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February 6 is International Zero Tolerance for Female Genital Cutting Day. The World Health Organization estimates that between 100 and 140 million women have undergone this harmful traditional practice, with two million girls and women at risk for female genital cutting (FGC) every year. IntraHealth most recently addressed this challenge in Ethiopia, where, as of 2000, approximately 80% of the female population had undergone FGC—99% in some regions.
In Ethiopia FGC is supported by a web of socio-cultural, financial and religious incentives. Many Ethiopian men believe FGC makes women better, more obedient wives. Many women believe FGC is necessary to protect their daughters' reputations and marriage prospects. Marriage is one of the few avenues of financial and social security and advancement for Ethiopian women; another socially advantageous role is to become a provider of FGC services, or excisor. Many people, both male and female, believe their religion demands FGC.
Most African countries, including Ethiopia, have had anti-FGC laws for years. But to truly address the problem the various incentives supporting the practice must be resolved. Beginning in 2003, under the USAID-funded PRIME II Project, IntraHealth partnered with the National Committee on Traditional Practices of Ethiopia to reduce FGC, focusing on health, gender, religion, human rights/law and access to information (a "five-dimensional approach"). We worked to identify communities' knowledge, attitudes and practices related to FGC, develop the capacity of community leaders to advocate against FGC, increase knowledge and change the attitudes of community members regarding FGC and evaluate the impact of anti-FGC interventions.
Focusing on communication channels, cultural and religious values and the social roles of men and women in the community, we trained male and female health providers, gender specialists, lawyers, judges, religious leaders, teachers and journalists as trainers in FGC elimination. These individuals, in turn, worked to train community leaders in behavior change and community mobilization within districts with the highest rates of FGC. Each community agent worked with 100 community members representing mothers, fathers, and unmarried men and women to encourage anti-FGC behavior.
Community activities included public anti-FGC declarations, cultural anti-FGC shows and the distribution of FGC educational materials. Several well-known excisors made public promises to cease performing FGC, and more than 2,200 community members agreed to ban FGC at public declarations. Through the project, Islamic and Christian religious leaders also met to discuss FGC, reaching national and local consensus on the need to publicly ban FGC.
While IntraHealth's anti-FGC activities in Ethiopia have ended, the National Committee on Traditional Practices of Ethiopia continues to expand the five-dimensional approach nationwide. Other organizations have also adapted the approach. The Somali Women Development Organization provides anti-FGC training to other groups and community members. In Harare the Anti-FGC Mothers’ Association supports women in protecting their daughters from FGC. The Somali Women Self-Help Association trains former excisors as traditional birth attendants or in making handicrafts to help them become financially independent.
More About FGC
FGC is the removal of part or all of a girl or woman's external genitalia for non-therapeutic reasons. The practice is widespread across sub-Saharan and eastern Africa, as well as in parts of Asia, the Middle East, and in certain immigrant communities in Europe, Australia and North America. FGC has many negative consequences. The procedure is extremely painful and, as it is rarely done under medical supervision or hygienic circumstances, it can lead directly to hemorrhage, shock, infection and death. The circumstances of the procedure—including poor instruments, unskilled cutters and the struggles of the victim—can also lead to injury of nearby tissue, such as the vagina, perineum, rectum, and urethra. Longer term problems include urinary retention, urinary tract infections, pelvic infections, incontinence, keloid scarring, dysmenorrhoea, sexual dysfunction and difficulty in childbirth. According to The Lancet1, approximately 22% of perinatal deaths in infants born to women with FGC are due to the physical effects of FGC on their mothers.
1WHO collaborative study group. 2006. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. The Lancet. http://www.who.int/reproductive-health/fgm