The dilemma of worldwide typology and terminology of FGM--with special reference to Sudan.

The dilemma of worldwide typology and terminology of FGM--with special reference to Sudan. Abstract The objective of this article is the development of pertinent FGM FGMabbr.female genital mutilation typology, through using the local languages and / or dialects that arecomprehensible to and culturally accepted by the individuals ofdifferent societies. WHO (1996) typology and the recently (2007) proposed modified WHOone have been criticized. Alternatives for FGM used typology andterminology have been suggested. [TEXT NOT REPRODUCIBLE IN ASCII ASCIIor American Standard Code for Information Interchange,a set of codes used to represent letters, numbers, a few symbols, and control characters. Originally designed for teletype operations, it has found wide application in computers. .] Introduction: Of all problems traceable to traditional beliefs, and whichadversely affect the health and lives of girls and women in Africatoday, those arising from FGM are by far the most serious. Original,professional, and pioneer reporting on the health hazards (includingfatality) of FGM practice in the Sudan had early been documented byBredie bredieNounS African a meat and vegetable stew [Portuguese bredo ragout] , et al (1945); Shandal (1967); El Dareer (1983); Rushwan et al(1983, 1994). More recent inputs on the health consequences andgynecological gynecological/gy��ne��co��log��i��cal/ (-kah-loj��i-k'l) gynecologic. complications have been recorded by El Fadil (2000). Thenegative psychological impacts were reported by Baasher (19[TEXT NOTREPRODUCIBLE IN ASCII]). Moreover, the negative psychosexual psychosexual/psy��cho��sex��u��al/ (-sek��shoo-al) pertaining to the mental or emotional aspects of sex. psy��cho��sex��u��aladj.Of or relating to the mental and emotional aspects of sexuality. impact ofFGM on women has been investigated by Abdel Magied and Musa (2002).Therefore, within the preceding context, it would seem logical toconsider FGM as a synonym of endemic fatal disease and type of slaveryspecific to girls and women, whenever and wherever it is prevalentand/or practiced (Abdel Magied, 1998). Nonetheless, in the Sudan the practice has been perpetuating formany generations. As such, the practice has been institutionalized as ahabit or a custom that became an integral part of the social system.Nevertheless, the reasons behind perpetuation of the practice arecomplex and should be visualized, considered, evaluated and addressedthrough a multidimensional scientific approach. The latter should givefull consideration to its inter-related culture, health, socio-economic,religious, official and legal perspectives (Abdel Magied, 2001, 2007). However, of the 28 identified African countries (Rahman and Toubia,2000) known to practice FGM, Sudan is one of the cases that are worthyof special attention. This is because of the extra prevalence of theunique practice of cosmetic "re-infibulation" or"re-circumcision" by Sudanese women. This is practiced afterdelivery, but also cosmetically for up to three times a year to have atighter vagina. The practice is claimed mainly for the pleasure of themale spouse (Abdel Magied et al, 2000). This is in addition to a spreadof FGM practice (due to negative acculturation acculturation,culture changes resulting from contact among various societies over time. Contact may have distinct results, such as the borrowing of certain traits by one culture from another, or the relative fusion of separate cultures. influence) amongcommunities (e.g. Southern tribes) where FGM was not part of theirculture (Abdel Magied, 2001 and 2007). Historical Developments of Previously Practiced Types of FGM inSudan: According to Bridie A bridie or Forfar bridie is a Scottish type of meat pastry or pie, originally from the town of Forfar, similar to a Cornish pasty in shape, but the pastry is not as hard and no potato is used. (1945), the operation involves removal of theclitoris clitoris/clit��o��ris/ (klit��ah-ris) the small, elongated, erectile body in the female, situated at the anterior angle of the rima pudendi and homologous with the penis in the male. clit��o��risn. and a large part of labia majora labia ma��jo��rapl.n.The two outer rounded folds of adipose tissue that lie on either side of the vaginal opening and that form the external lateral boundaries of the vulva. and the paring of the latter.This would strictly be the so called Pharaonic circumcision circumcision(sûr'kəmsĭzh`ən), operation to remove the foreskin covering the glans of the penis. It dates back to prehistoric times and was widespread throughout the Middle East as a religious rite before it was introduced among the orinfibulation which was the only type practiced in Sudan by then. The age at which the operation of FGM is performed varies from oneculture to another. According to El Dareer (1983), 18% of girls werecircumcised at five years of age including those aged from seven days tofour years. The minimum age of circumcision is seven to forty days andthis habitual practice is only found among Beja and Beni Amir tribes ofEastern Sudan. However, the age at which girls are generally circumcisedranges between 5-9 years old (Department of Statistics, Ministry ofEconomic and National Planning, Khartoum-Sudan, 1991). Shandall (1967) reported four types of circumcision that have beenpracticed in different Muslim and Arab countries, Australia, andSomalia. These types were classified as: Circumcision: this is analogous to that of the male. It consists ofremoval of the prepuce prepuce/pre��puce/ (pre��pus)1. a covering fold of skin.2. p. of penis.prepu��tialprepuce of clitoris of the clitoris only, preserving the clitorisitself and the posterior large parts of the labia minora labia mi��no��rapl.n.The two thin inner folds of skin within the vestibule of the vagina enclosed within the cleft of the labia majora.Labia minora. It is called"Sunna circumcision". Excision: this consists of removal of prepuce and glans ofclitoris, together with the adjacent part of the labia minora or thewhole of it without including the labia majora and without closure ofthe vulva vulva/vul��va/ (vul��vah) [L.] the external genital organs of the female, including the mons pubis, labia majora and minora, clitoris, and vestibule of the vagina. . Infibulation: this is really excision plus infibulation. It is thecommonest type in Sudan where it is known as "Pharaoniccircumcision". Introcision: this is most drastic operation of all of them. Atpuberty the vaginal orifice is enlarged by tearing it downwards withthree fingers bound around with opossum opossum(əpŏs`əm, pŏs`–), name for several marsupials, or pouched mammals, of the family Didelphidae, native to Central and South America, with one species extending N to the United States. string. The operator is usuallyan old man trained for the job This is followed by compulsory sexualintercourse sexual intercourseor coitus or copulationAct in which the male reproductive organ enters the female reproductive tract (see reproductive system). with a number of young men and sometimes with the older menof the tribe. Abu-Bakr (1982) described three types of female circumcisionpracticed in Sudan: Sunna Circumcision: this consists of the removal of the prepuce andglans clitoris. The rest of the clitoris is preserved together withposterior large parts of the labia minora. Excision: Removal of prepuce and glans of clitoris together withthe adjacent part or whole of labia minora without including the labiamajora and without closure of vulva. Infibulation: Excision plus infibulation. The second name for it isPharaonic circumcision. It consists of removal of the whole clitoris,the labia minora and the medial part of the labia majora. Modawi (1982) described three different types of femalecircumcision practiced in Sudan: Classic Pharaonic circumcision or infibulation: is also known inEgypt as the Sudanese circumcision. Sunna or clitrodectomy: the glans clitoris only is removed. Re-infibulation or Re-circumcision: This is sometimes done bymidwives to close the patulous patulous/pat��u��lous/ (pat��u-lus) spread widely apart; open; distended. pat��u��lousadj.Freely open or exposed; patent.patulousspread widely apart; open; distended. vagina after giving birth. According to Rushwan, et al (1983), there ate three types of femalecircumcision practiced in Sudan: Pharaonic Circumcision (Infibulation): This form represents classicinfibulation or classic Pharaonic circumcision. The process includes:Removal of clitories, labia minora, and part of the labia majora. Labiamajora are joined together, leaving an opening for the passage of urineand menstrual discharge. Intermediate circumcision: Is slightly less severe frominfibulation: The clitoris and part or all labia minora are usuallyremoved and the vaginal introitus is narrowed, most of the time bystitching. Sunna: the term embraces both excision and circumcision proper. Sudan Demographic Health Survey, SDHS SDHS San Diego Historical SocietySDHS Society of Dance History ScholarsSDHS Stephen Decatur High School (Berlin, Maryland)SDHS Satellite Data Handling SystemSDHS South-Doyle High School (Ministry of Economic andNational Planning, Department of Statistics, Khartoum, Sudan, 1991) usedthe same classification of typology that has been used by Rushwan etal(1983). Nevertheless, there are clues in old and recent published andunpublished literature that indicate a shift of the practice in theSudan from the severe form of infibulation to the milder form ofclitoridectomy clitoridectomy/clit��o��ri��dec��to��my/ (klit?ah-ri-dek��tah-me) excision of the clitoris. clit��o��ri��dec��to��myn.Excision of the clitoris. and non-circumcision. (Abdel Magied, 2007, 2008a and2008b). However, the latter typology terms, together with others, inaddition to some controversial terminologies create the presentworldwide dilemma of typology and terminology. Justification: Neither WHO (1996) used typology, nor the recently (2007) proposedone would resolve the worldwide dilemma of FGM typology and terminology. Objectives: Developing a compromising simple FGM typology and culturallyaccepted terminology and using the local language and/or dialects thatare suitable for and comprehensible by individuals of differentsocieties with different cultures, norms and practices of FGM. Methodology: This article is cross sectional, involving critical analysis anddevelopment of some secondary data. The latter is obtained frompublished articles, statements and whatever thought useful and relevantof professional reports and unpublished researches carried out by thecoworkers of the author of this article. Results and Discussion: Recent Practiced Types and Forros of FGM in Sudan: In the Sudan, FGM is inflicted on the victimized girl child withouther mature consent at an age normally between 5 and 9, and rarely at 10.At this age the development of the prepuce (hood) of the clitoris isonly vestigial ves��tig��i��aladj.Occurring or persisting as a rudimentary or degenerate structure. , and removing it would need a dexterous dex��ter��ous? also dex��trousadj.1. Skillful in the use of the hands.2. Having mental skill or adroitness.3. Done with dexterity. surgeon and withsophisticated surgical equipment. Accordingly, clitoridectomies whichate normally done by TBAs and midwives in the Sudan would involve atleast excision of the glans clitoris and the vestigial prepuce or hood(Abdel Magied, et al, 2003). Several ambiguous forms of FGM have recently been introduced inSudan. However, the most common form of infibulation, which is practicedin urban communities, is known as "Sandwich Circumcision". Thelatter is said to be gradually replacing the classical type of PharaonicCircumcision or Infibulation (Abdel Magied, 1998). It consists of: a)Excision of the prepuce and glans clitoris, b) This is followed by alongitudinal medial incision or trimming of the margins of the upper(anterior) two thirds of the labia minora, c) The remaining part of theclitoris then becomes sandwiched between the incised or trimmed aspectsof the labia minora, d) The two sides of the wound then become stitchedto cover the remaining part of the clitoris. An aperture varying fromthe head of a match stick to the tip of finger is left for passage ofurine and menstrual discharge. There are several recognized forms of FGM which have recently beendescribed by midwives and traditional birth attendants, TBA's(Abdel/ Magied et al, 2003). They reported two forms of pharaoniccircumcision (Infibulation): i) Al Tagleed(; which includes the processof removal of clitoris from the base, removal of the.labia minora,removal of the labia majora, and then both sides of the skin are broughttogether and sutured in zigzag(VVVV). This type of suturing is describedby Arabic adopted numbers as" Sabaa/Tamania" (1), leaving onlysmall hole, about the size of the head of a match stick or a little bitmore. This form of infibulation is practiced in western Sudan in Dar Furand Kordoufan. ii) The second form is called Al Kurbage; this includesremoval of the clitoris from the base, labia minora, and labia majora.The two sides of the skin of the labia majora are then sutured bythorns, leaving a hole about the size of the root of the feather of thepigeon's wing. This type is practiced in Eastern Sudan by theHadandwa and other Biga tribes. There are also two modifications of clitoridectomic genitalmutilation genital mutilationThe destruction or removal of a portion or the entire external genitalia, which may occur in the context of a crime of passion or as part of a cultural rite. See Bobbittize, Cutter, Female circumcision, Self-mutilation. which include two types; i) Al Makjour ([TEXT NOTREPRODUCIBLE IN ASCII]); which includes a process of cutting the head ofthe clitoris with the prepuce, splitting the rest of the clitorislongitudinally and introducing insulating material between the splitsurfaces of the clitoris until healing, ii) Al Ma'akouf ([TEXT NOTREPRODUCIBLE IN ASCII]); includes either cutting of the head of clitoriswith the prepuce or leaving it as it is, then splitting the clitorislongitudinally, and then making ah incision in one of the labia minora,stitching one of the edges of one of the spilt spilt?v.A past tense and a past participle of spill1. sides of the clitoriswith the incision in one of the labia minora. All these two forms aredone at the level of clitoris. Modification of the previously called Intermediate genitalmutilation includes two forms of infibulation: i) Al Nus ([TEXT NOTREPRODUCIBLE IN ASCII]): the process includes removal of the upper halfof the clitoris, removal of small portion of the upper parts of thelabia minora, removal of upper parts of labia majora, sutring the woundsup to the vaginal orifice, ii) AL Masnad ([TEXT NOT REPRODUCIBLE INASCII]): it includes two processes: a) removal of clitoris from the baseand suturing to stop hemorrhage, making incision in the upper parts ofthe labia minora and suturing, making longitudinal incisions along thelabia majora from the lower parts till half way and suturing the woundtill after the vaginal opening vaginal openingn.The narrowest portion of the vaginal canal, located in the floor of the vestibule, behind the urethral orifice. , leaving a small hole midway above thevaginal opening, b) removal of the clitoris from the base and suturingthe wound, leaving the labia minora intact, and removal of the labiamajora and then suturing leaving a small opening in the middle of thevulva. Dilemma of Typology and Terminology Typology: WHO(1996) recognizes four degrees of FGM which are classified intofour types: Type I Excision of the prepuce, with or without excision of part orthe entire clitoris. Type II Excision of the clitoris with partial or total excision ofthe labia minora. Type III Excision of part or all of the external genitalia external genitalian.1. The vulva of the female.2. The penis and scrotum of the male.secondary sex characteristicandtitching/narrowing of the vaginal opening (infibulation) Type IV Pricking, piercing or incising of the clitoris and/orlabia; stretching of the clitoris and/or labia; cauterization cauterization/cau��ter��iza��tion/ (kaw?ter-i-za��shun) destruction of tissue with a cautery. cauterizationdestruction of tissue with a cautery. by burningof the clitoris and surrounding tissue; scraping of tissue surroundingthe vaginal orifice (angurya cuts) or cutting of the vagina (gishiricuts); introduction of corrosive substances or herbs into the vagina tocause bleeding or for the purpose of tightening or narrowing it; and anyother procedure that falls under the definition given above. This classification (WHO, 1996), as well as WHO (2007)classification and the suggested typology seem non-specific, ambiguousand confusing when trying to fit in the types and forms of FGM practicedin Sudan. To begin with and for argument sake, let us agree that FGMincludes any intended permanent damage to part/parts or all the externalfemale genitalia genitalia/gen��i��ta��lia/ (jen?i-tal��e-ah) [L.] the reproductive organs.ambiguous genitalia , with particular emphasis on the girl child for nontherapeutic purposes. In the Sudan, some of the recent forms of clitoridectomiespracticed in the Sudan might fit in WHO (1996 and 2007) Type I FGM.However, one alternative of Al Maakouf ([TEXT NOT REPRODUCIBLE INASCII]) form which does not involve excision, but longitudinal splittingof the whole clitoris (Abdel Magied et al, 2003), neither fits in Type Inor in Type IV. Type II is not practiced in the Sudan; hence none of thetypes and forms of FGM practiced in Sudan would fit in WHO (1996 and2007) Type II. On the other hand the claimed Pharaonic ([TEXT NOTREPRODUCIBLE IN ASCII]) and intermediate ([TEXT NOT REPRODUCIBLE INASCII]) FGM practiced in Sudan, with all their forms, very well fit inType III (infibulation). On the other hand, damages inflicted ondifferent parts of the genitalia, mentioned under Type IV, are notpracticed in the Sudan. Moreover, introduction of substances or herbs totighten the vagina are only temporary cosmetic applications by adultwomen on themselves; hence should not be considered under FGM (AbdelMagied, 1998). "Introduction of harmful substances" as in typeIV of WHO (2007) is ambiguous. Moreover, the re-infibulation orre-circumcision practiced in the Sudan is not catered for in both WHOclassifications (WHO 1996 and WHO 2007). Consequently, the followingclassification of typology is suggested: Type I (Clitoridectomy \[TEXT NOT REPRODUCIBLE IN ASCII.]): Thisincludes all degrees of excision or damage inflicted on the clitoris.The nature and degree of excision of damage of the clitoris to be giventhe local name as "form" of clitoridectomy. Type II (Infibulation \[TEXT NOT REPRODUCIBLE IN ASCII.]): Thisincludes all degrees of excision of the genitalia beyond clitoridectomyto include other part/parts of the external genitalia, followed bysuturing of not. The nature of the degree of damage of the genitalia tobe given the local name as a "form" of infibulation. Type III (Re-infibulation or Re-circumcision \[TEXT NOTREPRODUCIBLE IN ASCII.]): This includes de-circumcision andre-circumcision of an already infibulated woman and suturing as inoriginal infibulations, after delivery or for cosmetic reasons. Type IV (Unclassified un��clas��si��fied?adj.1. Not placed or included in a class or category: unclassified mail.2. ): This includes all degrees of damage ofpart/parts of the genitalia that do not fall under Types I, II and III.The nature of and the degree of damage on the genitalia to be given thelocal name as a "form" of unclassified type IV FGM.Nonetheless, Elmusharaf et al, (2006) based on self reporting andclinical investigation of mutilated women and girls also challenged thevalidity of WHO (1996) classification and recommended revision of WHOtypology. Terminology: Abdel Magied (1998) criticized some of the terminologies used inFGM literature and suggested the use of alternatives: Mutilation MutilationSee also Brutality, Cruelty.Mutiny (See REBELLION.)Absyrtushacked to death; body pieces strewn about. [Gk. Myth.: Walsh Classical, 3]Agatha, St.had breasts cut off. [Christian Hagiog. and Female Circumcision: The term "Female Genital Mutilation [TEXT NOT REPRODUCIBLE INASCII.]" (FGM) would be most appropriate to describe the state of acircumcised female irrespective of the degree of excision of thegenitalia. The term "Female Circumcision [TEXT NOT REPRODUCIBLE INASCII.]" may also be used only when necessary. Sunna circumcision: The term "Sunna" implies linking FGM with Islamicreligion. Therefore, the habitual use of the term "Sunna" whenused in connection with FGM, especially in Muslim countries, impliesrecognition and perpetuation of the type as an Islamic practice.Therefore, the term "Sunna circumcision [TEXT NOT REPRODUCIBLE INASCII.]" should be abolished from the future FGM literature, except when rectifying a situation." The suggested alternative termis "Clitoridectomic Circumcision" or synonymously"Clitoridectomy /[TEXT NOT REPRODUCIBLE IN ASCII.] [TEXT NOTREPRODUCIBLE IN ASCII.]. This would also be consistent with the typologywhich has been suggested earlier. Infibulation versus Pharaonic Circumcision: Since the origin of the practice is still controversial and toavoid unnecessary confusion, the term "Pharaonic Circumcision\[TEXT NOT REPRODUCIBLE IN ASCII.]" should be abolished from future FGM literature. The alternativerelevant term would be "Infibulation/[TEXT NOT REPRODUCIBLE INASCII.]. Abolition versus Eradication: The word "eradication\[TEXT NOT REPRODUCIBLE IN ASCII.]"(extermination exterminationmass killing of animals or other pests. Implies complete destruction of the species or other group. ) implies a forceful physical act, while the wordabolition deals with a holistic concept. Abolition on its own has alwaysbeen used in connection with abolishment of slavery. Doubtless, FGM is atype of slavery specific to the female gender. It is, therefore,suggested that the term "Eradication" becomes excluded fromfuture FGM literature and be replaced by the term "Abolition\[TEXTNOT REPRODUCIBLE IN ASCII.]". Consequently, the following suggestedterminology would become relevant: Abolition of FGM ([TEXT NOT REPRODUCIBLE IN ASCII.]) instead ofEradication of FGM ([TEXT NOT REPRODUCIBLE IN ASCII.]) : FGM AbolitionCampaigns([TEXT NOT REPRODUCIBLE IN ASCII.]) instead of FGM EradicationCampaigns([TEXT NOT REPRODUCIBLE IN ASCII.]). FGM Abolitionists ([TEXT NOT REPRODUCIBLE IN ASCII.]) to be adoptedsynonymously for Anti-FGM Campaigners and their supporters (AbdelMagied, 1998). State of Circumcision ([TEXT NOT REPRODUCIBLE INASCII.]): When describing a female's status of circumcision, the term"Uncircumcised uncircumcisedUrology Referring to a ♂ or penis which has not been circumcised. See Circumcision. " should be one of three alternatives: Uncircumcised ([TEXT NOT REPRODUCIBLE IN ASCII.]). Clitoridectomised ([TEXT NOT REPRODUCIBLE IN ASCII.]). Infibulated ([TEXT NOT REPRODUCIBLE IN ASCII.]). Classifying the uncircumcised as one of the states of circumcisionof a female, serves establishing a purposive pur��po��sive?adj.1. Having or serving a purpose.2. Purposeful: purposive behavior.pur definition. First, it willserve the purpose of recognition of her circumcision situation as theideal state of circumcision of a female, worth of defending, protectionand campaigning for. Second, it will help lifting the negativepsychological stigma, resulting from the societal inferiorating attitudetowards the uncircumcised female (Abdel Magied and Omran, 1999). Conclusions: Up to 1983, three described types of circumcision were practiced inSudan. Those were namely: Pharaonic circumcision (infibulation),intermediate circumcision and Sunna circumcision (clitoridectomy).Recent forms of FGM introduced by traditional birth attendants (TBAs)and midisives include: Forms of infibulation: Al Tagleed. Al Kurbag. Sandwitch circumcision. Al Nus circumcision. Al Masnad circumcision. Forms of clitoridectomy include: Al Makjour. Al Ma'akouf. WHO (1996) typology has been criticized and challenged by AbdelMagied since 1998. Moreover, recently Al Musharf et al (2006) alsochallenged the validly of WHO (1996) typology for Sudan case.Accordingly, those authors recommended revision of WHO (1996) typology. Nonetheless, the present article criticizes WHO (1996) and therecently (2007) proposed typology. Nonetheless, the article suggests apertinent typology that suits Sudan case in particular and perhaps othercases. The present article was also critical about some used FGMterminologies and hence suggested pertinent alternatives for thenegative ones and recommended keeping the positive terminologies, Arabic terms were designated for the different types and forms ofFGM practiced in Sudan. Also suitable Arabic terms were designated foralternatives of negative terminologies as well as for the positive ones. References: Abdel Magied, Ahmed; El Balah, A. Sulima; Dawood, M. Kawther(2000): Re-Circumcision: The Hidden Devil of FGM in Sudan--Case Study onSudanese Men of Different Socio-economic Status. The Ahfad Journal, Vol.17, No. 2. Abdel-Magied, A. (2008a).The Shift from Infibualtion toClitrodectomy to Non-circumcision in Sudan. The Ahfad Journal, Vol 25,No. 1 Abdel Magied, Ahmed(2008b): Female Genital Mutilation in Sudan--AHuman Rights Issue (Unpublished book). Abdel-Magied, A. (1998). Some FGM Terminology Between the Negativeand Positive Impacts. The Ahfad Journal, Vol. 15, No. 2. Abdel-Magied, A. (2001). Overview and Assessment of Anti-FGMEfforts in Sudan. Khartoum Sudan: In Collaboration with UNICEF. Abdel-Magied, A. (2007). Social Determinants and Developments inPolicies and Practices Connected with Abolition of FGM in Sudan, inCollaboration with Social Research Center, American University, Cairo,Egypt (December, 2007) Abdel-Magied, A., Al-Musharf, H., & Adam, I. (2003). Midwives,Traditional Birth Attendants (TBAs) and the Perpetuation of FemaleGenital Mutilation (FGM) in the Sudan. The Ahfad Journal, Vol 20, No. 2. Abdel-Magied, A., Balah, S. A. E., & Dawood, K. M. (2000).Re-circumcision: The Hidden Devil of FGM in Sudan.--Case Study onSudanese Women of Different Socio-economic Status. The Ahfad Journal,Vol. 17, No. I. Abdel-Magied, A., & Omran, M. (1999) The Uncircumcised Femalein an Ideal State of Circumcision. The Ahfad Journal, Vol. 16 No. 2. Abdel-Magied, A., & Musa, S. (2002). Sexual Experiences andPsychosexual Effect of Female Genital Mutilation (FGM) or FemaleCircumcision (FC) on Sudanese Women. The Ahfad Journal, Vol. 19, No. 1. Abu-Bakr, S. (1982). Circumcision and Infibulation in The Sudan.No. 2 Volume 2, 162-178. In T. Baasher, R. H. O. Bannerman, H. Rashwan& I. Sharaf (Eds.), Traditional Practices Affecting the Health ofWomen and Children (Vol. 2, pp. 18-144). Alexendria: WHO\EMRO EMRO Eastern Mediterranean Regional Office (World Health Organization)EMRO Electromagnetic Radiation Operation(al)EMRO Emergency Management and Response Office TechnicalPublication Baasher, T. (1982).. Psycho-social Aspects of Female Circumcision,WHO Seminar on Traditional Practices Affecting the Health of Women andChildren. In T. Baasher, R. H. O. Bannerman, H. Rushwan & I. Sharaf(Eds.), Traditional Practices Affecting the Health of Women and Children(Vol. 2, pp. 162-178.). Alexandria: WHO\EMRO Technical Publication Bridie, E. D.; Lorenzen, A. E.; Cruickshank, A.; Hovell, J. S.;MacDonald, D. R.; Ali Bedri.; Abdel Haleem Mohamed;al Tigany AlMahi andAbd Allah Abu Shamma. (1945). Female Circumcision in Anglo-EgyptainSudan: McCorcodale Printing Press S.G. 1185CS. 5000.6\51. Department ofStatistics, Ministry of Economic and National Planning, Khartoum-Sudan(1991): Sudan Demographic and Health Survey(SDHS). El-Dareer, A. (1983). Women, Why do you weep? Circumcision and itsConsequences. Zed Press, London. El Fadil, Saad (2000): Gynecological Complications of FemaleGenital Mutilation (FGM). Proceedings of the World Congress Obstetricsand Gynecology. Washington D.C. (September, 2000). Elmusharaf, S., Elhadi, N., & Almorth, L. (2006). Reliabilityof self reported form of female genital mutilation and WHOclassification: cross sectional study. British Medical Journal The British Medical Journal, or BMJ, is one of the most popular and widely-read peer-reviewed general medical journals in the world.[2] It is published by the BMJ Publishing Group Ltd (owned by the British Medical Association), whose other ,333(7559), 124-127. Modawi, S. (1982). The Obstetrical and Gynecological Aspects ofFemale Circumcision in the Sudan. In Baasher, T.; Bannerman. R. H. O.,Rushwan H. & Sharaf. I (Eds.), Traditional Practices Affecting theHealth of Women and Children (Vol. 2, pp. 335-341). ALexandria: WorldHealth Organization, Regional Office for the Eastern Mditerranean. Rahman, A., & Toubia, N. (2000). Female Genital MutilationAguide to Laws and Policies World Wide. Zed Books, London and New York New York, state, United StatesNew York,Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of . Rushwan, H., Slot, C., Dareer, A. E., & Bushra, N. (1983).Female Circumcision in the Sudan; Prevalence, Complications, Attitudesand Changes: Faculty of Medicine, University of Khartoum The University of Khartoum (U of K) is a public co-educational university located in and near Khartoum, Sudan.Founded as Gordon Memorial College in 1902 and established in 1956 when Sudan gained independence, the University of Khartoum is the most historically . Rushwan, H. (1994). The Health Consequences of Female GenitalMutilation from a Health Providers Perspective. Paper presented at the47th World Health Assembly. The Briefing Session on Female GenitalMutilation, Geneva Geneva, canton and city, SwitzerlandGeneva(jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. . Shandall, A. A. (1967). Circumcision and Infibulation of Females;Ageneral Consideration of the Problem and A Clinical Study of theComplications in Sudanese Women. Sudan Medical Journal S.M.J, Vol 5 No.4. 178-212. WHO, (1996). Female Genital Mutilation. A Joint Statement WHOUNICEF\ UNFPA UNFPA United Nations Population Fund (formerly United Nations Fund for Population Activities)UNFPA United Nations Fund for Population Activities (now United Nations Population Fund). WHO Publications, 3. WHO (2007): WHO FGM Modified Typology--Notes on the Classificationof FGM. (1) Sabaa = seven in Arabic / Tamania = eight in Arabic Abdel Magied Ahmed (School of Health Sciences, Ahfad University forWomen Ahfad University for Women is a private women's university in Omdurman, Sudan,and was originaly founded as a girls school by babiker badri in 1905 and was awarded the status of university in 1966. )