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A new approach to end Female Genital Mutilation (FGM) in the EU

What is Female Genital Mutilation

What is Female Genital Mutilation (FGM)

Female genital mutilation (FGM) also known as female genital cutting or female circumcision, defined by the world health organisation (WHO), includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. In reality, different forms of cutting do not fall neatly into the taxonomy developed by the WHO. Nevertheless, FGM is generally  categorised into four main types;

1. Type 1 (Clitoridectomy) – partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

2. Type 2 (Excision) –partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina).

3. Type 3 (Infibulation) - narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

4. Type 4 (other) - all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

                                                            World health organisation (WHO) 2013


The practice of FGM is sometimes referred to as ‘Female Circumcision’ or ‘Female Genital Cutting’. REPLACE 1(Section 3.1.1  REPLACE Toolkit) found that different terms were used by members of the Sudanese and Somali communities to refer to the different types of FGM. The terms ‘circumcision’ and ‘sunna’ were mostly frequently used. The term ‘circumcision’, was sometimes qualified with the word ‘female’. For many participants the word ‘circumcision’ was used as a 'catch-all' term, just as FGM is used by campaigners and NGOs to refer to all types of FGM. Many participants used the Somali term ‘Gudniin/Gudniinka’, which translated means ‘circumcision’. Similarly, Sudanese participants tended to use the word ‘Khitan’ which also means ‘circumcision’. 

   Section 3.1.1  REPLACE Toolkit

How is the procedure carried out?

Just as there are a range of beliefs regarding the issue of FGM, the people who carried about the practice also differ. Who carries out the practice will largely be informed by beliefs about who should conduct the practice, but it can also be informed by other factors, such as whether the community is rural or urban based and the legality of the practice. In some locations men carry out the procedure, whereas in others this would be unacceptable. In Africa, particularly in rural locations, the procedure is traditionally carried out by women excisers that have no medical training and utilise unsanitised equipment, such as knives, scissors, scalpels, pieces of glass and razor blades and anaesthetics and antiseptic treatment are not generally used. However, because of the health messages disseminated by anti-FGM campaigns, some excisers may utilise sanitised blades. In other cases, particularly in urban areas, medically trained individuals will conduct the practice. In some instances, the procedure is conducted in ‘medicalised’ setting. 

Girls may have to be forcibly restrained and the age at which the practice is carried out varies, depending on the community or individual family, between infancy and the labour of a first child.  Depending on the region, girls as young as a few weeks old undergo the practice. According to figures released by UNICEF (2013) in half of the 29 countries across African and the Middle East where FGM is practiced, girls are cut before they reach the age of five.  

Where does it happen? 

According to a recent report by UNICEF (2013), it is estimated that more than 125 million girls and women alive today have been cut in the 29 countries in Africa and the Middle East where FGM is concentrated. Yet, one should not overlook the fact that FGM is also practiced Central and South East Asia, in countries such as Indonesia and Malaysia.  Given the sensitive nature of the topic, it is difficult to know the exact prevalence of the practice in countries of origin or within diasporic communities. With increasing globalisation and many people from FGM affected communities migrating to the EU and other developed regions, for economic reasons or asylum, the practice of FGM is no longer restricted to the traditional affected countries. There are now substantial populations of women living in the EU who have been subjected to FGM or who are at threat from FGM. In 2009 the European Parliament estimated that 500,000 women living in the EU have been subjected to FGM, with a further 180,000 girls and women at risk of undergoing FGM every year. However, without accurate prevalence figures, it is difficult to know the true reality of risk girls and women face. The world health organization (WHO) estimate about 140 million girls and women worldwide are living with the consequences of FGM (WHO, 2013).

FGM in an EU Context

It is only over the last decade or so that research has started to be conducted on the issue of FGM within Europe. Of the research that has been conducted (European Institute for Gender Equality, 2013, Exterkate, 2013; Behrendt, 2011; Hemmings 2011; Norman et al. 2009; Johnsdotter et al. 2009; Johnsdotter, 2007; Johansen 2007 and Morison et al. 2004), it is clear that the socio-cultural context of EU member states plays a significant role in how affected communities respond to anti-FGM messages and legislation. Not only do affected communities react to external environmental issues, they also respond to internal changes within their communities. Because of the different socio-cultural environments associated with each EU Member State, we cannot assume all affected communities hold similar beliefs regarding FGM. Furthermore, we should not assume that all individuals who identify as members of an affected community wish to continue the practice. Interventionists should also be aware that the length of time that people have resided in the EU may change the beliefs they hold regarding FGM.

FGM has no health benefits and harms girls and women in many ways.

There are a growing number of well conducted studies which demonstrate a significant association between FGM and various gynaecological and pregnancy complications. WHO Reports (2000; 2006) conclude that FGM has negative implications for women’s health, with women who have undergone FGM more likely than others to have adverse obstetric outcomes. FGM has no health benefits and it harms girls and women in many ways, both physically and mentally. The health impacts on girls and women subjected to FGM occurs at the time of the procedure as well as later into adulthood, particularly motherhood. 

FGM involves removing and damaging healthy and normal female genital tissue, interfering with the natural function of girls' and women's bodies. The practice causes severe pain and immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. Long term health consequences can include recurrent bladder and urinary tract infections, cysts, infertility, need for later surgeries and increased risk of childbirth complications and newborn deaths.

                                                                     World health organisation (WHO)

In addition to physical health consequences, a number of psychological, psycho-sexual, social and mental health consequences can be experienced. Case histories and personal accounts taken from women indicate that FGM is an extremely traumatic experience for girls and women, which stays with them for the rest of their lives. (2012)

Why is FGM carried out? 

FGM is a deeply rooted cultural practice for many communities. The reasons for its continuation differ from community to community. Even though the practice maybe deep rooted, this does not mean that beliefs regarding the practice do not change and evolve in response to both internal and external environmental changes. For example, in those geographical locations where FGM has not been traditionally performed, the practice may take on a new symbolic meaning. Indeed, research conducted by Johansen (2007) suggests that a certain form of the practice is perceived by some Somalis in Norway as a marker of ethnicity. Even though beliefs systems regarding the continuation of the practice differ slightly, the most frequently cited beliefs include: marriageability; cleanliness; purity, improved social status and social capital; health benefits and religion. Essentially, the justifications given for the practice are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons cited generally relate to tradition, power inequalities and the ensuing compliance of women to the dictates of their communities (FORWARD).

The law

In 2009 the European Parliament adopted the Resolution on Combating FGM in the EU (2008/2071(INI)). Additionally, in December 2012, the Council of Europe reiterated that FGM cannot be justified on the basis of ‘custom, tradition, culture, privacy, religion nor so-called honour’ (European Institute for Gender Equality, 2013: 39). The EU, like the United Nations, frames FGM as violence against women and girls, which occurs in the family or domestic unit. Violence against women and girls is understood by the EU as a violation of human rights and a form of discrimination against females.  Action taken so far by the EC to combat violence against women is through the Daphne Programme, which funded the REPLACE pilot study. 

The European Commission emphasises the need to adopt an EU-wide strategy for combating violence against women and eradicating FGM  by using all appropriate instruments, including criminal  law, within the limits of the EU’s powers, in the following three policy documents:

  • The Stockholm Programme (COM/2010)
  • A Strengthened Commitment to Equality between Women and Men – A Women’s Charter (COM/2010) 
  • The Strategy for equality between women and men 2010-2015 (COM/2010)

European Institute for Gender Equality 2013 report on female genital mutilation in the European union and Croatia (2013).

The UK first introduced the Prohibition of Female Circumcision Act in  (1985), this was then superseded by the Female Genital Mutilation Act in  2003. Any person found guilty of an offence under the Female Genital Mutilation Act 2003 will be liable to a maximum penalty of a fine or imprisonment of up to 14 years, or both.


REPLACE 2 Project

REPLACE represents a radical change to the way female genital mutilation (FGM) is tackled in the EU, by developing a new community-based approach to eradicating FGM. This project continues the innovative behavioural change approach to ending FGM that was developed in the one year EU Daphne III funded REPLACE (2010- 2011). Using a community participatory approach, REPLACE identified a number of barriers preventing the cessation of FGM in the EU. These included: ambiguity regarding terminology referring to the practice; religious beliefs; lack of communication about the issue; issues regarding choice and consent and the medicalisation of certain types of FGM. This insight facilitated the development of the REPLACE Pilot Toolkit which featured the REPLACE Behavioural Change Cyclic Framework. To read more about the REPLACE Pilot Toolkit or to download it click here.