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Monday, September 17, 2018

Child marriage

From Wikipedia, the free encyclopedia

Presentation of Marie Antoinette to Louis Auguste at Versailles, before their marriage. She was married at age 15, on 16 May 1770.

Child marriage is a formal marriage or informal union entered into by an individual before reaching a certain age, specified by several global organizations such as UNICEF as minors under the age of 18. The legally prescribed marriageable age in some jurisdictions is below 18 years, especially in the case of girls; and even when the age is set at 18 years, many jurisdictions permit earlier marriage with parental consent or in special circumstances, such as teenage pregnancy. In certain countries, even when the legal marriage age is 18, cultural traditions take priority over legislative law. Child marriage violates the rights of children; it affects both boys and girls, but it is more common among girls. Child marriage has widespread and long term consequences for child brides and grooms. According to several UN agencies, comprehensive sexuality education can prevent such a phenomenon.

Child marriage is related to child betrothal, and it includes civil cohabitation and court approved early marriages after teenage pregnancy. In many cases, only one marriage-partner is a child, usually the female. Causes of child marriages include poverty, bride price, dowry, cultural traditions, laws that allow child marriages, religious and social pressures, regional customs, fear of remaining unmarried, illiteracy, and perceived inability of women to work for money.

Child marriages were common throughout history for a variety of reasons including poverty, insecurity, as well as for political and financial reasons. Today, child marriage is still fairly widespread, particularly in developing countries, such as parts of Africa, South Asia, Southeast Asia, West Asia, Latin America, and Oceania. However, even in developed countries such as the United States legal exceptions mean that 25 US states have no minimum age requirement. The incidence of child marriage has been falling in most parts of the world. The countries with the highest observed rates of child marriages below the age of 18 are Niger, Chad, Mali, Bangladesh, Guinea and the Central African Republic, with a rate above 60%. Niger, Chad, Bangladesh, Mali and Ethiopia were the countries with child marriage rates greater than 20% below the age of 15, according to 2003–2009 surveys.

History

Child marriages were common in history. Princess Emilia of Saxony in 1533, at age 16 married George the Pious, Margrave of Brandenburg-Ansbach, then aged 48 years.

Historically, child marriage was common around the world, the average life expectancy did not exceed 50 years old, so child marriage was considered an effective practice to increase population. The practice began to be questioned in the 20th century, with the age of individuals' first marriage increasing in many countries and most countries increasing the minimum marriage age.

In ancient and medieval societies it was common for girls to be betrothed at or even before puberty. As Friedman claims, "arranging and contracting the marriage of a young girl were the undisputed prerogatives of her father in ancient Israel." Most girls were married before the age of 15, often at the start of their puberty. In the Middle Ages the age at marriage seems to have been around puberty throughout the Jewish world.

Ruth Lamdan writes: “The numerous references to child marriage in the 16th- century Responsa literature and other sources, shows that child marriage was so common, it was virtually the norm. In this context, it is important to remember that in halakha, the term ‘minor’ refers to a girl under twelve years and a day. A girl aged twelve and a half was already considered an adult in all respects.”

In Ancient Greece, early marriage and motherhood for girls was encouraged. Even boys were expected to marry in their teens. Early marriages and teenage motherhood was typical. In Ancient Rome, girls married above the age of 12 and boys above 14. In the Middle Ages, under English civil laws that were derived from Roman laws, marriages before the age of 16 were common. In Imperial China, child marriage was the norm.

Religion

Most religions, over history, influenced the marriageable age. For example, Christian ecclesiastical law forbade marriage of a girl before the age of puberty. Hindu vedic scriptures mandated the age of a girl's marriage to be adulthood which they defined as three years after the onset of puberty.

Jewish scholars and rabbis strongly discouraged marriages before the onset of puberty, but at the same time, in exceptional cases, girls ages 3 through 12 (the legal age of consent according to halakha) might be given in marriage by her father. By Judaism, the minimal girl age, for marriage, was 12 years and one day, "na'arah", as metioned in the ancient Talmud Mishnah books,(copiled between 536 BCE – 70 CE, redacted in the 3rd century CE), Order Nashim Masechet Kiddushin 41 a & b.

According to Halakha girls should not marry until they are 12 years and six months old, "bogeret". Although Moses Maimonides mentions in Talmud Mishneh Torah (compiled between 1170 and 1180 CE) that in exceptional cases, girls ages three through 12, might be given in marriage by her father, he also clarifies, in the same chapter, in verse 3:19 that: "Although a father has the option of consecrating his daughter to anyone he desires while she is a minor or while she is a maiden, it is not proper for him to act in this manner".

Some apocryphal accounts state that at the time of her betrothal to Joseph, Mary, the mother of Jesus, was 12–14 years old, but such accounts are unreliable.

Historically within the Catholic Church, prior to the 1917 Code of Canon Law, the minimum age for a dissoluble betrothal (sponsalia de futuro) was 7 years in the contractees. The minimum age for a valid marriage was puberty, or nominally 14 for males and 12 for females. The 1917 Code of Canon Law raised the minimum age for a valid marriage at 16 for males and 14 for females. The 1983 Code of Canon Law maintained the minimum age for a valid marriage at 16 for males and 14 for females.

Some Islamic marriage practices have permitted marriage of girls below the age of 10, because Shariat law is based in part on the life and practices of Muhammad, the Prophet, as described in part in Sahih Bukhari and Sahih Muslim. Muhammad married Aisha, his third wife, when she was about age six, and consummated the marriage when she was about age nine. Some mainstream Islamic scholars have suggested that it is not the chronological age that matters; marriageable age under Muslim religious law is the age when the guardians of the girl feel she has reached sexual maturity. Such determination of sexual maturity is a matter of subjective judgment, and there is a strong belief among most Muslims and scholars, based on Sharia, that marrying a girl less than 13 years old is an acceptable practice for Muslims.

Effects on each gender

Christian child marriage in the Middle Ages

Boys

Boys are sometimes married as children, although according to UNICEF, "girls are disproportionately the most affected", child marriage is five times more common among girls than boys. Research on the effects of child marriage on underage boys is small. As of September 2014, 156 million living men were married as underage boys.

Girls

Child marriage has lasting consequences on girls, from their health, education and social development perspectives. These consequences last well beyond adolescence. One of the most common causes of death for girls aged 15 to 19 in developing countries was pregnancy and childbirth. In Niger, which is estimated as having the highest rate of child marriage in the world, about 3 in 4 girls marry before their 18th birthday.

Causes of child marriage

According to UNFPA, factors that promote and reinforce child marriage include poverty and economic survival strategies; gender inequality; sealing land or property deals or settling disputes; control over sexuality and protecting family honour; tradition and culture; and insecurity, particularly during war, famine or epidemics. Other factors include family ties in which marriage is a means of consolidating powerful relations between families.

Dowry and brideprice

A traditional, formal presentation of the bride price at a Thai engagement ceremony.

Providing a girl with a dowry at her marriage is an ancient practice which continues in some parts of the world. This requires parents to bestow property on the marriage of a daughter, which is often an economic challenge for many families. The difficulty to save and preserve wealth for dowry was common, particularly in times of economic hardship, or persecution, or unpredictable seizure of property and savings. These difficulties pressed families to betroth their girls, irrespective of her age, as soon as they had the resources to pay the dowry. Thus, Goitein notes that European Jews would marry their girls early, once they had collected the expected amount of dowry.

A bride price is the amount paid by the groom to the parents of a bride for them to consent to him marrying their daughter. In some countries, the younger the bride, the higher the price she may fetch. This practice creates an economic incentive where girls are sought and married early by her family to the highest bidder. Child marriages of girls is a way out of desperate economic conditions, or simply a source of income to the parents. Bride price is another cause of child marriage and child trafficking.

Persecution, forced migration, and slavery

Social upheavals such as wars, major military campaigns, forced religious conversion, taking natives as prisoners of war and converting them into slaves, arrest and forced migrations of people often made a suitable groom a rare commodity. Bride's families would seek out any available bachelors and marry them to their daughters, before events beyond their control moved the boy away. Persecution and displacement of Roma and Jewish people in Europe, colonial campaigns to get slaves from various ethnic groups in West Africa across the Atlantic for plantations, Islamic campaigns to get Hindu slaves from India across Afghanistan's Hindu Kush as property and for work, were some of the historical events that increased the practice of child marriage before the 19th century.

Among Sephardi Jewish communities, child marriages became frequent from the 10th to 13th centuries, especially in Muslim Spain. This practice intensified after the Jewish community was expelled from Spain, and resettled in the Ottoman Empire. Child marriages among the Eastern Sephardic Jews continued through the 18th century in Islamic majority regions.

Fear, poverty, social pressures and sense of protection

English stage actress Ellen Terry was married at age 16 to George Frederic Watts who was 46 years old, a marriage her parents thought would be advantageous; later she said she was uncomfortable being a child bride. Terry died at the age of 81, in 1928.

A sense of social insecurity has been a cause of child marriages across the world. For example, in Nepal, parents fear likely social stigma if adult daughters (past 18 years) stay at home. Other fear of crime such as rape, which not only would be traumatic but may lead to less acceptance of the girl if she becomes victim of a crime. For example, girls may not be seen as eligible for marriage if they are not virgins. In other cultures, the fear is that an unmarried girl may engage in illicit relationships, or elope causing a permanent social blemish to her siblings, or that the impoverished family may be unable to find bachelors for grown up girls in their economic social group. Such fears and social pressures have been proposed as causes that lead to child marriages. Insofar as child marriage is a social norm in practicing communities, the elimination of child marriage must come through a changing of those social norms. The mindset of the communities, and what is believed to be the proper outcome for a child bride, must be shifted to bring about a change in the prevalence of child marriage.

Extreme poverty may make daughters an economic burden on the family, which may be relieved by their early marriage, to the benefit of the family as well as the girl herself. Poor parents may have few alternatives they can afford for the girls in the family; they often view marriage as a means to ensure their daughter's financial security and to reduce the economic burden of a growing adult on the family. Child marriage can also be seen as means of ensuring a girl's economic security, particularly if she lacks family members to provide for her. In reviews of Jewish community history, scholars claim poverty, shortage of grooms, uncertain social and economic conditions were a cause for frequent child marriages.

Drawings by young Syrian refugee girls in a community centre in southern Lebanon promote the prevention of child marriage.

An additional factor causing child marriage is the parental belief that early marriage offers protection. Parents feel that marriage provides their daughter with a sense of protection from sexual promiscuity and safe from sexually transmitted infections. However, in reality, young girls tend to marry older men, placing them at an increased risk of contracting a sexually transmitted infection.

Protection through marriage may play a specific role in conflict settings. Families may have their young daughters marry members of an armed group or military in hopes that she will be better protected. Girls may also be taken by armed groups and forced into marriages.

Religion, culture and civil law

Although the general marriageable age is 18 in the majority of countries, most jurisdictions allow for exceptions for underage youth with parental and/or judicial consent. Such laws are neither limited to developing countries, nor to state religion. In some countries a religious marriage by itself has legal validity, while in others it does not, as civil marriage is obligatory. For Catholics incorporated into the Latin Church, the 1983 Code of Canon Law sets the minimum age for a valid marriage at 16 for males and 14 for females. In 2015, Spain raised its minimum marriageable age to 18 (16 with court concent) from the previous 14. In Mexico, marriage under 18 is allowed with parental consent, from age 14 for girls and age 16 for boys. In Ukraine, in 2012, the Family Code was amended to equalize the marriageable age for girls and boys to 18, with courts being allowed to grant permission to marry from age 16 years if it is established that the marriage is in the best interest of the youth.

Many states in the US permit child marriages, with court's permission. Since 2015, the minimum marriageable age throughout Canada is 16. In Canada the age of majority is set by province/territory at 18 or 19, so minors under this age have additional restrictions (i.e. parental and court consent). Under the Criminal Code, Art. 293.2 Marriage under age of 16 years reads: "Everyone who celebrates, aids or participates in a marriage rite or ceremony knowing that one of the persons being married is under the age of 16 years is guilty of an indictable offence and liable to imprisonment for a term not exceeding five years." The Civil Marriage Act also states: "2.2 No person who is under the age of 16 years may contract marriage." In the UK, marriage is allowed for 16–17 years old with parental consent in England and Wales as well as in Northern Ireland, and even without parental consent in Scotland. However, a marriage of a person under 16 is void under the Matrimonial Causes Act 1973. The United Nations Population Fund stated the following:
In 2010, 158 countries reported that 18 years was the minimum legal age for marriage for women without parental consent or approval by a pertinent authority. However, in 146 countries, state or customary law allows girls younger than 18 to marry with the consent of parents or other authorities; in 52 countries, girls under age 15 can marry with parental consent. In contrast, 18 is the legal age for marriage without consent among males in 180 countries. Additionally, in 105 countries, boys can marry with the consent of a parent or a pertinent authority, and in 23 countries, boys under age 15 can marry with parental consent.
Lower legally allowed marriage age does not necessarily cause high rates of child marriages. However, there is a correlation between restrictions placed by laws and the average age of first marriage. In the United States, per 1960 Census data, 3.5% of girls married before the age of 16, while an additional 11.9% married between 16 and 18. States with lower marriage age limits saw higher percentages of child marriages. This correlation between higher age of marriage in civil law and observed frequency of child marriages breaks down in countries with Islam as the state religion. In Islamic nations, many countries do not allow child marriage of girls under their civil code of laws. But, the state recognized Sharia religious laws and courts in all these nations have the power to override the civil code, and often do. UNICEF reports that the top five nations in the world with highest observed child marriage rates – Niger (75%), Chad (72%), Mali (71%), Bangladesh (64%), Guinea (63%) – are Islamic majority countries.

Marriageable age in religious sources

Catholic Church


Male consent Female consent Notes
Catholic Church 16 14 Diriment impediment (can. 1083 § 1). Conferences of Bishops can adopt a higher age for liceity (§ 2). Marriage against the worldly power's directive need permission by the Ordinary for liceity (can. 1071 § 1 no. 2), which in case of sensible and equal laws regarding marriage age is regularly not granted. The permission by the Ordinary is also required in case of a marriage of a minor child (i.e. under 18 years old) when his parents are unaware of his marriage or if his parents reasonably oppose his marriage (can. 1071 § 1 no. 6).
Higher ages are set by Conferences of Bishops in specific countries.

Islam

In Quran, the "age of marriage" coincides with puberty. Classical Islamic law (Sharia) does not have a marriageable age because there is no minimum age at which puberty can occur. In Islam there is no set age for marriage, the condition is physical (bulugh) maturity and mental (rushd) maturity. So the age is variable. The Prophet Muhammad, who is said to serve as a role model (qudwah hasanah) for every Muslim, is reported by Sunni Hadith sources to have married Aisha when she was six or seven years old, with the marriage not being consummated until she had reached the age of nine or ten years old.

Büchler and Schlater observe that "marriageable age according to classical Islamic law coincides with the occurrence of puberty. The notion of puberty refers to signs of physical maturity such as the emission of semen or the onset of menstruation", but then claim the schools of Islamic jurisprudence (madhaahib) set the following marriageable ages for men and women.


Male consent Female consent Notes
Shafi'i 15 15
Hanbali 15 15
Maliki 17 17
Jafari 15 9
Hanafi 12 9

However other sources give different ages.

The Reliance of the Traveller, frequently considered the definitive summary of Shafi'i jurisprudence, states in the chapter on marriage as follows:
32.2a. A father arranging the marriage of a virgin daughter: A father can arrange the marriage of his virgin daughter without her permission even if she is beyond the age of puberty. It is up to him whether he consults her or not.
32.2b. Someone other than the father arranging the marriage of a virgin: However, if anyone other than the father is arranging the marriage of a virgin, such as a guardian appointed in the father's will or anyone else, he cannot give her in marriage unless she is beyond the age of puberty and has given her consent. In this case her silence is taken as consent.
In relation to proposed Saudi marriage reforms in 2009, it was observed that "although girls can marry even before reaching puberty, they cannot terminate the wedding contracts according to the Hanbali legal school, one of four major schools in Sunni Islam, which gives complete control over the female to the male guardian"

Hinduism

The Manu Smriti recommends arranged marriages for girls within three years from attainment of puberty (11-14). If unmarried, after this period, the girl may marry on her own will somebody from her own caste and rank by freewill (after 14). A man, aged thirty years, shall marry a maiden of twelve who pleases him, or a man of twenty-four a girl eight years of age; if (the performance of) his duties would (otherwise) be impeded, (he must marry) sooner.

Politics and financial relationships

Child marriage in 1697 of Marie Adélaïde of Savoy, age 12 to Louis, heir apparent of France age 15. The marriage created a political alliance.

Child marriages may depend upon socio-economic status. The aristocracy in some cultures, as in the European feudal era tended to use child marriage as a method to secure political ties. Families were able to cement political and/or financial ties by having their children marry. The betrothal is considered a binding contract upon the families and the children. The breaking of a betrothal can have serious consequences both for the families and for the betrothed individuals themselves.

Affects of child marriage on global regions

A UNFPA report stated that "For the period 2000–2011, just over one third (an estimated 34 per cent) of women aged 20 to 24 years in developing regions were married or in union before their eighteenth birthday. In 2010 this was equivalent to almost 67 million women. About 12 per cent of them were married or in union before age 15." The prevalence of child marriage varies substantially among countries. Around the world, girls from rural areas are twice as likely to marry as children as those from urban areas.

Africa

Poster against child and forced marriage

According to UNICEF, Africa has the highest incidence rates of child marriage, with over 70% of girls marrying under the age of eighteen in three nations. Girls in West and Central Africa have the highest risk of marrying in childhood. Niger has one of the highest rates of early marriage in sub-Saharan Africa. Among Nigerian women between the ages of twenty and twenty-four, 76% reported marrying before the age of eighteen and 28% reported marrying before the age of fifteen. This UNICEF report is based on data that is derived from a small sample survey between 1995 and 2004, and the current rate is unknown given lack of infrastructure and in some cases, regional violence.

African countries have enacted marriageable age laws to limit marriage to a minimum age of 16 to 18, depending on jurisdiction. In Ethiopia, Chad and Niger, the legal marriage age is 15, but local customs and religious courts have the power to allow marriages below 12 years of age. Child marriages of girls in West Africa and Northeast Africa are widespread. Additionally, poverty, religion, tradition, and conflict make the rate of child marriage in Sub-Saharan Africa very high in some regions.

In many tribal systems a man pays a bride price to the girl's family in order to marry her (comparable to the customs of dowry and dower). In many parts of Africa, this payment, in cash, cattle, or other valuables, decreases as a girl gets older. Even before a girl reaches puberty, it is common for a married girl to leave her parents to be with her husband. Many marriages are related to poverty, with parents needing the bride price of a daughter to feed, clothe, educate, and house the rest of the family. In Mali, the female:male ratio of marriage before age 18 is 72:1; in Kenya, 21:1.

The various reports indicate that in many Sub-Saharan countries, there is a high incidence of marriage among girls younger than 15. Many governments have tended to overlook the particular problems resulting from child marriage, including obstetric fistulae, premature births, stillbirth, sexually transmitted diseases (including cervical cancer), and malaria.

In parts of Ethiopia and Nigeria many girls are married before the age of 15, some as young as 7. In parts of Mali 39% of girls are married before the age of 15. In Niger and Chad, over 70% of girls are married before the age of 18.

As of 2006, 15–20% of school dropouts in Nigeria were the result of child marriage. In 2013, Nigeria attempted to change Section 29, subsection 4 of its laws and thereby prohibit child marriages. Christianity and Islam are each practiced by roughly half of its population, and the country continues with personal laws from its British colonial era laws, where child marriages are forbidden for its Christians and allowed for its Muslims. Child marriage is a divisive topic in Nigeria and widely practiced. In northern states, predominantly Muslim, over 50% of the girls marry before the age of 15.

In 2016, during a feast ending the Muslim holy month of Ramadan, the Gambian President Yahya Jammeh announced that child and forced marriages were banned.

In 2015, Malawi passed a law banning child marriage, which raises the minimum age for marriage to 18. This major accomplishment came following years of effort by the Girls Empowerment Network campaign, which ultimately led to tribal and traditional leaders banning the cultural practice of child marriage.

In Morocco, child marriage is a common practice. Over 41,000 marriages every year involve child brides. Before 2003, child marriages did not require a court or state's approval. In 2003, Morocco passed the family law (Moudawana) that raised minimum age of marriage for girls from 14 to 18, with the exception that underage girls may marry with the permission of the government recognized official/court and girl's guardian. Over the 10 years preceding 2008, requests for child marriages have been predominantly approved by Morocco's Ministry for Social Development, and have increased (c. 29% of all marriages). Some child marriages in Morocco are a result of Article 475 of the Moroccan penal code, a law that allows rapists to avoid punishment if they marry their underage victims. Article 475 was amended in January 2014 after much campaigning, and rapists can legally no longer avoid sentencing by marrying their victim.

In South Africa the law provides for respecting the marriage practices of traditional marriages, whereby a person might be married as young as 12 for females and 14 for males. Early marriage is cited as "a barrier to continuing education for girls (and boys)". This includes absuma (arranged marriages set up between cousins at birth in local Islamic ethnic group), bride kidnapping and elopement decided on by the children.

In 2016, the Tanzanian High Court – in a case filed by the Msichana Initiative, a lobbying group that advocates for girls' right to education – ruled in favor of protecting girls from the harms of early marriage. It is now illegal for anyone younger than 18 to marry in Tanzania.

A 2015 Human Rights Watch report stated that in Zimbabwe, one-third of women aged between 20 and 49 years old had married before reaching the age of 18. In January 2016, two women who had been married as children brought a court case requesting a change in the legal age of marriage to the Constitutional Court, with the result that the court declared that 18 is to be the minimum age for a legal marriage for both men and women (previously the legal age had been 16 for women and 18 for men). The law took effect immediately, and was hailed by a number of human rights, women's rights, medical and legal groups as a landmark ruling for the country.

The UN states that although the number of child marriages has declined on a worldwide scale, the problem remains most severe in Africa, despite the fact that Ethiopia cut child marriage rates by a third.

Americas

Child marriage is common in Latin America and the Caribbean island nations. About 29% of girls are married before age 18. The child marriage incidence rates varies between the countries, with Dominican Republic, Honduras, Brazil, Guatemala, Nicaragua, Haiti and Ecuador reporting some of the highest rates in the Americas. Bolivia and Guyana have shown the sharpest decline in child marriage rates as of 2012. In Guatemala, early marriage is most common among indigenous Mayan communities. Brazil is ranked fourth in the world in terms of absolute numbers of girls married or co-habitating by age fifteen. Poverty and lack of laws mandating minimum age for marriage have been cited as reasons of child marriage in Latin America. In an effort to combat the widespread belief among poor, rural, and indigenous communities that child marriage is a route out of poverty, some NGOs are working with communities in Latin America to shift norms and create safe spaces for adolescent girls.

Canada

Since 2015, the minimum marriageable age throughout Canada is 16. In Canada the age of majority is set by province/territory at 18 or 19, so minors under this age have additional restrictions (i.e. parental and court consent). Under the Criminal Code, Art. 293.2 Marriage under age of 16 years reads: "Everyone who celebrates, aids or participates in a marriage rite or ceremony knowing that one of the persons being married is under the age of 16 years is guilty of an indictable offence and liable to imprisonment for a term not exceeding five years." The Civil Marriage Act also states: "2.2 No person who is under the age of 16 years may contract marriage."

United States

Child marriage, as defined by UNICEF, is observed in the United States. The UNICEF definition of child marriage includes couples who are formally married, or who live together as a sexually active couple in an informal union, with at least one member – usually the girl – being less than 18 years old. The latter practice is more common in the United States, and it is officially called cohabitation. According to a 2010 report by National Center for Health Statistics, an agency of the government of United States, 2.1% of all girls in the 15–17 age group were in a child marriage. In the age group of 15–19, 7.6% of all girls in the United States were formally married or in an informal union. The child marriage rates were higher for certain ethnic groups and states. In Hispanic groups, for example, 6.6% of all girls in the 15–17 age group were formally married or in an informal union, and 13% of the 15–19 age group were. Over 350,000 babies are born to teenage mothers every year in the United States, and over 50,000 of these are second babies to teen mothers.

Laws regarding child marriage vary in the different states of the United States. Generally, children 16 and over may marry with parental consent, with the age of 18 being the minimum in all but two states to marry without parental consent. However all states but Delaware and New Jersey have exceptions for child marriage within their laws, and although those under 16 generally require a court order in addition to parental consent, when those exceptions are taken into account, 25 US states have no minimum age requirement. Those that do have set it as young as 13 or 14.

In 2018, Delaware became the first state to ban child marriage without exceptions, followed by New Jersey the same year.

Between 2000 and 2015 there were at least 207,468 child marriages in the United States of which over 1,000 marriage licences were for children under 15, some as young as ten years old.

Until 2008 the Fundamentalist Church of Jesus Christ of Latter Day Saints practiced child marriage through the concept of "spiritual marriage" as soon as girls were ready to bear children, as part of its polygamy practice, but laws have raised the age of legal marriage in response to criticism of the practice. In 2008 the Church changed its policy in the United States to no longer marry individuals younger than the local legal age. In 2007 church leader Warren Jeffs was convicted of being an accomplice to statutory rape of a minor due to arranging a marriage between a 14-year-old girl and a 19-year-old man. In March 2008 officials of the state of Texas believed that children at the Yearning For Zion Ranch were being married to adults and were being abused. The state of Texas removed all 468 children from the ranch and placed them into temporary state custody. After the Austin's 3rd Court of Appeals and the Supreme Court of Texas ruled that Texas acted improperly in removing them from the YFZ Ranch, the children were returned to their parents or relatives.

Musician Jerry Lee Lewis's third wife, Myra Gale Brown, was Lewis's first cousin once removed and was only 13 years old at the time.

Asia

Child marriage in India. In 1900, Rana Prathap Kumari age 12 married Krishnaraja Wadiyar IV age 16. Two years later, he was recognized as the King of Mysore under British India.

More than half of all child marriages occur in the South Asian countries of India, Pakistan, Bangladesh, and Nepal. There was a decrease in the rates of child marriage across South Asia from 1991 to 2007, but the decrease was observed among young adolescent girls and not girls in their late teens. Some scholars believe this age-specific reduction was linked to girls increasingly attending school until about age 15 and then getting married.

Western Asia

A 2013 report claims 53% of all married women in Afghanistan were married before age 18, and 21% of all were married before age 15. Afghanistan's official minimum age of marriage for girls is 15 with her father's permission. In all 34 provinces of Afghanistan, the customary practice of ba'ad is another reason for child marriages; this custom involves village elders, jirga, settling disputes between families or unpaid debts or ruling punishment for a crime by forcing the so-called guilty family to give their 5- to 12-year-old girls as a wife. Sometimes a girl is forced into child marriage for a crime her uncle or distant relative is alleged to have committed.

Over half of Yemeni girls are married before 18, some by the age eight. Yemen government's Sharia Legislative Committee has blocked attempts to raise marriage age to either 15 or 18, on grounds that any law setting minimum age for girls is un-Islamic. Yemeni Muslim activists argue that some girls are ready for marriage at age 9. According to HRW, in 1999 the minimum marriage age 15 for women was abolished; the onset of puberty, interpreted by conservatives to be at age nine, was set as a requirement for consummation of marriage. In practice "Yemeni law allows girls of any age to wed, but it forbids sex with them until the indefinite time they're 'suitable for sexual intercourse'." As with Africa, the marriage incidence data for Yemen in HRW report is from surveys between 1990 and 2000. Current data is difficult to obtain, given regional violence.

In April 2008, Nujood Ali, a 10-year-old girl, successfully obtained a divorce after being raped under these conditions. Her case prompted calls to raise the legal age for marriage to 18. Later in 2008, the Supreme Council for Motherhood and Childhood proposed to define the minimum age for marriage at 18 years. The law was passed in April 2009, with the age voted for as 17. But the law was dropped the following day following maneuvers by opposing parliamentarians. Negotiations to pass the legislation continue. Meanwhile, Yemenis inspired by Nujood's efforts continue to push for change, with Nujood involved in at least one rally. In September 2013, an 8-year-old girl died of internal bleeding and uterine rupture on her wedding night after marrying a 40-year-old man.

The widespread prevalence of child marriage in the Kingdom of Saudi Arabia has been documented by human rights groups. Saudi clerics have justified the marriage of girls as young as 9, with sanction from the judiciary. There are no laws in place defining a minimum age of consent in Saudi Arabia, though drafts for possible laws have been created since 2011.

Research by the United Nations Population Fund indicates that 28.2% of marriages in Turkey – almost one in three – involve girls under 18.

Child marriage was also found to be prevalent among Syrian and Palestinian Syrian refugees in Lebanon, in addition to other forms of sexual and gender-based violence. Marriage was seen as a potential way to protect family honor and protect a girl from rape given how common rape was during the conflict. Incidents of child marriages increased in Syria and among Syrian refugees over the course of the conflict. The proportion of Syrian refugee girls living in Jordan who were married increased from 13% in 2011 to 32% in 2014. Journalists Magnus Wennman and Carina Bergfeldt documented the practice, and some of its results.

Southeast Asia

A couple after celebrating their child marriage in Indonesia, about 1939.

Hill tribes girls are often married young. For the Karen people it is possible that two couples can arrange their children's marriage before the children are born.
Indonesia
In Indonesia, there are reports of Muslim clerics taking multiple underage wives, some less than 12 years old. Indonesian prosecutors have attempted to stop this practice by demanding prison terms for such clerics; however, local courts have issued soft sentences.

A young bride at her Nikah.

In Indonesia the 1974 Law on Marriage stipulates that a woman must be at least 16 years old and a man must be at least 19 years old to marry. With the popular rise of social networking sites like Facebook underage marriage appears to be increasing in areas like Gunung Kidul, Yogyakarta. Couples have reported becoming acquainted through Facebook and continuing their relationships until girls became pregnant. Among the Atjeh of Sumatra girls formerly married before puberty. The husbands, though usually older, were still unfit for sexual union. Among the islanders of Fiji, also, marriage took place before puberty.
Malaysia
In Malaysia, the public was shocked when they learned that a 41-year-old Malaysian weds a 11-year-old girl in Golok, a border town in southern Thailand. The man, who already has two wives and six children, is said to be the imam of a surau at a village in Gua Musang, Kelantan. The matter became viral when his second wife posted photographs of the man and the young girl and their alleged solemnisation. Amid public outrage, parents of the 11-year-old girl defend decision to allow their daughter's marriage to the 41-year-old man.

In response to this incident, Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail said the marriage between a 41-year-old man and his 11-year-old child bride remains valid under Islam.  She also said in a press statement that 'The Malaysian government "unequivocally" opposes child marriages and is already taking steps to raise the minimum age of marriage to 18. The child marriage in Gua Musang is still under active investigation by multiple agencies.

Following this controversy, Minister in the Prime Minister's Department Datuk Dr Mujahid Yusof Rawa proposed to impose a blanket ban on marriages involving under-aged children. In response, PAS Vice President Datuk Mohd Amar Nik Abdullah released a statement, saying that imposing a blanket ban on child marriage contravenes Islamic religious teachings, therefore, the blanket ban could not be accepted. "It is not wrong to marry young, from the religious perspective," he said on the sidelines of the Kelantan legislative assembly sitting. He also claimed that it is better to enforce existing laws to protect young children from being forced into unwanted early marriages.

PKR’s Latheefa Koya has taken to task the party’s president and Deputy Prime Minister Dr Wan Azizah Wan Ismail over the marriage of a 41-year-old man to a 11-year-old girl in Kelantan, saying all facts of the case were clear and established for the government to take action against child marriage.

Dr Wan Azizah Wan Ismail continues to attract criticism from activists over her perceived reluctance to take action against the 41-year-old man who married an 11-year-old child, with a coalition of women’s groups urging swift action to be taken to protect the girl, a Thai national who lives in Kelantan. The Joint Action Group for Gender Equality (JAG) said it was time to act, urging the government to conclude its lengthy investigations.

Selangor plans to amend the Islamic Family Law (State of Selangor) Enactment 2003 on the minimum age for marriage for Muslim women in the state which will be increased from 16 to 18 years, after child marriages were reported to have become rampant of late.

As the controversy surrounding the 41-year-old man who married an 11-year-old girl continues to simmer, another case of a child bride has been reported in Malaysia.  The marriage involves a 19-year-old from Terengganu and a 13-year-old girl from Kelantan. They tied the knot at a mosque in Kampung Pulau Nibong on June 20. Ibrahim Husin, 67, the kadi who performed the akad nikah, said he was approached by the couple, who came with two witnesses, and a wali, who was the bride’s uncle.

Bangladesh

Child marriage rates in Bangladesh are amongst the highest in the world. Every 2 out of 3 marriages involve child marriages. According to statistics from 2005, 49% of women then between 25 and 29 were married by the age of 15 in Bangladesh. According to a 2008 study, for each additional year a girl in rural Bangladesh is not married she will attend school an additional 0.22 years on average. The later girls were married, the more likely they were to utilize preventative health care. Married girls in the region were found to have less influence on family planning, higher rates of maternal mortality, and lower status in their husband's family than girls who married later.

Mia's Law was enacted in 2006 to protect child brides from abuse following the torture and murder of Mia Armador, an 11-year-old who was killed by her abusive 48-year-old husband. This law requires all marriages under 13 to require special government permission.

India

According to UNICEF's "State of the World's Children-2009" report, 47% of India's women aged 20–24 were married before the legal age of 18, with 56% marrying before age 18 in rural areas. The report also showed that 40% of the world's child marriages occur in India. As with Africa, this UNICEF report is based on data that is derived from a small sample survey in 1999. The latest available UNICEF report for India uses 2004–2005 household survey data, on a small sample, and other scholars report lower incidence rates for India. According to Raj et al., the 2005 small sample household survey data suggests 22% of girls ever married aged 16–18, 20% of girls in India were married between 13–16, and 2.6% were married before age 13. According to 2011 nationwide census of India, the average age of marriage for women in India is 21. The child marriage rates in India, according to a 2009 representative survey, dropped to 7%. In its 2001 demographic report, the Census of India stated zero married girls below age 10, 1.4 million married girls out of 59.2 million girls in the age 10–14, and 11.3 million married girls out of 46.3 million girls in the age 15–19 (which includes 18–19 age group). For 2011, the Census of India reports child marriage rates dropping further to 3.7% of females aged less than 18 being married.

The Child Marriage Restraint Act 1929 was passed during the tenure of British rule on Colonial India. It forbade the marriage of a male younger than 21 or a female younger than 18 for Hindus, Buddhists, Christians and most people of India. However, this law did not and currently does not apply to India's 165 million Muslim population, and only applies to India's Hindu, Christian, Jain, Sikh and other religious minorities. This link of law and religion was formalized by the British colonial rule with the Muslim personal laws codified in the Indian Muslim Personal Law (Shariat) Application Act of 1937. The age at which India's Muslim girls can legally marry, according to this Muslim Personal Law, is 9, and can be lower if her guardian (wali) decides she is sexually mature. Over the last 25 years, All India Muslim Personal Law Board and other Muslim civil organizations have actively opposed India-wide laws and enforcement action against child marriages; they have argued that Indian Muslim families have a religious right to marry a girl aged 15 or even 12. Several states of India claim specially high child marriage rates in their Muslim and tribal communities. India, with a population of over 1.2 billion, has the world's highest total number of child marriages. It is a significant social issue. As of 2016, the situation has been legally rectified by The Prohibition of Child Marriage Act, 2006.

According to "National Plan of Action for Children 2005", published by Indian government's Department of Women and Child Development, set a goal to eliminate child marriage completely by 2010. In 2006, The Prohibition of Child Marriage Act, 2006 was passed to prohibit solemnization of child marriages. This law states that men must be at least 21 years of age and women must but be at least 18 years of age to marry.

Some Muslim organizations planned to challenge the new law in the Supreme Court of India. In latter years, various high courts in India – including the Gujarat High Court, the Karnataka High Court and the Madras High Court – have ruled that the act prevails over any personal law (including Muslim personal law).

Nepal

UNICEF reported that 28.8% of marriages in Nepal were child marriages as of 2011. A UNICEF discussion paper determined that 79.6 percent of Muslim girls in Nepal, 69.7 percent of girls living in hilly regions irrespective of religion, and 55.7 percent of girls living in other rural areas, are all married before the age of 15. Girls who were born into the highest wealth quintile marry about two years later than those from the other quintiles.

Pakistan

According to two 2013 reports, over 50% of all marriages in Pakistan involve girls less than 18 years old. Another UNICEF report claims 70 per cent of girls in Pakistan are married before the age of 16. As with India and Africa, the UNICEF data for Pakistan is from a small sample survey in the 1990s.
The exact number of child marriages in Pakistan below the age of 13 is unknown, but rising according to the United Nations. Andrew Bushell claims rate of marriage of 8- to 13-year-old girls exceeding 50% in northwest regions of Pakistan.

Another custom in Pakistan, called swara or vani, involves village elders solving family disputes or settling unpaid debts by marrying off girls. The average marriage age of swara girls is between 5 and 9. Similarly, the custom of watta satta has been cited as a cause of child marriages in Pakistan.

According to Population Council, 35% of all females in Pakistan become mothers before they reach the age of 18, and 67% have experienced pregnancy – 69% of these have given birth – before they reach the age of 19. Less than 4% of married girls below the age of 19 had some say in choosing her spouse; over 80% were married to a near or distant relative. Child marriage and early motherhood is common in Pakistan.

Iran

The legal age of marriage in Iran for girls is 13 years old; however, some girls are forced into marriage as young as below the age of 10 years old. The same source pointed out that "child marriages are more common in socially backward rural areas often afflicted with high levels of illiteracy and drug addiction". The U.N. Committee on the Rights of the Child (CRC) examining child marriage in Iran has warned of a rising number of young girls forced into marriage in Iran. The Committee deplored the fact that the State party allows sexual intercourse involving girls as young as 9 lunar years and that other forms of sexual abuse of even younger children is not criminalized. CRC said that Tehran must "repeal all provisions that authorize, condone or lead to child sexual abuse" and called for the age of sexual consent to be increased from nine years old to 16. The Society For Protecting The Rights of The Child said that 43,459 girls aged under 15 had married in 2009. In 2010, 716 girls under the age of 10 had married, up from 449 in the year prior. On 8 March 2018 a member of the Tehran City Council, Shahrbanoo Amani said that there were 15,000 widows under the age of 15 in the country.

Europe

General

Each European country has its own laws; in both the European Union and the Council of Europe the marriageable age falls within the jurisdiction of individual member states. The Istanbul convention, the first legally binding instrument in Europe in the field of violence against women and domestic violence, only requires countries which ratify it to prohibit forced marriage (Article 37) and to ensure that forced marriages can be easily voided without further victimization (Article 32), but does not make any reference to a minimum age of marriage.

European Union

In the European Union, the general age of marriage as a right is 18 in all member states, except in Scotland where it is 16. When all exceptions are taken into account (such as judicial or parental consent), the minimum age is 16 in most countries, and in Estonia it is 15. In 3 countries marriage under 18 is completely prohibited. By contrast, in 9 countries there is no set minimum age, although all these countries require the authorization of a public authority (such as judge or social worker) for the marriage to take place.

State Minimum age Notes
Minimum age when all exceptions are taken into account General age
 Austria 16 18 16 with parental consent.
 Belgium none 18 Younger with judicial consent (with no strict minimum age). With parental consent, serious reasons are required for a minor to marry; without parental consent, the unwillingness of the parents has to constitute an abuse.
 Bulgaria 16 18 The new 2009 Family Code fixes the age at 18, but allows for an exception for 16 years olds, stating that "Upon exception, in case that important reasons impose this, matrimony may be concluded by a person at the age of 16 with permission by the regional judge". It further states that both persons wanting to marry, as well as the parents/guardians of the minor, must be consulted by the judge. (Chapter 2, Article 6)
 Croatia 16 18 16 with judicial consent.
 Cyprus 16 18 16 with parental consent, if there are serious reasons for the marriage.
 Czech Republic 16 18 Article 672 of Act No. 89/2012 Coll. the Civil Code (which came into force in 2014) states that the court may, in exceptional cases, allow a marriage of a 16 year old, if there are serious reasons for it.
 Denmark 18 18 Since 2017, marriage is no longer allowed under 18.
 Estonia 15 18 15 with court permission.
 Finland none 18 Under 18 with judicial authorization.
 France none 18 Under 18 needs judicial authorization.
 Germany 18 18 The minimum age was set at 18 in 2017.
 Greece none 18 Under 18 requires court permission, which may be given if there are serious reasons for such a marriage
 Hungary 16 18 16 with authorization from the guardianship authority
 Ireland none 18 Under 18 with a Court Exemption Order.
 Italy 16 18 16 with court consent.
 Latvia 16 18 16 with court consent.
 Lithuania none girls/15 boys 18 15 with court permission. Girls can marry below 15 with court permission if they are pregnant.
 Luxembourg none 18 Under 18 need judicial permission. New laws of 2014 fixed the marriageable at 18 for both sexes; prior to these regulations the age was 16 for females and 18 for males. The new laws still allow both sexes to obtain judicial consent to get married under 18.
 Malta 16 18 16 with parental consent.
 Netherlands 18 18 Exceptions were removed by a change in the law in 2015. 
 Poland 16 girls/18 boys 18 16 for girls with court consent.
 Portugal 16 18 16 with parental consent.
 Romania 16 18 16 with permission from the district's administrative board.
 Slovakia 16 18 16 with court consent, with a serious reason such as pregnancy.
 Slovenia none 18 Under 18 may be approved by the Social Work Centre if there are "well founded reasons" arising upon the investigation of the situation of the minor. (Art 23, 24 of the Law on Marriage and Family Relations).
 Spain 16 18 16 with court consent.
 Sweden 18 18 Not possible to marry under the age of 18 for Swedish citizens since July 1, 2014. Authorities take a different approach to individuals who were already married when the arrive in Sweden, as during the European migrant crisis, the Swedish Migration Agency identified 132 married children, of which 65 were in Malmö.
 United Kingdom 16 18 (16 Scotland) England and Wales: 16 with the consent of parents/guardians (and others in some cases) if under 18. Scotland: 16
Northern Ireland: 16 with parental consent (with the court able to give consent in some cases).

Scandinavia

In April 2016, Reuters reported "Child brides sometimes tolerated in Nordic asylum centers despite bans". For example, at least 70 girls under 18 were living as married couples in Sweden; in Norway, "some" under 16 lived "with their partners". In Denmark, it was determined there were "dozens of cases of girls living with older men", prompting Minister Inger Stojberg to state she would "stop housing child brides in asylum centres".

Marriage under 18 was completely banned in Sweden in 2014 and in Denmark in 2017. By contrast, marriage in Finland is permitted under 18 with a special judicial authorization, without any set minimum age (although in practice youth under 16 are unlikely to obtain authorization). Finland's child marriage laws have been criticized by the UN.

Balkans/Eastern Europe

In these areas, child and forced marriages are associated with the Roma community and with some rural populations. However, such marriages are illegal in most of the countries from that area. In recent years, many of those countries have taken steps in order to curb these practices, including equalizing the marriageable age of both sexes (e.g. Romania in 2007, Ukraine in 2012). Therefore, most of those 'marriages' are informal unions (without legal recognition) and often arranged from very young ages. Such practices are common in Bulgaria and Romania (in both countries the marriageable age is 18, and can only be lowered to 16 in special circumstances with judicial approval). A 2003 case involving the daughter of an informal 'gypsy king' of the area has made international news.

Belgium

The Washington Post reported in April 2016 that "17 child brides" arrived in Belgium in 2015 and a further 7 so far in 2016. The same report added that "Between 2010 and 2013, the police registered at least 56 complaints about a forced marriage."

Germany

In 2016 there were 1475 underage foreigners were registered in Germany, of which 1100 were girls. Syrians represented 664, Afghans 157 and Iraqis 100. In July 2016, 361 foreign children under 14 were registered as married.

Netherlands

The Dutch government's National Rapporteur on Trafficking in Human Beings and Sexual Violence against Children wrote that "between September 2015 and January 2016 around 60 child brides entered the Netherlands". At least one was 14 years old. The Washington Post reported that asylum centres in the Netherlands were "housing 20 child brides between ages 13 and 15" in 2015.

Russia

The common marriageable age established by the Family Code of Russia is 18 years old. Marriages of persons at age from 16 to 18 years allowed only with good reasons and by local municipal authority permission. Marriage before 16 years old may be allowed by federal subject of Russia law as an exception just in special circumstances.

By 2016, a minimal age for marriage in special circumstances had been established at 14 years (in Adygea, Kaluga Oblast, Magadan Oblast, Moscow Oblast, Nizhny Novgorod Oblast, Novgorod Oblast, Oryol Oblast, Sakhalin Oblast, Tambov Oblast, Tatarstan, Vologda Oblast) or to 15 years (in Murmansk Oblast and Ryazan Oblast). Others subjects of Russia also can have marriageable age laws.
Abatement of marriageable age is an ultimate measure acceptable in cases of life threat, pregnancy and childbirth.

United Kingdom

The marriageable age in the United Kingdom is 18, or 16 with consent of parents and guardians (and others in some cases), although in Scotland no parental consent is required over 16. Scotland and Andorra are the only European jurisdictions where 16 year-olds can marry as a right (i.e. without parental or court approval).

In the UK girls as young as 12 have been smuggled in to be brides of men in the Muslim community, according to a 2004 report in The Guardian. Girls trying to escape this child marriage can face death because this breaks the honor code of her husband and both families.

As with the United States, underage cohabitation is observed in the United Kingdom. According to a 2005 study, 4.1% of all girls in the 15–19 age group in the UK were cohabiting (living in an informal union), while 8.9% of all girls in that age group admitted to having been in a cohabitation relation (child marriage per UNICEF definition), before the age of 18. Over 4% of all underage girls in the UK were teenage mothers.

In July 2014, the United Kingdom hosted its first global Girl Summit; the goal of the Summit was to increase efforts to end child, early, and forced marriage and female genital mutilation within a generation.

Oceania

The Marquesas Islands have been noted for their sexual culture. Many sexual activities seen as taboo in Western cultures are viewed appropriate by the native culture. One of these differences is that children are introduced and educated to sex at a very young age. Contact with Western societies has changed many of these customs, so research into their pre-Western social history has to be done by reading antique writings. Children slept in the same room as their parents and were able to witness their parents while they had sex. Intercourse simulation became real penetration as soon as boys were physically able. Adults found simulation of sex by children to be funny. As children approached 11 attitudes shifted toward girls. When a child reaches adulthood, they are educated on sexual techniques by a much older adult.

Yuri Lisyansky in his memoirs reports that:
The next day, as soon as it was light, we were surrounded by a still greater multitude of these people. There were now a hundred females at least; and they practised all the arts of lewd expression and gesture, to gain admission on board. It was with difficulty I could get my crew to obey the orders I had given on this subject. Amongst these females were some not more than ten years of age. But youth, it seems, is here no test of innocence; these infants, as I may call them, rivalled their mothers in the wantonness of their motions and the arts of allurement.
Adam Johann von Krusenstern in his book about the same expedition as Yuri's, reports that a father brought a 10- to 12-year-old girl on his ship, and she had sex with the crew. According to the book of Charles Pierre Claret de Fleurieu and Étienne Marchand, 8-year-old girls had sex and other unnatural acts in public.

Consequences of child marriage

Birth rates per 1,000 women aged 15–19 years, worldwide.

Child marriage has lasting consequences on girls that last well beyond adolescence. Women married in their teens or earlier struggle with the health effects of getting pregnant at a young age and often with little spacing between children. Early marriages followed by teen pregnancy also significantly increase birth complications and social isolation. In poor countries, early pregnancy limits or can even eliminate a woman's education options, affecting her economic independence. Girls in child marriages are more likely to suffer from domestic violence, child sexual abuse, and marital rape.

Health

Child marriage threatens the health and life of girls. Complications from pregnancy and childbirth are the main cause of death among adolescent girls below age 19 in developing countries. Girls aged 15 to 19 are twice as likely to die in childbirth as women in their 20s, and girls under the age of 15 are five to seven times more likely to die during childbirth. These consequences are due largely to girls' physical immaturity where the pelvis and birth canal are not fully developed. Teen pregnancy, particularly below age 15, increases risk of developing obstetric fistula, since their smaller pelvises make them prone to obstructed labor. Girls who give birth before the age of 15 have an 88% risk of developing fistula. Fistula leaves its victims with urine or fecal incontinence that causes lifelong complications with infection and pain. Unless surgically repaired, obstetric fistulas can cause years of permanent disability, shame to mothers, and can result in being shunned by the community. Married girls also have a higher risk of sexually transmitted diseases, cervical cancer, and malaria than non-married peers or girls who marry in their 20s.

Child marriage not only threatens the mother’s health, it also threatens the lives of offspring. Mothers under the age of 18 years have 35 to 55% increased risk of delivering pre-term or having a low birth weight baby than a mother who is 19 years old. In addition, infant mortality rates are 60% higher when the mother is under 18 years old. Infants born to child mothers tend to have weaker immune systems and face a heightened risk of malnutrition.

Prevalence of child marriage may also be associated with higher rates of population growth, more cases of children left orphaned, and the accelerated spread of disease.

Illiteracy and poverty

Child marriage often ends a girl's education, particularly in impoverished countries where child marriages are common. In addition, uneducated girls are more at risk for child marriage. Girls that have only a primary education are twice as likely to marry before age 18 than those with a secondary or higher education, and girls with no education are three times more likely to marry before age 18 than those with a secondary education. Early marriage impedes a young girl’s ability to continue with her education as most drop out of school following marriage to focus their attention on domestic duties and having or raising children. Girls may be taken out of school years before they are married due to family or community beliefs that allocating resources for girls' education is unnecessary given that her primary roles will be that of wife and mother. Without education, girls and adult women have fewer opportunities to earn an income and financially provide for themselves and their children. This makes girls more vulnerable to persistent poverty if their spouses die, abandon, or divorce them. Given that girls in child marriages are often significantly younger than their husbands, they become widowed earlier in life and may face associated economic and social challenges for a greater portion of their life than women who marry later.

Domestic violence

Married teenage girls with low levels of education suffer greater risk of social isolation and domestic violence than more educated women who marry as adults. Following marriage, girls frequently relocate to their husband’s home and take on the domestic role of being a wife, which often involves relocating to another village or area. This transition may result in a young girl dropping out of school, moving away from her family and friends, and a loss of the social support that she once had. A husband's family may also have higher expectations for the girl's submissiveness to her husband and his family because of her youth. This sense of isolation from a support system can have severe mental health implications including depression.

Large age gaps between the child and her spouse makes her more vulnerable to domestic violence and marital rape. Girls who marry as children face severe and life-threatening marital violence at higher rates. Husbands in child marriages are often more than ten years older than their wives. This can increase the power and control a husband has over his wife and contribute to prevalence of spousal violence. Early marriage places young girls in a vulnerable situation of being completely dependent on her husband. Domestic and sexual violence from their husbands has lifelong, devastating mental health consequences for young girls because they are at a formative stage of psychological development. These mental health consequences of spousal violence can include depression and suicidal thoughts. Child brides, particularly in situations such as vani, also face social isolation, emotional abuse and discrimination in the homes of their husbands and in-laws.

Women's rights

The United Nations, through a series of conventions has declared child marriage a violation of human rights. The Convention on the Elimination of all Forms of Discrimination of Women (‘CEDAW’), the Committee on the Rights of the Child (‘CRC’), and the Universal Declaration of Human Rights form the international standard against child marriage. Child marriages impact violates a range of women's interconnected rights such as equality on grounds of sex and age, to receive the highest attainable standard of health, to be free from slavery, access to education, freedom of movement, freedom from violence, reproductive rights, and the right to consensual marriage. The consequence of these violations impact woman, her children and the broader society.

Development

High rates of child marriage negatively impact countries' economic development because of early marriages' impact on girls' education and labor market participation. Some researchers and activists note that high rates of child marriage prevent significant progress toward each of the eight Millennium Development Goals and global efforts to reduce poverty due to its effects on educational attainment, economic and political participation, and health.

A UNICEF Nepal issued report noted that child marriage impacts Nepal's development due to loss of productivity, poverty, and health effects. Using Nepal Multi-Indicator Survey data, its researchers estimate that all girls delaying marriage until age 20 and after would increase cash flow among Nepali women in an amount equal to 3.87% of the country's GDP. Their estimates considered decreased education and employment among girls in child marriages in addition to low rates of education and high rates of poverty among children from child marriages.

International initiatives to prevent child marriage

In December 2011 a resolution adopted by the United Nations General Assembly (A/RES/66/170) designated October 11 as the International Day of the Girl Child. On October 11, 2012 the first International Day of the Girl Child was held, the theme of which was ending child marriage.

In 2013 the first United Nations Human Rights Council resolution against child, early, and forced marriages was adopted; it recognizes child marriage as a human rights violation and pledges to eliminate the practice as part of the U.N.'s post-2015 global development agenda.

In 2014 the UN's Commission on the Status of Women issued a document in which they agreed, among other things, to eliminate child marriage.

The World Health Organization recommends increased educational attainment among girls, increased enforcement structures for existing minimum marriage age laws, and informing parents in practicing communities of the risks associated as primary methods to prevent child marriages.

Programs to prevent child marriage have taken several different approaches. Various initiatives have aimed to empower young girls, educate parents on the associated risks, change community perceptions, support girls' education, and provide economic opportunities for girls and their families through means other than marriage. A survey of a variety of prevention programs found that initiatives were most effect when they combined efforts to address financial constraints, education, and limited employment of women.

Girls in families participating in an unconditional cash transfer program in Malawi aimed at incentivizing girls' education got married and had children later than their peers who had not participated in the program. The program's effects on rates of child marriage were greater for unconditional cast transfer programs than those with conditions. Evaluators believe this demonstrated that the economic needs of the family heavily influenced the appeal of child marriage in this community. Therefore, reducing financial pressures on the family decreased the economic motivations to marry daughters off at a young age.

The Haryana state government in India operated a program in which poor families were given a financial incentive if they kept their daughters in school and unmarried until age 18. Girls in families who were eligible for the program were less likely to be married before age 18 than their peers.

A similar program was operated in 2004 by the Population Council and the regional government in Ethiopia's rural Amhara region. Families received cash if their daughters remained in school and unmarried during the two years of the program. They also instituted mentorship programs, livelihood training, community conversations about girls' education and child marriage, and gave school supplies for girls. After the two-year program, girls in families eligible for the program were three times more likely to be in school and one tenth as likely to be married compared to their peers.

Other programs have addressed child marriage less directly through a variety of programming related to girls' empowerment, education, sexual and reproductive health, financial literacy, life skills, communication skills, and community mobilization.

In 2018, UN Women announced that Jaha Dukureh would serve as Goodwill Ambassador in Africa to help organize to prevent child marriage.

Tipping point analysis

Researchers at the International Center for Research on Women found that in some communities rates of child marriage increase significantly when girls are a particular age. This "tipping point", or age at which rates of marriage increase dramatically, may occur years before the median age of marriage. Therefore, the researchers argue prevention programs should focus their programming on girls who are pre-tipping point age rather than only girls who are married before they reach the median age for marriage.

Prevalence data

Two sets of prevalence data for a sample of countries are provided in the table below. Column one lists the percentage of women aged 20–24 who were married or in union before the age of 18; this data, from International Center for Research on Women (ICRW) and UNICEF, is dated between 2006 and 2017. Column two lists the percentage of females aged 15-19 who were ever married; this data, from the UN, is dated between 1995 and 2002.

Country % girls married before 18
ICRW-UNICEF data (Year of data)
% females married
aged 15-19
UN data
(year of data)
 Niger 76 (2012) 62 (1998)
 Chad 67 (2014-2015) 49 (1996)
 Central African Republic 68 (2010) 42 (1995)
 Bangladesh 59 (2014) 48 (2000)
 Mali 52 (2015) 50 (1996)
 Guinea 51 (2016) 46 (1996)
 Malawi 42 (2015) 37 (2000)
 Mozambique 48 (2011) 47 (1997)
 Madagascar 41 (2012-2013) 34 (1997)
 Sierra Leone 39 (2013) 47 (1992)
 Burkina Faso 52 (2010) 35 (1999)
 India 27 (2015-2016) 30 (1999)
 Somalia 45 (2006) 38
 Nicaragua 35 (2011–2012) 32 (1998)
 Zambia 31 (2013–2014) 24 (2002)
 Eritrea 41 (2010) 38 (1995)
 Uganda 40 (2011) 32 (2001)
 Ethiopia 40 (2016) 30 (2000)
   Nepal 40 (2016) 40 (2001)
 Dominican Republic 36 (2014) 29 (1996)
 Afghanistan 35 (2015) 29
 South Sudan 52 (2010) -
 Nigeria 44 (2016-2017) 28 (1999)

Sunday, September 16, 2018

Female genital mutilation

From Wikipedia, the free encyclopedia

Billboard with surgical tools covered by a red X. Sign reads: STOP FEMALE CIRCUMCISION. IT IS DANGEROUS TO WOMEN'S HEALTH. FAMILY PLANNING ASSOCIATION OF UGANDA
Road sign near Kapchorwa, Uganda, 2004
Definition "Partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons" (WHO, UNICEF, and UNFPA, 1997).
Areas Africa, Asia, Middle East, and within communities from these areas
Numbers Over 200 million women and girls in 27 African countries; Indonesia; Iraqi Kurdistan; and Yemen (as of 2016)

Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual cutting or removal of some or all of the external female genitalia. The practice is found in Africa, Asia and the Middle East, and within communities from countries in which FGM is common. UNICEF estimated in 2016 that 200 million women living today in 30 countries—27 African countries, Indonesia, Iraqi Kurdistan and Yemen—have undergone the procedures.

Typically carried out by a traditional circumciser using a blade, FGM is conducted from days after birth to puberty and beyond. In half the countries for which national figures are available, most girls are cut before the age of five. Procedures differ according to the country or ethnic group. They include removal of the clitoral hood and clitoral glans; removal of the inner labia; and removal of the inner and outer labia and closure of the vulva. In this last procedure, known as infibulation, a small hole is left for the passage of urine and menstrual fluid; the vagina is opened for intercourse and opened further for childbirth.

The practice is rooted in gender inequality, attempts to control women's sexuality, and ideas about purity, modesty and beauty. It is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion. Health effects depend on the procedure. They can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain, the development of cysts, an inability to get pregnant, complications during childbirth, and fatal bleeding. There are no known health benefits.

There have been international efforts since the 1970s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are poorly enforced. Since 2010 the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. The opposition to the practice is not without its critics, particularly among anthropologists, who have raised difficult questions about cultural relativism and the universality of human rights.

Terminology

photograph
Samburu FGM ceremony, Laikipia plateau, Kenya, 2004

Until the 1980s FGM was widely known in English as female circumcision, implying an equivalence in severity with male circumcision. From 1929 the Kenya Missionary Council referred to it as the sexual mutilation of women, following the lead of Marion Scott Stevenson, a Church of Scotland missionary. References to the practice as mutilation increased throughout the 1970s. In 1975 Rose Oldfield Hayes, an American anthropologist, used the term female genital mutilation in the title of a paper in American Ethnologist, and four years later Fran Hosken, an Austrian-American feminist writer, called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females. The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children began referring to it as female genital mutilation in 1990, and the World Health Organization (WHO) followed suit in 1991. Other English terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those who work with practitioners.

In countries where FGM is common, the practice's many variants are reflected in dozens of terms, often alluding to purification. In the Bambara language, spoken mostly in Mali, it is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath"). A common Arabic term for purification has the root t-h-r, used for male and female circumcision (tahur and tahara). It is also known in Arabic as khafḍ or khifaḍ. Communities may refer to FGM as "pharaonic" for infibulation and sunna circumcision for everything else. Sunna means "path or way" in Arabic and refers to the tradition of Muhammad, although none of the procedures are required within Islam. The term infibulation derives from fibula, Latin for clasp; the Ancient Romans reportedly fastened clasps through the foreskins or labia of slaves to prevent sexual intercourse. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan, and as Sudanese circumcision in Egypt. In Somalia it is known simply as qodob ("to sew up").

Methods

diagram
Anatomy of the vulva, showing the clitoral glans, clitoral crura, corpora cavernosa, vestibular bulbs, and vaginal and urethral openings

The procedures are generally performed by a traditional circumciser (cutter or exciseuse) in the girls' homes, with or without anaesthesia. The cutter is usually an older woman, but in communities where the male barber has assumed the role of health worker he will perform FGM too. When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails. According to a nurse in Uganda, quoted in 2007 in The Lancet, a cutter would use one knife on up to 30 girls at a time. Health professionals are often involved in Egypt, Kenya, Indonesia and Sudan; in Egypt 77 percent of FGM procedures, and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016. Women in Egypt reported in 1995 that a local anaesthetic had been used on their daughters in 60 percent of cases, a general anaesthetic in 13 percent, and neither in 25 percent (two percent were missing/don't know).

Classification

Variation

The WHO, UNICEF and UNFPA issued a joint statement in 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons". The procedures vary considerably according to ethnicity and individual practitioners. During a 1998 survey in Niger, women responded with over 50 different terms when asked what was done to them. Translation problems are compounded by the women's confusion over which type of FGM they experienced, or even whether they experienced it. Several studies have suggested that survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that 73 percent had undergone it. In Sudan in 2006, a significant percentage of infibulated women and girls reported a less severe type.

Types

Standard questionnaires from United Nations bodies ask women whether they or their daughters have undergone the following: (1) cut, no flesh removed (symbolic nicking); (2) cut, some flesh removed; (3) sewn closed; or (4) type not determined/unsure/doesn't know. The most common procedures fall within the "cut, some flesh removed" category and involve complete or partial removal of the clitoral glans. The World Health Organization (a UN agency) created a more detailed typology: Types I–III vary in how much tissue is removed; Type III is equivalent to the UNICEF category "sewn closed"; and Type IV describes miscellaneous procedures, including symbolic nicking.

diagram

Type I is "partial or total removal of the clitoris and/or the prepuce". Type Ia involves removal of the clitoral hood only. This is rarely performed alone. The more common procedure is Type Ib (clitoridectomy), the complete or partial removal of the clitoral glans (the visible tip of the clitoris) and clitoral hood. The circumciser pulls the clitoral glans with her thumb and index finger and cuts it off.

Type II (excision) is the complete or partial removal of the inner labia, with or without removal of the clitoral glans and outer labia. Type IIa is removal of the inner labia; Type IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM.

Type III (infibulation or pharaonic circumcision), the "sewn closed" category, involves the removal of the external genitalia and fusion of the wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. Type III is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia, and Sudan (although not in South Sudan). According to one 2008 estimate, over eight million women in Africa are living with Type III FGM. According to UNFPA in 2010, 20 percent of women with FGM have been infibulated. In Somalia "[t]he child is made to squat on a stool or mat facing the circumciser at a height that offers her a good view of the parts to be handled. ... adult helpers grab and pull apart the legs of the girl. ... If available, this is the stage at which a local anaesthetic would be used":
The element of speed and surprise is vital and the circumciser immediately grabs the clitoris by pinching it between her nails aiming to amputate it with a slash. The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed is satisfactory or whether more is to be cut off.

After the clitoris has been satisfactorily amputated ... the circumciser can proceed with the total removal of the labia minora and the paring of the inner walls of the labia majora. Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together. ...

Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where the skin has been removed are well approximated. The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus.
The amputated parts might be placed in a pouch for the girl to wear. A single hole of 2–3 mm is left for the passage of urine and menstrual fluid. The vulva is closed with surgical thread, or agave or acacia thorns, and might be covered with a poultice of raw egg, herbs and sugar. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks. If the remaining hole is too large in the view of the girl's family, the procedure is repeated.

The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. In some areas, including Somaliland, female relatives of the bride and groom might watch the opening of the vagina to check that the girl is a virgin. The woman is opened further for childbirth (defibulation or deinfibulation), and closed again afterwards (reinfibulation). Reinfibulation can involve cutting the vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood. Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III:
The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and the task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with the help of the "little knife". This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis.
Type IV is "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization. It includes nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into the vagina to tighten it. Labia stretching is also categorized as Type IV. Common in southern and eastern Africa, the practice is supposed to enhance sexual pleasure for the man and add to the sense of a woman as a closed space. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia.

A definition of FGM from the WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria and Niger. These were removed from the WHO's 2008 definition because of insufficient information about prevalence and consequences. Angurya cutting is excision of the hymen, usually performed seven days after birth. Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour and other conditions. In a study by Nigerian physician Mairo Usman Mandara, over 30 percent of women with gishiri cuts were found to have vesicovaginal fistulae (holes that allow urine to seep into the vagina).

Complications

Short-term and late

FGM harms women's physical and emotional health throughout their lives. It has no known health benefits. The short-term and late complications depend on the type of FGM, whether the practitioner has had medical training, and whether they used antibiotics and sterilized or single-use surgical instruments. In the case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once (for example, to close an opening regarded as too wide or re-open one too small).

photograph
FGM awareness session run by the African Union Mission to Somalia at the Walalah Biylooley refugee camp, Mogadishu

Common short-term complications include swelling, excessive bleeding, pain, urine retention, and healing problems/wound infection. A 2014 systematic review of 56 studies suggested that over one in ten girls and women undergoing any form of FGM, including symbolic nicking of the clitoris (Type IV), experience immediate complications, although the risks increased with Type III. The review also suggested that there was under-reporting. Other short-term complications include fatal bleeding, anaemia, urinary infection, septicaemia, tetanus, gangrene, necrotizing fasciitis (flesh-eating disease), and endometritis. It is not known how many girls and women die as a result of the practice, because complications may not be recognized or reported. The practitioners' use of shared instruments is thought to aid the transmission of hepatitis B, hepatitis C and HIV, although no epidemiological studies have shown this.

Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supplied the clitoris. An infibulated girl may be left with an opening as small as 2–3 mm, which can cause prolonged, drop-by-drop urination, pain while urinating, and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but the urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces to seep into the vagina). This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility. Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the vagina and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra (where the vagina and uterus fill with menstrual blood). The swelling of the abdomen that results from the collection of fluid, together with the lack of menstruation, can lead to suspicion of pregnancy; Asma El Dareer, a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family.

Pregnancy, childbirth

Materials used to teach communities in Burkina Faso about FGM

FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with the more extensive FGM procedures. Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby's size. In women with vesicovaginal or rectovaginal fistulae, it is difficult to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such as pre-eclampsia harder. Cervical evaluation during labour may be impeded and labour prolonged or obstructed. Third-degree laceration (tears), anal-sphincter damage and emergency caesarean section are more common in infibulated women.

Neonatal mortality is increased. The WHO estimated in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM. The estimate was based on a study conducted on 28,393 women attending delivery wards at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III. The reasons for this were unclear, but may be connected to genital and urinary tract infections and the presence of scar tissue. According to the study, FGM was associated with an increased risk to the mother of damage to the perineum and excessive blood loss, as well as a need to resuscitate the baby, and stillbirth, perhaps because of a long second stage of labour.

Psychological effects, sexual function

According to a 2015 systematic review there is little high-quality information available on the psychological effects of FGM. Several small studies have concluded that women with FGM suffer from anxiety, depression and post-traumatic stress disorder. Feelings of shame and betrayal can develop when women leave the culture that practises FGM and learn that their condition is not the norm, but within the practising culture they may view their FGM with pride, because for them it signifies beauty, respect for tradition, chastity and hygiene. Studies on sexual function have also been small. A 2013 meta-analysis of 15 studies involving 12,671 women from seven countries concluded that women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report dyspareunia (painful sexual intercourse). One third reported reduced sexual feelings.

Distribution

Household surveys

map
FGM in Africa, Iraqi Kurdistan and Yemen, as of 2015 (map of Africa).

Aid agencies define the prevalence of FGM as the percentage of the 15–49 age group that has exerienced it. These figures are based on nationally representative household surveys known as Demographic and Health Surveys (DHS), developed by Macro International and funded mainly by the United States Agency for International Development (USAID), and Multiple Indicator Cluster Surveys (MICS) conducted with financial and technical help from UNICEF. These surveys have been carried out in Africa, Asia, Latin America and elsewhere roughly every five years, since 1984 and 1995 respectively. The first to ask about FGM was the 1989–1990 DHS in northern Sudan. The first publication to estimate FGM prevalence based on DHS data (in seven countries) was by Dara Carr of Macro International in 1997.

Type of FGM

Women are asked during the surveys: "Was the genital area just nicked/cut without removing any flesh? Was any flesh (or something) removed from the genital area? Was your genital area sewn?" Most women report "cut, some flesh removed" (Types I and II).

Type I is the most common form in Egypt, and in the southern parts of Nigeria. Type III (infibulation) is concentrated in northeastern Africa, particularly Djibouti, Eritrea, Somalia and Sudan. In surveys in 2002–2006, 30 percent of cut girls in Djibouti, 38 percent in Eritrea, and 63 percent in Somalia had experienced Type III. There is also a high prevalence of infibulation among girls in Niger and Senegal, and in 2013 it was estimated that in Nigeria three percent of the 0–14 age group had been infibulated. The type of procedure is often linked to ethnicity. In Eritrea, for example, a survey in 2002 found that all Hedareb girls had been infibulated, compared with two percent of the Tigrinya, most of whom fell into the "cut, no flesh removed" category.

Prevalence

graph
Percentage of the 15–49 group who have undergone FGM in 29 countries for which figures were available in 2016

FGM is found mostly in what Gerry Mackie called an "intriguingly contiguous" zone in Africa—east to west from Somalia to Senegal, and north to south from Egypt to Tanzania. Nationally representative figures are available for 27 countries in Africa, as well as Indonesia, Iraqi Kurdistan and Yemen. Over 200 million women and girls are thought to be living with FGM in those 30 countries.

The highest concentrations among the 15–49 age group are in Somalia (98 percent), Guinea (97 percent), Djibouti (93 percent), Egypt (91 percent) and Sierra Leone (90 percent). As of 2013, 27.2 million women had undergone FGM in Egypt, 23.8 million in Ethiopia, and 19.9 million in Nigeria. There is also a high concentration in Indonesia, where Type I (clitoridectomy) and Type IV [symbolic nicking]) are practised. The Indonesian Ministry of Health and the Indonesian Ulema Council both say that the clitoris should not be cut. The prevalence rate for the 0–11 group in Indonesia is 49 percent (13.4 million). Smaller studies or anecdotal reports suggest that FGM is also practised in Colombia, the Congo, Malaysia, Oman, Peru, Saudi Arabia, Sri Lanka, and the United Arab Emirates, by the Bedouin in Israel, in Rahmah, Jordan, and by the Dawoodi Bohra in India. It is also found within immigrant communities around the world.

graph
Percentage of the 0–14 group who have undergone FGM in 21 countries for which figures were available as of 2016.
 
Prevalence figures for the 15–19 age group and younger show a downward trend. For example, Burkina Faso fell from 89 percent (1980) to 58 percent (2010); Egypt from 97 percent (1985) to 70 percent (2015); and Kenya from 41 percent (1984) to 11 percent (2014). From 2010 household surveys asked women about the FGM status of all their living daughters. The highest concentrations among girls aged 0–14 were in Gambia (56 percent), Mauritania (54 percent), Indonesia (49 percent for 0–11) and Guinea (46 percent). The figures suggest that a girl was one third less likely in 2014 to undergo FGM than she was 30 years ago. If the rate of decline continues, the number of girls cut will nevertheless rise from 3.6 million a year in 2013 to 4.1 million in 2050 because of population growth.

Rural areas, wealth, education

Surveys have found FGM to be more common in rural areas, less common in most countries among girls from the wealthiest homes, and (except in Sudan and Somalia) less common in girls whose mothers had access to primary or secondary/higher education. In Somalia and Sudan the situation was reversed: in Somalia the mothers' access to secondary/higher education was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan access to any education was accompanied by a rise.

Age, ethnicity

FGM is not invariably a rite of passage between childhood and adulthood, but is often performed on much younger children. Girls are most commonly cut shortly after birth to age 15. In half the countries for which national figures were available in 2000–2010, most girls had been cut by age five. Over 80 percent (of those cut) are cut before the age of five in Nigeria, Mali, Eritrea, Ghana and Mauritania. The 1997 Demographic and Health Survey in Yemen found that 76 percent of girls had been cut within two weeks of birth. The percentage is reversed in Somalia, Egypt, Chad and the Central African Republic, where over 80 percent (of those cut) are cut between five and 14. Just as the type of FGM is often linked to ethnicity, so is the mean age. In Kenya, for example, the Kisi cut around age 10 and the Kamba at 16.

A country's national prevalence often reflects a high sub-national prevalence among certain ethnicities, rather than a widespread practice. In Iraq, for example, FGM is found mostly among the Kurds in Erbil (58 percent prevalence within age group 15–49, as of 2011), Sulaymaniyah (54 percent) and Kirkuk (20 percent), giving the country a national prevalence of eight percent. The practice is sometimes an ethnic marker, but it may differ along national lines. For example, in the northeastern regions of Ethiopia and Kenya, which share a border with Somalia, the Somali people practise FGM at around the same rate as they do in Somalia. But in Guinea all Fulani women responding to a survey in 2012 said they had experienced FGM, against 12 percent of the Fulani in Chad, while in Nigeria the Fulani are the only large ethnic group in the country not to practise it.

Reasons

Support from women

Dahabo Musa, a Somali woman, described infibulation in a 1988 poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again. Despite the evident suffering, it is women who organize all forms of FGM. Anthropologist Rose Oldfield Hayes wrote in 1975 that educated Sudanese men who did not want their daughters to be infibulated (preferring clitoridectomy) would find the girls had been sewn up after the grandmothers arranged a visit to relatives. Gerry Mackie has compared the practice to footbinding. Like FGM, footbinding was carried out on young girls, nearly universal where practised, tied to ideas about honour, chastity and appropriate marriage, and "supported and transmitted" by women.

photograph
Fuambai Ahmadu chose to undergo clitoridectomy as an adult.
 
FGM practitioners see the procedures as marking not only ethnic boundaries but also gender difference. According to this view, male circumcision defeminizes men while FGM demasculinizes women. Fuambai Ahmadu, an anthropologist and member of the Kono people of Sierra Leone, who in 1992 underwent clitoridectomy as an adult during a Sande society initiation, argued in 2000 that it is a male-centred assumption that the clitoris is important to female sexuality. African female symbolism revolves instead around the concept of the womb. Infibulation draws on that idea of enclosure and fertility. "[G]enital cutting completes the social definition of a child's sex by eliminating external traces of androgyny," Janice Boddy wrote in 2007. "The female body is then covered, closed, and its productive blood bound within; the male body is unveiled, opened and exposed."

In communities where infibulation is common, there is a preference for women's genitals to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive. Some men seem to enjoy the effort of penetrating an infibulation. The local preference for dry sex causes women to introduce substances into the vagina to reduce lubrication, including leaves, tree bark, toothpaste and Vicks menthol rub. The WHO includes this practice within Type IV FGM, because the added friction during intercourse can cause lacerations and increase the risk of infection. Because of the smooth appearance of an infibulated vulva, there is also a belief that infibulation increases hygiene.

Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure. In a study in northern Sudan, published in 1983, only 17.4 percent of women opposed FGM (558 out of 3,210), and most preferred excision and infibulation over clitoridectomy. Attitudes are changing slowly. In Sudan in 2010, 42 percent of women who had heard of FGM said the practice should continue. In several surveys since 2006, over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt supported FGM's continuance, while elsewhere in Africa, Iraq and Yemen most said it should end, although in several countries only by a narrow margin.

Social obligation, poor access to information

photograph
Keur Simbara, Senegal, abandoned FGM in 1998 after a three-year program by Tostan.
 
Against the argument that women willingly choose FGM for their daughters, UNICEF calls the practice a "self-enforcing social convention" to which families feel they must conform to avoid uncut daughters facing social exclusion. Ellen Gruenbaum reported that, in Sudan in the 1970s, cut girls from an Arab ethnic group would mock uncut Zabarma girls with Ya, Ghalfa! ("Hey, unclean!"). The Zabarma girls would respond Ya, mutmura! (A mutmara was a storage pit for grain that was continually opened and closed, like an infibulated woman.) But despite throwing the insult back, the Zabarma girls would ask their mothers, "What's the matter? Don't we have razor blades like the Arabs?"

Because of poor access to information, and because circumcisers downplay the causal connection, women may not associate the health consequences with the procedure. Lala Baldé, president of a women's association in Medina Cherif, a village in Senegal, told Mackie in 1998 that when girls fell ill or died, it was attributed to evil spirits. When informed of the causal relationship between FGM and ill health, Mackie wrote, the women broke down and wept. He argued that surveys taken before and after this sharing of information would show very different levels of support for FGM. The American non-profit group Tostan, founded by Molly Melching in 1991, introduced community-empowerment programs in several countries that focus on local democracy, literacy, and education about healthcare, giving women the tools to make their own decisions. In 1997, using the Tostan program, Malicounda Bambara in Senegal became the first village to abandon FGM. By 2018 over 8,000 communities in eight countries had pledged to abandon FGM and child marriage.

Religion

Surveys have shown a widespread belief, particularly in Mali, Mauritania, Guinea and Egypt, that FGM is a religious requirement. Gruenbaum has argued that practitioners may not distinguish between religion, tradition and chastity, making it difficult to interpret the data. FGM's origins in northeastern Africa are pre-Islamic, but the practice became associated with Islam because of that religion's focus on female chastity and seclusion. There is no mention of it in the Quran. It is praised in a few daʻīf (weak) hadith (sayings attributed to Muhammad) as noble but not required. In 2007 the Al-Azhar Supreme Council of Islamic Research in Cairo ruled that FGM had "no basis in core Islamic law or any of its partial provisions".

There is no mention of FGM in the Bible. Christian missionaries in Africa were among the first to object to FGM, but Christian communities in Africa do practise it. A 2013 UNICEF report identified 17 African countries in which at least 10 percent of Christian women and girls aged 15 to 49 had undergone FGM; in Niger 55 percent of Christian women and girls had experienced it, compared with two percent of their Muslim counterparts. The only Jewish group known to have practised it are the Beta Israel of Ethiopia. Judaism requires male circumcision, but does not allow FGM. FGM is also practised by animist groups, particularly in Guinea and Mali.

History

Antiquity

The practice's origins are unknown. Gerry Mackie has suggested that, because FGM's east-west, north-south distribution in Africa meets in Sudan, infibulation may have begun there with the Meroite civilization (c. 800 BCE – c. 350 CE), before the rise of Islam, to increase confidence in paternity. According to historian Mary Knight, Spell 1117 (c. 1991–1786 BCE) of the Ancient Egyptian Coffin Texts may refer in hieroglyphs to an uncircumcised girl ('m't):

ama
X1
D53B1

The spell was found on the sarcophagus of Sit-hedjhotep, now in the Egyptian Museum, and dates to Egypt's Middle Kingdom. (Paul F. O'Rourke argues that 'm't probably refers instead to a menstruating woman.) The proposed circumcision of an Egyptian girl, Tathemis, is also mentioned on a Greek papyrus, from 163 BCE, in the British Museum: "Sometime after this, Nephoris [Tathemis's mother] defrauded me, being anxious that it was time for Tathemis to be circumcised, as is the custom among the Egyptians."

The examination of mummies has shown no evidence of FGM. Citing the Australian pathologist Grafton Elliot Smith, who examined hundreds of mummies in the early 20th century, Knight writes that the genital area may resemble Type III because during mummification the skin of the outer labia was pulled toward the anus to cover the pudendal cleft, possibly to prevent sexual violation. It was similarly not possible to determine whether Types I or II had been performed, because soft tissues had deteriorated or been removed by the embalmers.

The Greek geographer Strabo (c. 64 BCE – c. 23 CE) wrote about FGM after visiting Egypt around 25 BCE: "This is one of the customs most zealously pursued by them [the Egyptians]: to raise every child that is born and to circumcise [peritemnein] the males and excise [ektemnein] the females ..." Philo of Alexandria (c. 20 BCE – 50 CE) also made reference to it: "the Egyptians by the custom of their country circumcise the marriageable youth and maid in the fourteenth (year) of their age, when the male begins to get seed, and the female to have a menstrual flow." It is mentioned briefly in a work attributed to the Greek physician Galen (129 – c. 200 CE): "When [the clitoris] sticks out to a great extent in their young women, Egyptians consider it appropriate to cut it out." Another Greek physician, Aëtius of Amida (mid-5th to mid-6th century CE), offered more detail in book 16 of his Sixteen Books on Medicine, citing the physician Philomenes. The procedure was performed in case the clitoris, or nymphê, grew too large or triggered sexual desire when rubbing against clothing. "On this account, it seemed proper to the Egyptians to remove it before it became greatly enlarged," Aëtius wrote, "especially at that time when the girls were about to be married":
The surgery is performed in this way: Have the girl sit on a chair while a muscled young man standing behind her places his arms below the girl's thighs. Have him separate and steady her legs and whole body. Standing in front and taking hold of the clitoris with a broad-mouthed forceps in his left hand, the surgeon stretches it outward, while with the right hand, he cuts it off at the point next to the pincers of the forceps. It is proper to let a length remain from that cut off, about the size of the membrane that's between the nostrils, so as to take away the excess material only; as I have said, the part to be removed is at that point just above the pincers of the forceps. Because the clitoris is a skinlike structure and stretches out excessively, do not cut off too much, as a urinary fistula may result from cutting such large growths too deeply.
The genital area was then cleaned with a sponge, frankincense powder and wine or cold water, and wrapped in linen bandages dipped in vinegar, until the seventh day when calamine, rose petals, date pits or a "genital powder made from baked clay" might be applied.

Whatever the practice's origins, infibulation became linked to slavery. Mackie cites the Portuguese missionary João dos Santos, who in 1609 wrote of a group near Mogadishu who had a "custome to sew up their Females, especially their slaves being young to make them unable for conception, which makes these slaves sell dearer, both for their chastitie, and for better confidence which their Masters put in them". Thus, Mackie argues, a "practice associated with shameful female slavery came to stand for honor".

Europe and the United States

portrait
Isaac Baker Brown "set to work to remove the clitoris whenever he had the opportunity of doing so".

Gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation. A British doctor, Robert Thomas, suggested clitoridectomy as a cure for nymphomania in 1813. The first reported clitoridectomy in the West, described in The Lancet in 1825, was performed in 1822 in Berlin by Karl Ferdinand von Graefe on a 15-year-old girl who was masturbating excessively.

Isaac Baker Brown, an English gynaecologist, president of the Medical Society of London and co-founder in 1845 of St. Mary's Hospital, believed that masturbation, or "unnatural irritation" of the clitoris, caused hysteria, spinal irritation, fits, idiocy, mania and death. He therefore "set to work to remove the clitoris whenever he had the opportunity of doing so", according to his obituary. Brown performed several clitoridectomies between 1859 and 1866. In the United States, J. Marion Sims followed Brown's work and in 1862 slit the neck of a woman's uterus and amputated her clitoris, "for the relief of the nervous or hysterical condition as recommended by Baker Brown". When Brown published his views in On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females (1866), doctors in London accused him of quackery and expelled him from the Obstetrical Society.

Later in the 19th century, A. J. Bloch, a surgeon in New Orleans, removed the clitoris of a two-year-old girl who was reportedly masturbating. According to a 1985 paper in the Obstetrical & Gynecological Survey, clitoridectomy was performed in the United States into the 1960s to treat hysteria, erotomania and lesbianism. From the mid-1950s, James Burt, a gynaecologist in Dayton, Ohio, performed non-standard repairs of episiotomies after childbirth, adding more stitches to make the vaginal opening smaller. From 1966 until 1989, he performed "love surgery" by cutting women's pubococcygeus muscle, repositioning the vagina and urethra, and removing the clitoral hood, thereby making their genital area more appropriate, in his view, for intercourse in the missionary position. "Women are structurally inadequate for intercourse," he wrote; he said he would turn them into "horny little mice". In the 1960s and 1970s he performed these procedures without consent while repairing episiotomies and performing hysterectomies and other surgery; he said he had performed a variation of them on 4,000 women by 1975. Following complaints, he was required in 1989 to stop practicing medicine in the United States.

Opposition

Colonial opposition in Kenya

Protestant missionaries in British East Africa (present-day Kenya) began campaigning against FGM in the early 20th century, when Dr. John Arthur joined the Church of Scotland Mission (CSM) in Kikuyu. An important ethnic marker, the practice was known by the Kikuyu, the country's main ethnic group, as irua for both girls and boys. It involved excision (Type II) for girls and removal of the foreskin for boys. Unexcised Kikuyu women (irugu) were outcasts.

Jomo Kenyatta, general secretary of the Kikuyu Central Association and later Kenya's first prime minister, wrote in 1938 that, for the Kikuyu, the institution of FGM was the "conditio sine qua non of the whole teaching of tribal law, religion and morality". No proper Kikuyu man or woman would marry or have sexual relations with someone who was not circumcised. A woman's responsibilities toward the tribe began with her initiation. Her age and place within tribal history was traced to that day, and the group of girls with whom she was cut was named according to current events, an oral tradition that allowed the Kikuyu to track people and events going back hundreds of years.

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Missionary Hulda Stumpf (bottom left) was murdered in Kikuyu in 1930 after opposing FGM.

Beginning with the CSM mission in 1925, several missionary churches declared that FGM was prohibited for African Christians. The CSM announced that Africans practising it would be excommunicated, which resulted in hundreds leaving or being expelled. The stand-off turned FGM into a focal point of the Kenyan independence movement; the 1929–1931 period is known in the country's historiography as the female circumcision controversy.

In 1929 the Kenya Missionary Council began referring to FGM as the "sexual mutilation of women", rather than circumcision, and a person's stance toward the practice became a test of loyalty, either to the Christian churches or to the Kikuyu Central Association. Hulda Stumpf, an American missionary with the Africa Inland Mission who opposed FGM in the girls' school she helped to run, was murdered in 1930. Edward Grigg, the governor of Kenya, told the British Colonial Office that the killer, who was never identified, had tried to circumcise her.

In 1956 the council of male elders (the Njuri Nchecke) in Meru announced a ban on FGM. Over the next three years, thousands of girls cut each other's genitals with razor blades as a symbol of defiance. The movement came to be known as Ngaitana ("I will circumcise myself"), because to avoid naming their friends the girls said they had cut themselves. Historian Lynn Thomas described the episode as significant in the history of FGM because it made clear that its victims were also its perpetrators.

Growth of opposition

The first known non-colonial campaign against FGM began in Egypt in the 1920s, when the Egyptian Doctors' Society called for a ban. There was a parallel campaign in Sudan, run by religious leaders and British women. Infibulation was banned there in 1946, but the law was unpopular and barely enforced. The Egyptian government banned infibulation in state-run hospitals in 1959, but allowed partial clitoridectomy if parents requested it. (Egypt banned FGM entirely in 2007.)

In 1959, the UN asked the WHO to investigate FGM, but the latter responded that it was not a medical matter. Feminists took up the issue throughout the 1970s. The Egyptian physician and feminist Nawal El Saadawi criticized FGM in her book Women and Sex (1972); the book was banned in Egypt and El Saadawi lost her job as director general of public health. She followed up with a chapter, "The Circumcision of Girls", in her book The Hidden Face of Eve: Women in the Arab World (1980), which described her own clitoridectomy when she was six years old:
I did not know what they had cut off from my body, and I did not try to find out. I just wept, and called out to my mother for help. But the worst shock of all was when I looked around and found her standing by my side. Yes, it was her, I could not be mistaken, in flesh and blood, right in the midst of these strangers, talking to them and smiling at them, as though they had not participated in slaughtering her daughter just a few moments ago.
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In 1975, Rose Oldfield Hayes, an American social scientist, became the first female academic to publish a detailed account of FGM, aided by her ability to discuss it directly with women in Sudan. Her article in American Ethnologist called it "female genital mutilation", rather than female circumcision, and brought it to wider academic attention. Edna Adan Ismail, who worked at the time for the Somalia Ministry of Health, discussed the health consequences of FGM in 1977 with the Somali Women's Democratic Organization. Two years later Fran Hosken, an Austria-American feminist, published The Hosken Report: Genital and Sexual Mutilation of Females (1979), the first to offer global figures. She estimated that 110,529,000 women in 20 African countries had experienced FGM. The figures were speculative but consistent with later surveys. Describing FGM as a "training ground for male violence", Hosken accused female practitioners of "participating in the destruction of their own kind". The language caused a rift between Western and African feminists; African women boycotted a session featuring Hosken during the UN's Mid-Decade Conference on Women in Copenhagen in July 1980.

In 1979, the WHO held a seminar, "Traditional Practices Affecting the Health of Women and Children", in Khartoum, Sudan, and in 1981, also in Khartoum, 150 academics and activists signed a pledge to fight FGM after a workshop held by the Babiker Badri Scientific Association for Women's Studies (BBSAWS), "Female Circumcision Mutilates and Endangers Women – Combat it!" Another BBSAWS workshop in 1984 invited the international community to write a joint statement for the United Nations. It recommended that the "goal of all African women" should be the eradication of FGM and that, to sever the link between FGM and religion, clitoridectomy should no longer be referred to as sunna.

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, founded in 1984 in Dakar, Senegal, called for an end to the practice, as did the UN's World Conference on Human Rights in Vienna in 1993. The conference listed FGM as a form of violence against women, marking it as a human-rights violation, rather than a medical issue. Throughout the 1990s and 2000s governments in Africa and the Middle East passed legislation banning or restricting FGM. In 2003 the African Union ratified the Maputo Protocol on the rights of women, which supported the elimination of FGM. By 2015 laws restricting FGM had been passed in at least 23 of the 27 African countries in which it is concentrated, although several fell short of a ban.

United Nations

In December 1993, the United Nations General Assembly included FGM in resolution 48/104, the Declaration on the Elimination of Violence Against Women, and from 2003 sponsored International Day of Zero Tolerance for Female Genital Mutilation, held every 6 February. UNICEF began in 2003 to promote an evidence-based social norms approach, using ideas from game theory about how communities reach decisions about FGM, and building on the work of Gerry Mackie on the demise of footbinding in China. In 2005 the UNICEF Innocenti Research Centre in Florence published its first report on FGM. UNFPA and UNICEF launched a joint program in Africa in 2007 to reduce FGM by 40 percent within the 0–15 age group and eliminate it from at least one country by 2012, goals that were not met and which they later described as unrealistic. In 2008 several UN bodies recognized FGM as a human-rights violation, and in 2010 the UN called upon healthcare providers to stop carrying out the procedures, including reinfibulation after childbirth and symbolic nicking. In 2012 the General Assembly passed resolution 67/146, "Intensifying global efforts for the elimination of female genital mutilations".

Non-practising countries

Immigration spread the practice to Australia, New Zealand, Europe and North America, all of which outlawed it entirely or restricted it to consenting adults. Sweden outlawed FGM in 1982 with the Act Prohibiting the Genital Mutilation of Women, the first Western country to do so. Several former colonial powers, including Belgium, Britain, France and the Netherlands, introduced new laws or made clear that it was covered by existing legislation. As of 2013 legislation banning FGM had been passed in 33 countries outside Africa and the Middle East.

North America

In the United States an estimated 513,000 women and girls had experienced FGM or were at risk as of 2012. The Centers for Disease Control's previous estimate was 168,000 as of 1990. A Nigerian woman successfully contested deportation in March 1994 on the grounds that her daughters might be cut, and in 1996 Fauziya Kasinga from Togo became the first to be granted asylum to escape FGM. In 1996 the Federal Prohibition of Female Genital Mutilation Act made it illegal to perform FGM on minors for non-medical reasons, and in 2013 the Transport for Female Genital Mutilation Act prohibited transporting a minor out of the country for the purpose of FGM. In addition, 24 states have legislation banning FGM. The American Academy of Pediatrics opposes all forms of the practice, including pricking the clitoral skin. The first FGM conviction in the US was in 2006, when Khalid Adem, who had emigrated from Ethiopia, was sentenced to ten years after severing his two-year-old daughter's clitoris with a pair of scissors.

Canada recognized FGM as a form of persecution in July 1994, when it granted refugee status to Khadra Hassan Farah, who had fled Somalia to avoid her daughter being cut. In 1997 section 268 of its Criminal Code was amended to ban FGM, except where "the person is at least eighteen years of age and there is no resulting bodily harm". As of July 2017 there had been no prosecutions. Canadian officials have expressed concern that a few thousand Canadian girls are at risk of "vacation cutting", whereby girls are taken overseas to undergo the procedure, but as of 2017 there were no firm figures.

Europe

According to the European Parliament, 500,000 women in Europe had undergone FGM as of March 2009. France is known for its tough stance against FGM. Up to 30,000 women there were thought to have experienced it as of 1995. According to Colette Gallard, a family-planning counsellor, when FGM was first encountered in France, the reaction was that Westerners ought not to intervene. It took the deaths of two girls in 1982, one of them three months old, for that attitude to change. In 1991 a French court ruled that the Convention Relating to the Status of Refugees offered protection to FGM victims; the decision followed an asylum application from Aminata Diop, who fled an FGM procedure in Mali. The practice is outlawed by several provisions of France's penal code that address bodily harm causing permanent mutilation or torture. All children under six who were born in France undergo medical examinations that include inspection of the genitals, and doctors are obliged to report FGM. The first civil suit was in 1982, and the first criminal prosecution in 1993. In 1999 a woman was given an eight-year sentence for having performed FGM on 48 girls. By 2014 over 100 parents and two practitioners had been prosecuted in over 40 criminal cases.

Around 137,000 women and girls living in England and Wales were born in countries where FGM is practised, as of 2011. Performing FGM on children or adults was outlawed under the Prohibition of Female Circumcision Act 1985. This was replaced by the Female Genital Mutilation Act 2003 and Prohibition of Female Genital Mutilation (Scotland) Act 2005, which added a prohibition on arranging FGM outside the country for British citizens or permanent residents. The United Nations Committee on the Elimination of Discrimination against Women (CEDAW) asked the government in July 2013 to "ensure the full implementation of its legislation on FGM". The first charges were brought in 2014 against a physician and another man; the physician had stitched an infibulated woman after opening her for childbirth. Both men were acquitted in 2015.

Criticism of opposition

Tolerance versus human rights

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Academic Obioma Nnaemeka criticized the renaming of female circumcision to female genital mutilation.

Anthropologists have accused FGM eradicationists of cultural colonialism, and have been criticized in turn for their moral relativism and failure to defend the idea of universal human rights. According to critics of the eradicationist position, the biological reductionism of the opposition to FGM, and the failure to appreciate FGM's cultural context, serves to "other" practitioners and undermine their agency—in particular when parents are referred to as "mutilators".

Africans who object to the tone of FGM opposition risk appearing to defend the practice. The feminist theorist Obioma Nnaemeka, herself strongly opposed to FGM, argues that renaming it female genital mutilation introduced "a subtext of barbaric African and Muslim cultures and the West's relevance (even indispensability) in purging [it]". According to Ugandan law professor Sylvia Tamale, early Western opposition to FGM stemmed from a Judeo-Christian judgment that African sexual and family practices—including dry sex, polygyny, bride price and levirate marriage—required correction; African feminists "take strong exception to the imperialist, racist and dehumanising infantilization of African women". Commentators highlight the appropriation of women's bodies as exhibits, such as the 1996 publication of the Pulitzer-prize-winning photographs (above) of a 16-year-old Kenyan girl undergoing FGM. The photographs were published by 12 American newspapers, without the girl consenting either to be photographed or to have the images published.

The debate has highlighted a tension between anthropology and feminism, with the former's focus on tolerance and the latter's on equal rights for women. According to the anthropologist Christine Walley, a common position within anti-FGM literature has been to present African women as victims of false consciousness participating in their own oppression, a position promoted by feminists in the 1970s and 1980s, including Fran Hosken, Mary Daly and Hanny Lightfoot-Klein. It prompted the French Association of Anthropologists to issue a statement in 1981, at the height of the early debates, that "a certain feminism resuscitates (today) the moralistic arrogance of yesterday's colonialism."

Comparison with other procedures

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Martha Nussbaum: a key moral and legal issue with FGM is that it is mostly conducted on children using physical force.

Nnaemeka argues that the crucial question, broader than FGM, is why the female body is subjected to so much "abuse and indignity", including in the West. Several authors have drawn a parallel between FGM and cosmetic procedures. Ronán Conroy of the Royal College of Surgeons in Ireland wrote in 2006 that cosmetic genital procedures were "driving the advance" of FGM by encouraging women to see natural variations as defects. Anthropologist Fadwa El Guindi compared FGM to breast enhancement, in which the maternal function of the breast becomes secondary to men's sexual pleasure. Benoîte Groult made a similar point in 1975, citing FGM and cosmetic surgery as sexist and patriarchal.

Carla Obermeyer has argued that FGM may be conducive to a subject's social well-being in the same way that rhinoplasty and male circumcision are. Despite the 2007 ban in Egypt, women there wanting FGM for their daughters seek amalyet tajmeel (cosmetic surgery) to remove what they see as excess genital tissue.

Cosmetic procedures such as labiaplasty and clitoral hood reduction do fall within the WHO's definition of FGM, which aims to avoid loopholes, but the WHO notes that these elective practices are generally not regarded as FGM. Some legislation banning FGM, such as in Canada and the US, covers minors only, but several countries, including Sweden and the UK, have banned it regardless of consent. Sweden, for example, has banned operations "on the outer female sexual organs with a view to mutilating them or bringing about some other permanent change in them, regardless of whether or not consent has been given for the operation". Gynaecologist Birgitta Essén and anthropologist Sara Johnsdotter argue that the law seems to distinguish between Western and African genitals, and deems only African women (such as those seeking reinfibulation after childbirth) unfit to make their own decisions.

The philosopher Martha Nussbaum argues that a key concern with FGM is that it is mostly conducted on children using physical force. The distinction between social pressure and physical force is morally and legally salient, comparable to the distinction between seduction and rape. She argues further that the literacy of women in practising countries is generally poorer than in developed nations, which reduces their ability to make informed choices.

Arguments have been made that non-therapeutic male circumcision, practised by Muslims, Jews and some Christian groups, also violates children's rights. Globally about 30 percent of males over 15 are circumcised; of these, about two-thirds are Muslim. An eight-member American Academy of Pediatrics circumcision task force issued a policy statement in 2012 that the health benefits of male circumcision outweigh the risks; they recommended that it be carried out, if it is performed, by "trained and competent practitioners ... using sterile techniques and effective pain management". The statement met with protests from a group of 38 doctors in Europe, who accused the task force of "cultural bias". At least half the male population of the United States is circumcised, while most men in Europe are not. Several commentators maintain that children's rights are also violated by the genital alteration of intersex children, who are born with anomalies that physicians choose to correct.

United States labor law

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