Female Genital Mutilation is thought to affect 200 million girls and women around the world.
A Queensland couple accused of sending their two girls to Africa to undergo FGM are due to face trial in May 2018 - the first time a criminal case has reached the state's courts.
But what exactly is the practice and where is it being carried out?
What is FGM?
Female genital mutilation refers to any practice of altering female genitalia for non-medical reasons. It has also been called female circumcision or genital cutting. It is a cultural practice typically performed on infants to teenage girls by a traditional circumciser in the girl's community rather than by medical professionals.
It is not a dictate of any major religion, and despite evidence of a long history as a cultural practice in some communities, FGM has no known health benefits, according to the World Health Organisation.
The WHO classifies FGM into four types, depending on the degree of severity.
Type 1 - Partial or total removal of the clitoris (clitoridectomy).
Type 2 - Partial or total removal of the clitoris and the labia.
Type 3 - Narrowing of the vaginal orifice with the creation of a covering seal by cutting and stitching the labia (infibulation).
Type 4 - All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping and cauterization.
All forms of the practice are considered a fundamental violation of the rights of women and girls by the United Nations. The procedure can cause pain, shock, bleeding, bacterial infection and longer-term problems including recurrent infections, lack of sexual pleasure, psychological trauma and childbirth problems, among other issues.
Since the UN campaign to eradicate the practice began in 2007, it has been criminalised in 18 African countries where the practice commonly occurred, as well as twelve industrialised countries (including Australia) which accept immigrants from those nations, according to the US-based Center for Reproductive Rights.
Why does it happen?
The origins of the practice are not well understood, and there is evidence that some circumcision practices predate Islam and Christianity in Egypt. And while it is viewed by the UN and most national governments as an act of violence or child abuse driven by gender discrimination, there are often strong cultural motivations driving families who want their daughters to undergo the practice.
“The reasons for the practice are multiple and complex”, Medina Idriess, a family and reproductive community health worker at Melbourne’s Multicultural Women’s Health Centre, told SBS News.
“Commonly it is a cultural issue. It has been done for a long long time, centuries…. it’s perceived as social obligation, something that's expected. But it is also to be part of the community. The families will have fear that if their daughter is not circumcised she will be subjected to some sanction from the community.”
Many communities view this as a rite of passage for girls to womanhood.
Medina Idriess, Health worker
“Also many communities view this as a rite of passage for girls to womanhood, to be prepared for marriage. Some believe it enhances hygiene, fertility, or child survival. It reinforces cultural identity ... and some believe it ensures a girl’s chastity before marriage and fidelity within marriage.”
Which countries practice FGM?
A UN study estimated at least 200 million girls and women worldwide have been subjected to some form of FGM. The majority of affected women are from Egypt, Ethiopia and Indonesia; while the practice is almost universal in the much smaller countries of Djibouti, Guinea and Somalia, according to the UN. In Indonesia in 2010, after a failed attempt to ban it outraged religious clerics, the government issued a decree that said it should only be done by health professionals and only involve the scratching of the clitoral hood “without injuring the clitoris.”
Research by UNICEF, which advocates for a zero-tolerance approach to FGM and campaigns to eliminate it by 2030, suggests there has been an overall decline in the prevalence of FGM over the last three decades, but not all countries have made progress and the pace of decline has been uneven. Population growth in the most affected countries means there could be an increase in the actual number of girls affected, even at the current rates of decline in the practice.
Does it happen in Australia?
Unlike in the UK, there is no systematically collected national data in Australia on the prevalence of FGM, says associate professor Yvonne Zurynski, director of research at the Australian Paediatric Surveillance Unit at the University of Sydney and the Childrens' Hospital in suburban Westmead.
“In a survey of Australian paediatricians, sixty per cent said that they believed it was practised in Australia,” Dr Zurynski, who was a co-author of the 2017 survey, told SBS News.
“In the same survey, paediatricians reported two children in whom the procedure was done in Australia and there was one child who was born in Australia but was taken to Indonesia for the procedure.
“Circinfo.org have analysed Medicare data and found that there were cases of circumcision procedures done in females for which a Medicare rebate was claimed. In other words, there is some evidence that FGM is practised in Australia but we really have no idea about prevalence because data about FGM is not routinely recorded and we have no systematic data collections or registries. Most paediatricians never ask about FGM.”
Most paediatricians never ask about FGM.
- Associate professor Yvonne Zurynski
Concerns in Australia came to prominence after a high profile court case in which a retired nurse, a mother of two girls and a Dawoodi Bohra community leader from Wollongong were sentenced in 2016 for carrying out FGM on the two girls when they were 7 years old.
Can it be eradicated?
Health worker Ms Idriess came to Australia from Eritrea via Egypt more than 25 years ago. She said that learning about the evidence around FGM - particularly the discovery that it was not a tenet of Islam or any other religion, but was rather a cultural practice that can cause harm, changed her personal views on the issue. "We used to believe it was healthy," she said.
She believes that Australian and global public health education programs have been successful in bringing about cultural change.
She cites the story of one Melbourne family, originally from Sudan, where an intervention via their daughter’s school stopped the girl being sent back to Sudan to be subjected to FGM. She said the local education and health authorities were able to convince the family not to proceed on the basis that it would be harmful to their daughter, as well as illegal.
She has worked for almost 20 years in multicultural community reproductive health, and she says that while there are women in Australia who have undergone FGM, from her work it appears to be extremely rare for families to subject their daughters to it now as attitudes have changed significantly.
“A whole generation born here in Australia have not been circumcised. People understand it is a harmful cultural issue,” she said.