(March 2004) Senegalese village women who embarked on a movement to end the traditional practice of female genital cutting (FGC) in 1997 have a simple message for health experts: People need relevant information in a language they understand to make their own decisions on key issues.

“I am proud to be here today to bring this message from the many other village leaders of the movement to abandon the tradition in Senegal,” Kerthio Diarra, a 43-year-old woman from the village of Malicounda Bambara told a recent symposium sponsored by the U.S. Agency for International Development in Washington, D.C. “Adults need information and education in their own national language before they can make important decisions that so deeply affect their lives.”

Speaking in the Senegalese language Wolof, Diarra said the drive to end FGC in Senegal has made inroads because of a broad-based education program for villagers run by the locally based organization Tostan. She noted that people in poor and isolated villages like hers who had never attended school have greatly benefited from learning, not just about the risks associated with FGC, but also about their bodies and about human rights. Village women have also learned to read and write and have developed management skills, thanks to Tostan.

With FGC showing little evidence of decline in some 28 African countries despite years of work and laws to discourage the practice, activists say they badly need to replicate promising projects such as Tostan’s.

Over the last 25 years, governments, nongovernmental organizations (NGOs), and donor agencies have increasingly recognized FGC as a health and human rights issue and have used various means to try to stop the practice. Their approaches have included community-based education programs, the introduction of alternative rituals that could be substituted for cutting ceremonies, and work with health providers to help them treat FGC complications.

Now, health and women’s advocacy groups say they need to focus on replicating the approaches that work. But getting communities to end an ancient practice that remains a rite of passage for an estimated 2 million girls every year is not easy. Experts say ending the custom would require complex cultural changes as well as greater financial resources and political commitment.

“Efforts have been going on for 25 years, and what needs to be done now is the scaling-up of what we have learned will work,” says Dr. Nahid Toubia, founder and president of the Research Action and Information Network for the Bodily Integrity of Women (RAINBO). “We need to expand now, but that needs a lot more money. It cannot be the trickle of $20,000 here and $50,000 there.”

Tostan Program in Senegal

Much of the work to end FGC has occurred in West Africa, and one of the best-known programs is the one run by Tostan (“breakthrough” in Wolof). Created in 1991, the NGO has adopted a holistic approach to addressing the issues around FGC, a procedure that involves the partial or total removal of the external female genitalia. Generally performed without anesthesia by traditional elders, in some cases for pay, FGC has health consequences that include hemorrhage, shock, pain, infection, psychological and sexual problems, and difficulties during childbirth, according to the World Health Organization (WHO).

With several hundred teachers deployed throughout Senegal, Tostan conducts 30-month adult and adolescent programs that teach through the use of stories, theater, poetry, proverbs, song, and dialogue. These “Village Empowerment Programs” have aimed to enhance women’s life skills and improve their socioeconomic conditions. Organizers and participants say the abandonment of FGC is an indirect result.

“The goal of the Tostan program is not and never has been to impose opinions or judgments on class participants on any given subject, so the Tostan teacher never told us to abandon ‘the tradition,'” says Diarra, who underwent FGC as a girl and saw her own daughter hemorrhage after being cut. As part of the Tostan program conducted in Malicounda Bambara in 1997, “we learned of positive traditional practices before studying the negative ones, understanding the effects of the negative practices on the body and learning the various consequences of our actions.”

At the end of the program, Diarra and 39 other village women declared an end to FGC following discussions with their husbands, the village chief, and the religious leader. Neighboring villages also began to speak out against FGC. Today, well over 1,200 communities, representing some 600,000 people, have communicated their decision to end the process through 14 public declarations in many regions of Senegal.

The U.S.-based Population Council, which has studied the Tostan approach, says the program’s key success factors include a comprehensive, participatory approach to learning that highlights positive cultural factors and values, encourages use of the women’s own stories, and promotes the sharing of information with relatives and friends. The Council says other organizations and African countries could use this program.

FGC Programs in Kenya and Egypt

Work to end FGC is also underway in other countries. For instance, the Kenyan NGO Maendeleo Ya Wanawake has offered an “alternative rite” since 1996. Instead of undergoing FGC, girls receive family life education in seclusion and then a public graduation ceremony that recognizes them as adults. In Egypt, the U.N. Development Programme is working with the National Council for Childhood and Motherhood in a bid to end FGC in 60 villages. The project aims to raise awareness of FGC issues through media campaigns, community leader networks, and other means.

FGC — also known as female genital mutilation and female circumcision — is practiced in parts of Asia and in immigrant communities in Europe, Australia, and North America as well.

U.S. Policy

In the United States, the American College of Obstetricians and Gynecologists says that nearly 168,000 immigrant women and girls in the country had either undergone FGC or were at risk for the practice in 1990. Sudanese-American obstetrician and gynecologist Nawal Nour, who founded and directs the Boston-based African Women’s Health Center at the Brigham and Women’s Hospital, says most of her patients are from Somalia, Sudan, and Ethiopia and that 90 percent of them have undergone FGC. She also has received increasing reports that parents are sending their daughters back to Africa to undergo the procedure.

“This issue is growing in an alarming fashion, and we must work along with the African community to find a way to stop it,” says Nour, who also spoke at the symposium, which was organized by the Population Reference Bureau to mark the International Day of Zero Tolerance for FGC on Feb. 6.

U.S. federal law prohibits the “cutting” of women under age 18. Those who perform the procedure may be fined, imprisoned for up to five years, or both. However, Nour says the United States should follow Britain’s lead and try to protect the girls who are being taken overseas. British law not only prohibits the practice in the country but also makes it illegal for girls to be taken abroad for the procedure.

Policy Recommendations

Health and development experts say FGC abandonment programs could be expanded and supported in many ways: In a 1999 report, WHO and the Program for Appropriate Technology in Health (PATH) recommended that policymakers:

  • Provide greater support to scale-up pilot projects into broad-based programs;
  • Pass and enact anti-FGC laws to provide legal support for project activities; and
  • Increase awareness among health providers of the extent and severity of FGC-related complications.

In addition, those who design and implement FGC-related programs could:

  • Use a participatory approach when designing programs, and include young girls and women;
  • Conduct country-specific research, bearing in mind that programs should incorporate local perceptions of the practice, reach audiences with low literacy rates, and convey nonjudgmental messages;
  • Include urban-educated women and men since FGC occurs among all socioeconomic groups;
  • Build on the positive community values that underlie FGC; and
  • Include work with the mass media.

Yvette Collymore is a senior editor at PRB.


References

The American College of Obstetricians and Gynecologists (ACOG), “Health Care for Underserved Women: Female Circumcision/Female Genital Mutilation (FC/FGM) Fact Sheet,” accessed online at www.acog.org, on Feb. 19, 2004.

Asha Mohamud, Nancy Ali, Nancy Yinger, Program for Appropriate Technology in Health/World Health Organization (PATH/WHO), Female Genital Mutilation, Programmes to Date: What Works and What Doesn’t (Geneva: WHO, 1999).

WHO, “Female Genital Mutilation: Fact Sheets,” accessed online at www.who.int/health_topics/female_genital_mutilation/en/ on Feb. 19, 2004.