(February 2010) The idea of intentionally harming—let alone mutilating—healthy young girls stirs feelings of anger and injustice. The fact that thousands of girls are mutilated daily in the name of culture, religion, or gender is difficult to imagine. Yet this is the reality: More than 100 million girls and women around the world have been mutilated in the most personal, intimate parts of their bodies.

Female genital mutilation (FGM), also known as female genital cutting or female circumcision, comprises all procedures involving partial or total removal of the external genitals of girls and women for nonmedical reasons. The practice has no health benefits and brings harm and grave pain to girls and women.

FGM damages normal female genital tissues and interferes with the natural functioning of women's genitals. The devastating health and social effects to women are both immediate and long term. The effects on health include urinary and reproductive tract infections, which can lead to infertility. FGM makes childbearing more difficult, increasing the risk to both mothers and children of dying during childbirth; the sharing of razor blades may increase the risk of HIV.

From a social perspective, FGM is recognized as a violation of the human rights of girls and women. It reflects inequality between the sexes and constitutes an extreme form of discrimination against women. The practice violates a person's right to health and security and physical integrity; the right to be free from torture and cruelty; and, indeed, the right to life, as the procedure may result in death.

Who Is at Risk?

The number of women and girls affected by FGM is hard to fathom. The numbers—100 million to 140 million women—exceed the size of the population in my home country of Tanzania, Kenya, Uganda, and Rwanda combined. Another 3 million girls and women are at risk of being cut this year on the African continent alone. Girls are usually cut somewhere between infancy and age 15, often between 4 and 8 years of age. In some regions it is postponed until just before marriage or at the time of childbirth.

Despite global efforts to promote the abandonment of the practice, FGM remains widespread. In Africa, almost 28 countries practice FGM and there are some reported cases in Western Asia as well as in India, Indonesia, and Malaysia. In some developed countries, FGM is still being upheld by African immigrants, some of whom send their daughters home to be cut.

FGM is a traditional practice passed down from generation to generation. Ending it will not happen overnight; it is a practice which has been embraced for many years in many cultures by Muslims, Christians, and Animists—although many scholars make a strong case that no religion either mandates or sanctions this harmful practice.

How Can We End FGM?

The most effective way to end FGM is through education, information, and advocacy that will raise public awareness and bring about changes in attitudes within communities where FGM is practiced. Several organizations have made the case convincingly in countries such as Senegal (Tostan), Ghana (Navrongo), and Ethiopia (IntraHealth and CARE).

Countries may pass laws to eradicate FGM, but legal instruments by themselves cannot end the practice since traditions and beliefs are strong and deeply rooted in societies. In order to eradicate a culturally embedded practice such as FGM, legal actions must be combined with initiatives that bring about changes in these beliefs and attitudes. Education is critical. This type of change requires a complex partnership—laws provide a basis that can allow governments and policymakers to end this practice and provide punishments when it is carried out. At the same time, activists are empowered to do their work more effectively when their efforts have a legal grounding. Clearly, public education—raising awareness about its negative consequences—and the support of community leaders are vital in producing behavior change, and have been essential to the success of the campaign to end FGM.

International Human Rights Covenants

There have been a number of successful initiatives in the global arena thanks to the adoption of international legal instruments. The process of creating international consensus on an issue such as FGM creates a forum for brainstorming, discussion, and dialogue among policymakers interested in achieving change.

Policymakers in Africa have a great role to play in enacting and implementing the international conventions and protocols that advocate for women and children's rights in their own countries. They can draw on a number of policy initiatives that have been undertaken thus far, as well as at the regional and country levels. Consensus within the continent and within regions is especially important, as it gives policymakers added authority to return to their home countries and districts with resolution and determination to eliminate FGM.

Many international covenants provide powerful platforms to foster grassroots efforts in ending FGM. As early as 1948, the Universal Declaration on Human Rights provided a solid foundation for classifying FGM as a human rights violation. In the intervening years, numerous efforts—including the 1987 Convention Against Torture and Other Cruel and Inhuman or Degradation Treatment or Punishment, the 1989 United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the 1995 Beijing Platform for Action—have all soundly endorsed the elimination of FGM as a violation of human rights.

Within Africa, numerous conventions provide further legal basis for ending FGM, including the 1982 African Charter on Human and People's Rights, which addresses traditional harmful practices; and the 1999 African Charter on the Rights of the Child. African countries themselves are increasingly adding their voices to the calls to end FGM. Some form of legislation has been approved in at least 18 African countries.

Beyond Laws

In addition to laws, there are other effective tools that must be used in order to achieve the elimination of FGM, including better access to education and women's empowerment, socioeconomic development, and innovative methods to replace FGM.

Education is critical to changing people's attitudes toward FGM—not only education on the harmful impact of FGM on women and infants, but education as a source of empowerment for women, as a means to bring information to women, as a first step in giving them power to make informed decisions. By education, I am not just speaking about schools and books. Gender education, sexual and reproductive health education, education about the value of women directed toward all people—including men and boys—is vital to making the needed change. These programs must be offered through schools, in families, and in the community so that all people—from the unskilled worker to the highest-level decisionmaker—can fully comprehend the emotional, physical, and psychological damage that FGM imposes upon women and societies. And youth in particular should be targeted by these educational and advocacy efforts to ensure that FGM is not passed on from generation to generation.

The laws and education must take root in Africa, but there is also an important role for Western countries to play in raising awareness about FGM by providing information to national policymakers, and donors and funders who can exercise influence through supporting laws and programs that eliminate FGM.

A woman's marriageability is one of the key considerations in the continuation of FGM. Therefore, socioeconomic development initiatives in Africa are important, as they can eradicate poverty and enhance the economic status of women. If education and career opportunities for women are fostered, dependency on men for their livelihoods will decrease. Once women perceive other viable options for security and survival besides marriage, it provides them with an opportunity to cease the practice. Economic development programs must especially target and empower women by providing microfinance, skills development, and more opportunities for education to the girl child.

Alternative rites-of-passage ceremonies have been proposed as among the promising approaches to ending FGM. Various grassroots organizations in East Africa, particularly in Tanzania and Kenya, have used this approach, which maintains traditional symbolism and values while adding an empowering program of reproductive rights and health education. Traditional dances, singing and feasting, gift giving, and the teaching of values and norms of culture without the cutting have yielded success.

Lessons From Tanzania

During my recent trip to Tanzania in December 2009, I met with girls and women, advocates, and leading women politicians to get a sense of how things have changed in the last few years in Tanzania since I lived there. They told me there have been some successes but also some setbacks. They reported that many excisors, the women who perform the cutting, have laid down their tools and undergone income-generation programs so that they can stop the cutting and yet have alternative means of livelihood. At the same time, it was disturbing to hear that the cutting continues in many regions but is now being done in less detectable manners. For example, it is now being performed on women at the time of childbirth, so that when they return from giving birth, they have been cut. Also, it is being performed on infants before the age of one year.

The women I spoke with felt strongly that there is still a desperate need for more advocacy efforts, for closer interaction between policymakers at all levels from the grassroots to society's opinion leaders, and for the inclusion of youth. I heard time and again that more funding is needed for capacity-building and income-generation programs for women. Only by supporting women in this way will there be a change in society's philosophy on marriage; only through giving opportunities to women to attain status in society will FGM be ended.

They felt too that grassroots efforts are crucial, where the messages of education and empowerment can resonate, where community and cultural leaders encourage women's groups in villages to design new rites-of-passage rituals. These new rituals can be an opportunity for education of young women on sexual reproductive health issues, on HIV and other health-related topics, and for life skills education to prepare young women for the future.

Conclusion

As we look for solutions to FGM, we must remember that it is not just about abandonment, it is also about empowerment—empowerment through educating women, men, and communities at large. It is about raising consciousness so that people can change their attitudes toward this outdated cultural practice. Women's self-worth should not be tied to undergoing female genital mutilation; rather, women should be respected and respect themselves because of their positive contributions to society. The elimination of FGM is a health, social, and economic issue to be vigorously pursued by policymakers everywhere.


The Honorable Amina Salum Ali is the Permanent Representative of the African Union to the United States. Ambassador Ali would like to express her gratitude to all the women and men in Africa who have worked to end this harmful traditional practice, and especially to the Tanzanian policymakers who gave of their time to meet with her on her recent trip, specifically: the Honorable Fatma O. Ali and Honorable Zuleikha, Members of Parliament; the Honorable Halima Mohamed Mamuya, Member of Parliament in the Special Seat for Women; and the Honorable Fatma Tawfik, chairperson of the Ruling Party Women's Organization for Dodoma Region, who is also chair of the NGO Women Awake. Special thanks also to Charlotte Feldman-Jacobs and Jay Gribble of the Population Reference Bureau for their editing, support, and encouragement of this paper. This article is based on an upcoming Occasional Paper by Ambassador Amina Salum Ali. Born and raised on the island of Zanzibar and educated in India, Ambassador Ali has held various ministerial positions in the Tanzanian government, including Minister of Finance and Minister of the Treasury, as well as Member of Parliament.