

Female genital cutting, also called female genital mutilation (FGM), is practiced in 28 African countries as well as in some Arab and Asian countries, and in immigrant communities in Europe, Australia, and the United States. Genital cutting is the excision of part or all of the female external genitalia for non-medical reasons. Cutting ranges from removal of the clitoral hood to its most extreme form, infibulation, involving removal of the clitoris as well as some or all of the labia minora. The labia majora are then sealed, leaving only a small opening to allow the flow of urine and menstrual blood. Infibulation is practiced predominantly in Somalia, the Sudan, and Djibouti as well as in some parts of Ethiopia and Egypt. Between 100 million to 132 million girls and women now living have undergone genital cutting. In the next year, approximately 2 million females will endure the procedure.

In some societies, genital cutting marks an important rite of passage into womanhood; in others, it is believed to be esthetically pleasing and to guarantee virginity, curb female sexual desires, maintain hygiene, prevent promiscuity, and increase fertility. Men may refuse to marry a woman who has not undergone the procedure. Although communities commonly believe that genital cutting is religiously prescribed, no basis for it exists in either the Koran or the Bible.

In some countries, genital cutting is a rite of passage, taking place around the age of 14 and accompanied by elaborate celebrations. In other countries, genital cutting is traditionally performed at a younger age. In Eritrea, the median age for undergoing genital cutting is 1.8 months, compared to 6.3 years in Mali and 10.8 years in the Central African Republic.¹ Ethiopians perform genital cutting within a few days of birth, and Sudanese girls experience it by age 12.² Ninety-eight percent of Somali females undergo genital cutting as compared to 10 percent of Tanzanian females.³

While the reasons for practicing female genital cutting vary, its negative outcomes are clear and well-documented. Ordinarily performed without anesthesia and using unhygienic methods and instruments, its consequences include sickness or death due to infection, hemorrhage, tetanus, or blood poisoning. In Sudan, 10 to 30 percent of girls die from infibulation.⁴ The agony of the procedure itself may cause long-lasting psychological damage. Genital cutting usually makes sexual intercourse very painful and difficult for women. Pregnant women who have undergone genital cutting frequently experience prolonged labor and complications in delivery.

Marriage and childbearing are important to most women and rejecting genital cutting carries with it a potential loss of status and acceptance within the community. As a result, women, important teachers of cultural traditions, are often the procedure's strongest proponents. Those who perform genital cutting also advocate strongly for it's continuation because it provides most of their income.

Preference for Sons Runs Deep

In many societies, preference for sons is a powerful tradition. This preference manifests itself in neglect, deprivation, and discriminatory treatment of daughters to the detriment of their physical and mental health. Male preference adversely affects females through inequitable allocation of food, education, and health care, a disparity frequently reinforced throughout life.

Male preference begins early in life. In regions where this practice is firmly entrenched, high rates of poverty and infant mortality frequently occur. Parents with scarce economic resources may feel that it is more important for male children to survive. Dowries, to be paid when daughters marry, may be a further incentive for son preference. As a result, female children and infants are often fed after males and receive food of lower nutritional value. In rural Bangladesh malnutrition is nearly three times as common among girls as among boys. Further, boys are more than twice as likely as girls to receive medical care for diarrhea. In India, every sixth infant death is specifically due to practices arising from son preferences.⁵

The educational and economic implications of son preference are grave. Despite substantial increases in the number of women who have attained at least seven years of education, there are far fewer females than males enrolled in secondary schools in many developing countries. While 91 females per 100 males attend secondary school in Peru, only 49 females per 100 males are enrolled in Bangladesh, and 50 per 100 in Mali.⁶ This disparity between males' and females' access to education leaves women in lifelong positions of economic and social disadvantage.

Early Marriage Usually Results in Early Childbearing

In many cultures, the tradition of marrying daughters at a young age is common. Female children, already malnourished and undervalued, are often married to much older men. In such marriages, females have little power and sense of self-determination. Those who marry early cannot stay in school and often have little motivation or ability to plan their families.

Some cultures believe early marriage guarantees a long period of fertility; very young brides may need a smaller dowry. Females' age at marriage is slowly rising in most of Africa; but in East Africa and Nigeria, it is dropping as young virgins, considered less likely to be infected with HIV/AIDS, are sought as brides. Early marriage is most prevalent in Sub-Saharan Africa and in South Asia. In Bangladesh, 47 percent of women, ages 20 to 24, are married by age 15. In Guatemala, India, and Niger, the rates are 12, 18, and 50 percent, respectively.⁷

Early marriage and childbearing are closely linked to low educational attainment. In Cameroon, 27 percent of married women, under age 20, finished seven years of school, compared to 77 percent of unmarried women.⁶ In Guatemala, teenage mothers are five times less likely to finish secondary education than women whose first birth occurs later.⁸

Early marriage usually results in early childbearing, with severe consequences for the health of young mothers and their babies. Infants born to teenage mothers are up to 80 percent more likely to die within their first year than are infants born to mothers ages 20 to 29.⁹ Maternal mortality rates are twice as high for women ages 15 to 19 as for women ages 20 to 29.¹⁰

What Can Be Done to Change Harmful Practices?

Cultural traditions are powerful, and only careful efforts will alter or eliminate harmful ones. Western pressure for change is sometimes heavy handed and insensitive and is often perceived as culturally imperialistic. Efforts to change harmful traditions are most effective when they originate within the culture that practices them.

Women's groups and human rights activists have placed genital cutting on the agendas or many governments and international organizations. Belgium, Ghana, Sweden, and the United Kingdom have outlawed various forms of genital cutting, while Sudan and Djibouti forbid infibulation. Public education campaigns make open discussion of the practice more acceptable. Successful programs have retrained practitioners of genital cutting either to undertake different careers or to modify the practice, retaining its importance as a rite of passage while avoiding inflicting harm.

In September 1997, African legislators endorsed a plan to end female genital cutting in Africa by the year 2005. The forum called all African states to enact specific, clear legislation for the abolition of genital cutting and other harmful practices. It urged legislation and the establishment of concrete mechanisms for implementing policies to eliminate of all forms of violence against women and children. Endorsed by delegates from 40 countries, the declaration also called the "degrading and inhuman practices of female genital mutilation and other harmful practices in Africa" a disgrace.

Early marriage is an increasing focus of reform for governments throughout the developing world. While laws outlining minimum ages for marriage have been enacted in some countries, the laws often fail to prevent forced marriages of the very young. Legal limits on age at marriage typically apply only to unions lacking parental consent; marriages arranged by parents can involve children well below a country's legal minimum age. While the betrothal of infants and female children has become less prevalent, the age of first marriage in sub-Saharan Africa and South Asia remains low.

At the 1994 United Nations International Conference on Population and Development, world leaders, high ranking officials, representatives of non-governmental organizations, and United Nations together set explicit objectives to end gender bias and gender discrimination and their severe consequences. The Programme of Action called for:

• Eliminating all forms of discrimination against the girl child and the root causes of son preference, which result in female infanticide and prenatal sex selection;
• Increasing public awareness of the value of the girl child and concurrently strengthening the girl child's self-image, self-esteem and status;
• Improving the welfare of the girl child, especially in regard to health, nutrition, and education.

Harmful traditions sometimes seem impossible to change. Efforts to alter or eradicate them require the cooperation and understanding of community leaders, policy makers, and the people who have experienced or witnessed hardships these practices cause. Community education is critical to increasing public awareness of the negative consequences of these practices and changing societal norms. Laws condemning harmful practices must be implemented and enforced. When respectful of tradition, advocacy can unite communities, reinforcing practices which benefit all members, while at the same time confronting those which damage the integrity and diminish the humanity of girls and women.

Written by: Lauren Hersh, February 1998

Resources and References

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Africa (IAC)
c/o UNECA/ATRCW, PO Box 3001
Addis Ababa, Ethiopia
Tel:(251 1)51 72 00; Fax: 51 46 82
or contact the Liaison Office:
147 rue de Lausanne, SH-1202
Geneva, Switzerland
Tel:(41 22)731 24 20 - 732 08 21; Fax: 738 18 23

Female Genital Cutting: Findings from the Demographic and Health Surveys Program summarizes research results from the Central African Republic, Cote d'Ivoire, Egypt, Eritrea, Mali, northern Sudan, and Yemen.
Contact Tonya Gary:
Macro International
11785 Beltsville Drive, Suite 300
Calverton, MD 20705 USA
Tel:(301)572-0200; Fax: 572-0999; E-mail: reports@macroint.com 

RAINBO is a not-for-profit organization conducting advocacy and research and providing technical assistance and consultation related to FGM and women's right to bodily integrity.
915 Broadway, Suite 1109
New York, NY 10010-7108
Tel: (212)477-4154; Web site: http://www.rainbo.org.

1. Carr D. Female Genital Cutting: Findings from the Demographic and Health Surveys Program. Calverton, MD: Macro International, 1997.
2. Shaw E. Female circumcision: perceptions of clients and caregivers. J Am Coll Health 1985; 33:193-197.
3. Noble J. Cover J. Yanagishita M. The World's Youth, 1996. Washington, DC: Population Reference Bureau, 1996.
4. Heise LL. Violence against women: the missing agenda. In: Koblinsky M, Timyan J. Gay J. ed. The Health of Women: a Global Perspective. San Francisco: Westview Press, 1993.
5. Heise LL, Pitanguy J. Germain A. Violence Against Women: the Hidden Health Burden. [World Bank Discussion Paper, #255] Washington, DC: World Bank, 1994.
6. Alan Guttmacher Institute. Hopes and Realities: Closing the Gap between Women 's Aspirations and Their Reproductive Experiences. New York, NY: The Institute, 1995.
7. Singh S. Samara R. Early marriage among women in developing countries. Internat Fam Plann Perspect 1996; 22:148-157+.
8. Wulf D, Singh S. Sexual activity, union and childbearing among adolescent women in the Americas. Internat Pam Plann Perspect 1991; 17:137-144.
9. McDevitt TM, Adlakha A, Fowler TB et al. Trends in Adolescent Fertility and Contraceptive Use in the Developing World. [TPC/95-1] Washington, DC: U.S. Bureau of the Census, 1996.
10. Shane B. Family Planning Saves Lives. 3rd ed. Washington, DC: Population Reference Bureau, 1997.

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