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The Cultural Context of Families

Fam Proc 38:431-443, 1999

Attitudes toward and Perceived Psychosocial Impact of Female

Circumcision as Practiced among the Bedouin-Arabs of the Negev
ALEAN AL-KRENAWI, Ph.D.a
RACHEL WIESEL-LEV, Ph.D.a
aDr. Al-Krenawi is a Senior Lecturer and Dr. Wiesel-Lev is a Lecturer in the Department of Social Work, Ben-Gurion University of the
Negev, P.O. Box 653, Beer-Sheva 84105, Israel. Send correspondence to Dr. Al-Krenawi at the above address or e-mail:
alean@bgumail.bgu.ac.il.
The present pilot study examines attitudes toward and the perceived psychosocial impact of circumcision as practiced
among the Bedouin-Arabs of the Negev, Israel. A convenience sample of 24 women participated in the study: 12 who
had experienced the ritual, and 12 who had not, but who had witnessed or been told about the practice of the ritual on
women in their extended families. Two research instruments were used: a structured questionnaire, and a
semi-structured open-ended interview. Data showed differences in subject responses depending on the research tools.
The structured questionnaire revealed that women who had experienced the circumcision gave legitimization and
cognitive rationalization to it. In contrast, the semi-structured interview revealed that these same subjects reported
insult: traumatization, direct negative influences, and narcissistic insult, and described emotional difficulties during the
research interviews. The findings indicated that they had difficulties in mother-daughter relationships and trust.
Implications of the ritual on the continuity of polygamy and marital/sexual problems are discussed.

In approximately 40 countries, girls and women are subjected to various forms of circumcision as an "initiator process"
or "religious necessity" (Black & Debelle, 1995). This operation is practiced among, but not limited to, the Nilotic and
Cushitic or Bantu peoples (Webb & Hartly, 1994), Omanis, Eritreans (Black & Debelle, 1995), Somalis, Ethiopians,
Sudanese (Al-Safi, 1970; Hicks, 1993; Van der Kwaak, 1992), Yemenis (Milos, 1993), and Egyptians (Al-Sadawi, 1980,
1983; Bishara, 1989; Toubia, 1985). It is practiced on the African continent and the Arabian Peninsula; in Asian countries
such as Indonesia, Pakistan, India, Malaysia (French, 1992); in Western countries, including the United States, Canada,
England, France (Gallard, 1995), and the Netherlands (Hicks, 1993); in Australia (Tompkins, 1962); and in South America
(Jordan, 1994).
Female circumcision is practiced within a wide range of ethnic groups and religious faiths, including Jews (Falashas);
indigenous religions (Webb, 1995); the Russian Skopotozy, a Christian sect that quotes Matthew 19:12 as their justification
(Miniru, 1994); and Coptic Christians (Abdalla, cited in Gottschall, 1992). Miniru (1994) suggests that female
circumcision has disappeared in some cultures, however, or has decreased in incidence, as among the Igbos in Nigeria.
Circumcision is most often performed on girls between 4 and 10 years old, but it is also performed on infants, or, in
some groups, delayed until a woman gives birth to her first child (Toubia, 1994). Most often, the procedure is done without
anesthesia while women hold the girls down. The procedure is performed with razor blades, glass, kitchen knives, scissors,
or even the "teeth of the midwife" (Council on Scientific Affairs, American Medical Association, 1995, p. 1714; Van der
Kwaak, 1992).
There are three levels of female circumcision practiced: (1) Sunna, a mild or modified form; (2) excision/clitoridectomy
(Lightfoot-Klein, 1989); and (3) infibulation/Pharaonic circumcision (e.g., clasping a ring to the genital organ to prevent
copulation) or introcision. "Sunna" is an Arabic word meaning tradition. Mild sunna consists of "the prickling, slitting or
removal of the prepuce of the clitoris, leaving little or no damage" (Lightfoot-Klein, 1989, p. 33). Clitoridectomy/excision
is defined as "the removal of part or all of the clitoris, as well as all or part of the labia minora. This operation often results
in scar tissue that is so extensive that it occludes the vaginal opening" (Lightfoot-Klein, 1989, p. 33). The most extreme
level is infibulation or Pharaonic circumcision, which may also include introcision (Lightfoot-Klein, 1989). Omar-Hashi
and Silver (1994) and Hicks (1993) have noted that there are physical, and sexual impacts of such a ritual, while Lane and
Rubenstien (1996) point out that, from the time of circumcision, sexual relations can be extremely painful. The
circumcision may also lead to sexually related health problems, such as internal infection. Many cultures that practice
female circumcision "do not naturally see the link between circumcision suffered by a woman in her childhood and the pain,
infections and health complications she may suffer in her later years" (World Health Organization, 1994, p. 2).

Psychological Consequences

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Psychological consequences have been less studied than physical or sexual consequences; but when a girl is taught that,
prior to the procedure, her genitals are dirty, smelly, and consequently sexually repellent to men, issues of self-concept and
self-esteem are called into play (Cohen, 1989). Moreover, she is often informed that she would be socially unacceptable
were she not to submitthat she would have to contend with ostracism and scapegoating and the resultant anxiety and
depression. In Sudan, where social pressures are very strong and traditional practices are taken for granted, the expression
"son of an uncircumcised mother" is the most forceful verbal invective used (Al-Safi, 1970; Cohen, 1989, p. 22). In an
analysis of the psychological concomitant of circumcision, Grassivaro (1986) concluded that most women of Somalia,
regardless of age, social status, or ethnic extraction advocate continuation of the practice and are in favor of circumcising
their daughters.

BEDOUIN-ARAB OF THE NEGEV

Although originally intended to refer only to those who herded camels, Bedouin-Arab has come to be known as the
general name for all the Arabic-speaking nomadic tribes in the Middle East (Kay, 1978). The Bedouin-Arabs have lived in
the Negev region for two millennia (Hebrew Encyclopedia, 1954) and are one national, linguistic, political, and geographic
entity. As such, they ought to be considered asdistinct from other non-Bedouin Arab communities in Israel, as well as
distinct fromalthough related toBedouin-Arab tribes in other countries. Tribal structure remains important to this
population's self-identity, particularly as a social support network (Al-Krenawi, 1996; Marks, 1974). Today, the
Bedouin-Arabs are undergoing a rapid and dramatic process of urbanization: of the Negev's 120,000, forty percent now
live in recognized villages and sixty percent live in unrecognized villages without basic infrastructure and social services
(Al-Krenawi & Graham, 1997).

Significance of Family Honor

The concept of "ard" has deep roots in Bedouin-Arab society. Ard is normally translated into other languages as "a
woman's honor." However, when a Bedouin-Arab speaks of unsullied ard, it in fact has a wider, more familiar meaning.
First, it signifies that no man has ever dared to dishonor him by dishonoring his wife or daughters, which means that he and
his forebears were powerful enough to deter any outsider from looting their property or raping their women. Second, it
indicates that he owes no moral debt and carries no stain upon his honor that would force him to sacrifice all he has to
remove it. Bedouin-Arabs believe that it is possible to erase any mark of shame [ar] that a man may sustain except a stain
on his ard, which remains forever (Abu-Lughod, 1985; Arad, 1984; Dodd, 1973; Ginat, 1987; Mass & Al-Krenawi, 1994;
Peristiany, 1974).
Historically, in Arab society, women are regarded as somewhat untrustworthy and unreliable, both physically and
intellectually, and they are believed to be sexually threatening to men (Al-Abbadi, 1973; Al-Aref, 1934; Sanua, 1979). In
Libyan society, women are perceived as "physically and mentally weak in comparison to men" (Attir, 1985, p. 121). Similar
beliefs are found in many Arab societies (Al-Sadawi, 1977, 1985; El-Islam, 1975; Fleur-Lobban, 1993; Kaki, 1989).
Women thus face strict societal limitations (Al-Krenawi, Maoz & Riecher, 1994; Arad, 1984; Mass & Al-Krenawi, 1994).
In a Bedouin-Arab man's family, the good behavior of the women and children, whom he is considered to own, support
his honor. To keep the honor of the family inviolate, tradition has restricted a married woman's social connections to the
cellular family, that is, that part of the extended family (tribe) most nearly related to her husband. A woman must not be
absent from her husband's home except for everyday obligations. Girls learn these rules by heart in childhood, and the rules
gradually become more restrictive as she matures to womanhood. All her life she is controlled by a guardian, although her
family and social status change as she becomes older (Ben-David, 1981; Lewando-Hundt, 1984).
It should be noted that, in Bedouin-Arab society, there are two different worlds that exist at the same time: the men's
world, which is more public; and, the women's world, which is more secret (Al-Krenawi, 1995). Abu-Lughod (1985)
pointed out that women spend much of their time apart from the men, living with the children in a separate world as a kind
of community within the larger society. Thus, the Bedouin-Arab social world is divided in two: in one half are the adult
men, in the other are the women and children. There are different values and customs for men and womeneach gender
following its own codes. Therefore, the Bedouin-Arab society has to teach children and young peoplemale and
femaletheir prescribed positions and roles in the divided society (Al-Krenawi, 1995).
The circumcision ritual itself is inextricably associated with key Bedouin-Arab constructions of womanhood. It should
benoted that the practice of the circumcision ritual, and of the extent of the genital mutilation caused, varies across the
Bedouin-Arabs of the Negev. While some tribes have abandoned the practice, other tribes still practice it. In Arabic, the
ritual is called T'hoor [circumcision]the same word used for male circumcision, which is obligatory for all male
Muslims. The root of T'hoor comes from the word Taharah [purification], and the stated purpose of this act is to make the
girl "pure." Thus, Thoor covers such a wide range of kinds of circumcision that it is imagined by outsiders to be nothing
more than a relatively harmless ritual initiation.

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But female circumcision, as practiced among the Bedouin-Arabs, is often a euphemism for female mutilation. It is a
sacred women's ritual performed by women (Asali, Khamaysa, Aburabia, et al., 1995) and surrounded with great secrecy
by the women themselves. Its persistence reflects, in part, the conservatism of Arab women (Al-Sadawi, 1980, 1985;
Toubia, 1985). Often fathers are not aware of whether their own daughters have had the ritual, and husbands-to-be do not
inquire and are not told (Asali et al., 1995). The ritual is a rite of passage from childhood into womanhood; it signifies that
the woman is pure and is therefore ready to take her full place in Bedouin-Arab society through the attendant
female-constructed responsibilities of being a mother and wife (Al-Krenawi & Graham, in press). But another purpose of
the circumcision is to suppress a woman's sexuality. Asali et al. (1995) point out that the most common form of
circumcision among Bedouin-Arabs is a clitoridectomy: the removal of part or all of the clitoris, as well as about 1 cm of
the labia minora nearest the clitoral prepuce. As described in the introduction above, this form is intrusive enough to quality
as female mutilation. Because of the secrecy, even among women, and our inability to access medical records on this
matter, our assumption of the procedure used among the women interviewed is based on the medical data given by Asali et
al. and the kinds of things the women said about their experiences.
The aim of this pilot study was to explore Bedouin-Arab women's attitudes toward female circumcision. More
specifically, answers to the following questions were sought: (1) how do Bedouin-Arab women perceive the act of female
circumcision? and (2) what is the psychosocial effect of female circumcision on those women who had experienced the
ritual? Since circumcision is regarded by Bedouin-Arab women as a secret act, recruiting participants had to take place
secretly as well.

METHOD
Over a 5-month period in the latter part of 1998, a convenience sampling of 24 Bedouin-Arab women was interviewed
by a female Bedouin-Arab social work student who was familiar with the circumcision ritual. Before initiating the study, the
researcher spent some time to establish good relationships with the women, developing a knowledge of their backgrounds,
and creating a mutual sense of trust. When asked to be research subjects, all the women hesitated, because the ritual is a
secret issue. Among more educated women, who were in a state of transition between Western and Eastern values, there
was also embarrassment at how they might be depicted before Western readers. They knew how Westerners viewed such
rituals, and they felt that they would be looked down upon as primitive or inferior. In the end, however, all agreed after the
normal ethical standards of research consent were explained to them in detail. They were all concerned that their anonymity
be protected. They were promised that no one would be ableto recognize them through the data, and that, although the
findings would be published, their participation would remain confidential. At the conclusion of the research, the findings
were made available to them prior to publication. Successful data collection was strongly related to the strength of the
student's relationship with the subjects, and the subjects' commensurate sense of comfort in divulging personal and, at
times, painful data to someone of the same gender and cultural background.

Sample
The sample consisted of 24 Bedouin-Arab women recruited from both recognized and unrecognized Bedouin-Arab
villages in the Negev. Participants were divided into two groups according to different circumcision experiences. Group 1
consisted of 12 women who had been circumcised between the ages 13-15 (mean age, 13.67; SD = 2.55) by a woman who
specialized in performing the ritual, the traditional surgeon-midwife called Mtahra in Arabic. Group 2 consisted of 12
women who had not been circumcised, but who had witnessed circumcision or who heard of the ritual having been
performed within their extended families. All participants ranged in age from 18 to 36 (Group 1, mean = 22.5); Group 2,
mean = 23.1).
Of the subjects, 33% from Group 1 and 32% from Group 2 were married; 67% from Group 1 and 66% from Group 2
were single. Among the married women in both groups, 87.5% were the first of two wives in polygamous marriages and
12.5% were their husband's second wife. Married women had an average of four (SD = 2.94) children. In terms of
education, 13% of Group 1 and 40% of Group 2 had a high-school diploma, while 87% of Group 1 and 60% of Group 2
had less than 12 years of education. Regarding occupations, among Group 1 (circumcised), 42% were unemployed, 27%
were blue collar, and 31% were university students. In Group 2 (not circumcised), 34% were unemployed, 25% blue collar,
37% were university students, and 4% were teachers.

Instruments
The interviews were conducted in either the subjects' homes, or in a place that both the interviewer and the subject
agreed upon. Two research instruments were used: a questionnaire of attitudes, and a semi-structured, open-ended
interview. The first consisted of a four-part questionnaire tapping demographic variables: for example, age, family status,
education, age at circumcision (T'hoor) experience; attitudes toward sexual abuse (according to the Gottman Scale);
attitudes toward circumcision; and attitudes toward the Mtahra. The scale consisted of 28 statements covering three kinds

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of personal attitudes toward: (a) sexual abuse within a family (7 items, such as "looking at a girl when she undresses,"
"forcing sex relations on a child"); (b) circumcision (13 items, such as "circumcision enhances marital quality,"
"circumcision preserves male dominance," "circumcision has detrimental effects on women's sexuality"); and, (c) the
Mtahra (8 items, such as "a woman who respects tradition," "a sadistic woman"). Respondents were asked to rate their
agreement with each statement on a 4-point scale, ranging from "not at all" (1) to "very much" (4). This scale was
developed by the authors in Arabic; the Cronbach alpha for the scale overall was 0.86, indicating high reliability.
The second instrument was a semi-structured, open-ended interview, including questions regarding: attitudes toward
circumcision; the girl's perception about her parents' attitudes toward circumcision; attitudes toward the Mtahra; and how
the circumcision was performed. A thematic analysis was conducted according to the Tutty, Rothery, and Grinnell (1996)
guidelines of identifying meaningunits and categories and classifying them according to themes.

RESULTS
Findings are presented in two parts: First, quantitative, and then qualitative. Table 1 shows the correlations of variables
in this study. The correlations indicate that: (a) the older the interviewed woman was, the lower her level of education
(r = -.73); (b) the higher the level of education, the stronger the subject's negative feelings toward circumcision (r = -.56)
and toward the Mtahra (r = -.56); (c) the older the woman was when she was circumcised, the stronger her positive feelings
toward it (r = .54); and (d) the older the woman was, the stronger her positive feelings toward the Mtahra (r = .71).

Table 1
Correlations of Demographic Variables and Attitudes toward Sexual Abuse, Circumcision, and the Mtahra
Age of Age (n = 24) Education ASA (n = 24) AGM (n = 24) AWM (n = 24)
Circumcision (n = 24)
(n = 12)
Age of circumcision 1.000
Age 0.57 1.000
Education -0.52* -0.73*** 1.000
ASA 0.19 0.07 -0.02 1.000
AGM 0.54* 0.18 -0.56** -0.11 1.000
AWM 0.71** 0.27* -0.56** -0.00 0.82*** 1.00
Key: ASA = attitudes toward sexual abuse; AGM = attitudes toward circumcision; AWM = attitudes toward the Mtahra.
* p < .05; ** p < .01; *** p < .001

To compare attitudes toward sexual abuse, circumcision, and the Mtahra between these two groups, an analysis of
variance (MANOVA) was conducted. In the results, presented in Table 2, two variables did not yield a significant
difference, while the third did: those who were circumcised perceived circumcision more positively than those who were
not circumcised (M = 2.10 and M = 1.65, respectively; F[1, 22] = 5.2, p < .05).

Table 2
Means, Standard Deviation, and F Values of Analysis of Variance for Comparison of Attitudes between the Two Groups
Group 1 Group 2 F Values (df = 1,22)
ASA 2.97 3.01 0.01
(0.71) (0.90)
AGM 2.10 1.65 5.2*
(0.61) (0.34)
AWM 2.46 2.07 2.5
Wilks F(4,19) = 2.5, p < .07.
Key: ASA = attitudes toward sexual abuse; AGM = attitudes toward circumcision; AWM = attitudes toward the Mtahra.
* p < .05

Since education and the age of circumcision were highly correlated with the attitudes toward circumcision and the
Mthara, a stepwise regression analysis was performed to assess the influence of these two factors. Attitudes toward
circumcision and Mthara were condensed into one variable with a high correlation (r = .82). Results indicated that,
although 19% of attitudes could be predicted by this variable (F[1, 21] = 4.93; p < .05), only education contributed

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significantly to negative attitudes toward circumcision (|gb> = -.44).

Analysis of Qualitative Data

The following analysis is based on the semi-structured open-ended interview; thus, we have incorporated quotationsfrom
the subjects about the following issues: women's perception of their status; their attitudes toward circumcision; attitudes
toward the Mtahra and the circumcision itself; and the consequences of the ritual.

Women's Perception of Their Status

Bedouin-Arab society is patriarchal, and male dominance over females is the norm. Women's social status is dependent
upon their marital status, as well as their ability to bear and rear children, especially boys. As Y (Group 2) said:

Everything must be done according to my father. He decides. I was a very good student at school [the only one
among a family of 13 children]. My uncle, who was school principal, convinced him to let me go on with my
studies. He wanted me to be a teacher, but I preferred social work. He said it's not proper to become a social worker
because you have to visit your clients' houses, and a woman in our tribe should not be visiting others by herself.
Although he gave his consent, he worried that I might not get married because I am too educated.

This participant repeated that one reason her father hesitated in allowing her to attend university was because she could
meet men from other tribes and families, which he did not like.
Culturally, it is expected in the Bedouin-Arab society that girls marry while they are younger. If a girl is over 20 years
old and unmarried, it may cause difficulties for her and her family. Such a situation may lead to a polygamous marriage as a
second or third wife (Al-Krenawi, 1998). This may affect both the girl's social status and self-image, and her family's honor.
As stated by A (Group 1): "It is very important that I marry and have children. If a daughter reaches the age of marriage and
is still not married, her father feels shame."

Attitudes toward Circumcision

Attitudes toward circumcision indicated some diversity. L, a participant from Group 2 (not circumcised), said;

The first time I heard about it, I was in sixth grade. A friend returned after being absent from school for one week,
and told us in secret that women should be circumcised because otherwise other women will laugh at her later, and
she would not be able to cook for her husband. A girl who is not circumcised may be considered impure [Najsah]. I
was really scared.

According to Bedouin-Arab culture, women who have not been circumcised are considered Najsah [impure], and the food
they cook supposedly smells bad; therefore, girls believe they have to go through this ritual in order to gain purification
[Tahara].
"Once I asked my teacher about it," said T (Group 2). "She told us it was customary before Islam [was established] I
think it's both a very dangerous custom and illogical. I was impure before getting married; why should I be pure after it? . . .
Men do not know about it, and do not interfere. It's done entirely by women, quietly." "There are friends who convince you
to do it, so do mothers and neighbors . . . It's very hard to resist," another woman from Group 2 said.
Some participants who were circumcised (Group 1) viewed it in a positive manner, while others of the same group
expressed strong feelings against it. P (Group 1) said, "It does not have any purpose except agony and pain. . . . It
differentiates between girls and boys. It helps the girl feel feminine, to control her urges and temptation, not to follow her
feelings." Another woman from Group 1 said, "Mother says it is done for the girl, so she becomes stronger, more
masculine, and so no one will be able to play with her feelings."

Description of Circumcision
Circumcisions are carried out secretly, mostly without any previous preparation of the girl. Often it is the decision of
mothers and aunts. A (Group 1), who was circumcised without anesthesia (which is the usual method), said:

I was nine years old. I remember playing with my cousin. Mother came, gave me sweets, and asked me to follow
her to do a circumcision. I didn't know what it was. I followed her to a small room. She locked the door. I felt
something was wrong, but did not know what. Another woman was in the room. My mother put me on the bed and
then I was circumcised. I screamed and screamed. I felt they were two heartless animals who had stolen a piece of
my body. After a week, I went back to play with my cousin. She had not gone through this. I wondered why, what
was wrong with me that I had to undergo it. I started to hate all people. They are all thieves . . . they lie, give candies

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to do something wrong.

From the story of this participant, we can see that she lost trust in the main people in her life, and even developed a sense of
hatred toward people.

Attitudes toward the Mtahra

The age of circumcision among the interviewed women ranged typically from 13-15 years. The ritual was performed
without preparation, under poor medical conditions, and without anesthetics. Some of the participants tended to view the
Mtahra in a permissive way, as a woman who kept tradition rather than as a sadist; others, however, spoke of the Mtahra
as a criminal. Some of the views the women expressed from Group 1 were:

"She was a very nice woman, she tried to calm me down. She said to me that it hurts now but will prevent me from
suffering later."
"I hate her. It's natural. If I could, I would kill her. A woman like the Mtahra deserves death."
"If by accident I met her, I would probably ignore her, or looking at her with a demeaning look. I would not show
how much I was hurt."

One of the participants who had not been circumcised (Group 2) said:

I overheard a conversation between my mother and a Mtahra in our tribe. I was in high school. The Mtahra said
she is not performing it anymore (probably after the near death of another girl). After that my mother ceased
pressuring me to do it.

Consequences of Being Circumcised

Feelings of fear, shame, anger, and helplessness are created out of this experience, even among those in Group 1 who
spoke positively about the value of their circumcision. Some of the women interviewed directed their feelings toward their
parents, others toward their relationships with their future husbands. A (Group 1) said:

It hurt me a lot. After such an experience, anyone who treats me nicely and gives kind words frightens me. I am
scared of nice people. My mother gave me sweets to catch me. I appreciate people who criticize me more than
those who talk to me nicely. . . . I feel something was stolen from me without my consent. I will have a problem
when I marry. The groom will run away from me. I may think of suicide at my wedding day. . . . Men are not to
blame for it, but I will not be able to have sex with them. I think my husband will treat me well but I will be the
problem. . . . I hate my mother. I feel my parents acted as dogs who eat a dead sheep [a Bedouin-Arab proverb].

P (Group 1) said, "One day my mother talked about it, but not directly to me. She said she expected me to go through
with it. I was terrified."
"I perceive it as an abuse," said a woman from Group 2. "Although some girls agree to do it, they are too young to
understand what it means. They are intimidated by their mother's or friends' threats of being impure. If a grown-up woman
decides to do it, it's her business."
Another woman from Group 2 said, "It's an awful experience. I am lucky I didn't go through it. It's enough to hear about
it from friends; it's scary, even to talk about it; scary. . . My body is mine. I would go crazy if someone did it to me."

DISCUSSION
In this pilot study, we tried to explore Bedouin-Arab women's attitudes toward female circumcision. One of the
limitations of the present study was the small size of the sample. This was because of difficulties in obtaining the agreement
of Bedouin-Arab women to participate in this study due to the sensitive and highly secrete nature of the ritual. There were
also other considerations: that touching upon this subject might create retraumatization from the memory of the
circumcisions, or stress over breaking one of the tribe's most secret rituals; or that possible bias might be introduced by the
interviewer (who, in this case, was a Bedouin-Arab woman herself), or by the principal researchers (of whom one was a
male Bedouin-Arab social worker and the other a female Jewish social worker). Nonetheless, we believe that the results
help to broaden the understanding of the psychological and social aspects of this phenomenon.
In the present study, we used two different instruments to examine the attitudes toward and psychosocial impact of the
circumcision ritual among the Bedouin-Arab women. First, the structured interview shows that women who experienced
the ritual, as compared to those who were not circumcised, were slightly more positive toward the ritual. The findings also

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showed, however, that the subjects who had been circumcised expressed various emotional difficulties, as well as
psychosocial problems, such as the loss of trust within the mother-daughter relationships. On one hand, the quantitative
(structured) interview revealed that the rationalization of their circumcision appeared to help women carry on with their
dual roles as wives to their husbands, and as daughters to their mothers who had initiated the ritual. On the other hand, the
qualitative structure of the second, more open-ended interview allowed subjects to express themselves emotionally in
relation to the ritual. The drawback of the open-ended interview was that the telling of the story caused some
retraumatization.
The two research instruments used in this study explain some of the differences related to the attitudes toward and
psychosocial impact of the ritual. Because of the structure of Bedouin-Arab society, the stylized questionnaire limited the
subjects' ability to express their attitudes toward and the psychosocial effect of circumcision. The structured instrument was
not wholly appropriate for the interviewed subjects, due to the "orality" of Bedouin-Arab culture (a so-called narrative
culture). They prefer to tell stories or to express themselves through proverbs and metaphors rather than to fill in forms
(Al-Krenawi, 1998).
It should be noted that there are implications of the circumcision ritual at several different levels. One of these is
marriage, since the practice of this ritual may affect the sexuality of the women who experience it. Any sexual relationship
may be experienced as a revival of the insult. Often women cannot enjoy a sexual relationship: any touching of her genitals
may remind her of the performance of the ritual. Therefore, a woman who has experienced this ritual may avoid sexual
relatonships with her mate as much as possible, which, in turn, may be perceived by her husband as rejection. This situation
may cause marital problems and lead the husband to seek additional wives.
Another explanation is derived from the inconsistency of the feelings that emerged between the cognitive assumption that
"being circumcised means to be pure," or "being circumcised means worthiness as a woman," and such feelings as "being
robbed of a very important part of my body," and, "being hurt by those whom I was supposed to trust." This suggests a
dissonance between body image (femininity) and social image (evaluation by other women as a candidate for marriage),
which could cause conflicts of feminine self-identity. One of the subjects asked, "Who owns my body, me or my husband?"
According to Fitts's theory of self-esteem (1964), self-image consists of five dimensions: body image, social image,
cognitive image, personality image, and sexual image. Since these dimensions are interrelated, damaging or decreasing one
of them is likely to affect the others. Being circumcised harms the women's body image. As stated by one of the subjects
(Group 1), "I felt something stolen from my body." This, in turn, most likely harmed the woman's sexual image. Another
woman from Group 1 said, "I would not be a good wife [without the circumcision]." Damaged body image often causes
problems in sexual relationships; thus, women are punished twice: first their body image is harmed, then their sexuality.
Should she be frigid, unresponsive, or fearful of sex, her husband might take another wife, which would also adversely
affect her social status. The consequences of such a process lowers the woman's self-esteem (Rosenberg, 1979). Given the
social constructions of gender and the consequent social relations, it is not surprising that Bedouin-Arab women encounter
numerous psychological and psychosocial problems, as do their counterparts in other regions of the Arab world
(Al-Sadawi, 1980, 1985; El-Islam & Abu Dagga, 1992; Grotberg, 1990; Racy, 1980). It could be extrapolated that the
practice of the circumcision ritual in itself significantly contributes to the continuity of polygamy and to marital/sexual
problems between husbands and wives.
This study has been offered as a beginning point for the provision of culturally grounded knowledge that can better
inform practitioners and raise public awareness concerning circumcision. As practiced among the Negev Bedouin-Arabs,
circumcision ought to be called female mutilation. This is a subject that cannot be addressed merely as a "feminist issue";
yet, it is not simply a cultural, racial, or ethnic issue either. Rather, it is a human rights issue. Mutilation can be seen as a
violation against women in terms of the physical and psychological trauma suffered (Arbesman, Kahler, & Buck, 1993). In
fact, it is estimated that mutilation is in violation of 18 tenets of the U.N.'s human rights document (NOCIRC, 1995). The
World Health Organization calls for an eradication of genital mutilationand female circumcision, even in its mildest form
is included in this termby the year of 2000 (WHO, 1994). However, this call raises questions about the type of
intervention that might be legitimate when practitioners encounter people such as the Bedouin-Arabs whose rituals occur
within the context of cultural and religious custom.
Practitioners are bound by their professional ethics to appreciate the culturally specific context in which the practice is
conceived and carried out. Since female circumcision and female mutilation are strongly linked to Bedouin-Arab notions of
family honor, purity of womanhood, female sexuality, and gender-proscribedfamily structure, any intervention needs to be
collaboratively applied, rather than arbitrarily imposed. As one anthropologist noted with reference to a different society
that practices genital mutilation: "What if the women concerned have a different perception" regarding mutilation practices?
"What if they do not want to be enlightened" by Western values and approaches? (Van der Kwaak, 1992, p. 785).
Family and marital psychosocial interventions, therefore, should be carried out with much care regarding the data
presented here. On one hand, practitioners should not fall into the trap of permitting circumcision to remain a hidden
phenomenon by avoiding talking about it with their clients; on the other hand, they should be very careful not to take a

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judgmental stance either against the ritual or for it. We recommend, however, that social interveners try to bring about a
change in at least the way ritual circumcision is carried out; for example, trying to encourage their clients to perform it
under adequate medical conditions; to raise the age-level of the girls; to explain the procedure to the girls; and to enable
girls not only to express their views regarding the ritual, but to accept their decision about whether or not they agree to
submit to it. On the community policy level, it is recommended that programs for sex and health education be developed
that can be delivered by female nurses.
Finally, the present study raises several questions for further research, such as: Why do women continue this practice,
since men are not involved, and sometimes do not know about its existence within their homes? Further
ethnomethodological research among other cultures may provide a basis for transnational, cross-cultural principles of
intervention.

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Manuscript received August 11, 1998; Revisions submitted February 24, 1999; Accepted July 6, 1999.