Female genital mutilation (FGM) is the partial or total removal of external female genitalia, or other deliberate injury to female genital organs, carried out for non-medical reasons. Africa accounts for the largest share of this practice globally, with over 144 million girls and women affected out of more than 230 million worldwide. The practice is concentrated in a belt of countries stretching from West Africa through the Horn of Africa, with near-universal rates in Somalia, Guinea, and Djibouti, where 90 percent or more of women and girls have been cut.
The Four Types of FGM
The World Health Organization classifies FGM into four types based on severity. Type I involves partial or total removal of the clitoral glans, the visible part of the clitoris responsible for sexual pleasure, sometimes along with the fold of skin surrounding it. Type II goes further, removing the clitoral glans and the inner folds of the vulva, sometimes including the outer folds as well.
Type III, often called infibulation, is the most severe form. The vaginal opening is narrowed by cutting and repositioning genital tissue to create a seal, sometimes with removal of the clitoris as well. This seal must later be opened for intercourse and childbirth, and in some communities is resealed afterward. Type IV is a catch-all category covering other harmful procedures like pricking, piercing, scraping, or burning of the genitalia.
The type performed varies by country and ethnic group. Infibulation is most common in the Horn of Africa, particularly Somalia, Eritrea, and parts of Sudan and Ethiopia, while Types I and II are more widespread across West and East Africa.
Why the Practice Continues
FGM is rooted in a mix of social, cultural, and sometimes religious expectations, though no major religion requires it. In many communities, it is considered a rite of passage into womanhood, a prerequisite for marriage, or a way to ensure a girl’s virginity and “purity.” Social pressure is the primary driver: families who refuse risk stigma, and uncut girls may be considered unmarriageable.
In some regions, the practice is so deeply normalized that both men and women see it as simply what is done, with mothers and grandmothers arranging the cutting for daughters because they experienced it themselves. The age at which it happens varies widely. Some girls are cut as infants, others during childhood or adolescence. In certain communities, it occurs just before marriage.
Immediate Physical Harm
FGM is typically performed without anesthesia, and cutting nerve-rich genital tissue causes extreme pain. Most procedures in rural settings use unsterilized razors, knives, or scissors, sometimes the same instrument on multiple girls in a single session. The immediate risks include severe bleeding if an artery is cut, shock from pain or blood loss, and infections ranging from localized wound infections to tetanus and sepsis. Swelling of the surrounding tissue can block urination, causing painful retention. In the worst cases, hemorrhage or infection leads to death.
Even when the procedure goes as “intended,” impaired wound healing is common. Girls are sometimes bound with their legs tied together for weeks to allow scar tissue to form, particularly after infibulation.
Long-Term Health Consequences
The damage from FGM persists for life. Scar tissue can cause chronic pain, recurrent urinary tract infections, and menstrual problems when blood flow is obstructed. Women with Type III FGM often experience painful intercourse and may require surgical opening of the seal before they can have sex or give birth.
During childbirth, scar tissue that has replaced normal elastic genital tissue does not stretch properly, increasing the risk of prolonged labor, tearing, and the need for emergency intervention. Complications are particularly serious in rural areas without access to skilled obstetric care. Beyond the physical, many women report lasting psychological effects including anxiety, flashbacks to the event, and difficulties with sexual intimacy, though large-scale data on mental health outcomes remains limited.
The Rise of Medicalization
A growing and troubling trend is the medicalization of FGM, where trained healthcare workers perform the cutting instead of traditional practitioners. Medicalization rates are strikingly high in some countries: 67 percent in Sudan, 38 percent in Egypt, and 15 percent in both Kenya and Guinea. In parts of Somalia’s Puntland and Jubbaland regions, research found that 63 percent of new cases between 2016 and 2019 were performed by medical professionals.
Health organizations universally oppose this trend. While medicalized cutting may reduce some immediate risks like infection, it does not prevent the long-term damage. More critically, it legitimizes the practice, making it harder to eliminate by giving it a veneer of medical respectability. When a nurse or doctor performs FGM, families feel reassured that it is safe, which undermines abandonment efforts.
Where FGM Is Most Common
Prevalence varies enormously across the continent. Somalia, Guinea, and Djibouti have rates above 90 percent. Other high-prevalence countries include Mali, Sierra Leone, Sudan, Egypt, and Eritrea. In contrast, countries like Uganda, Niger, and Cameroon have prevalence below 5 percent, and many southern African nations have no tradition of the practice at all.
Even within high-prevalence countries, rates differ sharply by region and ethnicity. In Kenya, for instance, the national rate masks the fact that certain communities practice FGM almost universally while others do not practice it at all. This patchwork pattern means that national statistics, while useful, can obscure the lived reality in specific communities.
Legal Status Across the Continent
Most African countries with significant FGM prevalence have passed laws banning the practice. More than 25 African nations now have legislation criminalizing FGM, and the African Union’s Maputo Protocol explicitly calls for its elimination. Enforcement, however, is uneven. In many rural areas, laws are poorly known or deliberately ignored. Prosecutions remain rare, and some communities have responded to bans by performing the cutting at younger ages or moving girls across borders to countries with weaker enforcement.
Somalia, which has the world’s highest FGM prevalence, has no federal law banning the practice, though some regional administrations have taken steps toward prohibition.
Signs of Change
Despite the scale of the problem, FGM rates are declining in many countries, particularly among younger age groups. Girls aged 15 to 19 are significantly less likely to have been cut than their mothers’ generation in countries like Kenya, Egypt, and Burkina Faso. This shift is driven by a combination of legal reform, community-led education programs, and broader social changes including urbanization, increased girls’ education, and exposure to alternative perspectives through media and migration.
Community-based approaches have proven more effective than top-down legal bans alone. Programs that engage entire communities, including men, religious leaders, and traditional elders, in collective decisions to abandon the practice have shown measurable results. When enough families in a community agree to stop simultaneously, the social pressure that sustains FGM begins to break down. The challenge is that population growth in high-prevalence regions means the absolute number of girls at risk continues to rise even as the percentage being cut falls.