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女阴残割

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(重定向自女性割禮
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Campaign road sign against female genital mutilation (cropped) 2.jpg
一幅设在乌干达的反对女性生殖器切割的广告牌(2004年)[1]
定义 在1997年由WHO联合国儿童基金会联合国人口基金定义为“女性性器官切除类型一指部分或全部切除阴蒂以及阴蒂包皮或者对女性性器官在非医治的情况下伤害。”[2]
地区 常见于非洲的27个国家,亚洲的也门伊拉克库尔德斯坦也存在[3]
人数 在这些国家有1.33亿人(2014年)[4]
年龄 自出生到青春期前[5]
盛行率
Legislation

女阴残割Female genital mutilation,FGM),又称为女性生殖器切割(female genital cutting,FGC),或女性割礼(female circumcision)。世界卫生组织将其定义为“所有非因医疗因素而涉及移除女性部分或全部外生殖器,或是造成其他类型伤害的手术。”[9]撒哈拉以南北非,以及中东等地区,许多族群英语Ethnic groups of Africa将女阴残割视为传统习俗的一部分,目前已知有27个国家境内具有这种风俗[10]。每个地区进行女阴残割的时间不同,有的是在出生后几天,有的则是到青春期才进行。这27个国家中,当中只有一半的国家能够取得统计数据。根据这些资料显示,大多数的女孩在5岁之前就会进行女阴残割[11]

不同民族之间的女阴残割过程不尽相同,有些切除部分阴蒂阴蒂包皮,也有的切除整个阴蒂和小阴唇。更甚者甚至将大小阴唇全部切除,使阴道愈合,俗称锁阴手术英语Infibulation,WHO则称之为“第三型女阴残割”。被锁阴后的女性下体仅剩下一个小孔,让尿液和经血排除,直到要进行性交及生育时,才再次将阴道口打开[12]。女阴残割所造成的影响因操作程序不同而有所差异,包含反复感染、囊肿、不孕、生产时并发症,及致命性出血[13]

女阴残割是对女性的一种性控制,具有性别不平等的意味。执行女阴残割的地区将此举视作纯洁、端庄,与美丽的象征,且认为女阴残割可以帮助女性保守对丈夫的忠贞[14]。手术通常由家族中的女性成员操作,因为她们认为没有进行女阴残割会使她们的女儿或孙女遭受社会排斥[15]。目前逾1.3亿名女性已接受过FGM,并分布于29个国家[16]。逾800万女性接受过锁阴手术,主要分布于吉布提厄立特里亚索马里,和苏丹[17]

在上述具有女阴残割习俗的国家,大多明令立法禁止这类风俗,但成效不彰[18]。自从1970年代起,各国纷纷说服人们废止它。2012年,联合国大会认定女阴残割违反人权[19]。但也并非没有反对干预此习俗,特别是人类学家埃里克·西尔弗曼英语Eric Silverman表示,女阴残割已经成为人类学的一项中心道德议题,因其涉及文化相对论、人权的普世性和宽容性等难题[20]

联合国2015年提出永续发展目标的目标5“实现两性平等,并赋予所有妇女权力”有具体目标“消除各种有害的做法,例如童婚、未成年结婚、强迫结婚,以及女性生殖器切割”含消除生殖器切割[21]

词源[编辑]

英文[编辑]

photograph
肯亚莱基皮亚高原桑布鲁人在进行女性割礼,摄于2004年。

1980年以前,切除女性生殖器的习俗通常被称为女性割礼(female circumcision),暗示其与男性割礼的相似性[22]。1929年,在苏格兰长老会传教士马里昂·史蒂文森英语Marion Scott Stevenson领导之下,肯亚宣教协会英语Kenya Missionary Council开始将此习俗视为对女性的一种性伤害[23]。到了1970年代,将FGM视为性伤害的人数增加[24]。人类学家罗斯·欧德菲尔德·海耶斯(Rose Oldfield Hayes)在1975年的一篇论文标题中首次使用了“女阴残割”(female genital mutilation)这个字;1979年,奥地利裔美籍学者弗兰·霍斯肯英语Fran Hosken在她的重要论文《霍斯肯报告:女性生殖器及性器官残割》(The Hosken Report: Genital and Sexual Mutilation of Females.)中,确立了“女阴残割”这个字。[n 1]

其后,泛非洲影响妇女及儿童的传统医疗实务协会英语Inter-African Committee on Traditional Practices Affecting the Health of Women and Children于1990年始用“女阴残割”这个词汇[26];而在1997年4月,世界卫生组织、联合国儿童基金会(UNICEF),和联合国人口基金(UNFPA)同样宣布采用“女性残割”一词为描述女性割礼的术语,其他医疗人士同时也使用包括“女性生殖器切割”之同义词汇称之[27]

其他语言[编辑]

在具有女性割礼盛行的地方,则对于此习俗有许多称呼[28] ,通常与纯洁的意象有关。比如说,阿拉伯语男性割礼(tahur)和女性割礼(tahara)中,带有“t-h-r”的字根,而这类字根则通常带有纯洁的意思[29]。在马利班巴拉语中,男性或女性割礼皆称为“bolokoli”,意指“洗净双手”。东尼日利亚的伊博语则将其称为“isa aru”或“iwu aru”,则为“沐浴”之意[30]

圣行割礼通常又称为阴蒂切除术,但也用于更极端的形式;圣行阿拉伯语中意为“行为”、“道路”,也意指传统的穆罕默德,但过程其实和伊斯兰教无关[31]锁阴手术英语Infibulation一词的拉丁文“infibulation”源自于扣环(fibula)。据说古罗马时期,为避免奴隶性交,会使用扣环紧扣于他们的包皮或阴唇[32],苏丹和埃及苏丹人将女性锁阴手术称为“法老的割礼”[32],但古埃及仅有男性有割礼,女性并无此习俗[33]。索马里则称之为“qodob”意指“缝合”[34]

割礼进行方式[编辑]

diagram
女阴构造图,包含了阴蒂阴蒂海绵体前庭球、以及阴蒂脚

女性割礼通常由女生家中的传统割礼师执行,有时会有麻醉师陪同。割礼师通常是较老的女性,但在有些社区,男性理发师兼任健康工作者,也会负责执行这项手术[35][n 2][36]。在埃及、苏丹和肯亚,通常会有专业的医疗人士陪同。根据一项2008年的调查,在埃及77%的女性割礼会由专业医疗人士陪同,通常是内科医生[37]

当由传统割礼师执行仪式时,很有可能是使用没有消毒的切割器具,包括刀子、激光、剪刀、玻璃、磨利的石头和指甲[38]。一位乌干达的护士曾在2007年的《柳叶刀》(The Lancet)说,一位割礼师可能会同时用同一把刀,为30位女性执行这个仪式[39]。手术过程可能会进行全身麻醉或是局部麻醉,有时甚至不进行任何麻醉,取决于专业医疗人士的判断和参与程度。曾有1995年的报导指出,在埃及,60%的情况会进行局部麻醉,13%全身麻醉,而25%完全不进行任何麻醉[40]

残割的种类[编辑]

分类法[编辑]

diagram

1997年4月,世界卫生组织(WHO)、联合国儿童基金会(UNICEF)和联合国人口基金(UNFPA)发表了一份联合声明,明确定义了“女性残割”的内容:“无论是因文化还是其他非治疗性的原因,凡是涉及部分切除、全部切除女性外生殖器,或是其他伤害女性生殖器官的步骤流程,皆被归类于‘女性残割’”[41]

而“女性残割”的步骤根据不同的族群以及不同的医疗从事人员也会有所不同。 1998年在尼日尔的调查显示,当女性受访者被问及其自身所遭遇的“女性残割”过程,其回答的内容超过50种不同的类型[28]。然而,在受访者回答其所遭遇的“女性残割”类型,甚至是否曾经遭遇这样简单的问题,由于语言的隔阂,使得调查研究的数据可靠性产生质疑。有些研究甚至认为这些受访者的受访内容其可信度是不可靠的。而在2003年加纳的研究指出,在1995年约有4%的受访女性不曾遭受“女性残割”,然而在2000年,这一群女性中其中有 11 % 的受访者,也遭受了“女性残割”。在坦桑尼亚的研究中,有 66 %的受访女性是曾遭受“女性残割”,但在实际的体检结果,却证实了其中有73%的女性曾遭受“女性残割”[42]。 而给予受访者的标准问卷问题内容如下:

  1. 切割,但无肉体组织被移除 (意即穿刺,或象征性的割礼);
  2. 切割,而有一部分的组织被移除
  3. 完全缝合密闭
  4. 其他不确定或是未知的类型[n 3]

大多数的步骤流程皆被归类于“切割,有部分的组织被移除”,其中还涉及完全的移除或是部分的移除女性阴蒂头[44]

世界卫生组织分类第一型与第二型[编辑]

世界卫生组织目前根据组织被移除的多寡,将女性割礼很详尽地归类为类型I - III,而类型 III 指的是“完全缝合密闭”。另外,类型 IV则是对于象征性的割礼与其他杂项步骤流程进行描述[45]

类型 I 又可细分为Ia与Ib两细项:
  • Ib:即阴蒂切除术,此类型较1为普遍。即部分或是完全的切除阴蒂头与阴蒂包皮。Susan与Nahid Toubia曾在论述中提及:“阴蒂头被以拇指和食指捏著拉出来,并以尖锐的物品切下。”[47]
一位进行阴唇切除的白人女性
类型二

世卫组织定义的女性器切除类型二指部分或全部切除小阴唇,有时也切除大阴唇或阴蒂头。

类型二又可分为三细项:

  • IIa:仅切除小阴唇。
  • IIb:切除部分或全部切除阴蒂头和小阴唇。
  • IIc:切除部分或全部切除阴蒂头、小阴唇和大阴唇。

第三型[编辑]

第三型(锁阴手术英语infibulation或残暴割礼),属于缝合类别,是将外阴部去除并将两侧伤口互相缝合。小(或和大阴唇)会被切除,阴蒂则不一定。第三a型是将小阴唇去除缝合,而第三b则处理外阴唇[n 5]。此作法常见于位于非洲东北部的吉布提、厄立垂亚、埃塞俄比亚、索马里和苏丹(不包含南苏丹)。数据估计之变化:根据一篇2008年的研究,超过800万非洲女性有此经历[n 6]。根据联合国人口基金会于2010年的调查显示,20%接受女阴残割的女性被施行缝阴手术[50]

专业助产士卡姆福特·莫莫英语Comfort Momoh如此描述锁阴手术:“年长女性和亲友们会将女孩调整至切石卧位英语Lithotomy position。之后她们会快速地深切两侧的阴蒂根部,直至小系带。之后再使用剃刀直接切除大小阴唇。”[51]在索马里,女孩的阴唇被切下之后,会被拿给年长女性,以确认手术是否完全[52]

确认之后,执刀者会在伤口中插入物品(如树枝),为女性的阴部留下一个 2-3 mm 的开口,供经血和尿液排出[n 7][54],并以手术用缝线(也可能是龙舌兰金合欢属植物的刺)缝合外阴。有些手术者会在伤口敷上药膏,药膏可能是以生蛋、药草或是砂糖等调配而成[55]。为了帮助伤口愈合,女孩的双脚会被捆绑起来(通常是从髋部绑到踝部)。捆绑的时间不一定,通常一周后会放松,两周后会完全解开,有些则可能长达六周[56]

专业助产士卡姆福特·莫莫英语Comfort Momoh 亦曾如此描述:

(阴道开口处)是由鼓膜般的皮肤延伸覆盖外阴处所余之小孔。在执行切除的情况下,女孩多半会被牢牢固定住,但亦可能因剧烈挣扎,导致切口不受控制或杂乱无章;甚至可能因挣扎时用力过度而骨折或脱臼。[51]

若女孩的家人认为锁阴手术后留下的开口太大,会再进行锁阴手术[57]。阴部的洞会在结婚后为了性交而开启,第一次可能是助产士用小刀先割开,也有可能是她的先生直接用阴茎顶破。在包括索马里兰在内的一些国家,新郎及新娘的女性亲友会观看新娘阴部的开口,以确认她婚前未进行过性行为[58]。心理学家洪尼莱特富特 - 克莱因(Hanny Lightfoot-Klein)在1980年代采访过上百对苏丹的女性及男性,访问有关接受锁阴手术后的性行为:

若新娘已进行过锁阴手术,新郎想直接用阴茎顶破锁阴手术处,插入阴道进行性行为,以一般夫妻行房的频率,约需要三至四天至数个月不等。有些男性因为锁阴手术,完全无法进行阴道插入式性行为(在我的研究中,约占15%),一般会由助产士进行手术切开,不过因为这反映男性的性能力较弱,因此会在非常秘密的情形下进行。有些无法进行插入式性行为的男性,即使在锁阴手术的开口未打开的情形下,仍设法要让妻子怀孕,若妻子怀孕了,其阴部的开口会切开以便分娩。有些(也许是所有)有这类情形的男性会用小刀协助打开妻子阴部的开口,过程中会疼痛,因为其阴部是渐渐撕裂越来越多,直到开口处可以让阴茎插入为止。[59]

女性在分娩时阴部被再次打开,分娩后再将之缝合,此过程称为去缝阴手术和再缝阴手术。再缝阴手术包含再次剪开阴道来重建回第一次缝阴手术保留的那针孔大小的阴道口。此手术大约在婚前、分娩后、离婚和丧偶时执行[n 8][61]

第四型[编辑]

女性器切除类型四

世界卫生组织定义第四型为“所有其他对女性外生殖器有害的的非医疗性行为”,包括刺入、刺穿、切割、刮除和烧灼。[2]它包括切割阴核(象征性的割礼)、烧灼或使阴部有疤痕,和植入物体到阴道使之更紧。[62]阴唇牵拉英语Labia stretching也归类为第四类。[63]常见于非洲南部和东部,此法是为了增强男性的性快感,而添加一种封闭空间感于女性。从八岁开始,就鼓励女孩使用棍棒和按摩伸展其小阴唇。乌干达女孩被教育若无伸展阴唇则很难分娩。[n 9][65]

世界卫生组织在1995年针对女阴残割的定义有包括在尼日及尼日利亚进行的吉西里切割英语gishiri cutting[n 10](gishiri cutting)或安古利亚切割(angurya cutting)。因为有关其发生率及程序资讯的不足,世界卫生组织2008年的定义中已不包括这些方式[63]。吉西里切割是为了处理不孕及难产等几种问题,用刀片切割阴道前壁或后壁。在尼日利亚医生马里奥·乌斯曼·曼达拉(Mairo Usman Mandara)的研究中,进行过吉西里切割的女性,超过30%会有膀胱阴道瘘的问题。安古利亚切割是将处女膜切除,会在出生后第七天进行[66]

并发症[编辑]

短期及后续[编辑]

印尼的女阴残割相关照片
—— — Stephanie Sinclair, 纽约时报[67]

女阴残割对女性一生的身体及情绪健康都是有害的[68][69],对于健康没有任何已知的帮助[70] 。其短期及后续的并发症和进行的女阴残割种类,施行者是否有手术经验,是否有用抗生素丶用未消毒的手术器材或是医疗用的单次使用器材有关。若是进行锁阴手术,后遗症的严重程度有许多影响因子,包含手术后所留下的孔穴大小、缝合是用手术用缝线还是植物的刺,以及程序是否进行不只一次(例如因为留下的孔穴太大而重新缝合,或是因为留下的孔穴太小而再开启一个孔穴)等[13]

手术后的常见并发症包括肿胀、出血过多、疼痛、尿滞留,或伤口感染。2015年的一份采集了56篇研究的回顾文章中提到,逾十分之一的女性在女阴残割后发生了上述的并发症,其中的女阴残割甚至包括象征性的阴蒂切口(第四型),不过第三型的风险仍是最高的,报告也中认为此结果可能有低估[71]。其他短期症状包括致命的大量出血、贫血泌尿道感染败血症破伤风坏疽坏死性筋膜炎(细菌将组织"吃掉")及子宫内膜炎[69][72][13]。因为这类的并发症可能没有识别或是汇报,因此不确定有多少名女性因为这些并发症而死亡[73][74]。手术者可能会用同一套器具为不同的人进行手术,这可能也会造成乙型肝炎丙型肝炎HIV]的扩散,不过还没有流行病学的研究可以证实这一点[74]

后续的并发症因女阴割残的类型不同而异[13]。。并发症包含导致难产的疤痕和蟹状瘤英语Keloid、受感染的表层状囊包,也会影响阴蒂相关的神经增生英语Neuroma[75][76]。受到阴户缝合的女生可能会在阴户留有2-3mm的孔洞,这个洞会造成解尿迟缓、滴尿、小便时疼痛英语Dysuria,以及频尿等症状。尿液可能会在伤痕下聚积,造成皮肤底下长年潮湿,有可能会导致感染以及结石。有性行为或自然产的妇女在阴户上会有较大的孔穴,但还是会因为伤痕组织而造成尿道开口受阻难产。可能会出现膀胱阴道瘘直肠阴道瘘(也就是阴道和尿道之间或是直肠和阴道之间有异常通道)[13][77]。这些损害以及其他对尿道及膀胱的伤害可能会造成感染、尿失禁性交疼痛不孕[75]

由于月经期产生的经血淤塞、滞留在阴道和子宫而造成的痛经也很常见。如果阴道完全堵塞,会造成阴道积血子宫积血英语Hematometra[13]。由于经血淤积造成的腹部肿胀和不来月经,使女孩看起来像是怀孕。雅斯玛·艾尔·达理尔(Asma EI Dareer)医生在1979年报告,一名有上述症状的年轻苏丹女孩被其家人所杀[78]

怀孕与生产[编辑]

照片的连结
—— — Nahid Toubia, RAINBO, 1999[79]

女阴残割会提高女性在怀孕及生产时的风险,女阴残割的普及率越高,这部分越明显[13]。接受锁阴手术的妇女会为了使生产容易一些,会在怀孕期间吃的较少,以减小胎儿的体积[80]。若女性有膀胱阴道瘘或是直肠阴道瘘,很难在产前检查中采集到纯淬的尿液检体,因此更不容易诊断出妊娠毒血症[75]。在分娩时无法进行宫颈评估,可能会造成滞产难产。锁阴手术的妇女更常出现三度撕裂伤,肛门括约肌损伤及紧急的剖宫产[13][81]

女阴残割也会提高新生儿死亡的比例。世界卫生组织在2006年针对非洲部分地区统计,在统计每一千名出生的新生儿中,就有10至20个新生儿死亡是因为女阴残割造成。此 统计资料是由布基纳法索、加纳、肯尼亚、尼日利亚、塞内加尔和苏丹的28个产科中心,对28393分娩妇女进行的研究。上述地区的研究发现,各种的女阴残 割都会提高新生儿死亡的风险,其中第一型女阴残割占15%,第二型及第三型女阴残割分别占32% 及55%,其原因还不清楚,但可能和性器官及泌尿道的感染以及瘢痕组织的存在所造成。研究者认为女阴残割和母亲会阴的受损及产后出血有关,也可能会让婴儿需要接受心肺复苏,甚至死产,其原因可能和分娩中,胎儿娩出的第二阶段时间过长有关[82]

心理影响、房事[编辑]

关于女阴残割造成的心理影响,根据一篇2015年发表的系统综述表明,现行几乎没有质量可靠的信息。一些小型的调查发现,受过女阴残割的女性遭受焦虑、抑郁和创伤后心理压力紧张症候群的困扰[74]。当受过女阴残割的女性离开进行割礼的文化社群,发现女阴残割并不是一种正常现象之后,她们会感到耻辱和被背叛;但如果这些受过女阴残割的女性依然留在进行割礼的文化社群中,她们会为自己受过割礼而感到骄傲,因为对于她们来说,女阴残割意味着美丽、尊重传统、和贞洁[13]

几乎没有研究探讨女阴残割对性功能造成的影响[74]。一份在2013年发表的元分析报告,在分析了15个调查、总共涵盖了来自7个国家的12,671名受过女阴残割的女性后发现,受过割礼的女性感到毫无性欲的可能性是未受过割礼女性的两倍,而且报告性交疼痛的概率高52%。一共有1/3的调查者报告性欲减退[83]

分布[编辑]

盛行率[编辑]

Prevalence in 15–49 age group
map
29个女阴残割比例较高的国家中,15至49岁女性接受女阴残割的比例(联合国儿童基金会2014年资料)[6]也参考非洲地图.
graph

女阴残割的盛行区域位于非洲,东迄索马里,西至塞内加尔,南至坦桑尼亚、北至埃及。政治科学家Gerry Mackie英语Gerry Mackie称此区域为“令人感兴趣的连续区”(intriguingly contiguous[84]。截至2014年年 (2014年-Missing required parameter 1=month!),29个盛行国家中,已有1.3亿名女性已经接受过女阴残割。预估到2050年,此数字会随人口增加而上升至2亿[n 11]

2013年时埃及、埃塞俄比亚和尼日利亚有最多的女性与女孩遭遇女阴残割,估计分别是2720万人、2380万人以及1990万人[86](埃及于2007将女阴残割视为违法行为、埃塞俄比亚在2004年、尼日利亚则是在2015年)[87][88][8]。2014年,女阴残割在南撒哈拉地区成年女性盛行率为39%,对于14岁以下的女孩,盛行率为17%。在西非南非这个比例分别是44%与14%,西非中非为31%与17%[6]

上述的资料是由人口与健康调查组织英语Demographic and Health Surveys(DHS)的家户调查而来,是由Macro International所提供,资金来源主要是来自美国国际开发署多指标集调查组织英语Multiple Indicator Cluster Surveys提供,由联合国儿童基金会提供的技术及财务支援[89]。调查是在非洲、亚洲及拉丁美洲等地进行,自1984年及1995年进行,约每五年进行一次[90][91]

第一份有关女阴残割的调查是1989年至1990年由人口与健康调查组织(DHS)在北苏丹进行的调查,第一份估计女阴残割盛行率的出版物是1997年由Macro International的Dara Carr制作,根据七个国家的DHS资料整理而得[92]。联合国儿童基金会2013年根据70份调查所得的报告,指出女阴残割集中在非洲的27个国家、也门及伊拉克的库尔德族[93],在这些国家中有1.33亿位女性进行了女阴残割[4]

在上述29个国家以外,在印度、阿联、以色列的贝都因人英语Negev Bedouin有女阴残割的记录,在哥伦比亚、刚果、阿曼、秘鲁及斯里兰卡也有出现过,但不常见[94]。在约旦、沙特阿拉伯、印尼及马来西亚以及澳洲、新西兰、欧洲、斯堪的纳维亚、美国及加拿大的移民群体也有这类的情形[n 12][96]

种族[编辑]

不同种族的盛行率
—— — UNICEF 2013[97]

在有女阴残割的国家中,多半不是所有女性接受女阴残割,而是会随着种族而不同[98]。例如在伊拉克,女阴残割主要是出现在库尔德人中,分布在阿尔贝拉(15至49岁的当地库尔德女性有58%接受女阴残割)、苏莱曼尼亚(54%)及基尔库克(约20%),全国接受女阴残割女性比例有8%[99]

有时女阴残割是一个种族的标志,但有时也会随所在家而不同。埃塞俄比亚和肯亚的东北部邻近索马里。在这三个国家索马里人女阴残割的比例相近[100]。不过根据2012年的问卷,所有几内亚的富拉尼人女性都有进行女阴残割[101],在查德的富拉尼人只有12%进行过,而在尼日利亚,富拉尼人是唯一不进行女阴残割的主要族群[102]

中东的库尔德地区也广泛存在女阴残割的行为,2011年6月,伊拉克库尔德三省将女性割礼和家庭暴力列入刑事犯罪,这是个具有里程碑意义的法律,但始终无法获得有效实施。在伊拉克北部库尔德三省,享有很大的自主权,库尔德当地人平均寿命特别是女性也比伊拉克其他省份要好。但在当地有切割女性生殖器官的传统。据德国非政府组织2010年的对当地1700名妇女的调查中发现在埃尔比勒苏莱曼尼亚两个省份中72.7%的女性都被切割了生殖器,某些地区几乎100%。此外许多库尔德女性由于畏惧强奸荣誉谋杀而自愿将下体缝合,部分人甚至选择切除输卵管并将下体完全缝合,终身不嫁。[103]

地区、经济能力及教育程度[编辑]

研究发现女阴残割较常出现在乡村地区,最富裕家庭的女性进行女阴残割的比例较少。大部分国 家中,若女性接受小学或小学以上的教育,其女儿接受女阴残割的比例会较少,但苏丹及索马里例外,索马里女性若接受中学或中学以上的教育,她的女儿接受 女阴残割的比例反而会增加。在苏丹境内,女性只要有接受教育,女儿接受女阴残割的比例就会上升[104]

女阴残割的种类[编辑]

在问卷中,以下是有关女阴残割种类的问题[105]

  • 女阴部位是否只穿孔或切割,但没有切除性器的任一部位?
  • 女阴是否有割除任何部位?
  • 女阴部位有缝合(锁阴手术)吗?

大部分有受过手术的女性会回答:"切除部分部位",属于WHO分类的第1类及第2类[44]。第1类及第2类在埃及都有人进行[n 13]Mackie在2003年提出第2型比较常见[107],而2011年的一份研究指出第1型比较常见[108]。在尼日利亚南部较常看到第1型,北部则是更严格的女阴残割[109]

第3型(锁阴手术)集中在非洲东北部、特别是吉布提厄立特里亚索马里苏丹[110]。在2002年至2006年的问卷中,吉布提进行过女阴残割的女性中,有30%是进行锁阴手术,在厄立特里亚和索马里分别是38%及63%[111]。在尼日及塞内加尔的女性进行锁阴手术的比例也比较高[112]。。2013年在尼日利亚14岁以下的女童中,估计有3%有进行锁阴手术[113]。在厄立特里亚,这类的手术和其种族有关,例如2002年有一份统计指出,所有Hedareb族英语Hedareb的少女都进行了锁阴手术,而提格里-提格利尼亚族英语Tigray-Tigrinya people只有2%,她们大部分是进行“只切割,没有切除性器任一部位”的女阴残割[114]

进行女阴残割的年龄[编辑]

年龄范围
—— — UNICEF 2013[5]

女阴残割不一定是从女孩变为女人之间的成年礼,不过常常在女儿年龄较小时进行[115]。女性一般是在刚过15岁之后进行[5]。在一些国家有相关的统计数据,其中有一半的国家其女性是在约五岁时进行女阴残割[5]。在尼日利亚、马里、加纳及毛里塔尼亚有进行女阴残割的女性中,有80%是在五岁前进行女阴残割[116]。1997年也门的人口及健康统计指出76%的女婴是在出生后二周就进行女阴残割[117]

在索马里、埃及、查德及中非共和国的情形则所有不同,进行女阴残割的有80%是在五岁至十四岁之间进行[116]。女阴残割的种类和种族有关,平均年龄也是,在肯亚,Kisi族英语Kisi people平均在十岁进行女阴残割,坎巴族则是在十六岁[118]

盛行率的变化[编辑]

根据UNICEF 2013年的调查,在29个国家中比较15至19岁和45至49岁女阴残割的比例,有一半的国家呈现下降的趋势[119]。女阴残割比例很高的国家,其变化不大,但原本女阴残割比例就较低的国家,其比例正在下降,或者采用较轻微的方式[120]。根据UNICEF 2014年的资料,女孩接受女阴残割的比例较30年前低了1/3[121]

graph
Togo和贝宁在0至14岁的女阴残割比率(UNICEF,2014年11月)大约巳降至0[6],其他UNICEF的报告中,这些国家此年龄的实施比率为0.4%和0.3%[122]

回应有关女阴残割问卷的女性,是表示她们之前是否有进行过女阴残割,因此15岁到49岁的发生率不表示目前的趋势[123]。UNICEF以15岁到49岁为基准,因为14岁以下的女孩都有后续会进行女阴残割的风险[n 14]。另一个造成发生率判断上的困扰是在反对女阴残割的国家,母亲比较不会说自己的女儿其实已进行了女阴残割[124]

在2010年时DHS及MICS的问卷开始问妇女她们的女儿是否有进行女阴残割[[125],问卷指出0–14岁女阴残割发生率最低的是在贝宁的0.3%(15至49岁比率为7%),最高的是马里74%(15至49岁比率为89%)[6]

埃及在2008年至2010年之间有进行一项研究(埃及在2007年法律禁止女阴残 割,2008年视为犯罪行为),针对索哈杰基纳大学医院中的4158名女性以及5岁至25岁的女孩进行有关女阴残割的问卷。研究者指出 在埃及以第1型的女阴残割最为常见。在2000至2009年之间,受访者有3711个已进行了女阴残割,比率达89.2%[n 15]。2000年进行女阴残割的比率有9.6%,在2006年开始下降,2009年下降到7.7%。在2007年后大部分的女阴残割是由一般的外科医生进行,研究者推测这是因为女阴残割视为犯罪行为,妇产科医生不愿意执行,因此改由一般外科医生进行[108]


原因[编辑]

女性的支持[编辑]

索马里的女诗人Dahabo Musa在其1988的诗中将锁阴手术描述为“三次女性的伤痛”:锁阴手术本身、在新婚的初夜将阴部打开、在分娩后再将阴部缝合[126]。虽然有明显的痛苦,但在有女阴残割习俗的地区,都是女性在组织管理包括锁阴手术在内的各种的女阴残割。人类学家 Rose Oldfield Hayes在1975年提到住在城巿的受教育男性不希望其女儿接受锁阴手术(比较倾向接受阴蒂切除术),但可能某一天他的母亲安排亲戚来访,也就帮孙女作了锁阴手术[127]。Gerry Mackie比较女阴残割及缠足。缠足和女阴残割有些类似,都是因为荣誉、女性贞节、认为对婚姻有益,也都是受到其他女性长辈的支持[n 16]

图 1996年普立兹普立兹特写摄影奖
—— — Stephanie Walsh, Newhouse News Service[129]

实现女阴残割的人认为女阴残割主要是表示性别的差异,依此观点,女阴残割是对女性的去男性化,而男性的割礼是对男性的去女性化[130]Fuambai Ahmadu英语Fuambai Ahmadu狮子山科诺族英语Kono people的人类学家,在进入桑德社群英语Sande society时接受了阴蒂切除术,作为成人的象征。她认为强调阴蒂在女性性机能中重要性的想法是男性中心的假设,非洲的女性符号是子宫的受孕[131],锁阴手术强调封闭及受孕的概念。加拿大人类学家Janice Boddy提到:“阴蒂切除完成了孩童性器官的社会定义,去除了外在轮廓上的雌雄同体。因此女性的身体是被包覆的、封闭的,有生育能力的血液封闭在其中,而男性的身体是不隐藏的、开放的,暴露的。”[132]

在习惯进行锁阴手术的族群中,一般会希望女性的生殖器是光滑、干燥、无气味的,不论男性或女性都会排斥自然正常的外阴[133]。男性似乎会享受用阴茎将锁阴部位顶开的成果[134]。由于进行过锁阴手术的外阴较光滑,这些族群也认为锁阴手术有助于清洁卫生[135]。女性会为了减少阴道润滑而在阴道中塞入树叶、树皮、牙膏等物品。世界卫生组织将这类的行为归类在第4型女阴残割中,因为这些在性交中增加的摩擦会造成破皮,也会提高感染的风险[136]

在问卷中女性支持女阴残割的常见理由包括社会认同、宗教、清洁卫生、保持贞节、适于结婚及增加男性的性快感[137]。在一份1983年发表,针对北苏丹的研究中指出,3210名女性中只有558人(17.4%)反对女阴残割,赞成的人赞成阴唇切除及锁阴手术过于阴蒂切除术[138]。不过女性的态度也在慢慢改变。2000年时苏丹有42%知道女阴残割的女性认为此作法需继续实施[139]。在2006年时,在马里、几内亚、狮子山、索马里、冈比亚及埃及有超过50%的女性认为应该继续女阴残割,而在非洲其他地区、伊拉克及也门的大部分女性认为不应该再进行女阴残割,不过在一些国家中,赞成和反对的比例其实差距不大[140]

社会规定[编辑]

photograph
Molly Melching在在2007年于塞内加尔举行的禁止女阴残割十周年纪念会

针对那些愿意为其女儿进行女阴残割的女性,联合国儿童基金会认为这是:“自我执行的社会习俗”,这些家庭认为需要遵守,以避免没进行女阴残割的女儿遭到社会的排斥[141]

美国人类学家Ellen Gruenbaum在1970年代研究指出,阿拉伯人中已接受女性残割的女孩会嘲笑哪些没有接受女性残割的哲尔马英语Zabarma people女孩:“嘿!脏鬼!”(Ya, Ghalfa!),哲尔马女孩会反讽他们“mutmura”(mutmura是一种谷仓,常需要打开及关闭,就像接受锁阴手术的女性一样)。不过她们仍会感受到压力,回去会问母亲说:“怎么回事!我们没有像阿拉伯人一样的小刀(可以进行锁阴手术)吗?”[142]

由于相关的医学资讯的不足,也因为施行女阴残割者会对女阴残割的后果加以淡化,因此,女性不会将其身体健康的情形和女阴残割联想到一起。拉拉·白尔德(Lala Baldé)是塞内加尔梅迪纳·谢里夫村(Medina Cherif)的女性组织领袖,她在1998年告诉Mackie说,当女孩们生病甚至死亡时,会归因于邪灵的影响。当其他女性知道女阴残割和健康恶化之间的因果关系时,她们崩溃痛哭。他认为在提供这些资讯前后的调查,可以看出对女阴残割的支持程度有非常明显的变化[143]

1991年由Molly Melching成立的美国非营利组织Tosta英语Tostan在许多国家提出了社区赋权方案,着重在识字、卫生相关教育及地区的民主,让女性可以做自己的决定[144]。1997年Malicounda Bambara配合Tostan方案,成为第一个废止女阴残割的村庄,在2014年在八个国家已有超过七千个社群放弃女阴残割和童婚[145]。有一个联合国人口基金会和联合国儿童基金会的联合计划2014年为止已在非洲十五个国家进行,也是依相同的方式进行[141]

宗教[编辑]

photograph
塞内加尔的Keur Simbara地区,在三年Tostan的计划后,在1998年禁止女阴残割[146]

问卷发现非洲有许多人认为女阴残割是宗教上的要求,特别是在马里,茅利塔利亚,几内亚及埃及等国家,有此想法的人特别的多[147]。格林鲍姆(Gruenbaum)提到当地的人不太会区分此实务是出于宗教、习俗还是贞操,因此不太容易说明这数据进一步的意义[148]在一个联合国人口基金联合国儿童基金会合作的计划案中,在2008年到2013年间,有20941位宗教领袖及传统领袖公开说明女阴残割和宗教无关,宗教领袖发出了2898篇宗教敕令,反对女阴残割[149]


虽然女阴残割最早出现在东北非的时间是在伊斯兰教之前,不过因为伊斯兰教强调女性的贞操及隔离,因此此一实务开始认为和伊斯兰教有关[n 17]。在可兰经中没有提到女阴残割,在数篇圣训(一般认为是记录穆罕默德的言行录)中赞赏这种行为,认为是高贵的,但不是必须的,其中也有建议使用较温和的方式,对妇女比较仁慈[n 18][152]。。2007年在开罗举行的艾资哈尔大学伊斯兰研究最高委员会中认定:“女阴残割在核心伊斯兰教法及其他部分规定中都没有依据。”[153][n 19] 也有泛灵论的族群进行女阴残割,特别是在几内亚及马里。也有基督徒进行女阴残割的情形[155],例如在尼日,约有55%的基督徒妇女及女孩进行了女阴残割,而穆斯林族群中只有2%[156]圣经上只提到男性的割礼,没提到女阴残割,而到非洲的宣教士是最早反对女阴残割的一群人之一[157]。非洲的犹太教族群中只有埃塞俄比亚的贝塔以色列人有进行女性器切除。犹太教要求男性实行割礼,反对女阴残割[158]

历史[编辑]

古代[编辑]

咒语1117

“如果一个人想要知道如何生活,必须使用来自未受女阴残割女子['m't]的b3d(埃及象形文字代号,含义未知)和未受割礼的秃头男子的皮屑 [šnft]摩擦全身,并每日覆诵之(一段咒语)。”

————来自埃及棺木上的一段铭文,公元前1991-1786[159]

现在不清楚女阴残割的起源[160]。Gerry Mackie根据女阴残割的分布,猜测这是起源自麦罗埃文明和帝国的一夫多妻制,这是在伊斯兰教兴起之前,为了增加父亲的信任[161]

根据历史学家Mary Knight的研究,古埃及棺材文本英语Coffin Texts中的咒语1117用圣书体提到一名未受女阴残割的女子('m't):

a m a
X1
D53 B1

上述的咒语出现在Sit-hedjhotep的石棺中,石棺现在在埃及博物馆,大约是埃及中王国时期的产物(Paul F. O'Rourke认为'm't 可能反而是指一个受女阴残割的女子)[162]

大英博物馆中有一份公元前163年的希腊文莎草纸,上面提到一个应该已经被女阴残割(但其实没有进行)的埃及女孩Tathemis:

在这件事之后,Nephoris(Tathemis的妈妈)骗我,而且开始焦虑,因为依照埃及人的习俗,那时应该是Tathemis要接受割礼的时候。她要我给她她1300银币,好帮Nephoris买衣服并且准备她的嫁妆。若她在第18年(公元前163年)的Mecheir月时,二项没有都达成,或是Tathemis没有进行割礼,她要立刻赔给我2400银币[163]

澳洲病理学家 Grafton Elliot Smith在二十世纪初检查了上百具木乃伊,指出无法从木乃伊找到进行女阴残割的证据。由其阴部来看,像是第三型的女阴残割,因为在制作木乃伊的 过程中,大阴唇的皮肤被拉到肛门处以覆盖阴裂,可能是为了避免性暴力。因为软组织可能被尸体防腐者除去或是已被腐化分解,因此也无法确定是否有进 行过第一型或第二型的女阴残割[164]

斯特拉波

有一个埃及人热切遵行的习俗:举起每一个刚出生的婴儿,为其进行男性割礼[peritemnein]或女性割礼[ektemnein]nbsp;...

——-斯特拉波,Geographica,公元前25年[165]

希腊地理学家斯特拉波(公元前64年至公元23年)在公元前25年造访埃及后,写下了有关女阴残割的描述(如右)[n 20][n 21]。哲学家斐洛(公元前20年至公元50年)也写道:“埃及人依照其国家的习俗,会在十四岁的少年及少女举行割礼,那时少年已开始有精子,少女也开始有月经。”[168]有一份认为是希腊医师盖伦写的文章中也有提到:“当年轻女性的阴蒂大幅度伸出时,埃及人会认为应该将其切除。”[169]

另一位希腊医生阿弥陀的埃提乌斯英语Aëtius of Amida(第 5世纪中至第6 世纪中)在其"Sixteen Books on Medicine"中的第16本中,引用了医生Philomenes的话。当阴蒂长的太大,或是当和衣服磨擦时会引发性冲动时,就会进行女阴残割。埃提乌斯说:“这种情形下,埃及人似乎认为在阴蒂大幅变大之前切除会比较妥当,尤其是少女快要嫁人的时候。”

手术是以这样的方式进行:少女坐在椅子上,一个充满肌肉的少年站在她后面,手臂在少女的大腿下面,让少女的腿分开,并且稳住身体及腿。医生站在少女前面,用左手的泛口钳夹住少女的阴蒂,并且往外拉,右手从钳夹住的点割下阴蒂。

阴蒂不会完全切除,会保留部分的组织,长度大约会和鼻孔相当。手术只是为了切除过多的组织。因为阴蒂是类似皮肤的组织,若割除太多,怕会出现尿瘘的情形[170]

接下来会用海绵、乳香粉、酒或冰水清理外阴道,然后用浸满醋的亚麻绷带包扎至第七天,接着使用炉甘石洗剂、玫瑰花瓣、枣核或是“烤过黏土制成的阴部涂抹粉末”[171]

缩阴手术的起源不明,但后来演变成和奴隶有关。Mackie曾引述葡萄牙宣教士 João dos Santos英语João dos Santos在1609年提到摩加迪休群岛上人们的文字:“他们的习俗㑹将女性(的阴部)缝合,特别是年轻的女奴,使她们无法生育,也让女奴 比较好卖,一方面是贞节,也有助于主人对她们的信任。”英国的探险家威廉·乔治·布朗英语William George Browne在1799年也写到埃及人会进行女阴残割,而且会为女奴进行锁阴手术以避免怀孕[172]。Mackie认为是:“一项和女奴有关的手术变成了荣誉的象征。”[173]

欧洲及美国[编辑]

portrait
艾萨克·贝克·布朗英语Isaac Baker Brown“只要他找到机会,就会动手切除阴蒂。”[174]

19世纪欧洲及美国的妇产科医生用切除阴蒂的方式来治疗精神错乱及女性的自慰[175]。英国医生罗伯特·托马斯在1813年建议用切除阴蒂来治疗色情狂[176]。第一个有记录的西方切除阴蒂是记载在1825年的《柳叶刀》杂志上,是1822年在柏林由卡尔·费迪南德·冯·格雷夫英语Karl Ferdinand von Graefe进行,是对一位十五岁,自慰过度的女性所施行的手术[177]

艾萨克·贝克·布朗英语Isaac Baker Brown是英国的妇产科医生,伦敦医学会英语Medical Society of London的主席,也是1845年伦敦圣玛丽医院的共同创办人,他相信自慰,或是“对于阴蒂的不正常刺激”会造成耻骨神经末梢的兴奋,会造成歇斯底里、脊髓刺激、痉挛、白痴、癫狂甚至死亡”[178]。依照在1873年《医疗时报公报》中讣闻中提到内容,“只要他有机会,就会动手切除阴蒂。”[179]布朗医生在1859年到1866之间进行了多次的阴蒂切除手术。他后来发表了《对女性某些形式的精神错乱,癫痫,僵住症,和歇斯底里的可治愈性》(1866年),伦敦的医师指责他是骗子,并将他赶出伦敦产科协会英语Obstetrical Society of London[180]

美国的J.·马里恩·西姆斯延续了布朗医师的研究,在1862年在一名女性病患主诉经痛、抽搐和膀胱问题后,切开其子宫颈,并且切除阴蒂,“用布朗医师建议的方式来缓解紧张及歇斯底里的状态。”[181]。在同一世纪,纽奥兰的外科医生A. J. Bloch因一名二岁的女童持续性的自慰,切除其阴蒂[182]。依照1985年产科和妇科调查的论文,1960年代美国还有用切除阴蒂来治疗歇斯底里,色情狂和女同性恋[183]

反对声浪[编辑]

肯亚宣教士及殖民政府的反对[编辑]

Muthirigu

小刀在鞘中
他们会和教会对抗
时候到了
(教会的)长者啊
当肯雅塔来的时候
他会给你们女生的衣服
你们要为他作饭

——— Muthirigu (1929),
基库尤人舞蹈时的歌曲,对抗教会对于女阴残割的反对[184]

二十世纪初,约翰·阿瑟英语John Arthur加入在英属东非(现今肯亚)基库尤的苏格兰福音会(CSM)服事,新教传教士当时就开始反对女性割礼的活动。基库尤人是肯亚的主要族群,他们称男生及女生的割礼为irua,男性是割除包皮,女性则是类型二的女阴残割(部分或全部切除小阴唇),这是基库尤人重要的族群记号,没有实行割礼的女性称为irugu,会被逐出社群之外[185]

乔莫·肯雅塔基库尤中央联盟英语Kikuyu Central Association的主席及1963年起的首任总理,他在1938年提到,对于基库尤人而言,女性割礼的规定:"是整个部落法律、宗教及道德中,不可缺少的条件(conditio sine qua non)。"没有一个正常的基库尤人会和没有行割礼的人发生性关系或结婚。女性对部落的责任从她的成年礼开始。她在部落历史中的记录会从这一天开始,部落会依当时的事件为受割礼的女性命名,这是基库尤的口头传统,让基库尤人可以追溯上百年前的人物及事件[186]

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宣教士Hulda Stumpf(左边下方)因为反对女阴残割,在1930年在基库尤被谋杀。

1925年起,苏格兰福音会开始宣布非洲的基督徒禁止进行女阴残割,许多非洲的宣教机构也有类似的声明。苏格兰福音会宣布进行女阴残割的非洲人会被逐出教会,因此有上百人离开教会或是被赶出教会[187]。这样的对峙使得女阴残割成为肯亚独立运动的焦点,肯亚在1929年至1931年有 1929年至1932年肯亚反对女阴残割运动英语Campaign against female genital mutilation in Kenya in 1929–32[188],殖民政府及教会反对女阴残割,而基库尤人反对殖民政府及教会的作法。

929年肯亚宣教协会开始认为女阴残割不是割礼,而是"对女性的性残害",而个人是否进行女阴残割也就代表他忠于基督教会或是忠于基库尤中央联盟英语Kikuyu Central Association[189]。Hulda Stumpf是非洲内地会英语Africa Inland Mission的美国宣教士,在她协助成立的女子学校中反对女阴残割,在1930年被谋杀。肯亚总长爱德华·格里格告诉肯亚殖民地办公 室说,凶手试图要为Stumpf进行女阴残割[190]

1956年时梅鲁族长老协会(Njuri Nchecke)宣布禁止女阴残割,之后的三年内,数千名少女用小刀为彼此进行女阴残割。这个活动在梅鲁族称为Ngaitana(我要为自己进行女阴残割),因为避免让朋友知道她们已经进行了女阴残割。历史学家莱恩·汤玛斯将这个视为是女阴残割历史中的重要内容,因为清楚的看出女阴残割的受害者也成为了加害者[191]

反对声浪持续扩大[编辑]

photograph
纳瓦勒·萨达是一位批评女阴残割的非洲女权主义者。

1920年代在埃及展开反对女阴残割的活动,这是目前已知第一场不是由殖民政府或是传教士发起的反对女阴残割活动,当时埃及医师社群号召禁止女阴残割[192],同时苏丹的宗教领袖及英藉妇女也发起的平行的活动。苏丹在1946年禁止锁阴术,但这条法律并不盛行也鲜少强制执行[193][n 22]。埃及政府在1959年在州营医院禁止锁阴术,但却允许在双亲要求下执行部分阴蒂切除术[195][n 23]

联合国在1959年要求世界卫生组织调查女阴残割,但世界卫生组织回应这不是医疗相关议题[196]。女性主义者在1970年代开始提出此一议题[197]。埃及医生纳瓦勒·萨达在1972年出版的《Women and Sex》中批评女阴残割,这本书在埃及是禁书,她也因为失去了公共卫生总干事的工作[198]。她在1980年出版的《The Hidden Face of Eve: Women in the Arab World》中的 "The Circumcision of Girls" 一节中描述她自己在六岁时接受阴蒂切除术的情形:

我不知道他们从我身上切除了什么,我没有去找。我只是哭,向我的妈妈呼唤求助。但最令人惊吓的是我环顾四周,发现她就站在我身边,是的,就是她,我没有弄错,身为我的妈妈,站在这一群陌生人之间,和他们微笑及说话,就好像他们几分钟前没有参与杀害她女儿的行动一样[199]

1975年时,美国社会科学家罗斯·欧德菲尔德·海耶斯(Rose Oldfield Hayes)发表女阴残割相关记录,她是第一位发表这类记录的女性学者,她是在和苏丹的女性直接讨论此议题后,所得到的资料。她在《美国民族学家》期刊发表的论文中,称这种习俗为“女阴残割”(female genital mutilation),带来学术界更广泛的注意[200]

四年之后的1979年,奥地利裔美籍的女性主义者弗兰·霍斯肯英语Fran Hosken出版了《霍斯肯报告:女性生殖器及性器官残割(The Hosken Report: Genital and Sexual Mutilation of Females)》(1979)。霍斯肯在此本著作中估计,全球约有110,529,000名女性实施过女阴残割,分布于20个非洲国家[201]。这是第一篇提出女阴残割实施人数的文献,该数据虽为估计值,但后来进行的几次调查也大略符合此数字。Mackie认为霍斯肯的著作虽然对于数据与资料来源稍嫌不严谨,但唤醒世界对于此议题的重视[202] 。霍斯肯用“男性暴力的训练场”来描述女阴残割,将其中女性的参与者称为是“参与了毁灭同类的活动”[203]。这段话造成西方及非洲女性主义者之间的冲突。联合国在1980年7月于哥本哈根举行的十年中期会议,非洲女性主义者就杯葛其中一个以霍斯肯为主题的会议[204]

在1979年,世界卫生组织在苏丹喀土木举办“传统习俗影响妇女与孩童健康研讨会”,1981年巴拜克巴德里妇女研究科学协会英语Babiker Badri Scientific Association for Women's Studies(BBSAWS)也在喀土木举办了三天的研习营“携手对抗女性割礼对女性造成的残疾与危害”(Female Circumcision Mutilates and Endangers Women – Combat it!) 。活动结束后有150位学者与活跃人士签署,宣示对抗女阴残割。另一个巴拜克巴德里妇女研究科学协会在1984年举办的研习营,其中邀请国际社群,签署给联合国的联合声明。签署者同意他们在联合声明中所写到的“女性割礼是对人权的暴力,侵犯女性的尊严,剥夺女性的性欲,并且是对于女性健康的无端羞辱。”[205]其中包括了:

  • 建议非洲女性完全根除女性割礼相关手术。
  • 禁绝所有实务上有关女阴残割的信仰内涵,如将切除阴蒂视为“圣训”等等。
  • 应设计替代仪式,现在一般会称为"替代式成人礼"[206]

泛非洲影响妇女及儿童的传统医疗实务协会(The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children)1984年成立于塞内加尔达喀尔,此协会呼吁中止女性割礼这项习俗,1993年在维也纳举办的联合国世界人权会议英语World Conference on Human Rights也提出类似诉求。这次会议将女阴残割列为对妇女的暴力行为,并认定此议题是违反人权的议题,不只是医学议题而已[207]。在1990年代到2000年年代,非洲政府严惩或是限制女性割礼。在2003年七月,非洲联盟批准了马普拖协议英语Maputo Protocol中关于女权的部分,支持禁绝女阴残割[208]。截至2015年,27个实行女阴残割的非洲国家中,至少有23个通过禁止法令,不过少数国家仍未完全禁止[n 24]

联合国[编辑]

照片
玛丽·卡罗罗·欧古鲁特英语Mary Karooro Okurut是乌干达的性别、劳动暨社会发展部长,在2014年英国政府与联合国儿童基金会于伦敦共同举办的女性高峰会上演讲

联合国大会 于1993年12月提出的包含女阴残割在内 48/104 条文内的提案,也就是消除对妇女的暴力行为宣言。联合国在2003年起,将2月6日订为女阴残割国际零容忍日英语International Day of Zero Tolerance to Female Genital Mutilation[211]。同年,UNICEF开始推广以Gerry Mackie发展的实证性社会规范方法英语social norms approach评估介入行为。Gerry 在对于中国如何放弃缠足的习俗研究中,利用赛局理论推估社群究竟如何取得最终共识,而UNICEF也利用此一研究的基础来进行分析FGM[212],并于2005年,在佛罗伦斯因诺琴蒂研究中心英语Innocenti Research Centre首次发表相关研究[213]

2008年,联合国人权事务高级专员办事处等多个联合国组织在内,共同发表了一份声明,认定女阴残割是对人权的侵犯[214]。在2012年12月时,联合国大会通过67/146号决议,要求致力消除女阴残割的恶行[19]。而在2014年7月联合国儿童基金会和英国政府则共同主持了第一次女性高峰会,目标为结束女阴残割和童婚等习俗[215]

2007年,UNFPA 和 UNICEF 发起了一项联合计划,旨在使15岁以下少女进行女阴残割的比例减少四成,并使至少一个国家根绝该习俗。在2008年参与该计划的国家共15国,包含:吉布提埃及埃塞俄比亚几内亚几内亚比绍肯亚塞内加尔,和苏丹。隔年,布吉内法索冈比亚索马里乌干达加入;2011年,马利厄立特里亚毛里塔尼亚也加入该计划[216]。该计划的第一阶段从2008年到2013年为止,投入了近3700万美金,当中有2000亿的资金是由挪威捐献[217]。第二期则由2014年至2017年[218]

2013年的计划中已经让12,753个社区宣布不进行女阴残割,整合了5,571个关于女阴残割的先天与后天的照护预防治疗的卫生设施,并且培训了超过10万个在照护与预防女阴残割相关领域的医生,护士以及助产士。这项计划帮助了建置乌干达与肯亚的通过仪式替代方案,并在苏丹支援了早已存在的儿童保护计划的 Saleema 行动。Saleema 在阿拉伯文的意思是"完整",这个行动促使了这个名词成为对尚未施行女阴残割女性的完整表述[219]。此计划也注意到反女阴残割的执法成效薄弱,即使有进行逮捕,也会因为检查机关取证的不充份而失效[220]。因此这个计划在八个国家(吉布提、厄立特里亚、埃塞俄比亚、几内亚、几内亚比绍、肯尼亚、塞内加尔和乌干达)培训了3011人执行相关法律,并且支援相关宣传,提升当地的意识[221]

不执行女阴残割的国家[编辑]

概述[编辑]

截至2013年年 (2013年-Missing required parameter 1=month!)在非洲及中东以外的国家,已有33个国家立法禁止女阴残割[222]。由于有已进行女阴残割的移民进入澳洲、新西兰、北美及北欧国家,这些国家有些是完全立法禁止,或是只限于在已同意的成人身上进行[n 25][224]。瑞典在1982年禁止女阴残割,是第一个立法禁止的西方国家[225]。许多以往的殖民国家,包括比利时、英国、法国及荷兰也随后提出新的法案禁止,或是明确表示这已在既有的法律中[226]

北美[编辑]

加拿大政府在1994年7月给予远从索马里避难的卡德拉·哈桑·法拉赫难民身份,她离开索马里的原因是要避免她的女儿遭受女阴残割之苦,加拿大政府从此即认定女阴残割是一种对女性的迫害[227]。于1997年,加拿大政府着手修改加拿大刑法法典英语Criminal Code of Canada268条法条中的部分法条,来明定禁止女阴残割的恶行,但是不包括那些已经满18岁且不会因此造成身体伤害的女性[228]。目前,截至 2015年2月为止,还没有此类迫害事件发生[229]

美国疾病控制与预防中心(CDC)在1997年时预估,在1990年时美国有168,000位女性经历过女阴残割或是在这样的风险当中[230]。在2015年时,美国疾病控制与预防中心一份初步且未公开的报告中,预测美国大约有500,000位女性曾经历过女阴残割或是有可能经历过 [231]。在1996年的3月,一名尼日的女性成功抗议美国政府驱逐出境的命令,因为她的女儿有可能因此遭受女阴残割之苦[232]。另外,于 1996年来自多哥共和国法丽亚·卡玲嘉英语Fauziya Kasinga成为美国第一位因为逃避女阴残割而取得庇护的女性[233]。虽然,截至2006年为止,有许多联邦受理上诉的法庭主张父母亲不应该基 于害怕他们的小孩会遭受女阴残割的理由而接受庇护,尤其是那些已经成为合法住民或是美国公民的小孩[234]

脚注[编辑]

  1. ^ Claire C. Robertson, Professor of History and Women's Studies at The Ohio State University, 2002: "The Hosken Report is the single most influential document responsible for raising consciousness of FGC."[25]
  2. ^ UNICEF 2005: "The large majority of girls and women are cut by a traditional practitioner, a category which includes local specialists (cutters or exciseuses), traditional birth attendants and, generally, older members of the community, usually women. This is true for over 80 percent of the girls who undergo the practice in Benin, Burkina Faso, Côte d'Ivoire, Eritrea, Ethiopia, Guinea, Mali, Niger, Tanzania and Yemen. In most countries, medical personnel, including doctors, nurses and certified midwives, are not widely involved in the practice."
  3. ^ UNICEF 2013: "These categories do not fully match the WHO typology. Cut, no flesh removed describes a practice known as nicking or pricking, which currently is categorized as Type IV. Cut, some flesh removed corresponds to Type I (clitoridectomy) and Type II (excision) combined. And sewn closed corresponds to Type III, infibulation."[43]
  4. ^ "[There is a] common tendency to describe Type I as removal of the prepuce, whereas this has not been documented as a traditional form of female genital mutilation. However, in some countries, medicalized female genital mutilation can include removal of the prepuce only (Type Ia) (Thabet and Thabet, 2003), but this form appears to be relatively rare (Satti et al, 2006). Almost all known forms of female genital mutilation that remove tissue from the clitoris also cut all or part of the clitoral glans itself."[46]
  5. ^ WHO 2014: "Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

    "Type IIIa, removal and apposition of the labia minora; Type IIIb, removal and apposition of the labia majora."[48]

  6. ^ USAID 2008: "Infibulation is practiced largely in countries located in northeastern Africa: Djibouti, Eritrea, Ethiopia, Somalia, and Sudan. ... Sudan alone accounts for about 3.5 million of the women. ... [T]he estimate of the total number of women infibulated in [Djibouti, Somalia, Eritrea, northern Sudan, Ethiopia, Guinea, Mali, Burkina Faso, Senegal, Chad, Nigeria, Cameroon and Tanzania, for women 15–49 years old] comes to 8,245,449, or just over eight million women."[49]
  7. ^ Jasmine Abdulcadira, Swiss Medical Weekly, 2011:"In the case of infibulation, the urethral orifice and part of the vaginal opening are covered by the scar. In a virgin infibulated woman the small opening left for the menstrual fluid and the urine is not wider than 2–3 mm; in sexually active women and after the delivery the vaginal opening is wider but the urethral orifice is often still covered by the scar."[53]
  8. ^ Elizabeth Kelly, Paula J. Adams Hillard, Current Opinion in Obstetrics & Gynecology, 2005: "Women commonly undergo reinfibulation after a vaginal delivery. In addition to reinfibulation, many women in Sudan undergo a second type of re-suturing called El-Adel, which is performed to recreate the size of the vaginal orifice to be similar to the size created at the time of primary infibulation. Two small cuts are made around the vaginal orifice to expose new tissues to suture, and then sutures are placed to tighten the vaginal orifice and perineum. This procedure, also called re-circumcision, is primarily performed after vaginal delivery, but can also be performed before marriage, after cesarean section, after divorce, and sometimes even in elderly women as a preparation before death."[60]
  9. ^ WHO 2005: "In some areas (e.g. parts of Congo and mainland Tanzania), FGM entails the pulling of the labia minora and/or clitoris over a period of about 2 to 3 weeks. The procedure is initiated by an old woman designated for this task, who puts sticks of a special type in place to hold the stretched genital parts so that they do not revert back to their original size. The girl is instructed to pull her genitalia every day, to stretch them further, and to put additional sticks in to hold the stretched parts from time to time. This pulling procedure is repeated daily for a period of about two weeks, and usually no more than four sticks are used to hold the stretched parts, as further pulling and stretching would make the genital parts unacceptably long."[64]
  10. ^ gishiri”出自豪萨语,为“盐”之意。
  11. ^ UNICEF 2014: "If there is no reduction in the practice between now and 2050, the number of girls cut each year will grow from 3.6 million in 2013 to 6.6 million in 2050. But if the rate of progress achieved over the last 30 years is maintained, the number of girls affected annually will go from 3.6 million today to 4.1 million in 2050.

    "In either scenario, the total number of girls and women cut will continue to increase due to population growth. If nothing is done, the number of girls and women affected will grow from 133 million today to 325 million in 2050. However, if the progress made so far is sustained, the number will grow from 133 million to 196 million in 2050, and almost 130 million girls will be spared this grave assault to their human rights."[85]

  12. ^ UNICEF 2014: "Although no nationally representative data on FGM/C are available for countries including Colombia, Jordan, Oman, Saudi Arabia and parts of Indonesia and Malaysia, evidence suggests that the procedure is being performed."[95]
  13. ^ Mohammed A. Tag-Eldin (World Health Organization, 2008): "The most common forms of FGC still widely practised throughout Egypt are type I (commonly referred to as clitoridectomy) and type II (commonly referred to as excision)."[106]
  14. ^ UNICEF 2003: "The percentage of girls and women of reproductive age (15 to 49) who have experienced any form of FGM/C is the first indicator used to show how widespread the practice is in a particular country ... A second indicator of national prevalence measures the extent of cutting among daughters aged 0 to 14, as reported by their mothers. Prevalence data for girls reflect their current – not final – FGM/C status, since many of them may not have reached the customary age for cutting at the time of the survey. They are reported as being uncut but are still at risk of undergoing the procedure. Statistics for girls under age 15 therefore need to be interpreted with a high degree of caution ..."[95]
  15. ^ "From 2000 to 2009, 3711 of the young participants (89.2%) underwent FGM and 447 (10.8%) did not. The mean age at the time of FGM was 8.2 ± 0.9 years. About three quarters (74.3%) of the procedures were performed at home and the remaining 25.7% at private clinics."[108]
  16. ^ Gerry Mackie, 1996: "Footbinding and infibulation correspond as follows. Both customs are nearly universal where practiced; they are persistent and are practiced even by those who oppose them. Both control sexual access to females and ensure female chastity and fidelity. Both are necessary for proper marriage and family honor. Both are believed to be sanctioned by tradition. Both are said to be ethnic markers, and distinct ethnic minorities may lack the practices. Both seem to have a past of contagious diffusion. Both are exaggerated over time and both increase with status. Both are supported and transmitted by women, are performed on girls about six to eight years old, and are generally not initiation rites. Both are believed to promote health and fertility. Both are defined as aesthetically pleasing compared with the natural alternative. Both are said to properly exaggerate the complementarity of the sexes, and both are claimed to make intercourse more pleasurable for the male."[128]
  17. ^ Gerry Mackie, 1996: "FGM is pre-Islamic but was exaggerated by its intersection with the Islamic modesty code of family honor, female purity, virginity, chastity, fidelity, and seclusion."[150]
  18. ^ Gerry Mackie, 1996: "The Koran is silent on FGM, but several hadith (sayings attributed to Mohammed) recommend attenuating the practice for the woman's sake, praise it as noble but not commanded, or advise that female converts refrain from mutilation because even if pleasing to the husband it is painful to the wife."[151]
  19. ^ Maggie Michael, Associated Press, 2007: "[Egypt's] supreme religious authorities stressed that Islam is against female circumcision. It's prohibited, prohibited, prohibited," Grand Mufti Ali Gomaa said on the privately owned al-Mahwar network."[154]
  20. ^ Strabo, Geographica, c. 25 BCE: "One of the customs most zealously observed among the Aegyptians is this, that they rear every child that is born, and circumcise [περιτέμνειν, peritemnein] the males, and excise [ektemnein] the females, as is also customary among the Jews, who are also Aegyptians in origin, as I have already stated in my account of them."[166]

    Book XVI, chapter 4, 16.4.9: "And then to the Harbour of Antiphilus, and, above this, to the Creophagi [meat-eaters], of whom the males have their sexual glands mutilated [kolobos] and the women are excised [ektemnein] in the Jewish fashion."

  21. ^ Knight 2001 writes that there is one extant reference from antiquity, from Xanthus of Lydia in the fifth century BCE, that may allude to FGM outside Egypt. Xanthus wrote, in a history of Lydia: "The Lydians arrived at such a state of delicacy that they were even the first to 'castrate' their women." Knight argues that the "castration", which is not described, may have kept women youthful, in the sense of allowing the Lydian king to have intercourse with them without pregnancy. Knight concludes that it may have been a reference to sterilization, not FGM.[167]
  22. ^ FGM is still practised in Sudan. Some states banned it in 2008–2009, but 截至2013年 (2013-Missing required parameter 1=month!), there was no national legislation.[194]
  23. ^ Egypt banned FGM entirely in 2007.
  24. ^ For example, UNICEF 2013 lists Mauritania as having passed legislation against FGM, but (as of that year) it was banned only from being conducted in government facilities or by medical personnel.[209] The following countries, in which FGM is concentrated, have placed restrictions on it. An asterisk indicates a ban:
    Benin (2003), Burkina Faso (1996*), Central African Republic (1966, amended 1996), Chad (2003), Côte d'Ivoire (1998), Djibouti (1995, amended 2009*), Egypt (2008*), Eritrea (2007*), Ethiopia (2004*), Ghana (1994, amended 2007), Guinea (1965, amended 2000*), Guinea-Bissau (2011*), Iraq (2011*), Kenya (2001, amended 2011*), Mauritania (2005), Niger (2003), Nigeria (2015*), Senegal (1999*), Somalia (2012*), Sudan, some states (2008–2009), Tanzania (1998), Togo (1998), Uganda (2010*), Yemen (2001*).[210]
  25. ^ UNICEF 2005: "Beyond economic factors, migratory patterns have frequently reflected links established in the colonial past. For instance, citizens from Benin, Chad, Guinea, Mali, Niger and Senegal have often chosen France as their destination, while many Kenyan, Nigerian and Ugandan citizens have migrated to the United Kingdom.

    "In the 1970s, war, civil unrest and drought in a number of African states, including Eritrea, Ethiopia and Somalia, resulted in an influx of refugees to Western Europe, where some countries, such as Norway and Sweden, had been relatively unaffected by migration up to that point. Beyond Western Europe, Canada and the USA in North America, and Australia and New Zealand in Australasia also host women and children who have been subjected to FGM/C, and are home to others who are at risk of undergoing this procedure."[223]

参考资料[编辑]

  1. ^ Masinde, Andrew. "FGM: Despite the ban, the monster still rears its ugly head in Uganda", New Vision, Uganda, 5 February 2013.
  2. ^ 2.0 2.1 "Classification of female genital mutilation", Geneva: World Health Organization, 2014 (hereafter WHO 2014).
  3. ^ Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change, New York: United Nations Children's Fund, July 2013 (hereafter UNICEF 2013), pp. 5, 26–27.
  4. ^ 引用错误:没有为名为133million的参考文献提供内容
  5. ^ 5.0 5.1 5.2 5.3 UNICEF 2013, p. 50.
  6. ^ 6.0 6.1 6.2 6.3 6.4 6.5 The State of the World's Children 2015: Executive Summary, New York: UNICEF, November 2014, Table 9, pp. 84–89.
  7. ^ UNICEF 2013, p. 9; for the bans, Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change, New York: UNFPA–UNICEF, Annual Report 2012 (hereafter UNFPA–UNICEF 2012), p. 12.
  8. ^ 8.0 8.1 Alexandra Topping, "Nigeria's female genital mutilation ban is important precedent, say campaigners", The Guardian, 29 May 2015.
  9. ^ "Classification of female genital mutilation", World Health Organization, 2013 (hereafter WHO 2013).
  10. ^ UNICEF 2013, p. 2
  11. ^ UNICEF 2013, pp. 47, 50, 183.
  12. ^ WHO 2013; WHO 2008, p. 4
  13. ^ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 Abdulcadira, Jasmine; Margairaz, C.; Boulvain, M; Irion, O. "Care of women with female genital mutilation/cutting", Swiss Medical Weekly, 6(14), January 2011 (review).
  14. ^ 肯亚女行割礼为守贞 “割掉就不会找男人” 苹果日报 2015/7/3
  15. ^ UNICEF 2013, p. 15: "There is a social obligation to conform to the practice and a widespread belief that if they [families] do not, they are likely to pay a price that could include social exclusion, criticism, ridicule, stigma or the inability to find their daughters suitable marriage partners."

    Nahid F. Toubia, Eiman Hussein Sharief, "Female genital mutilation: have we made progress?", International Journal of Gynecology & Obstetrics, 82(3), September 2003, pp. 251–261: "One of the great achievements of the past decade in the field of FGM is the shift in emphasis from the concern over the harmful physical effects it causes to understanding this act as a social phenomenon resulting from a gender definition of women's roles, in particular their sexual and reproductive roles. This shift in emphasis has helped redefine the issues from a clinical disease model (hence the terminology of eradication prevalent in the literature) to a problem resulting from the use of culture to protect social dominance over women's bodies by the patriarchal hierarchy. Understanding the operative mechanisms of patriarchal dominance must also include understanding how women, particularly older married women, are important keepers of that social hegemony." PubMed doi:10.1016/S0020-7292(03)00229-7

  16. ^ Female Genital Mutilation/Cutting: What Might the Future Hold?, New York: UNICEF, 22 July 2014 (hereafter UNICEF 2014), p. 3/6: "If nothing is done, the number of girls and women affected will grow from 133 million today to 325 million in 2050." Also see p. 6/6:

    "Data sources: UNICEF global databases, 2014, based on Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and other nationally representative surveys, 1997–2013. Population data are from: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2012 revision, CD-ROM edition, United Nations, New York, 2013.

    "Notes: Data presented in this brochure cover the 29 countries in Africa and the Middle East where FGM/C is concentrated and for which nationally representative data are available."

  17. ^ P. Stanley Yoder, Shane Khan, "Numbers of women circumcised in Africa: The Production of a Total", USAID, DHS Working Papers, No. 39, March 2008, pp. 13–14: "Infibulation is practiced largely in countries located in northeastern Africa: Djibouti, Eritrea, Ethiopia, Somalia, and Sudan. Survey data are available for Sudan, Eritrea, Ethiopia and Djibouti. Sudan alone accounts for about 3.5 million of the women. ... [T]he estimate of the total number of women infibulated in [Djibouti, Somalia, Eritrea, northern Sudan, Ethiopia, Guinea, Mali, Burkina Faso, Senegal, Chad, Nigeria, Cameroon and Tanzania, for women 15–49 years old] comes to 8,245,449, or just over eight million women." Also see Appendix B, Table 2 ("Types of FGC"), p. 19.

    UNICEF 2013, p. 182, identifies "sewn closed" as most common in Djibouti, Eritrea, Somalia for the 15–49 age group (a survey in 2000 in Sudan was not included in the figures), and for the daughters of that age group it is most common in Djibouti, Eritrea, Niger and Somalia. See UNICEF statistical profiles: Djibouti (December 2013), Eritrea (July 2014), Somalia (December 2013).

    Also see Gerry Mackie, "Ending Footbinding and Infibulation: A Convention Account", American Sociological Review, 61(6), December 1996 (pp. 999–1017), p. 1002: "Infibulation, the harshest practice, occurs contiguously in Egyptian Nubia, the Sudan, Eritrea, Djibouti and Somalia, also known as Islamic Northeast Africa."

  18. ^ For countries in which it is outlawed or restricted, UNICEF 2013, p. 8; for enforcement, UNFPA–UNICEF 2012, p. 48.
  19. ^ 19.0 19.1 "67/146. Intensifying global efforts for the elimination of female genital mutilation", United Nations General Assembly, adopted 20 December 2012.

    Emma Bonino, "Banning Female Genital Mutilation", The New York Times, 19 December 2012.

  20. ^ Eric K. Silverman, "Anthropology and Circumcision", Annual Review of Anthropology, 33, 2004 (pp. 419–445), pp. 420, 427.
  21. ^ 联合国永续发展目标(SDGs)说明
  22. ^ Martha Nussbaum, Sex and Social Justice, New York: Oxford University Press, 1999, p. 119.
  23. ^ James Karanja, The Missionary Movement in Colonial Kenya: The Foundation of Africa Inland Church, Göttingen: Cuvillier Verlag, 2009, p. 93, n. 631.
  24. ^ "Eliminating Female genital mutilation: An Interagency Statement", New York: World Health Organization, 2008 (hereafter WHO 2008), p. 22.
  25. ^ Claire C. Robertson, "Getting beyond the Ew! Factor: Rethinking U.S. Approaches to African Female Genital Cutting," in Stanlie M. James and Claire C. Robertson (eds.), Genital Cutting and Transnational Sisterhood, Urbana: University of Illinois Press, 2002 (pp. 54–86), p. 60.

    Fran Hosken, The Hosken Report: Genital and Sexual Mutilation of Females, Lexington: Women's International Network, 1994 [1979].

  26. ^ UNICEF 2013, pp. 6–7.
  27. ^ WHO 2008, pp. 4, 22.
  28. ^ 28.0 28.1 UNICEF 2013, p. 48.
  29. ^ Fadwa El Guindi, "Had This Been Your Face, Would You Leave It as Is?" in Rogaia Mustafa Abusharaf (ed.), Female Circumcision: Multicultural Perspectives, Philadelphia: University of Pennsylvania Press, 2007, p. 30.
  30. ^ Chantal Zabus, "The Excised Body in African Texts and Contexts," in Merete Falck Borch (ed.), Bodies and Voices: The Force-field of Representation and Discourse in Colonial and Postcolonial Studies, New York: Rodopi, 2008, p. 47.

    For "a young woman must 'have her bath' before she has a baby," Chantal Zabus, "'Writing with an Accent': From Early Decolonization to Contemporary Gender Issues in the African Novel in French, English, and Arabic," in Simona Bertacco (ed.), Language and Translation in Postcolonial Literatures, New York: Routledge, 2013, p. 40.

  31. ^ Ibrahim Lethome Asmani, Maryam Sheikh Abdi, "De-linking Female Genital Mutilation/Cutting from Islam", USAID/UNFPA, 2008, p. 3.

    That sunna can refer to more severe forms, Ellen Gruenbaum, The Female Circumcision Controversy: An Anthropological Perspective, Philadelphia: University of Pennsylvania Press, 2001, p. 2.

  32. ^ 32.0 32.1 Leonard J. Kouba, Judith Muasher, "Female Circumcision in Africa: An Overview", African Studies Review, 28(1), March 1985 (pp. 95–110), pp. 96–97.
  33. ^ Rossella Lorenzi. How Did Female Genital Mutilation Begin?. How Did Female Genital Mutilation Begin?. 
  34. ^ Raqiya D. Abdalla, Template:" 'My Grandmother Called it the Three Feminine Sorrows': The Struggle of Women Against Female Circumcision in Somalia," in Abusharaf 2007, p. 190.
  35. ^ UNICEF 2013, pp. 42–44 and Table 5, p. 181 (for cutters), p. 46 (for home and anaesthesia).
  36. ^ Michael Miller and Francesca Moneti, Changing a harmful social convention: Female genital cutting/mutilation, Florence: UNICEF Innocenti Research Centre, 2005, p. 7.
  37. ^ UNICEF 2013, pp. 43–45.
  38. ^ Elizabeth Kelly, Paula J. Adams Hillard, "Female genital mutilation", Current Opinion in Obstetrics & Gynecology, 17(5), October 2005 (pp. 490–494), p. 491. PubMed
  39. ^ Wairagala Wakabi, "Africa battles to make female genital mutilation history", The Lancet, 369 (9567), 31 March 2007, pp. 1069–1070. PubMed doi:10.1016/S0140-6736(07)60508-X
  40. ^ UNICEF 2013, p. 46 (two percent were missing/don't know).
  41. ^ WHO 2008, p. 4.
  42. ^ P. Stanley Yoder, Shanxiao Wang, Elise Johansen, "Estimates of Female Genital Mutilation/Cutting in 27 African Countries and Yemen", Studies in Family Planning, 44(2), June 2013 (pp. 189–204), p. 190. PubMed doi:10.1111/j.1728-4465.2013.00352.x

    Elizabeth F. Jackson, et al., "Inconsistent reporting of female genital cutting status in northern Ghana: Explanatory factors and analytical consequences," Studies in Family Planning, 34(3), 2003, pp. 200–210. PubMed

    Elise Klouman, Rachel Manongi, Knut-Inge Klepp, "Self-reported and observed female genital cutting in rural Tanzania: Associated demographic factors, HIV and sexually transmitted infections", Tropical Medicine and International Health 10(1), 2005, pp. 105–115. PubMed doi:10.1111/j.1365-3156.2004.01350.x

    In Sudan in 2006, a significant percentage of infibulated women and girls reported a less severe type. See Susan Elmusharaf, Nagla Elhadi, Lars Almroth, "Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study", British Medical Journal, 332(7559), 27 June 2006. PubMed 位于PMC的全文本内容:1502195 doi:10.1136/bmj.38873.649074.55

  43. ^ UNICEF 2013, p. 48.
  44. ^ 44.0 44.1 UNICEF 2013, p. 47, Table 5.2; Yoder, Wang and Johansen, 2013, p. 189.
  45. ^ WHO 2014; WHO 2008, p. 4, and Annex 2, p. 24, for Types I–IV; Annex 2, pp. 23–28, for a more detailed discussion.
  46. ^ WHO 2008, p. 25. Also see Nahid Toubia, "Female Circumcision as a Public Health Issue", The New England Journal of Medicine, 331(11), 1994, pp. 712–716. PubMed doi:10.1056/NEJM199409153311106

    Carol R. Horowitz, J. Carey Jackson, Mamae Teklemariam, "Female Circumcision" (letters), The New England Journal of Medicine, 332, 19 January 1995, pp. 188–190; Toubia's reply. doi:10.1056/NEJM199501193320313

  47. ^ Susan Izett, Nahid Toubia, Female Genital Mutilation: An Overview, World Health Organization, 1998.
  48. ^ WHO 2014.
  49. ^ P. Stanley Yoder, Shane Khan, "Numbers of women circumcised in Africa: The Production of a Total", USAID, DHS Working Papers, No. 39, March 2008, pp. 13–14. Also see Appendix B, Table 2 ("Types of FGC"), p. 19.
  50. ^ "Frequently Asked Questions on Female Genital Mutilation/Cutting", UNFPA, April 2010: "Types I and II are the most common, with variation among countries. Type III, infibulation, constitutes about 20 percent of all affected women and is most likely in Somalia, northern Sudan and Djibouti."
  51. ^ 51.0 51.1 Comfort Momoh, "Female genital mutilation" in Comfort Momoh (ed.), Female Genital Mutilation, Oxford: Radcliffe Publishing, 2005, p. 7; also see Edna Adan Ismail, "Female genital mutilation survey in Somaliland", Edna Adan Maternity and Teaching Hospital, 2009, pp. 12–14.
  52. ^ Ismail 2009, p. 12; also see Abusharaf 2007, p. 190.
  53. ^ Abdulcadira et al. 2011.
  54. ^ For a twig, Momoh 2005, p. 7.
  55. ^ Kelly and Hillard 2005, p. 491; for the poultice, Ismail 2009, p. 14.
  56. ^ Kelly and Hillard 2005, p. 491 (Kelly and Hillard say the girls are tied for 2–6 weeks); Momoh 2005, pp. 6–7; for progressive loosening of the binding, Ismail 2009, p. 14.
  57. ^ Abdalla 2007, p. 190.
  58. ^ Abdalla 2007, pp. 191, 198; for the relatives, Ismail 2009, p. 14.
  59. ^ Hanny Lightfoot-Klein, "The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in The Sudan", The Journal of Sex Research, 26(3), 1989 (pp. 375–392), p. 380.

    Also see El Dareer 1982, pp. 42–49; Hanny Lightfoot-Klein, Prisoners of Ritual: An Odyssey Into Female Genital Circumcision in Africa, New York: Routledge, 1989.

  60. ^ Kelly and Hillard 2005, p. 491.
  61. ^ Asma El Dareer, Woman, Why Do You Weep: Circumcision and its Consequences, London: Zed Press, 1982, pp. 56–64.

    Also see Rebecca J. Cooke, Bernard M. Dickens, "Special commentary on the issue of reinfibulation", International Journal of Gynaecology and Obstetrics, 109(2), May 2010, pp. 97–99. PubMed doi:10.1016/j.ijgo.2010.01.004

    Gamal I. Serour, "The issue of reinfibulation", International Journal of Gynaecology and Obstetrics, 109(2), May 2010, pp. 93–96. PubMed doi:10.1016/j.ijgo.2010.01.001

    Olukunmi O. Balogun, et al., "Interventions for improving outcomes for pregnant women who have experienced genital cutting", Cochrane Database of Systematic Reviews, 2, 2013. PubMed doi:10.1002/14651858.CD009872.pub2

  62. ^ WHO 2008, p. 24; UNICEF 2013, p. 7.
  63. ^ 63.0 63.1 WHO 2008, p. 27.
  64. ^ "Female Genital Mutilation: A Teachers' Guide", World Health Organization, 2005, p. 31.
  65. ^ For the countries in which labia stretching is found (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Tanzania, Uganda and Zimbabwe), see Nkiru Nzegwu, "'Osunality' (or African eroticism)" in Sylvia Tamale (ed.), African Sexualities: A Reader, Cape Town: Fahamu/Pambazuka, 2011, p. 262.

    For the rest, Brigitte Bagnol and Esmeralda Mariano, "Politics of Naming Sexual Practices," in Tamale 2011, pp. 272–276 (p. 272 for Uganda).

  66. ^ Mairo Usman Mandara, "Female genital cutting in Nigeria: View of Nigerian Doctors on the Medicalization Debate," in Bettina Shell-Duncan and Ylva Hernlund (eds.), Female "Circumcision" in Africa: Culture Controversy and Change, Boulder: Lynne Rienner Publishers, 2000 (pp. 253–282), pp. 98, 100; for fistulae, p. 102.

    Mairo Usman Mandara, "Female genital mutilation in Nigeria", International Journal of Gynecology & Obstetrics, 84(3), pp. 291–298. PubMed doi:10.1016/j.ijgo.2003.06.001

  67. ^ Stephanie Sinclair, "Inside a Female-Circumcision Ceremony", The New York Times Magazine, April 2006, slideshow of images from Indonesia (article).
  68. ^ Rigmor C. Berg, et al., "Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis", BMJ Open, 4(11), 2014: e006316. PubMed doi:10.1136/bmjopen-2014-006316
  69. ^ 69.0 69.1 Dan Reisel, Sarah M. Creighton, "Long term health consequences of Female Genital Mutilation (FGM)", Maturitas, 80(1), January 2015 (pp. 48–51), p. 49. PubMed doi:10.1016/j.maturitas.2014.10.009
  70. ^ "Female genital mutilation", New York: World Health Organization, February 2014.
  71. ^ Rigmor C. Berg, Vigdis Underland, Immediate health consequences of female genital mutilation/cutting (FGM/C), Kunnskapssenteret (Norwegian Knowledge Centre for the Health Services), systematic review no. 8, 2014, pp. 4–5 (full text). ISBN 978-82-8121-856-7
  72. ^ Christos Iavazzo, Thalia A. Sardi, Ioannis D. Gkegkes, "Female genital mutilation and infections: a systematic review of the clinical evidence", Archives of Gynecology and Obstetrics, 287(6), June 2013, pp. 1137–1149. PubMed doi:10.1007/s00404-012-2708-5
  73. ^ UNICEF 2005, p. 16.
  74. ^ 74.0 74.1 74.2 74.3 Reisel and Creighton 2015, p. 50.
  75. ^ 75.0 75.1 75.2 Kelly and Hillard 2005, pp. 491–492
  76. ^ Amish J. Dave, Aisha Sethi, Aldo Morrone, "Female Genital Mutilation: What Every American Dermatologist Needs to Know", Dermatologic Clinics, 29(1), January 2011, pp. 103–109. PubMed doi:10.1016/j.det.2010.09.002
  77. ^ Hamid Rushwan, "Female genital mutilation: A tragedy for women's reproductive health", African Journal of Urology, 19(3), September 2013, pp. 130–133. doi:10.1016/j.afju.2013.03.002
  78. ^ El Dareer 1982, p. 37. Also see Asma El Dareer, "Preliminary report on a study on prevalence and epidemiology of female circumcision in Sudan today," WHO seminar, Khartoum, 10–15 February 1979; Asma el Dareer, "Female circumcision and its consequences for mother and child," Yaounde, 12–15 December 1979, cited in Rushwan 2013.
  79. ^ Nahid Toubia, Caring for Women with Circumcision: A Technical Manual for Health Care Providers, New York: RAINBO, 1999, cited in Mumtaz Rashid, Mohammed H. Rashid, "Obstetric management of women with female genital mutilation", The Obstetrician and Gynaecologist, 9(2), April 2007, pp. 95–101. doi:10.1576/toag.9.2.095.27310
  80. ^ Rashid and Rashid 2007, p. 99.
  81. ^ Rashid and Rashid 2007, p. 97.
  82. ^ Emily Banks, et al, "Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries", The Lancet, 367(9525), 3 June 2006, pp. 1835–1841. PubMed doi:10.1016/S0140-6736(06)68805-3

    "New study shows female genital mutilation exposes women and babies to significant risk at childbirth", World Health Organization, 2 June 2006.

  83. ^ Rigmor C. Berg, Eva Denison, "A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review", Health Care for Women International, 34(10), March 2013. PubMed 位于PMC的全文本内容:3783896 doi:10.1080/07399332.2012.721417.

    For a summary of Berg and Denison, see Reisel and Creighton 2015, p. 51.

    Also see S. Sibiani and A. A. Rouzi, "Sexual function in women with female genital mutilation", Fertility and Sterility, 93(3), September 2008, pp. 722–724. PubMed doi:10.1016/j.fertnstert.2008.10.035

  84. ^ Gerry Mackie, John LeJeune, "Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory", Innocenti Working Paper No. 2008-XXX, UNICEF Innocenti Research Centre, 2008, p. 5.
  85. ^ UNICEF 2014, p. 3.
  86. ^ UNICEF 2013, p. 2.
  87. ^ UNFPA–UNICEF 2012, p. 12.
  88. ^ "National Legislation, Decrees and Statements Banning FGM/C", UNFPA Egypt.
  89. ^ Yoder, Wang and Johansen, 2013, p. 190.
  90. ^ UNICEF 2013, Box 1.1, p. 4.
  91. ^ Yoder, Wang and Johansen, 2013, p. 190; "DHS overview", Demographic and Health Surveys; "Questionnaires and Indicator List", Multiple Indicator Cluster Surveys, UNICEF.
  92. ^ Yoder, Wang and Johansen, 2013, p. 191; Dara Carr, Female genital cutting: Findings from the Demographic and Health Surveys program, Calverton, MD: Macro International Inc., 1997.
  93. ^ UNICEF 2013, pp. 3, 5.
  94. ^ WHO 2008, pp. 29–30.
  95. ^ 95.0 95.1 UNICEF 2013, p. 23.
  96. ^ For Australia, New Zealand, Europe, Scandinavia, the United States and Canada, UNICEF 2005, p. 4.
  97. ^ UNICEF 2013, p. 34.
  98. ^ UNICEF 2013, pp. 28–37.
  99. ^ UNICEF 2013, pp. 27 (for eight percent), 31 (for the regions).

    Berivan A. Yasin, et al, "Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city", BMC Public Health, 13, September 2013. PubMed 位于PMC的全文本内容:3844478 doi:10.1186/1471-2458-13-809

  100. ^ Yoder, Wang and Johansen, 2013, p. 196, 198.
  101. ^ "Guinea" (2012), UNICEF statistical profile, July 2014, p. 2/4.
  102. ^ For Chad, UNICEF 2013, pp. 35–36; for Nigeria, T. C. Okeke, et al, "An Overview of Female Genital Mutilation in Nigeria", Annals of Medical Health Sciences Research, 2(1), Jan–June 2012, pp. 70–73. PubMed 位于PMC的全文本内容:3507121 doi:10.4103/2141-9248.96942 FGM is practised in Nigeria by the Yoruba, Hausa, Ibo, Ijaw and Kanuri people.
  103. ^ Agence France-Presse: 伊拉克库尔德地区禁止女性割礼. The Raw story. 
  104. ^ For rural areas, UNICEF 2013, p. 28; for wealth, p. 40; for education, p. 41.
  105. ^ UNICEF 2013, p. 134–135.
  106. ^ Mohammed A. Tag-Eldin, "Prevalence of female genital cutting among Egyptian girls", Bulletin of the World Health Organization, 86(4), April 2008.
  107. ^ Gerry Mackie, "Female Genital Cutting: A Harmless Practice?", Medical Anthropology Quarterly, 17(2), 2003 (pp. 135–158), p. 148.
  108. ^ 108.0 108.1 108.2 Salah M. Rasheedemail, Ahmed H. Abd-Ellah, Fouad M. Yousef, "Female genital mutilation in Upper Egypt in the new millennium", International Journal of Gynecology and Obstetrics, 114(1), July 2011, pp. 47–50. doi:10.1016/j.ijgo.2011.02.003 PMID 21513937
  109. ^ For north and south, Okeke, et al 2012, pp. 70–73.
  110. ^ Yoder and Khan 2008, pp. 13–14.
  111. ^ UNICEF 2013, p. 47, Table 5.2.

    For the years, see UNICEF FGM statistical profiles: Djibouti, December 2013: "Source for all charts on this page: MICS 2006"; Eritrea, July 2014, p. 2/4: "Source: DHS 2002"; Somalia, December 2013, p. 2/4: "Source for all charts on this page: MICS 2006."

  112. ^ UNICEF 2013, p. 114: "In Somalia, Eritrea, Niger, Djibouti and Senegal, more than one in five girls have undergone the most radical form of the practice known as infibulation ..."
  113. ^ "Nigeria: Statistical profile on female genital mutilation/cutting", UNICEF, July 2014.
  114. ^ UNICEF 2013, p. 48.
  115. ^ Gerry Mackie, "Female Genital Cutting: The Beginning of the End", in Shell-Duncan and Hernlund 2000 (pp. 253–282), p. 275.
  116. ^ 116.0 116.1 UNICEF 2013, pp. 47, 183.
  117. ^ UNICEF 2005, p. 6.
  118. ^ UNICEF 2013, p. 51.
  119. ^ UNICEF 2013, p. 99.
  120. ^ Yoder, Wang and Johansen, 2013, p. 193; UNICEF 2013, pp. 99, 114.
  121. ^ UNICEF 2014, p. 2.
  122. ^ Togo, UNICEF, July 2014, p. 4; Benin, UNICEF, July 2014, p. 4.
  123. ^ UNICEF 2013, pp. 85, 113.
  124. ^ UNICEF 2013, pp. 25, 100; Yoder, Wang and Johansen, 2013, p. 196.
  125. ^ Yoder, Wang and Johansen, 2013, p. 194; UNICEF 2013, p. 25.
  126. ^ Abdalla 2007, p. 187.
  127. ^ Hayes 1975, pp. 620, 624.
  128. ^ Gerry Mackie, "Ending Footbinding and Infibulation: A Convention Account", American Sociological Review, 61(6), December 1996 (pp. 999–1017), pp. 999–1000. Also see Mackie 2000, p. 256.
  129. ^ "Stephanie Welsh", 1996 Pulitzer Prize winners
  130. ^ Rogaia Mustafa Abusharaf, "Introduction: The Custom in Question," in Abusharaf 2007, p. 8; El Guindi 2007, pp. 36–37.
  131. ^ Fuambai Ahmadu, "Rites and Wrongs: An Insider/Outsider Reflects on Power and Excision," in Shell-Duncan and Hernlund 2000, pp. 284–285.
  132. ^ Janice Boddy, Civilizing Women: British Crusades in Colonial Sudan, Princeton: Princeton University Press, 2007, pp. 112. Also see Silverman 2004, p. 429.
  133. ^ Ellen Gruenbaum, "Socio-Cultural Dynamics of Female Genital Cutting: Research Findings, Gaps, and Directions", Culture, Health & Sexuality, 7(5), September–October 2005 (pp. 429–441), pp. 435–436.
  134. ^ Gruenbaum 2005, p. 437; Gruenbaum 2001, p. 140; Janice Boddy, Wombs and Alien Spirits: Women, Men, and the Zar Cult in Northern Sudan, Madison: University of Wisconsin Press, 1989, p. 52.
  135. ^ Gruenbaum 2005, p. 437.
  136. ^ Bagnol and Mariano 2011, pp. 277–281; for Type IV, WHO 2008, pp. 27–28.
  137. ^ UNICEF 2013, p. 67.
  138. ^ Asma El Dareer, "Attitudes of Sudanese People to the Practice of Female Circumcision", International Journal of Epidemiology, 12(2), 1983 (pp. 138–144), p. 140. PubMed doi:10.1093/ije/12.2.138
  139. ^ UNICEF 2013, p. 178.
  140. ^ UNICEF 2013, p. 52: "The highest levels of support can be found in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt, where more than half the female population think the practice should continue." Also see Figure 6.1, p. 54 and Figures 8.1A – 8.1D, pp. 90–91.
  141. ^ 141.0 141.1 UNICEF 2013, p. 15.
  142. ^ Gruenbaum 2005, pp. 432–433.
  143. ^ Mackie 2003, pp. 147–148.
  144. ^ UNICEF-UNFPA 2012, pp. 21–22.

    Nafissatou J. Diop, Amadou Moreau, Hélène Benga, "Evaluation of the Long-term Impact of the TOSTAN Programme on the Abandonment of FGM/C and Early Marriage: Results from a qualitative study in Senega", UNICEF, January 2008.

    Louisa Kasdon, "A Tradition No Longer", World & I, November–December 2005, pp. 66–73.

    Jean Faraca, "Confronting Female Genital Cutting", Wisconsin Public Radio, interview with Molly Melching and Gerry Mackie, 3 November 2011, from 2:43 mins.

  145. ^ For Malicounda Bambara, Mackie 2000, p. 256ff; for over 7,000 communities, "Our Success", Tostan, accessed 25 October 2014.
  146. ^ Malick Gueye, "Social Norm Change Theorists meet again in Keur Simbara, Senegal", Tostan, 4 February 2014.
  147. ^ UNICEF 2013, pp. 69–70; Figure 6.12, p. 71.
  148. ^ Gruenbaum 2001, p. 50; Mackie and LeJeune 2008, p. 8.
  149. ^ UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change, Summary Report of Phase I, 2008–2013 (hereafter 2013 UNFPA-UNICEF Joint Programme evaluation), p. 26.
  150. ^ Mackie 1996, p. 1008.
  151. ^ Mackie 1996, pp. 1004–1005.
  152. ^ Also see Ibrahim Lethome Asmani, Maryam Sheikh Abdi, "De-linking Female Genital Mutilation/Cutting from Islam", USAID/UNFPA, 2008.
  153. ^ "Fresh progress toward the elimination of female genital mutilation and cutting in Egypt", UNICEF, 2 July 2007; UNICEF 2013, p. 70.
  154. ^ Maggie Michael, "Egypt Officials Ban Female Circumcision", Associated Press, 29 June 2007, p. 2.
  155. ^ For animist groups, UNICEF 2013, p. 175; for Christians, p. 73.
  156. ^ UNICEF 2013, front page: "Niger. 55% of Christian girls and women have undergone FGM/C, compared to 2% of Muslim girls and women," and p. 73.
  157. ^ Samuel Waje Kunhiyop, African Christian Ethics, Zondervan, 2008, p. 297: "Nowhere in all of Scripture or in any of recorded church history is there even a hint that women were to be circumcised."

    For missionaries, Jocelyn Murray, "The Church Missionary Society and the 'Female Circumcision' Issue in Kenya 1929–1932", Journal of Religion in Africa, 8(2), 1976, pp. 92–104.

  158. ^ Shaye J. D. Cohen, Why Aren't Jewish Women Circumcised? Gender and Covenant In Judaism, Berkeley: University of California Press, 2005, p. 59; Adele Berlin (ed.), "Circumcision," The Oxford Dictionary of the Jewish Religion, New York: Oxford University Press, 2011, p. 173.
  159. ^ Mary Knight, "Curing Cut or Ritual Mutilation?: Some Remarks on the Practice of Female and Male Circumcision in Graeco-Roman Egypt", Isis, 92(2), June 2001 (pp. 317–338), p. 330.

    Also see Adriaan de Buck and Alan H. Gardiner, The Egyptian Coffin Texts, Chicago: Chicago University Press, 1961, Vol. 7, pp. 448–450.

  160. ^ Mackie 1996, p. 1003; Abusharaf 2007, p. 2.
  161. ^ Mackie 2000, pp. 264, 267; UNICEF 2013, p. 30; Shell-Duncan and Hernlund 2000, p. 13; Mackie 1996, p. 1003.

    Also see C. G. Seligman, "Aspects of the Hamitic problems in the Anglo-Egyptian Sudan",The Journal of the Royal Anthropological Institute of Great Britain and Ireland, 1913, 40(3), (pp. 593–705), pp. 639–646; Esther K. Hicks, Infibulation: Female Mutilation in Islamic Northeastern Africa, Transaction Publishers, 1996, p. 19ff.

  162. ^ Knight 2001, p. 330. Knight adds that Egyptologists are uncomfortable with the translation to uncircumcised, because there is no information about what constituted the circumcised state.

    Paul F. O'Rourke, "The 'm't-Woman", Zeitschrift für Ägyptische Sprache und Altertumskunde, 134(2), February 2007 (pp. 166–172), pp. 166ff (hieroglyphs), 172 (menstruating woman). doi:10.1524/zaes.2007.134.2.166

  163. ^ Knight 2001, pp. 329–330; F. G. Kenyon, Greek Papyri in the British Museum, British Museum, 1893, pp. 31–32 (also here [1]).
  164. ^ Knight 2001, p. 331, citing G. Elliot Smith, A Contribution to the Study of Mummification in Egypt, Cairo: L'Institut Egyptien, 1906, p. 30, and Marc Armand Ruffer, Studies in the Paleopathology of Egypt, Chicago: University of Chicago Press, 1921, p. 171.
  165. ^ Knight 2001, p. 318.
  166. ^ Strabo, Geographica, Book VII, chapter 2, 17.2.5. Cohen 2005, p. 59ff, argues that Strabo conflated the Jews with the Egyptians).
  167. ^ Knight 2001, p. 326.
  168. ^ Knight 2001, p. 333.
  169. ^ Knight 2001, p. 326 (Knight writes that the attribution to Galen is suspect).
  170. ^ Knight 2001, pp. 327–328 (a paragraph break has been added for ease of reading).
  171. ^ Knight 2001, p. 328.
  172. ^ Mackie 1996, p. 1003.
  173. ^ Mackie 1996, p. 1009.
  174. ^ J. F. C. "Isaac Baker Brown, F.R.C.S.", Medical Times and Gazette, 8 February 1873, p. 155.
  175. ^ Sarah W. Rodriguez, "Rethinking the History of Female Circumcision and Clitoridectomy: American Medicine and Female Sexuality in the Late Nineteenth Century", Journal of the History of Medicine and Allied Sciences. 63(3), July 2008, pp. 323–347. PubMed doi:10.1093/jhmas/jrm044
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    Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era, New York: Simon and Schuster, 2008, p. 82.

  177. ^ Shorter 2008, p. 82; Uriel Elchalal, et al., "Ritualistic Female Genital Mutilation: Current Status and Future Outlook", Obstetrical & Gynecological Survey, 52(10), October 1997, pp. 643–651. PubMed
  178. ^ Elchalal, et al, 1997; Peter Lewis Allen, The Wages of Sin: Sex and Disease, Past and Present, Chicago: University of Chicago Press, 2000, p. 106.
  179. ^ J. F. C. 1873, p. 155; Allen 2000, p. 106.
  180. ^ John Black, "Female genital mutilation: a contemporary issue, and a Victorian obsession", Journal of the Royal Society of Medicine, 90, July 1997 (pp. 402–405), p. 403, 404–405. PubMed 位于PMC的全文本内容:1296388

    Allen 2000, p. 106; also see Elizabeth Sheehan, "Victorian Clitoridectomy: Isaac Baker Brown and His Harmless Operative Procedure", Medical Anthropology Newsletter, 12(4), August 1981. PubMed

  181. ^ Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology, New Brunswick: Rutgers University Press, 1998, p. 146.
  182. ^ John Milton Hoberman, Testosterone Dreams: Rejuvenation, Aphrodisia, Doping, University of California Press, 2005, p. 63.
  183. ^ Lawrence Cutner, "Female genital mutilation", Obstetrical & Gynecological Survey, 40(7), July 1985, pp. 437–443. PubMed Cited in Nawal M. Nour, "Female Genital Cutting: A Persisting Practice", Reviews in Obstetrics and Gynecology, 1(3), Summer 2008, pp. 135–139. PubMed 位于PMC的全文本内容:2582648

    Also see G. J. Barker-Benfield, The Horrors of the Half-Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth-Century America, New York: Routledge, 1999, p. 113.

  184. ^ Kenneth Mufuka, "Scottish Missionaries and the Circumcision Controversy in Kenya, 1900–1960", International Review of Scottish Studies, 28, 2003, p. 55.
  185. ^ Lynn M. Thomas,Template:" 'Ngaitana (I will circumcise myself)': Lessons from Colonial Campaigns to Ban Excision in Meru, Kenya" in Shell-Duncan and Hernlund, 2000, p. 132.

    For irua, Jomo Kenyatta, Facing Mount Kenya, New York: Vintage Books, 1962 [1938], p. 129; for irugu being outcasts, Kenyatta, p. 127, and Zabus 2008, pp. 48–49.

  186. ^ Kenyatta 1962 [1938], pp. 127–130.
  187. ^ Klaus Fiedler, Christianity and African Culture, Leiden: Brill, 1996, p. 75.
  188. ^ Boddy 2007, pp. 241–245.

    Also see Ronald Hyam, Empire and Sexuality: The British Experience, Manchester: Manchester University Press, 1990; Murray 1976, pp. 92–104.

  189. ^ Thomas 2000, p. 132; for the "sexual mutilation of women", Karanja 2009, p. 93, n. 631.

    Also see Robert Strayer, Jocelyn Murray, "The CMS and Female Circumcision", in Robert Strayer (ed.), The Making of Missionary Communities in East Africa, New York: State University of New York Press, 1978, p. 139ff.

  190. ^ Boddy 2007, pp. 241, 244.

    Dana Lee Robert, American Women in Mission: A Social History of Their Thought and Practice, Macon: Mercer University Press, 1996, p. 230.

  191. ^ Thomas 2000, pp. 129–131 (p. 131 for the girls as "central actors"); Lynn Thomas, Politics of the Womb: Women, Reproduction, and the State in Kenya, Berkeley: University of California Press, 2003, pp. 89–91.

    Also see Lynn M. Thomas, Ngaitana (I will circumcise myself)': The Gender and Generational Politics of the 1956 Ban on Clitoridectomy in Meru, Kenya", Gender and History, 8(3), November 1996, pp. 338–363.

    Kenya banned FGM in 2011; see UNFPA–UNICEF 2012, p. 14.

  192. ^ UNICEF 2013, p. 10, calls the Egyptian Doctors' Society opposition the "first known campaign" against FGM; for independence, Boddy 2007, p. 147.
  193. ^ Boddy 2007, pp. 202, 299.
  194. ^ UNICEF 2013, pp. 2, 9.
  195. ^ Elizabeth Heger Boyle, Female Genital Cutting: Cultural Conflict in the Global Community, Baltimore: Johns Hopkins University Press, 2002, pp. 92, 103.
  196. ^ Boyle 2002, p. 41.
  197. ^ Bagnol and Mariano 2011, p. 281.
  198. ^ Gruenbaum 2001, p. 22.

    Homa Khaleeli, "Nawal El Saadawi: Egypt's radical feminist", The Guardian, 15 April 2010.

    Jenna Krajeski, "The Books of Nawal El Saadawi", The New Yorker, 7 March 2011.

    Jenna Krajeski, "Rebellion", The New Yorker, 14 March 2011.

  199. ^ Nawal El Saadawi, The Hidden Face of Eve, London: Zed Books, 2007 [1980], p. 14.
  200. ^ Hayes 1975, p. 618; Gruenbaum 2001, p. 21.
  201. ^ Yoder and Khan 2008, p. 2.
  202. ^ Mackie 2003, p. 139.
  203. ^ Hosken 1994 [1979], p. 5.
  204. ^ Boyle 2002, p. 47; Bagnol and Mariano 2011, p. 281.
  205. ^ Shahira Ahmed, "Babiker Badri Scientific Association for Women's Studies", in Abusharaf 2007, pp. 176–180.
  206. ^ Ahmed 2007, p. 180.
  207. ^ Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide, New York: Zed Books, 2000, p. 10–11; for Vienna, UNICEF 2013 p. 8.
  208. ^ Emma Bonino, "A brutal custom: Join forces to banish the mutilation of women", The New York Times, 15 September 2004; Maputo Protocol, pp. 7–8.
  209. ^ UNICEF 2013, p. 8.
  210. ^ UNICEF 2013, pp. 8–9;UNFPA–UNICEF 2012 annual report, p. 12].
  211. ^ "48/104. Declaration on the Elimination of Violence against Women", United Nations General Assembly, 20 December 1993.

    Charlotte Feldman-Jacobs, "Commemorating International Day of Zero Tolerance to Female Genital Mutilation", Population Reference Bureau, February 2009.

  212. ^ UNICEF 2013, p. 15; Francesca Moneti, David Parker, The Dynamics of Social Change, Florence: UNICEF Innocenti Research Centre, October 2010, p. 6.
  213. ^ UNICEF 2013, p. 15; Michael Miller and Francesca Moneti, Changing a harmful social convention: Female genital cutting/mutilation, Florence: UNICEF Innocenti Research Centre, 2005.
  214. ^ WHO 2008, p. 8; Yoder, Wang and Johansen, 2013, p. 190.
  215. ^ "No time to lose: New UNICEF data show need for urgent action on female genital mutilation and child marriage", UNICEF, 22 July 2014; "Girl Summit", The Guardian.
  216. ^ "UNFPA–UNICEF Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change", Volume 1, 2008–2012, September 2013, p. viii.
  217. ^ 2013 UNFPA-UNICEF Joint Programme evaluation, p. 38.
  218. ^ "Joint Programme on the Abandonment of Female Genital Mutilation/Cutting. Funding Proposal for a Phase II", UNFPA–UNICEF, January 2014.

    "Joint Programme on the Abandonment of Female Genital Mutilation/Cutting. Management Response and Key Actions", UNFPA–UNICEF, 19 February 2014.

  219. ^ 2013 UNFPA-UNICEF Joint Programme evaluation, pp. 4, 16–17; for alternative rites of passage and the Saleema initiative, pp. 22–23.
  220. ^ UNFPA–UNICEF 2012, p. 48.
  221. ^ UNFPA–UNICEF 2012, pp. 12–13.
  222. ^ UNICEF 2013, p. 8.
  223. ^ UNICEF 2005, p. 4.
  224. ^ Australia: "Review of Australia's Female Genital Mutilation Legal Framework", Attorney General's Department, Government of Australia.

    New Zealand: "Section 204A – Female genital mutilation – Crimes Act 1961", New Zealand Parliamentary Counsel Office.

    Europe: "Eliminating female genital mutilation", European Commission.

    United States: "18 U.S. Code § 116 – Female genital mutilation", Legal Information Institute, Cornell University Law School.

    Canada: Section 268, Criminal Code.

  225. ^ Birgitta Essén, Sara Johnsdotter, "Female Genital Mutilation in the West: Traditional Circumcision versus Genital Cosmetic Surgery", Acta Obstetricia Gynecologica Scandinavica, 83(7), July 2004 (pp. 611–613), p. 611. PMID 15225183
  226. ^ Boyle 2002 p. 97.
  227. ^ Clyde H. Farnsworth, "Canada Gives Somali Mother Refugee Status", The New York Times, 21 July 1994.
  228. ^ Section 268, Criminal Code; UNICEF 2013, p. 8.

    Also see Audrey Macklin, "The Double-Edged Sword: Using the Criminal Law Against Female Genital Mutilation," in Abusharaf 2007, p. 211ff; "Female Genital Cutting", Clinical practice guidelines, No. 299, The Society of Obstetricians and Gynaecologists of Canada, November 2013.

  229. ^ Also see Mobina S. B. Jaffer, "Criminal Code, Bill to Amend – Second Reading, Debates of the Senate (Hansard), 1st Session, 41st Parliament, 148(79), 15 May 2012.
  230. ^ Wanda K. Jones, et al., "Female Genital Mutilation/Female Circumcision: Who Is at Risk in the U.S.?", Public Health Reports, 112, September/October 1997 (pp. 368–377), p. 372.
  231. ^ Julie Turkewitz, "Effects of Ancient Custom Present New Challenge to U.S. Doctors: Genital Cutting Cases Seen More as Immigration Rises", The New York Times, 6 February 2015.

    Alexandra Topping, "FGM affects three times more people in the US than previously thought", The Guardian, 5 February 2015.

  232. ^ Patricia Dysart Rudloff, "In Re: Oluloro: Risk of female genital mutilation as 'extreme hardship' in immigration proceedings", 26 Saint Mary's Law Journal, 877, 1995.
  233. ^ Nussbaum 1999, pp. 118–119.

    Celia W. Dugger, "June 9–15; Asylum From Mutilation",The New York Times, 16 June 1996.

    "In re Fauziya KASINGA, file A73 476 695", U.S. Department of Justice, Executive Office for Immigration Review, decided 13 June 1996.

  234. ^ Alida Yvonne Lasker, "NOTE: Solomon's Choice: The Case for Granting Derivative Asylum to Parents", 32 Brooklyn Journal of International Law, 231, 2006.

文献书目[编辑]

  • Al-Qaradawi, Y. (2004, February 7). Islamic ruling on female circumcision. Retrieved March 29, 2006.
  • Al-Qaradawi, Y. (2004, December 13). Circumcision: Juristic, medical & social perspectives. Retrieved March 29, 2006.
  • Boyle, E. H. (2002). Female genital cutting: Cultural conflict in the global community. Baltimore: Johns Hopkins University Press. ISBN 978-0-8018-7063-7.
  • Dettwyler, Katherine A. (1994). Dancing skeletons: life and death in West Africa. Prospect Heights, Ill.: Waveland Press. ISBN 0-88133-748-X.
  • Ferguson, I and Ellis, P. (1995). Female Genital Mutilation: a Review of the Current Literature Department of Justice, Canada. Working document
  • Gruenbaum, E. (2001). The female circumcision controversy. Philadelphia: University of Pennsylvania Press. ISBN 978-0-8122-1746-9.
  • Hoffman, B. (2002). Womanhood and Circumcision: Three Maasai women have their say. Berkeley: Berkeley Media.
  • Hrzán, Daniela. (Re)Discovering FGC: Anthropology, Whiteness, Feminism. In: Tißberger, Martina/ Dietze, Gabriele/ Hrzán, Daniela/ Husmann-Kastein, Jana (eds.). Weiß – Weißsein – Whiteness: Kritische Studien zu Gender und Rassismus/Critical Studies on Gender and Racism. Frankfurt/Main: Peter Lang, 2006, pp. 113–142.
  • IRIN. Razor's Edge - The Controversy of Female Genital Mutilation. IRIN. 2005. 
  • Johnson, Michelle C. (2000). Becoming a Muslim, Becoming a person: Female 'circumcision', religious identity, and personhood in Guinea-Bissau. In B. Shell-Duncan & Y. Herlund (Eds.), Female circumcision in Africa: Culture, controversy, and change. Boulder: Lynne Rienner Publishers.
  • Kandela, P. (1995, January). Egypt sees U turn on female circumcision. British Medical Journal, 310, 12.
  • Kassindja, F. (1998). Do they hear you when you cry. New York: Delacorte Press. ISBN 0-38531-832-4.
  • Obermeyer, Carla Makhlouf (2003). The health consequences of female circumcision: Science, advocacy, and standards of evidence. Medical Anthropology Quarterly, 17(3), 394-412. PMID 12974204. doi:10.1525/maq.2003.17.3.394
  • Pieters, G., & Lowenfels A. B. (1977). Infibulation in the horn of Africa. New York State Journal of Medicine, 77(5), 729-31. PMID 265433.
  • Research papers from medical gynecologists, judges, linguistics, and social scientists on the subject (1994). University of Khartoum, Sudan. Umm Atteya Organization website (Arabic). Retrieved March 29, 2006.
  • UNICEF (1999). Consultation on the elimination of female genital mutilation: 14 December-16 December 1998. New York: Author. 40 pp.
  • World Health Organization. (1996). Female genital mutilation: Report of a WHO Technical Working Group (unpublished document WHO/FRH/WHD/96.10). Geneva: World Health Organization. Retrieved 2007-02-21.

出版物[编辑]

  • Aldeeb, Sami (2000). Male and Female Circumcision in the Jewish, Christian and Muslim Communities, Religious debate. Beirut, ISBN 1855134063.
  • Daw, E. (1970). Female circumcision and infibulation complicating delivery. Practitioner, 204(222), 559-63. PubMed

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  • Dewhurst, C.J., & Michelson, A. (1964). Infibulation complicating pregnancy. British Medical Journal, 2(5422), 1442. PubMed

.

  • Dirie, Waris (2001). Desert Flower. Autobiography of a Somali woman's journey from nomadic tribal life to a career as a fashion model in London and to the post of special ambassador at the United Nations. Dirie recounts her personal experience with female genital mutilation that began with circumcision at age five.
  • Leonard, Lori (2000). We did it for pleasure only: Hearing alternative tales of female circumcision. Qualitative Inquiry, 6(2), 212-228.
  • Mernissi, Fatima. Beyond the veil: Male-female dynamics in a modern Muslim society. Cambridge, MA: Schenkman Pub. Co. ISBN 0-470-59613-9.
  • Mustafa, Asim Zaki (1966). Female circumcision and infibulation in the Sudan. Journal of Obstetrics and Gynaecology of the British Commonwealth, 73(2), 302–306. doi:10.1111/j.1471-0528.1966.tb05163.x.
  • Robinett, Patricia (2006). The rape of innocence: One woman's story of female genital mutilation in the USA. N.p.: Aesculapius Press. ISBN 1-878411-04-7.

参见[编辑]