Introduction
Female genital mutilation (FGM) is a practice that involves the alteration or partial or total removal of the external female genitalia for non-medical reasons. There are three main types of FGM, classified by severity and procedure:

Type I: Clitoridectomy. This consists of the partial or total removal of the clitoris and/or its prepuce.

Type II: Excision. This involves the partial or total removal of the clitoris and the labia minora, with or without the removal of the labia majora.

Type III: Infibulation. This is the most severe and invasive form. It involves the removal of the clitoris and the labia minora, followed by the narrowing of the vaginal opening by stitching the labia majora. Infibulation leaves only a small orifice for the passage of urine and menstrual blood and is often reopened (defibulation) and restitched (reinfibulation) on various occasions, such as after childbirth.

Fig. 2 - Map of FGM in Africa - Kaplan A. and Lopez A.

There is also a Type IV which includes any other harm to the female genitalia (Fig. 1) (National FGM Centre).

Despite the associated health risks and psychological trauma, the practice remains widespread in several regions of the world, including Sierra Leone.

The public and political debate on this topic has intensified, especially after the recent statements by President Julius Maada Bio.

A Cultural Rite, Not a Religious Prescription
It is essential to emphasize that infibulation is a practice linked to ancestral cultures and is not prescribed by any religion. It is an initiation rite that precedes marriages or puberty, regardless of the faiths that have emerged over time. Consequently, its practice is observed in Christian communities, Muslim communities, among a small Jewish minority, the Beta Israel of Ethiopia, and in populations who follow traditional African religions. This demonstrates that its persistence is due to social norms and secular traditions, not religious dogmas.

The countries where the practice is most widespread include mainly Egypt, Somalia, Ethiopia, Sudan, and Eritrea, but cases are also found in other sub-Saharan African nations, the Middle East, and Asia (Fig. 2) (6).

Unfortunately, the problem is also present in Europe and Italy due to migratory flows. A 2019 study by the University of Bicocca and the Department for Equal Opportunities (Fig. 3) [23] found that approximately 87,600 immigrant women who have undergone FGM reside in Italy, of whom 7,600 are minors. This data highlights how the fight against this practice must be addressed at a global level, with targeted strategies in Western countries as well.

According to data from the Italian National Institute of Health, the scale of the phenomenon is alarming worldwide [7]:

200 million women have been mutilated in the 30 countries in Africa, the Middle East, and Asia where this practice is still in use.

15 years or younger is the age at which most women are mutilated.

1.4 billion dollars per year are the costs of health complications related to female genital mutilation in the 27 most affected countries.

3 million girls under the age of 15 are at risk of undergoing genital mutilation each year.

An even more dramatic figure, reported by AMREF Health Africa, reveals that every 12 minutes a girl dies due to female genital mutilation [1].

Fig. 3 - Female Mutilation Survey, University of Milan Bicocca and Department for Equal Opportunities 2019

The President's Stance and the Legal Context
President Bio has taken a strong stand against infibulation, calling it a harmful practice that undermines the well-being of women and the nation's development. In 2023, during the Gender Equality Leaders Summit, he promised to put an end to this practice in Sierra Leone, marking a historic moment for the country.

However, despite the political commitment, the legal context has significant gaps. The 2012 Female Genital Mutilation Act only prohibits the practice on girls under 18, creating a legal vacuum for adult women. This means that, even if the government is committed to protecting minors, women over 18 can still be subjected to infibulation without the perpetrators being legally prosecuted.

This legal loophole has been harshly criticized by human rights groups and international organizations, who are calling for a total ban on the practice.

Cultural Roots and Health Consequences
Infibulation is deeply rooted in some of Sierra Leone's cultural and social traditions, often linked to concepts of purity, honor, and preparation for marriage. The practice is seen as a rite of passage and a requirement for social acceptance, a pressure that makes it difficult for women and families to oppose it.

However, the health consequences are devastating. In the short term, women can suffer from severe hemorrhaging, infections, and unbearable pain. In the long term, infibulation can lead to recurring urinary infections, chronic pain, life-threatening complications during childbirth for both the mother and the newborn, and severe psychological trauma.

Strategies for Eradication
To effectively eradicate infibulation in Sierra Leone, an approach that goes beyond political declarations alone is needed. The first step is the adoption of more rigorous legislation that criminalizes all forms of FGM, regardless of age and consent.

Furthermore, it is essential to invest in educational programs and awareness campaigns that challenge traditional social norms. As supported by experts like Professor Pia Grassivaro Gallo [9-20], whose research has explored the complexities of these practices, it is crucial to involve communities, religious leaders, and traditional healers to promote alternative rites that maintain the symbolic value of the rite of passage without causing mutilation.

Conclusion
Sierra Leone is at a crossroads. While President Bio's commitment offers hope for change, the persistence of infibulation and the legislative gaps demonstrate the need for more decisive action. A combined approach of legislative reform and cultural awareness is the only way to ensure a future in which the women of Sierra Leone are free from this harmful practice.

How to Support the Cause: The Avaaz Campaign
International organizations continue to lobby for a law that completely bans infibulation in Sierra Leone. Among them, the online activism platform Avaaz has launched a petition to support President Bio in his commitment. The petition urges the government of Sierra Leone to implement legislation that fully criminalizes the practice and protects women and girls.

You can support this cause by signing the Avaaz petition, thus showing the government of Sierra Leone that the international community stands with it in the fight against FGM.

Bibliography

1. Amref Health Africa. "Mutilazioni genitali femminili." 

2. Amnesty International. "Sierra Leone: Female Genital Mutilation - A human rights issue." Rapporto.

3. Ganiyu O. Shakirat et al. September 4 2022 An Overview of Female Genital Mutilation in Africa: Are the Women Beneficiaries or Victims? Cureus 

4. Human Rights Watch. "Sierra Leone: Female Genital Mutilation." Briefing.

5. Kagume, J. (2020). "The struggle against FGM in Sierra Leone: A critical analysis of the legal framework." Journal of African Law, vol. 64(2), pp. 250-268.

6. Kaplan A. e Lopez A. (2010) Mapa de la Mutilación Genital Femenina en España 2009, Bellaterra: Universitat Autònoma de Barcelona.

7. Istituto Superiore Sanità. "Mutilazione genitale femminile (MGF)." Disponibile su: https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/m/mutilazione-genitale-femminile-mgf
Petizione Avaaz contro l'infibulazione in Sierra Leone 

8. National FGM Centre 

9. Pia Grassivaro Gallo, Carlotta Baccan, Lucrezia Catania , Universita’ di Padova. 15 Mag 2020 Forme di violenza alla donna nel periodo coloniale e post- coloniale in AOI Scienzaonline 

10. Pia Grassivaro Gallo e Roberta Tartaglia 10 Set 2018 L’Appiattimento del seno nelle camerunensi e nigeriane. La prima segnalazione per l’Italia. Scienzaonline 

11. Pia Grassivaro Gallo, Lucrezia Catania 2015 Modificazioni espansive dei genitali femminili, tra eredità e ambiente
Africa: passaggi di età attraverso il rito Ed. Altra Vista 

12. Pia Grassivaro Gallo, Langstadt Veronica 20 Feb 2013
MUTILAZIONI GENITALI FEMMINILI (MGF): la prevenzione rivolta agli immigrati (rapporto preliminare) Scienzaonline 

13. Pia Grassivaro Gallo. 2012 Vincere l'infibulazione si può: il rito alternativo e il programma di prevenzione. 

14. Pia Grassivaro Gallo, Dionisio E. 29 Giu 2010 Il superamento dell’U’kwevha (Allungamento delle Piccole Labbra) tra le popolazioni Venda del Sud-Africa Scienzaonline 

15. Pia Grassivaro Gallo 23 Feb 2010 Le immigrate africane del veneto e le iniziative di prevenzione alle MGF Scienzaonline 

16. Pia Grassivaro Gallo 18 Mar 2009
Il superamento della Infibulazione a Merka (Somalia): il programma di Mana Sultan Abdurahman Ali Isse (Merka 1953-2007) Scienzaonline 

17. Pia Grassivaro Gallo, Endrighi L., Viviani F. 22 Ott 2008 Genital Stretching and AIDS/HIV in Africa Scienzaonline 

18. Pia Grassivaro Gallo 22 Ott 2008 L’infibulation en milieu somali et in Nubie. Crime contre la femme? Perfectionnement de la forme feminine? Scienzaonline 

19. Pia Grassivaro Gallo, TITA E., VIVIANI F 17 Apr 2005 Alle Radici delle Modificazioni Etniche dei Genitali Femminili Scienzaonline

20. Pia Grassivaro Gallo e Barbara Fusto 17 Mar 2005 Recente evoluzione delle MGF in Occidente e nei paesi d'origine Scienzaonline 

21. The Guardian. "Sierra Leone's president vows to end female genital mutilation." Articolo giornalistico.

22. UNICEF. "Female Genital Mutilation/Cutting: A global concern." Rapporto.

23. Università della Bicocca e del Dipartimento per le Pari Opportunità (2019) Mutilazioni genitali femminili. 

* Board Member, SRSN (Roman Society of Natural Science)

Petition against Infibulation Avaaz