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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
One particular kind of sexual coercion deserves separate mention, the sexual exploitation of young children. The consequences of this form of coercion are likely to be even more traumatic and long-lasting than those of violence against adult women. Child abuse is even more likely than abuse against women to be perpetrated by persons known to the young person. Evidence from the United States indicates that a history of childhood sexual abuse is associated with unhealthy sexual behavior as an adolescent or adult and greater incidence of sexually transmitted diseases (Laumann et al., 1995:Table 9.15; Browne and Finkelhor, 1986). Children in difficult circumstances—street children, orphans, refugees—are especially vulnerable to abuse (Rajani and Kudrati, 1996; Shamim and Chowdhury, 1993).6
FEMALE GENITAL MUTILATION
Several authors have argued that maintaining virginity until marriage is a main purpose of the practice of female genital mutilation (El-Saadawi, 1982; Dualeh and Fara-Warsame, 1982; van der Kwaak, 1992). Female genital mutilation is the term now used by the World Health Organization (WHO) to cover a spectrum of procedures for which the older term "female circumcision" has often been used.7 The practice has been reported in more than 30 countries on the African continent, 7 in the Middle East, and 4 in Asia and in other areas to which certain ethnic groups from these countries have migrated, including Western Europe, the United Kingdom, and the United States (World Health Organization, 1994). It is estimated by the Institute of Medicine that there are currently 114 million women and girls who have been "circumcised," with 2 million new procedures performed each year (Howson et al., 1996).
There are three primary kinds of procedures, with wide variation among and even within groups. The most widely practiced, often called "Sunna" circumcision, from an Arabic word meaning "tradition," consists of the removal of the prepuce or the tip of the clitoris or both. The clitoris is not completely ablated. Clitoridectomy, or excision, consists of
In 1996 representatives of 119 governments, and of United Nations agencies and non-governmental organizations, met in Stockholm, Sweden, for a World Congress Against Commercial Sexual Exploitation of Children. They unanimously adopted an Agenda for Action, which called for a broad range of actions, including criminalization of commercial sexual exploitation of children, education and social mobilization to inform both children and their guardians of children's rights, and programs and counseling for victims.
WHO defines "female genital mutilation" to encompass clitoridectomy, infibulation, and other related practices, which vary in their severity. In 1993 the 46th World Health Assembly passed resolution WHA46.18 using the term FGM.