Type IV & FGM



What, Where, Why?

The piercing the clitoris or surrounding tissue, pricking, is a procedure in which the skin is pricked with a sharp object. Blood may flow but no tissue is removed and no stitching is done. Pricking is practiced in different communities around the world, either as a traditional form of FGM or as a substitute for more extensive excision. The practice is classified by the WHO as Type IV FGM. (WHO, 2008)

In some communities in Southeast Asia, for example, pricking is considered to be a part of girls’ socialization. Some see it as an Islamic practice. The practice is generally perceived as harmless by communities (Wahlberg A. et al, 2017).

Studies suggest that pricking is becoming more popular among some communities that traditionally practice other types of FGM. In Somaliland, pricking is considered a “Sunna” and seen as a less severe form of FGM in comparison to other practices such as “Pharaonic”  infibulation (type III). (Ingvild & Mette, 2014). Nevertheless, studies show that “Sunna” may also refer to other types of FGM outside infibulation, such as types I and II.

In Guinea, where various forms of FGM are practiced, research suggests that some families are also beginning to opt for type IV FGM involving a “symbolic slight incision of the genitals”. (UNHCR, 2001)

Although the practice of pricking is increasingly discussed, empirical data on the practice and its possible consequences for girls and women are lacking. (Wahlberg A. et al, 2017).

Controversies around pricking

In reviewing the typology of FGM, WHO has taken into account the debate around pricking and its harmful effects. In its inter-agency statement (2008), the organization explained the choice to maintain this practice in the FGM typology:

“Discussion on whether pricking should be included in the typology and defined as a type of FGM has been extensive. Some researchers consider that it should be removed from the typology, both because it is difficult to prove if there are no anatomical changes, and because it is considered significantly less harmful than other forms.” (WHO, 2008)

The WHO noted that pricking is also considered by some experts as a possible “risk reduction strategy”, replacing more invasive procedures. However, others have argued that pricking should remain within the typology of FGM “either to allow for the documentation of changes brought about by more stringent procedures or to avoid their use as a ‘cover-up’ for more invasive procedures, as there are strong indications that pricking, described as substitution, often involves a change in terminology rather than an actual change in practice”. [Translating note]

In addition, studies have shown that “when women claiming to have undergone ‘pricking’ were medically examined, they were found to have undergone a wide variety of practices, ranging from Type I to Type III. The term can therefore be used to legitimize or cover more invasive procedures.”

For these reasons, WHO has decided to maintain pricking in type IV.

A controversial article, written by an anonymous author and published in The Economist in 2016, advocated the acceptance of a “symbolic incision”, performed by a health professional. The author(s) argued that a new approach to the prevention of FGM was needed and that the “symbolic incision” was preferable to more invasive practices such as type I, II or III. (Anonymous, 2016) Another article, written by two American gynaecologists, gave new impetus to this debate in 2018. The authors, Arora and Jacobs, also advocated pricking as a “compromise solution”. According to them, it almost never has a lasting effect on morphology or function, if done correctly. Thus, allowing this less invasive procedure could allow families to preserve cultural and religious traditions whilst protecting girls from more dangerous forms of excision and infibulation of the vulva. (Arora & Jacobs, 2018)

However, advocates of zero tolerance strongly oppose pricking as an acceptable solution. Experts have argued that even a “small incision” can have significant negative consequences for a girl’s mental and physical health – because there is no direct correlation between the extent of the incision and its consequences. In fact, the way in which the practice is performed, such as holding the girls on the floor, can be more traumatic than the cut itself. (Richard, 2018)

A participant in the discussion informed us that Stop FGM Middle East & Asia brings together activists from several countries where pricking is practiced. In her experience, when pricking is used to define a practice, this is usually not the case. In fact, an Indonesian study showed that pricking occurs in only 3% of cases. 

A Somali member explained that it is difficult to measure pricking, as there are many different definitions of what a “light” cut would imply. For example, some people think it is a “light form” when there are no sutures. Some practitioners perform infibulations with the labia side by side. This is how the activist herself underwent a mutilation with infibulation, which was considered a “mild form” by her family.

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