FEMALE GENITAL MUTILATION (FGM) FRANCE
Initial findings of survey on FGM and disability (Excision et Handicap, ExH)
It is estimated that in 2004 around 53,000 adult
women residing in France had been subjected to
female genital mutilation (FGM). This practice exposes
women to chronic healthproblems, in addition to
difficulties in their daily sexual and emotional lives.
The first kindof problem is recognized, but rarely
quantified, while little is known about the second.
Two public health issues arise from FGM: preventing
the practice in communities at risk andcaring for
affected women. The national FGM and disability
survey (ExH) has collected new data on the
consequences of FGM and has developed a knowledge
base which will improvecare management for victims
Female genital mutilation is carried out on girls in many countries of
sub-Saharan Africa. Some of the migrant women and their daughters
living in France are victims of this practice.
Specific health problems
Box 1
The ExH survey, a long-term
survey
ExH was a « case-control » survey
administered in five regions of
France* between 2007 and 2009 on a
sample of 2,882 adult immigrant
women or girls who were surveyed
during hospital gynaecological
consultations or in mother and baby
clinics. Among these women, 685
were victims of genital mutilation.
The women were all over 18 and 70%
were below 35 years old.
The sample was composed of twothirds immigrant women and onethird daughters of immigrants. Half
of them were in a couple at the time
of the survey.
* The survey was administered in HauteNormandie, Île-de-France, PACA, Pays de la
Loire et Nord-Pas-de-Calais.
As indicated by WHO surveys administered in countries where the
practice is common, FGM exposes women to specific health problems
and complications during childbirth. Difficulties of daily living,
particularly in sexual life, are rarely considered in these surveys, although
they may have many consequences, sometimes even serious ones. The issue has come to the attention of public
authorities due to the risks for women associated with this practice. Nonetheless, the extent and nature of these
women’s needs in the context of the French healthcare system are yet to be evaluate.
Pain and functional disorders
In the ExH survey, FGM was found to cause a range of health problems such as urinary and gynaecological infections
or tearing during childbirth. Women with FGM also report feelings of sadness and discouragement more frequently
than the control group (after taking account of social characteristics). These women report more severe pain, which
more frequently disrupts their daily life. For instance, one in ten women with FGM suffer from discomfort when
urinating, walking or when wearing certain clothes.
Institut national d’études démographiques • 133, bld Davout 75 980 Paris cedex 20 • www.ined.fr
Difficulties in sexual lives
It is regarding sexuality that the most striking findings are obtained. Women with FGM have recurrent difficulties in
their sexual lives, and more often report experience which is unsatisfying or even systematically painful. Many of
these women see a direct link between their mutilation and difficulties they face in their sexual lives. The survey
indicates that the victims of this practice would like to receive support and information on these issues, even though
speaking of their sexuality and sexual problems is often difficult (especially for women from societies where these
subjects are rarely discussed).
Demand for reconstructive surgery
Box 2
Rappel
The development of reconstructive surgery ( the cost of the operation
has been covered by the French social security since 2003. It is available
in around 15 hospitals and clinics, mainly in the Paris region but also in
the provinces) offers victims the possibility of «repairing» the damage. A
majority of the surveyed women knew of the existence of this type of
surgery, mainly through the media, healthcare professionals or a person
in their social circle. Among the survey respondents, 5% had undergone
this procedure or were preparing to undergo it and 20% were interested
in the possibility, mostly to improve their sexual lives, to regain their
female integrity or for their health. Women who were not interested in
the surgery reported having «accepted their fate» and «not feeling the
need». This procedure is all the more appealing for young women (below
35 years) who have grown up in France. Reconstructive surgery is still
marginal however, and the procedure is unlikely to become systematic.
The number of women concerned
by FGM in France was estimated in
2004 on the basis of INSEE data
(census and Family survey) and
prevalence surveys conducted in
African countries. Based on
hypotheses of the perpetuation of
FGM from one generation to the
next by age at arrival in France, and
hypotheses of age at circumcision,
the number of women with FGM in
France is estimated at between
42,000 and 61,000, with a medium
hypothesis of 53,000.
Institut national d’études démographiques • 133, bld Davout 75 980 Paris cedex 20 • www.ined.fr
The risk of FGM among young girl
Some 11% of daughters of women with FGM are themselves
subjected to the procedure. However, this proportion is much
smaller among those who were born in France (3%) where the
practice is illegal. Moreover, FGM has been dying out in recent
generations, not only among immigrant communities but also
in the countries of origin. Some young girls who were
uncircumcised at the time of the survey, especially those
younger than 15 years old, may still be at risk. The level of risk
can be ascertained by questioning mothers about their own
intentions and those of the father or the family in the home
country. In 7 out of 10 cases, there is no reported intention to
circumcise the girl on the part of the parents or family
members. In 3 out of 10 cases there is still a risk for the girl,
either upon her return to her country of origin (with the parents’ knowledge), or because one or other parent
directly or indirectly expresses this intention. A survey of this kind requires a lot of time, a team of professionals who
are conscious of the ethical implications, and a political and institutional will to improve expertise on the subject
(Thanks to the support of the Direction générale de la santé, the
survey was national in scope. Health professionals played a crucial role in data collection ). However, the survey owes
its success primarily to all the women who agreed to take part. The study has shed light on the issue of female
genital mutilation. Even though the French healthcare system prevents most of the complications encountered in the
country of origin, a good quality of life - including sexual life - for the victims of this practice is nonetheless as
important as eliminating the health risks.
Armelle Andro (Universite Paris1), Marie Lesclingand (Université de Nice), Emmanuelle
Cambois (Ined)
POUR EN SAVOIR +
WHO, 2000. « A systematic review of the health implication of female genital mutilation including sequelae in childbirth »
WHO, 2006. – « Female genital mutilation – new knowledge spurs optimism», Progress in sexual and reproductive health
research, n° 72.
HCDH, ON USI DA, OMS, PNUD, UNC EA, UNESCO , UNF PA, UNHCR, UNIC EF, UNiFEM, 2008. – « Eliminating Female genital
mutilation »
Andro A., Lesclingand M., 2007. – "Female genital mutilation: the situation in Africa and in France", Population & societies, n° 438
Andro A., Lesclingand M., Cambois E., Cirbeau C., 2009. – « Volet quantitatif du projet Excision et Handicap (ExH) :
Mesure des lésions et traumatismes et évaluation des besoins en chirurgie réparatrice », Rapport de recherche
pour la DGS, 87 p.
Andro A., Lesclingand M., Pourette D., 2010. – « Female Genital Mutilation and the Path to Surgical
Reconstruction: A Personal Journey within Family Dynamics », Cairn-info.
Institut national d’études démographiques • 133, bld Davout 75 980 Paris cedex 20 • www.ined.fr