There are many challenges and opportunities in our work towards ending female genital cutting around the world within the next generation.
One of the challenges is working with a deeply entrenched social norm that has been practiced for centuries. Over time, female genital cutting has become attached to many other norms -- religious, medical and cultural, to name a few. In Indonesia at the moment, we appear to have a perfect storm -- a confluence of all of these.
When we meet with people to talk to them about ending female genital cutting, they expect us to talk about Africa. These days, I am bucking the trend by raising the issue of Indonesia with them, where FGC happens on a daily basis.
One of the only surveys we have on FGC in Indonesia dates back to 2001 from USAID which states that up to 22% of girls can go through excision:
Female circumcision practices can be divided into two main groups: "symbolic only" types where there is no incision or excision, accounting for about 28% of all the cases and "harmful" forms, involving incision (49%) and excision (22%).
Almost exactly a year ago, in November 2010, the Ministry of Health in the Republic of Indonesia issued a report stating that FGC is permitted so long as it is carried out by health professionals and following specific guidelines. This was a complete reversal of its position in 2006.
The 2010 Regulation approves what is already a culturally normalized practice, with a study in 2003 reporting that 92% of Indonesian families would choose to continue the practice of FGC on their children and grandchildren.
The authorization of FGC according to the Indonesian Ministry of Health is regulated by strict medical guidelines (see Article 4 below) under which only doctors, midwives, and nurses trained to MOH standards are allowed to carry out the procedure. According to Indonesia's Minister of Women's Empowerment, Linda Amalia Sari Gumelar, the high demand for FGC makes it hard to control the practice and therefore medicalization is necessary in order "to avoid further harm."
It is a specious argument, as it is of course, the practice itself that is most harmful to women, physically, emotionally and psychologically. It also completely contravenes the first sentence of the Hippocratic Oath "First do no harm" and medical professionals will find themselves extremely compromised about how to react to this.
It is important to note that FGC has no link with Islam whatsoever, although it is often wrongly thought to be part of that religious doctrine, as noted by the UK group FORWARD:
However, Muslims who practise FGM rationalize it as a Muslim religious obligation in spite of the fact that FGM predates Islam and it is interesting to note that globally most Muslims do not practise FGM.
FGC remains a practice that denies a woman her right to bodily integrity. Artha Budi Susila Duarsa from Yarsi University in Jakarta makes the case that "even a small wound on the genitals can lead to sexual, physiological and physical problems."
In May of this year, The Legal Aid Institute for Women's Protection in Indonesia (LBH Apik) sent a petition to President Susilo Bambang Yudhoyono. They protested against the passing of the regulation of FGC on the grounds that it opposes the principles of various laws including the laws on child protection and health.
The national coordinator for LBH Apik, Nursyahbani Katjasungkana said:
"In almost all civilized nations, circumcising [female] children is considered as a discrimination and violence towards females and as an injudicious act towards the female physique."
Nursyahbani, who is also a lawyer and international rights activist, was brought up in a family where FGC was an unchallenged norm. She had undergone the practice as a baby along with her sister, just as her mother before them. When Nursyahbani had a daughter of her own, she felt immense pressure to have the procedure performed on her baby. She now deeply regrets the decision she made to have her daughter cut and speaks openly with her daughter about the experience. According to the Jakarta Post:
"The first time I saw clearly how female sexuality was oppressed was in the case of my own daughter. I knew that female circumcision ... was a means to control women's bodies and their sexuality."
In June, over 100 Indonesian civil society organisations released a joint statement with Amnesty International stating that by lifting its ban on FGC, Indonesia is "reinforcing the perception that others are entitled to control a woman's or a girl's sexuality."
The joint statement calls for the guidance to be repealed immediately; specific legislation to prohibit FGC to be enacted and for more to be done to raise awareness to change cultural perceptions.
It is clear that FGC is a social norm in Indonesia as much as in parts of West Africa, where social change programmes have enabled communities to abandon the practice. What is different is the lack of awareness that FGC is an issue. These guidelines are tantamount to the Government of Indonesia admitting there is a problem. We therefore need to work to encourage the government to take positive action to tackle FGC as opposed to issuing guidelines which essentially condone the practice.
We must also act before these guidelines become part of legislation, a very real worry for the future.
[i] REGULATION OF THE MINISTER OF HEALTH ON FEMALE CIRCUMCISION
NUMBER 1636/ MENKES/PER/XI/2010
(1) Female circumcision shall be performed according to the following procedures:
(a) the carer shall wash his/her hands with soap and clean flowing water for 10 ten minutes;
(b) The carer shall wear sterile gloves;
(c) The patient shall lie on her back, legs parted carefully;
(d) Fixation shall be done on the knees, exposing the vulva;
(e) The carer shall clean vulva with povidon iodine 10%, using gauze
(f) The carer shall remove smegma existing between frenulum clitoris and glands of clitoris until the area becomes clean
(g) The carer shall then make a small cut on the skin covering the frontal part of clitoris (frenulum clitoris) using the tip of a sterile disposable needle of size 20G-22G from the mucous side toward the skin without harming the clitoris.
(h) The carer shall wash again the operated area with providon iodine 10%;
(i) The carer shall finally take off the gloves; and
(j) Wash his/her hands with soap and clean flowing water