Female genital mutilation (FGM), an ancient tradition of cutting, scraping, piercing or nicking of genitals of young girls, was believed to be practised predominantly in sub-Saharan Africa and the Middle East. But a recent report by the United National Children’s Fund revealed that it is also common in Indonesia.
Around 60 million women, or half of the women in Indonesia, the world’s most populous Muslim majority, is estimated to have undergone FGM.
Traditional “circumcisers” have long carried out the practice, known as female khitan or sunat perempuan in Indonesia. In recent years, medical practitioners have been increasingly performing FGM, institutionalising the ritual into medical practice.
Many maternity clinics now offer the procedure as part of a birth delivery package, done soon after labour, without additional charges.
Why female circumcision is common in Indonesia
In Indonesia, people perceive circumcision as a required act of faith and part of tradition. A majority of Muslims in Indonesia follow the Shafi'i school that obliges circumcision for boys and girls.
Indonesia tried to ban the practice in 2006. But religious clerics reacted by releasing an edict declaring that it was part of a religious practice. In 2010, the Indonesian Health Ministry released a regulation that allowed medical personnel to perform female genital cutting on young girls.
The argument supporting medicalisation of FGM is that it is better to have trained medical personnel perform the procedure than risking severe infections if performed by traditional circumcisers.
However, medicalisation may actually be even more dangerous. Midwives tend to use scissors instead of penknives. Hence, they actually conduct real cutting of the skin. Traditional circumcisers, meanwhile, use penknives for more symbolic acts of scraping or rubbing.
In 2014, the Ministry lifted the regulation. However, medical establishments continue to carry out the procedure. Female genital cutting is now more commonly performed by medical personnel than traditional circumcisers.
In a 2001-2002 Population Council Indonesia study on female circumcision, of the 2,215 reported cases, 68% was performed by traditional birth attendants and traditional circumcisers. The remaining 32% was performed by medical personnel, mostly midwives.
The 2013 National Basic Health Survey (Riskesdas) shows medical personnel perform more than half or 53.2% of reported FGMs. Of that percentage, 50.9% were done by midwives, 2.3% by other medical personnel. Meanwhile, traditional birth attendants or circumcicers perform 46.8% of FGMs.
Performed on babies
The 2001-2002 study showed that 85.2% of FGMs was performed before girls reach the age of nine. The 2013 survey showed the age to be going down: 96.7% of FGMs were performed before the age of five years. Of that, 82.8% were performed on babies between the ages 0 and 11 months.
The majority of those who had undergone FGM could not remember the process or pain when asked as adult respondents. Consequently, there was no evidence of immediate or long-term physical or psychological complications.
Nevertheless, direct observation of FGM procedures in 2001-2002 showed that it certainly involves pain, rubbing and scraping (24.3%). There was real genital cutting (49.2% incision and 22.4% excision). There was also stretching (3%) and a small proportion of pricking and piercing (1.1%).
The 2001-2002 study showed that 92% of interviewed parents wanted the practice to continue. This data came from eight districts in six provinces: West Sumatra, Banten, East Kalimantan, East Java, Gorontalo, and South Sulawesi. Those parents not only want their daughters to undergo circumcision but also their future grandchildren.
The 2013 National Basic Health Survey showed most parents (90%-94.9%) have similar wishes in nine provinces in Indonesia, including Aceh, East Kalimantan, most of Sulawesi and Gorontalo, as well as Maluku and North Maluku. The other 24 provinces in Indonesia showed lower percentages.
Different from Africa?
It is difficult to compare practices of female genital mutilation or cutting in Africa with those in Indonesia and it should be done with caution.
The 2001-2002 Population Council study shows that much of traditional circumcision in Indonesia is limited to scraping, rubbing and piercing with a needle to produce a drop of blood.
In contrast, in Africa the practice frequently involves partial or total removal of the clitoris (or the prepuce) and stitching to narrow the vaginal opening (infibulation).
Of the 1997 WHO types of female circumcision classification , the practice in Indonesia is referred to the “unclassified type” or Type IV:
“All other harmful procedures to the female genitalia for non-medical purposes”.
Nevertheless, any form of female genital mutilation is unacceptable.
That it is done without the consent of the baby or little girl and without clear health benefits or religious mandate is enough to classify this act as a violation of human and health rights of the girl child.
The World Health Organisation (WHO) stated clearly in 1997 that female genital mutilation must not be institutionalised, nor should any form of genital cutting is performed by any health professionals in any setting or health establishments.
By allowing doctors, midwives and nurses to perform FGM, the Health Ministry has wrongly legitimised the practice as medically sound, and thus further institutionalising the practices in Indonesia.
Indonesia should stop the medicalisation of FGM. The government should carry out a campaign that informs the public that female circumcision is not obligatory under Islamic law. The government should also update the pre-service midwifery training curricula.