MALAYSIA

FGM AND CULTURE

In Malaysia and South East Asia, ‘female circumcision’ is more often used and is viewed as more acceptable. The term ‘female circumcision’ medicalises the practice and conveys positive connotations in Malaysia, because the Malay term (sunat perempuan) lends legitimacy to the practice as a parallel to male circumcision by projecting the same ideas of ‘cleanliness’ and ‘necessity’. Because the Arabic term (khitan) is also used in religious circles, it reinforces a view that the practice is endorsed by all schools of thought within Islam

FGC is believed to have been imported into South East Asia alongside Islam, as there is no record of an indigenous practice on the Malay peninsula before Islam’s arrival

Sunat perempuan and sunat are the most commonly used terms in Malaysia, Singapore,

Indonesia, Brunei and southern Thailand. In multi-ethnic Malaysia, the ethnic Malays practise both female and male genital cutting. The Chinese Malaysians and Indian Malaysians generally do not practise FGC, and all non-Malay general practitioners who were contacted for a 2011 survey confirmed that they did not perform FGC.

Malays do not practise pharaonic circumcision/Type 3 (often referred to as ‘infibulation’). In Malaysia, as in most of South East Asia, the cut has traditionally been relatively minor: pricking is common, and flesh the size of a grain of rice is sometimes removed. It is extremely difficult to verify physically whether a woman has been cut, and long-term medical complications have not been reported. However, researchers emphasise two developments that suggest a shift toward more severe forms of the practice:

▪ calls by some for ‘more “orthodox” forms of Islamic practice’; and

▪ The paradoxical results of medicalisation, which, despite having the aim of reducing harm, sometimes causes overconfidence in medical equipment and facilities, leading to deeper cuts or cuts on the clitoris rather than the prepuce

The practice of FGC within Malay-Muslim communities, either in Malaysia, southern Thailand or Singapore, is described as ‘a less damaging form (compared with Africa), an incision of the clitoris or skin above the clitoris, or partial removal of the clitoris.’ There is debate in the literature as to how to define this practice in terms of the WHO’s classifications. Most define the practice as Type 4 (pricking, piercing, incising, scraping and cauterising), while some refer to it as Type 1a (removal of the prepuce/clitoral hood only). This debate is complicated by translations, which can at times be confusing, and the fact that the word ‘prepuce’ does not exist in Malay and therefore is often replaced in surveys or studies with the ambiguous phrase ‘tip of the clitoris’.

Type 4 FGC in Malay-Muslim communities is universally confirmed in the research literature. The literature describes how the prepuce is subjected to a minute cut: it is ‘incised’ (not removed), ‘nicked’, ‘pricked’, ‘scratched’, ‘braised’ or ‘pierced a little’.

In Malaysia, southern Thailand and Singapore, the most common age of FGC cutting is from 7–14 days after birth up to the age of one year, but there is an inclination toward having it done before six months. A study in 2009 indicates that 88.6% of girls and women who have undergone FGC are cut before the age of one, even though FGC may be performed on girls up to ten years of age. However, if a woman is to marry a Muslim man, irrespective of her age, it is believed she will have to undergo the procedure. One tradition of cutting 40 days following birth is associated with the extinguishing of the ‘postpartum fire’ (a period of confinement for the mother after giving birth); however, most study participants nowadays highlight the low level of activity of the little girl at this age, the absence of shame or embarrassment for her, the softness of her skin and the little time needed to perform FGC, making any time acceptable ‘as long as the child is too young to remember.

There are three types of FGC practitioners in Malaysia:

  1. traditional midwives called Mak Bidans (‘indigenous midwives’);
  2. general practitioners, particularly doctors owning their own clinics; and
  3. government midwives (sometimes involved, but to a lesser degree).

Mak Bidans assist with deliveries; provide postnatal care, such as massaging the mother and looking after the newborn; and are registered with the local health centre, where they receive health education. In accordance with the 1966 Midwives Act, only government midwives, nurse-midwives and medical doctors are allowed to deal with childbirth; Mak Bidans are to perform traditional rituals and customs. The number of home deliveries in Malaysia is decreasing, even in rural areas, and Mak Bidans are ageing; meanwhile, the younger generation is not interested in inheriting their skills.

The toolkit of the Mak Bidan consists of razor blades (often disposable, but not sterilised or changed every time), small pairs of scissors, pen knives, needles, nail clippers or blades. There is a sense of extreme caution displayed by the Mak Bidans, who, nevertheless, sometimes lack knowledge of how to prevent infection or are elderly and suffering with ‘poor vision’ and ‘tremors’, and therefore struggle to find the clitoris

Traditionally, in South East Asia, the ritual of cutting girls is done quietly, kept between traditional midwives (Mak Bidans) and parents – unlike the male circumcision ceremony, for which most parents hold a feast. The Mak Bidans’ main function used to be delivering babies, and they still give traditional postpartum massages, which are in high demand. In addition to the baby’s first haircut, which is ceremonial, traditional midwives also perform FGC. The way FGC is performed differs from one cutter to another, and from one Malaysian state to another. Generally, before the ritual is performed, offerings, which can consist of glutinous rice, eggs, virgin thread, piper betel, areca nut or roast chicken, are handed to the Mak Bidan on a plate, along with a small fee. The materials used during FGC also differ from one cutter to another. Some request two yards of white cloth, a lime, two grains of cold powder, a small pair of scissors and a few ringgits. Others use materials such as raw thread, thin knives, hollow coins and flour. Some do not require anything. Some firstly bathe the child with lemon water, then cover her with a white cloth against cold and nudity, to respect the child’s dignity. Some will ask for permission from the child, even if she is still small and does not understand what is happening. Prayers are said before the tip of the clitoris is cut, such as Shahadah (a declaration of faith in one

God [Allah] and His messenger) and bismillah (‘in the name of Allah’). A small, teased-out piece of tissue and a drop of blood satisfy the Mak Bidan that the ritual is fulfilled. The tissue from the cut may be given to the mother to be buried. Cold powder or wound medicine is applied for quick healing. Turmeric, in powder or pieces, is often used in Malay spiritual healing and midwifery. ‘Its efficacy is attributed to the qualities of

earth and air elements as neutralising and thwarting the negative fire and air elements, of which all the spirits are constituted.

The reasons why some members of Malay-Muslim communities choose not to practise FGC have not been specifically researched. Some local studies, however, bring up arguments that negate the reasons for practising. The argument that it is a form of violence against women is recent in the Malaysian debate.

Anisah Ab Ghani (1995) found that 5.4% of respondents who did not carry out FGC on their

daughters believe that:

  •  FGC will reduce their daughter’s sexual appetite;
  •  FGC is not compulsory; and
  •  FGC is only a custom.

More recently, Pillai et al. (2021) found that, when given a list of choices by researchers, respondents most commonly choose the following reasons to disapprove of FGC:

  •  FGC has no health benefits (23.4%);
  •  FGC is a form of violence against women and children (18.7%);
  •  FGC is dangerous and painful (14.0%); and
  •  there is no clear verse stated in the Koran (12.1%)

 

FGM AND LAW 

The Federal Constitution of Malaysia does not have any specific provisions on FGC but could be used to ban or regulate FGC. The Constitution does have a provision on equality of rights and gender-based discrimination, which is, however, not legally inclusive of FGC.

In April 2009, the Fatwa Committee of The National Council for Islamic Religious Affairs Malaysia (‘the Fatwa Committee’) issued an opinion (‘the 2009 fatwa’) that FGC is ‘part of Islamic teachings and should be observed by Muslims[,] except [that,] when the procedure is deemed harmful, it should be avoided’. This sole issuance by the Fatwa Committee is in itself non-binding but has had a significant impact in Malaysia and worldwide. 

The 2009 fatwa has had a big influence on FGC in Malaysia, as it was the first form of official legislation on a widespread, but not officially recognised nor promoted, practice. It marked a paradigm shift, moving FGC from a recommended Islamic practice to a compulsory act of faith. It also dissociated from the process, guiding principles and outcome decreed by the Grand Mufti of Al-Azhar University. The 2009 fatwa led the majority of Malay Muslims to see FGC as an obligation, irrespective of the fatwa’s legal status, and pushed parents towards medicalised FGC. In general, even non-gazetted fatwas have a strong influence on personal decision-making.

In Malaysia, no civil law specifically prohibits FGC, nor is there support for criminalisation. FGC is not mentioned in provisions for, or even associated with, children’s rights or gender equality.

FGM AND RELIGION 

In Malaysia, the majority of Muslims are Sunni and follow the Shafi'i doctrine, the only maddhab (‘school of thought’) to regard FGC as mandatory in Islam, even though some Malay Muslims believe FGC is practised by all Islamic maddhahib. Religious scholars state that FGC is not a requirement in the Koran; rather, those who support the practice build their reasoning on the hadiths.

Religion is cited in all the studies discussed in this Country Profile as a driver of FGC.

  •  ‘The reasons for female circumcision are religious.’18
  •  ‘FGC is a religious requirement in Malaysia.’19
  •  ‘FGC differentiates Muslims from non-Muslims.’20
  •  ‘FGC is Fitrah, honour for female, preserving Muslim identity.’21
  •  ‘FGC marks the entry of a woman into faith, whether as an adult convert, or as a child born into the community.’

Extremely high numbers of Muslim respondents, virtually irrespective of education or age, cite religion as one driver (among others) or one reason for cutting their own daughters.

FGM AND HEALTH

The Malaysian Medical Council is thought to regard FGC as a predominantly Muslim issue. Therefore, it chooses to be silent on the matter. There seems to be general agreement that FGC is not to be performed by members of the medical profession, but practising doctors consider the Council’s silence to be ‘tacit approval’. Medicalised FGC is already popular and continues to be supported by doctors and the younger generations. The majority of medical practitioners lack awareness of civil or religious legalities or of the global concerns and ethics surrounding FGC. However, doctors would be disinclined to continue the practice if there were clear instructions from the Malaysian Medical Council and if FGC were made illegal.

In 2011, Dahlui12 was already reporting a downward trend in the choice of Mak Bidans between the generations of mothers and their daughters in Malaysia: the Mak Bidans cut 79% of the mothers and 69% of the daughters, while GPs cut 6.1% of the mothers and 29% of the daughters. In a 2017 study13 conducted in an antenatal hospital, featuring an overwhelming majority of respondents of childbearing age, 73% chose doctors as their preferred practitioners of FGC. A review of two unrelated studies carried out in rural settings of the same provinces of Malaysia – Kedah and Penang – ten years apart, but by the same research team, clearly shows a preference for health professionals among the younger generations.

Health as a driver of FGC comes up regularly in the literature. After religion (78%), health is cited by 69% of respondents in Khalid et al, (2017), as the reason for FGC. 

What exactly is meant in these studies by ‘health reasons’, however, is neither fully described nor explained. There seems to be a belief that FGC leads to ‘improved vaginal health’ and ‘prevention of sexually transmittable infections’,28 possibly because beliefs surrounding male circumcision are sometimes entangled with those surrounding FGC.

What ‘cleanliness’ means for a Malay Muslim is approached by Faradilla:

  •  ‘Cleanliness is next to godliness[. W]e must maintain taharah [purification and cleanliness].’
  •  ‘The clitoral hood is dirty. Sunat is for cleanliness.’
  •  ‘This is to remove dirt. If we want to take ablution, we must shower according to hadas besar and kecil [specific ritualised showers with Arabic incantations to be performed after sexual activities and menstruation].’
  •  ‘Islam is very clean. So whenever we want to pray, we must clean that area. So it’s a lot easier to just cut it (clitoral hood) off. No need to clean.’

Between 30% and 60% of respondents in Malay communities that were surveyed in the literature see FGC as maintaining cleanliness or hygiene. The belief that FGC serves  cleanliness may stem from the fear that one’s prayers might not be fully accepted otherwise – a belief that overlooks the biological fact that FGC has no impact on cleanliness

Internationally, health campaigns have highlighted the dangers and risks of FGC being conducted by traditional “cutters” thus driving the practice from traditional practitioners to healthcare professionals. In the past 30 years, Malaysia has transitioned from a mostly rural population to an urban one. Modern health care is now ubiquitous and the level of education among the population is high and access to information easy. Health clinics, both private and public, are available almost everywhere. With modern medicine easily accessible and affordable and an increase in awareness of the importance of hygiene and infections, more parents are turning to doctors to perform FGC on their children, hence the trend toward medicalisation of FGC in Malaysia

DATA SOURCE

https://www.fgmcri.org/media/uploads/Country%20Research%20and%20Resources/Malaysia/malaysia_country_profile_v2_(june_2024).pdf

https://bmjopen.bmj.com/content/9/4/e025078

https://link.springer.com/chapter/10.1007/978-981-19-6723-8_8

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591112/

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