chapter 1
THE ABUSE OF WOMEN—A WORLDWIDE ISSUE

"Violence against women" means any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life.

—United Nations Declaration on the Elimination of Violence against Women, 1993

Domestic violence has existed in almost all societies throughout history. Its origin can be traced back centuries to the development of patriarchal and hierarchical systems of authority in which males controlled all property. In such systems, women and children were often considered to be the property of men. The growth of male-oriented societies promoted the widely accepted belief in male superiority that in turn formed the basis for women's subordination (Vivian C. Fox, "Historical Perspectives on Violence against Women," Journal of International Women's Studies, vol. 4, November 2002). This belief in men's domination over women, which was often supported by economic, social, cultural, and religious institutions, made it acceptable for men to use violence as a way to control women. As the United Nations Declaration on the Elimination of Violence against Women stated,

Violence against women is a manifestation of historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of the full advancement of women. … [V]iolence against women is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men.

In fact, until the end of the nineteenth century, the law supported a man's right to control his wife by force, and it was not until the advent of the women's liberation movement during the late 1960s and 1970s that domestic violence gained recognition as a social issue. Today, there are social service and justice system resources, including shelters and counseling, available to victims of abuse. In the United States, victims also have legal options. Yet despite this relatively recent progress in the United States, the use of violence in family and intimate partner relationships is still regarded as a man's right in many parts of the world.

An international examination of male violence against women reveals that it is a universal constant—it appears in practically every culture throughout the world and is tolerated by many governments. Many groups, including the United Nations (UN), believe that collaborative international efforts are needed to address this farreaching health and social problem.

EUROPEAN TRADITIONS

The subservient role of women was well established by the Middle Ages. During the fourteenth century in France, a man could legally beat his wife for failing to obey his orders as long as he did not kill or permanently maim her. The 1371 tale of Geoffrey de la Tour de Landry reflected the contemporary attitude toward "the wickedness of a nagging wife" and the proper punishment for her behavior:

Here is an example to every good woman that she suffer and endure patiently, nor strive with her husband, nor answer him before strangers, as did once a woman who did answer her husband before strangers with short words: and he smote her with his fist down to earth; and then with his foot he struck her in her visage and broke her nose, and all her life after she had her nose crooked, which so shent [spoiled] and disfigured her visage after, that she might not for shame show her face, it was so foul blemished. And this she had for her language that she was wont to say to her husband, and therefore the wife ought to suffer, and let the husband have the words, and to be her master, for that is her duty.

There were some, however, who cautioned men to treat women with some restraint. Bernard of Siena, Italy, advised the husband in 1427 to treat his wife as well as he did his fowl and livestock. It is doubtful whether his advice was heeded, though, since Siena was also home to the Rules on Marriage, which declared:

When you see your wife commit an offense, don't rush at her with insults and violent blows, rather, first correct the wrong lovingly. [If this doesn't work] scold her sharply, bully and terrify her. And if this still doesn't work … take up a stick and beat her soundly. It is better to punish the body and correct the soul than to damage the soul and spare the body. You should beat [your wife] only when she commits a serious wrong. Then readily beat her, not in rage but out of charity and concern for her soul.

Social and religious values were designed to teach women that it was their duty to yield to their husbands' desires. If they resisted, however, those values also taught that it was in a woman's best interest to have the badness beaten out of her. Violence was justified if an appeal to reason or faith was unsuccessful. Wife beating was rarely viewed as the first recourse.

AMERICAN TRADITIONS

Early Laws Allow "Chastisement"

In colonial America, English common law allowed physical "chastisement," as long as the husband did not inflict permanent damage on his wife. The early Puritans, however, forbade wife beating. According to a Massachusetts Bay Colony edict, "No man shall strike his wife nor any woman her husband on penalty of such fine not exceeding ten pounds for one offense, or such corporal punishment as the County shall determine."

Calvin Bradley v. The State (of Mississippi) resulted in the first American legal ruling on the subject of "reasonable chastisement." In that 1824 case, the court found that Bradley, convicted by a lower court of assault and battery against his wife, had gone too far in chastising his wife. "If the defendant now before us could shew from the record, in this case he confined himself within reasonable bounds, when he thought proper to chastise his wife, we would deliberate long before an affirmance of the judgment," the court noted. While criticizing Bradley for bringing shame to his family, the court ruled:

Family broils and dissensions cannot be investigated before the tribunals of the country, without casting a shade over the character of those who are unfortunately engaged in the controversy. To screen from public reproach those who may be thus unhappily situated, let the husband be permitted to exercise the right of moderate chastisement in cases of great emergency and use salutary restrains in every case of misbehavior, without being subjected to vexatious prosecutions, resulting in mutual discredit and shame of all parties concerned.

Early Feminists Fail to Improve Wives' Legal Status

The first women's rights movement, inaugurated in 1848 at the Seneca Falls Woman's Rights Convention, was the first movement to analyze the husband's right to chastise his wife as a symbol of the political system of male dominance over females. In the Declaration of Sentiments (1848), the women objected to the status of married women: "In the covenant of marriage, she is compelled to promise obedience to her husband, he becoming, to all intents and purposes, her master —the law giving him power to deprive her of her liberty, and to administer chastisement."

A North Carolina High Court's ruling in State v. Jesse Black in 1864 illustrated the assertion of the Seneca Falls women, that upon marriage, husbands became the rulers of their wives. The case involved a man who abused his wife after she called him names. In its ruling the court said:

A husband is responsible for the acts of his wife and he is required to govern his household, and for that purpose the law permits him to use towards his wife such a degree of force as is necessary to control an unruly temper and make her behave herself; and unless some permanent injury be inflicted, or there be an excess of violence, or such a degree of cruelty as shows that it is inflicted to gratify his own bad passions, the law will not invade the domestic forum, or go behind the curtain.

In 1874, just ten years later, the North Carolina court again expressed concern about excessive abuse but advised against public scrutiny of, or interference in, domestic and marital relationships. In State v. Richard Oliver, the court found:

From motives of public policy and in order to preserve the sanctity of the domestic circle, the Courts will not listen to trivial complaints…. If no permanent injury has been inflicted, nor malice, cruelty, nor dangerous violence shown by the husband, it is better to draw the curtain, shut out the public gaze, and leave the parties to forget and forgive.

A Change in Direction

In a landmark Alabama case in 1871, a court found that a husband did not have the right to physically abuse his wife, even "moderately" or with "restraint." In Fulgham v. State, the court ruled that a married woman deserved protection under the law. The ruling stated:

A rod which may be drawn through the wedding ring is not now deemed necessary to teach the wife her duty and subjection to the husband. The husband is therefore not justified or allowed by law to use such a weapon, or any other, for her moderate correction. The wife is not to be considered as the husband's slave. And the privilege, ancient though it be, to beat her with a stick, to pull her hair, choke her, spit in her face or kick her about the floor, or to inflict upon her like indignities, is not now acknowledged by our law.

In the same year (1871), the Massachusetts Supreme Court rejected a husband's manslaughter defense that he had a right to chastise his wife for drunkenness. He had hit his inebriated wife several times on the cheek and temple; she had fallen as a result, hit her head, and died. In Commonwealth v. McAfee, the Massachusetts Supreme Court announced that "beating or striking a wife violently with the open hand is not one of the rights conferred on a husband by the marriage, even if the wife be drunk or insolent."

Although the Alabama and Massachusetts cases declared husbands did not have the right to physically chastise their wives, no criminal penalties were yet attached to physical abuse. In fact, in a case three years earlier, State v. Rhodes, the North Carolina Supreme Court declared that although a husband's whipping of his wife "would without question have constituted a battery if the subject of it had not been the defendant's wife," they refused to convict him of assault and battery, ruling that if domestic assaults were prosecuted, "the evil of publicity would be greater than the evil involved in the trifles complained of."

Although Maryland enacted a law in 1882 that punished wife beaters with forty lashes with a whip or a year in jail, even in the early twentieth century courts still refused to convict wife batterers. In 1910 the U.S. Supreme Court ruled in Thompson v. Thompson that a wife had no cause for action on an assault and battery charge against her husband because it "would open the doors of the courts to accusations of all sorts of one spouse against the other and bring into public notice complaints for assaults, slander and libel."

Despite Laws, Little Recourse for Battered Wives

Thus, although court decisions affirmed that a husband could no longer legally beat his wife, in almost all cases a battered wife in the early twentieth century still had no legal recourse against her husband. Any criminal proceedings against a wife batterer had to be initiated by the state; women could not sue their husbands. Instead, the criminal justice system set up a separate court system—the family court—to deal with domestic complaints. According to author Reva B. Siegel, this act decriminalized physical abuse of women ("'The Rule of Love': Wife Beating as Prerogative and Privacy," Yale Law Journal, vol. 106, June 1996). Rather than punishing wife beaters, judges and social workers urged couples to reconcile, providing counseling designed to prevent divorce. Assault in this context was viewed as an inappropriate expression of emotions; wives and husbands needed to learn how to rechannel those emotions.

The ruling of a 1962 landmark case changed the legal consequences of physical abuse of a spouse. In Self v. Self, the Supreme Court of California agreed with earlier rulings, stating that a spouse's right to sue would "destroy the peace and harmony of the house." Despite that finding, the court observed that this outdated assumption was based "on the bald theory that after a husband has beaten his wife there is a state of peace and harmony left to be disturbed." Therefore, "one spouse may maintain an action against the other" for physical abuse.

Despite the ruling enabling victims to seek legal recourse, by 1965 there had been little change. Jurisdictions throughout the United States ignored the complaints of battered women. For example, in Washington, D.C., 7,400 women filed official complaints and just two hundred arrest warrants were issued.

Social and Legal Recognition of Domestic Violence

In 1973 the first battered women's shelter in the United States opened in St. Paul, Minnesota. By 1976 there were four hundred programs for battered women operating in the United States. EMERGE, the first treatment program for male offenders, opened in Boston, Massachusetts, in 1977, and the following year many states enacted laws to protect victims of domestic violence. A decade later, in 1988, the U.S. surgeon general declared domestic abuse the leading health hazard to women in the United States. By the 1990s, there were well over a thousand battered women's programs in the United States.

In 1994 the Violence against Women Act granted female victims of violence, including battered women, federal civil rights protection. The civil rights section of the Violence against Women Act was tested in the U.S. Supreme Court in 1999, when Christy Brzonkala filed a civil suit after being raped by two football players from Virginia Polytechnic Institute. In a five-to-four decision in U.S. v. Morrison, the Supreme Court ruled that Congress could not enact a federal civil remedy "for victims of gender-motivated violence." Individuals who committed crimes motivated by a gender bias, the Court ruled, could not be held accountable at the federal level.

The U.S. Congress passed a revised act in October 2000, Victims of Trafficking and Violence Protection Act of 2000, which included sections on Strengthening Law Enforcement to Reduce Violence against Women, Strengthening Services to Victims of Violence, Limiting the Effects of Violence on Children, Strengthening Education and Training to Combat Violence against Women. The new legislation made no mention of women's civil rights. And although spouse abuse is illegal in the United States and women may now sue their abusers for damages at the state level, battering continues. Many women still feel helpless and trapped in abusive relationships, unable to tell others about their problems and unsure of where to seek and obtain help.

ABUSE IN OTHER CULTURES

Abuse threatens women's health and human rights throughout the world. Global estimates suggest as many as 30% of the world's women are at risk for violence (beatings, coerced sexual activity, or other physical abuse) at least once in their lives. It may occur in the home, the workplace, or the community and it may take different forms throughout the stages of a woman's life. (See Table 1.1.) Women of all races, ethnic backgrounds, and ages are subjected to forced abortion, rape, genital mutilation, and other acts of violence, often at the hands of their partners or persons known to them.

Data about violence against women are scarce. Most researchers agree that even when the data are available, rates of sexual abuse and domestic violence are significantly underestimated because many incidents are unreported. The official statistics that are collected by organizations such as the Statistical Commission and Economic Commission for Europe and the UN Interregional Crime and Justice Research Institute (UNICRI), are believed to be underreported—but still paint frightening pictures of the magnitude of the problem. For example, in industrialized countries, less than 1% of women were sexually assaulted in the past five years, and 1.3% of women had been victims of other offensive sexual behavior, according to J. N. van Kesteren, P. Mayhew, and P. Nieuwbeerta in Criminal Victimisation in Seventeen Industrialised Countries: Key Findings from the 2000 International Crime Victims Survey (The Hague: UN Interregional Crime and Justice Research Institute, 2000). The U.S. Department of State, in its 2003 Country Reports on Human Rights Practices, reported that between 10% and 15% of Ukrainian women had been raped. The report found that in Bosnia and Herzegovinia as well as China, 30% of women were thought to have been victims of domestic violence; in Egypt, 67% of urban women and 30% of rural women had been victims of domestic violence. Another survey finds that reported instances of domestic abuse in the Ukraine rose by 16% in the five years ending January 1, 2000.

This section describes selected examples of violence against women practiced in various cultures. Although these practices are among the most extreme and dramatic instances of abuse, the fact that they have persisted into the twenty-first century is a shocking acknowledgment of a social problem of global proportions.

Bride Burning

In India, Pakistan, and Bangladesh, disputes over a bride's dowry—the money, property, or belongings given to the husband by the bride's family after marriage—has created a serious domestic violence crisis. The inability or unwillingness of a bride's family to meet dowry demands often results in brutality and sometimes death. The National Crime Bureau of the Government of India in 2002 estimated that each year about six thousand women are killed over dowry disputes (although they acknowledge

TABLE 1.1

that the recorded number is a gross underestimate of actual murders of young women). Such women's groups as the International Society against Dowry and Bride Burning in India put the number closer to twenty-five thousand annually in India alone, according to Himendra Thakur in "Are Our Sisters and Daughters for Sale?" (http://www.indiatogether.org/wehost/nodowri/stats.htm [accessed November 16, 2004]). Many are victims of bride burning, a preplanned homicide committed by the groom and his family, in which women are doused with kerosene in the kitchen and set on fire; their deaths are later blamed on kitchen accidents. The risks for women are exacerbated by the unwillingness of many parents to shelter daughters in danger.

The phenomenon of burning brides who are unable to meet exorbitant dowry demands is alarming. Ahmed-Ghosh reported in "Chattels of Society: Domestic Violence in India" that in India a young bride is being beaten, burnt to death, or pushed to commit suicide every six hours (Violence against Women, vol. 10, January 2004). In the urban centers of Maharashtra state and greater Bombay, about one in five deaths of women aged fifteen to forty-four are due to "accidental burns"; the rate for younger women aged fifteen to twenty-four is one in four.

Although India has had an anti-dowry law since 1961, and Dowry Prohibition acts were passed in 1984 and 1986, the prohibition is not enforced. Dowry is still exchanged between the parents of newlyweds. Men usually only need to claim that their wives died as a result of a house fire or cooking accident or committed suicide to be freed from blame or suspicion. When cases are brought to court, it takes years for them to be heard. When they are heard, there is a high rate of acquittals. An Indian special public prosecutor quoted in "'Dowry Deaths' in Bangalore" said that in the first six months of 1999, out of 381 dowry death cases pending, fifty-one defendants had been acquitted and only eight convicted (Frontline, vol. 16, no. 17, August 14–27, 1999).

The lack of Indian society's recognition of domestic violence as a serious issue was graphically illustrated when the Indian Parliament unveiled the Protection from Domestic Violence Act of 2002. The act protected the right of husbands to beat their wives occasionally.

Wife Beating Still an Accepted Form of Discipline

In Iran and much of the Middle East, wife beating is an accepted form of discipline. The Koran, the basis of Islamic law, states:

The men are placed in charge of the women, since God has endowed them with the necessary qualities and made them breadwinners. The righteous women will accept this arrangement obediently, and will honor their husbands in their absence, in accordance with God's commands. As for the women who show rebellion, you shall first enlighten them, then desert them in bed, and you may beat them as a last resort. Once they obey you, you have no excuse to transgress against them. God is high and most powerful.

Some interpret this passage of the Koran as allowing a Muslim husband to physically punish his wife whenever he determines she has misbehaved. For example, in his book, The Woman in Islam, Egyptian-born Sheikh Muhammad Kamal Mustafa states that wife beating can be used as a last resort, using "a rod that must not be stiff, but slim and lightweight so that no wounds, scars, or bruises are caused." The author was sentenced in January 2004 in a Barcelona court for publishing the book. The court found that the book contained incitement to violence against women and violated women's constitutional rights. The book was removed from bookstores in Spain.

The practice of wife beating is so culturally accepted that many women endorse the violence. In a 1996 study by Egypt's National Population Council, 86% of the 14,779 married women who responded said they believed a man is justified in beating his wife for refusing sex, talking back, talking to other men, neglecting his children, wasting money, or burning food. Agreement with a man's right to beat his wife varied according to the respondents' age, education, employment, and place of residence. The study also found that one out of every three married women had been beaten at least once by her spouse. Among pregnant women, 32% received a beating from their husbands; 44% of those women said they were beaten as often or more often during pregnancy than they had been before becoming pregnant.

Because premarital virginity and postmarital sexual fidelity are required of Islamic women, it is traditionally the role of male relatives to enforce chaste sexual conduct. In extreme cases, they do it through murder, known as "honor killing." In Islamic countries, men who kill a female relative because they perceive she is no longer chaste are generally given a lighter sentence than men convicted of other types of murders. Under a 1990 law, any Iraqi man who killed his own mother, sister, daughter, aunt, niece, or female cousin for adultery could receive immunity from prosecution.

The Hudood ordinances enacted in Pakistan in 1979 provided harsh punishments for violators of Islamic law; the ordinances replaced a system that included many more protections for women, according to Asma Jahangir in "Pakistan: The Women's Commission and the Hudood Ordinances," (http://www.ahrchk.net/hrsolid/mainfile.php/2003vol13no04-05/2292/ [accessed September 18, 2004]). Under the Hudood ordinances, a female or non-Muslim witness is not allowed to testify in certain trials. Consequently, if a man rapes a woman in the presence of several females, he cannot be convicted by their testimony. In addition, rape of wives was made legal under the code, and women were liable for prosecution for adultery, or zina. In many cases, women alleging rape have been arrested and charged with zina. Punishment under the Hudood ordinances include death by stoning for unlawful sexual relations.

Increased conservatism in the Islamic world has forced more and more women to wear head scarves, undergo female circumcision, and avoid men in school and the workplace. The fundamentalist Taliban regime governing Afghanistan until 2002 banned women from any work outside the home, kept them from seeking and receiving needed medical care, and prevented girls from attending school. Women and girls could not appear outside the home unless they were accompanied by a male family member and wore a "burqa," a garment that covers the wearer from head to toe.

During 2002 Afghan women and girls took their first steps toward a new life by returning to school and work. Still, many women and girls remain trapped by poverty and rules imposed by strict husbands. In October 2002, CNN chief international correspondent Christiane Amanpour traveled to Afghanistan and broadcast a report on the CBS newsmagazine Sixty Minutes depicting impoverished families who sold their young daughters, as well as others who persisted in the belief that girls should not be educated.

Rape

In many parts of the world, women who are raped have nowhere to turn for help. In Colombia, for example, fewer than 0.5% of investigated rape cases in 1995 went to trial. Most cases—95%, according to Colombia's Institute for Legal Medicine—are never reported because the women know no action will be taken against their rapists.

rape in war. The use of rape as a weapon of war occurs in many parts of the world. The high rates of rape in war are attributed to the idea that women are viewed as property, and men gain ownership of women by taking sexual liberties with them. Rape in the context of war is also provoked by the tendency to demonize and dehumanize the enemy, and by the climate of anger, hate, and immediate fear of death.

In Darfur, Sudan, rape has been used as a weapon of war by government-sponsored militia known as Janjawid since 2003 ("Darfur: Rape as a Weapon of War: Sexual Violence and Its Consequences," Amnesty International, July 19, 2004, http://web.amnesty.org/library/Index/ENGAFR540762004?open&of=ENG-373). The Janjawid, supported by the government army, attacks villages in Darfur, kills men, and rapes civilian women. The attacks are in response to the insurgency of two armed political groups and have led to the displacement of at least 1.2 million persons, according to Amnesty International. Women and girls are also targeted for abductions and sexual slavery.

During the Bosnian civil war it was estimated that Serbs, aware of how important chastity is to Muslims, raped more than twenty thousand Muslim women, forcing many women to bear Serbian children. Serbian "Rape Camps" existed across Bosnia, where Muslim women were held and routinely raped, according to Roy Gutman in "Rape Camps: Evidence Serb Leaders in Bosnia Oked Attacks" (Newsday, April 19, 1993). In Rwanda, as many as three hundred thousand ethnic Tutsi women were raped by the majority Hutu military during a bloody civil war in the 1990s, as reported by Llezlie L. Green in "Propaganda and Sexual Violence in the Rwandan Genocide: An Argument for Intersectionality in International Law" (Columbia Human Rights Law Review, Summer 2002, pp. 733-76). Many women became pregnant as a result of the rapes. Because abortion is illegal in Rwanda, women were forced to seek illegal abortions. Others abandoned their babies or committed infanticide. For those women who kept their children, survival has been precarious. Most of these women watched as their husbands and families were murdered at the same time they were raped. Now, their Tutsi neighbors shun their offspring and blame the mothers for their existence, according to Binaifer Nowrojee in Shattered Lives: Sexual Violence during the Rwandan Genocide and its Aftermath (Human Rights Watch, http://hrw.org/reports/1996/Rwanda.htm, September 1996).

The UN established war crimes tribunals for Rwanda and the former Yugoslavia, although neither has had much success. In 1997 the Rwanda Tribunal filed its first indictment for rape and sexual abuse. The international community has recently established a permanent International Criminal Court (ICC) to prosecute persons accused of crimes against humanity, including sexual violence, who are not brought to justice in their own countries. The ICC was to be formally established when sixty countries had ratified the Rome Statute of the International Criminal Court. On April 11, 2002, ten nations simultaneously ratified the statute, bringing the total to sixty-six and triggering its adoption. The Rome Statute entered into force on July 1, 2002. The first eighteen judges were sworn in on March 11, 2003. As of September, 2004, the ICC had been ratified by ninety-four nations.

The United States entered the ICC under the administration of President Bill Clinton. However, on May 6, 2002, the United States formally renounced its signature on the statute. President George W. Bush's administration cited serious reservations about the ICC and its functions, including concerns that it would have unchecked prosecutorial power and might undermine the UN Security Council's efforts to preserve international peace. Despite the U.S. decision to withdraw, there is widespread optimism about the establishment of the ICC and its potential global contribution to an effective justice system free of political influence. Some international affairs experts and historians mark the Rome Statute adoption as a historic achievement and the ICC as the most significant advance in international law since the founding of the UN.

consequences of rape. The consequences of rape include immediate emotional symptoms, such as shock, anger, shame, fear, and helplessness. Rape also can trigger lasting psychological problems, such as confusion, disturbing or recurring memories, and self-blame. Physical injuries, sexually transmitted diseases, fatigue, and changes in appetite and sleep patterns may also occur in response to the trauma. Long-term consequences can be serious and debilitating. Rape victims may suffer from anger, distrust, and psychiatric disorders including:

• Post–traumatic stress disorder—Recurring memories and dreams, memory impairment, anxiety, sleep disorders, and social and emotional withdrawal
• Depression—Feelings of hopelessness, helplessness, loss of focus and purpose in life, fatigue, despair, and thoughts of suicide
• Alcohol and drug abuse—Substance abuse may occur as the victim attempts to self-medicate to relieve physical pain and dull the effects of bad memories and feelings or other emotional distress

Female Genital Mutilation

Female genital mutilation is practiced in twenty-eight African countries, in some parts of Asia and the Middle East, and among immigrant communities in Europe, Australia, Canada, and the United States. The World Health Organization estimates that between one hundred million and 140 million women and girls worldwide have undergone genital mutilation, and that each year another 2 million girls are at risk of undergoing genital mutilation of some type. Surveys of five African nations find that 93% of women in Mali and 89% of Sudanese women have been genitally mutilated. Slightly less than half the women of the Central African Republic and the Ivory Coast and 12% of Togo's women have also been "circumcised."

Different societies practice different rituals of socalled female circumcision, and young girls are subjected to a variety of procedures. Some procedures remove the foreskin of the clitoris; others involve "infibulation," in which the clitoris and labia minora are surgically removed and the two sides of the vulva are abraded and sewn together, usually with catgut. These procedures are performed without an anesthetic and often with primitive, unsterilized tools. Immediate health risks include hemorrhage, tetanus, blood poisoning, shock, and death. Women and girls who survive are left with terrible scarring, and their future sexual relationships are usually joyless and very painful. The inadequate openings the surgery leaves for the flow of urine and menstrual blood can cause vaginal and urinary tract infections and sometimes sterility, the ultimate disaster for women whose value is based on their fertility (ability to reproduce).

Infibulated women who do give birth must be surgically reopened, only to be resewn again after childbirth. In Somalia, a study of thirty-three infibulated women found that their final stage of labor was five times longer than normal, five of the babies died, and twenty-one babies suffered oxygen deprivation from the prolonged, obstructed labor. The information was reported by Lori L. Heise et al. in Violence against Women: The Hidden Health Burden (Washington, DC: The World Bank, 1994).

Some Muslims believe the Koran demands female genital mutilation (although, as the World Health Organization points out, the practice predates Islam); others see women's genitalia as unclean and believe infibulation is a ritual purification. Men in such cultures will not marry unmutilated women, believing them to be unclean, promiscuous, and sexually untrustworthy. Many women do not object to the procedure since they view it as a tradition and a natural part of their role in life. Some women, however, are trying to increase awareness about the procedure. They insist that female genital mutilation is not an important African tradition that must be maintained in the face of Western influence. Rather, they see it as violence directed against women. Many people believe that female genital mutilation stems from men's desire to control women's sexuality.

In June 1996 efforts to educate the public about this practice paid off when the U.S. Immigration and Naturalization Service (INS) recognized for the first time that the fear of genital mutilation was legitimate grounds for asylum. Fauziya Kasinga, a 19-year-old Tobago woman who feared she would be circumcised if she returned home, was detained in prison for one year while the INS made its decision. The ruling quoted an INS report that said that "women have little legal recourse and may face threats to their freedom, threats or acts of physical violence or social ostracism for refusing to undergo this harmful traditional practice or attempting to protect their female children."

The U.S. Congress outlawed infibulation in the United States under the Federal Prohibition of Female Genital Mutilation Act of 1996. Anyone found guilty of performing this surgery faces up to five years in jail. In addition, U.S. representatives to the World Bank and other international financial institutions are required to oppose loans to the twenty-eight African countries where the practice exists if those countries fail to conduct educational programs to prevent it.

In Egypt a 1995 government-supported study indicated that more than 97% of the 14,770 never-married women participants had undergone circumcision. Two years later, an Egyptian court overturned Egypt's ban on female genital mutilation. The ban was later restored through a decision from the Egyptian Supreme Court. Although it remains in effect, women's rights groups continue to work to change the Muslim tradition in villages where midwives and barbers still perform mutilations.

The Missing Women

In China, South Korea, India, Nepal, and other Asian countries, sons are favored over daughters for their economic value and their ability to carry on the family name. Some prospective parents believe that a female child is more likely to present a financial burden to her family, while a male child is a potential breadwinner who will not require such expenditures as a dowry. Preference for boys where resources are scarce can mean that daughters receive less food, education, and medical care than their brothers. The poor health care and nutrition daughters receive results in a higher child mortality rate among girls than boys.

In China, the problem is particularly acute. The U.S. Department of State, in its 2003 publication Country Reports on Human Rights Practices, stated: "Female infanticide, sex-selective abortions, and the abandonment and neglect of baby girls remained problems due to the traditional preference for sons and the birth limitation policy." This so-called "one child policy," established in 1979, imposed a variety of penalties on most couples who chose to have more than one child. The policy was instituted as law, with minor changes, in 2002. According to the Department of State report, the male-to-female birth ratio in China is about 116.9 to one hundred, as compared with a statistical norm of 106 to one hundred. For second births, which require parents to pay a social compensation fee of one-half to eight times the average workerís annual disposable income, the ratio was even higher, at 151.9 to one hundred.

In India, the male-to-female ratio has increased to one hundred males to every 92.7 females, a large demographic difference. Based on comparisons of male-to-female sex ratios, Princeton University demographer Ansley Coale estimated that at least sixty million women are missing, mainly from Asia and North Africa. These are females who have been aborted, given inferior care in childhood, underfed, and subjected to various forms of gender violence resulting in death.