The (missing) key ingredient in getting to zero FGM

Will attempts to put an end to the practice of female genital mutilation be futile — no matter how many aid dollars are spent, or how many campaigns launched? Interventions, suggest FGM experts we spoke with, are “set up to fail” when carried out in silos instead of combining multiple, mutually reinforcing strategies.

And is the same true of the distribution of aid dollars aimed at addressing the issue?

Despite strong rhetoric and undeniable good intentions, donors that focus solely on big organizations and big campaigns run the risk of making a smaller impact if they miss out on making their support available at the grass-roots level, warn the experts.

Indeed, a girl may have a chance to run away from the practice, but this can easily be undone if she has no “safe haven” institution to turn to, no law that would allow her to remain indefinitely in such an institution, and no system that would allow authorities to immediately intervene. She would run the risk of being discriminated against in her community, where at least in some populations the belief is that women and girls are not grown women if they remain “uncut.”

“There is a lot of money, but I don’t think most of that money is reaching the places it’s supposed to reach. Because, for us, it’s supposed to reach the groups that work at the grass-roots level … [where] we’re seeking behavior change,” said Mary Wandia, FGM program manager at international human rights group Equality Now.

Speaking to Devex ahead of Friday’s International Day of Zero Tolerance for FGM — a United Nations-designated date aimed at raising awareness about the practice — Wandia noted that a number of grass-roots organizations as such are already struggling to engage with funders, as they have insufficient systems in place to attract and gain these donors’ trust.

“When you don’t have one [intervention], it undermines all other efforts,” she said.

There are a number of countries that have, over time, proven that combining a set of strategies works. In Burkina Faso, for example, the government has put in place a law prohibiting the practice, has set up mechanisms to educate citizens, and has created a national hotline that allows citizens to report FGM cases in order to prevent them, or bring the perpetrators to justice. A UNICEF report in 2013 showed that FGM cases among women and girls aged 15-49 in the country had fallen significantly, down from above 80 percent to below 60 percent and showed that there was widespread consensus for halting the practice.

In Kenya meanwhile, the work of an anti-FGM board that sensitizes communities is complemented by a special FGM prosecution unit, which works hand in hand with child protection officers to bring perpetrators to justice.

Barriers remain

Despite these successes though, the work is far from over. About 30 million girls in close to 30 countries — the majority of which are in Africa — remain at risk of having their genitalia cut over the next decade.

Wandia says the challenges vary. In largely Muslim countries like Mali, religion is a key obstacle, with religious leaders often taking the view that FGM is a requirement under Islam.

There are cultures meanwhile that won’t allow women and girls to do household chores like cooking or fetching water if they don’t undergo the procedure — with the risk of stigma. In others, a lack of laws that deem FGM illegal, or weak enforcement of laws when they do exist, makes it hard to stop the practice.

There’s also the problem of “ignorance” among marginalized communities living in remote areas, said the expert, referring to the lack of access to formal education being compounded by insufficient information on FGM and how their women and girls can and should be protected.

But one of the biggest issues confronting anti-FGM groups is the medicalization of the practice, which Wandia said has risen exponentially over the past year in several countries like Egypt.

Medicalization was once thought to be an intervention that would lead to the abandonment of FGM, but instead it had the effect that some proponents began to blame the procedure rather than the practice as a whole.

“It came many years from campaigns that didn’t frame [FGM] in the human rights context,” Wandia said.

While there have been a number of attempts to shut down medicalization of FGM, including harsh laws that sentence practitioners to life imprisonment if the victim dies undergoing the procedure, Wandia notes it’s best to also involve health workers themselves, who in several cases are also not aware of the dangers or pain they are putting girls in.

Wandia suggests informing them of the legal consequences, as well as the reality that they are performing a procedure against their Hippocratic Oath to “do no harm.” Medical associations should also start putting out guidelines on medicalization and, if need be, invoke sanctions on health personnel involved in performing the deed.

But amid the practical advice, Wandia underscores the importance of framing FGM in a human rights context. To do otherwise, she said, risks making little or no gains.

In Senegal, there has been no significant reduction or change in the prevalence of FGM in recent year. Nor has there been a change in attitude toward the practice, despite the efforts of awareness-raising interventions that have discussed the challenges and impact of FGM on communities. This is largely because, Wandia said, the intervention failed to frame FGM in the right way.

“That [example in Senegal] settles the debate between people who frame it as a human rights issue, and people who think you just need the community to learn [about FGM] and abandon it in their own time,” she argued.

Going to the grass roots

Although they are doing their part to help address the issue, international development groups need to do a better job connecting with community-based organizations, those small local organizations that have close connections with families in rural and remote areas.

“[International development agencies] are doing fantastic work, but we still have more to do in order to end FGM,” said Comfort Momoh, an award-winning FGM and public health specialist at Guy's and St. Thomas' NHS Foundation Trust in London, U.K. “To me it's about reaching out to the community, the grass-roots community.”

But as Wandia noted, many of these grass-root organizations struggle to connect with donors. They tend to lack the linguistic and outreach capacities of their larger counterparts, as well as an established reputation and a strong connection to the western world.

One way to address this is to carry out a thorough mapping of smaller civil society organizations within the country, according to Nihal Elwan, a veteran youth and gender expert who has studied FGM in Egypt for nearly a decade.

“[It’s like] Googlemaps and you say ‘OK, in this region you have one, two, three, four, five organizations that serve this community’ ... Then you have five options to work, rather than think ‘Oh there's this one NGO in the major town, I'm going to work with them’ and they probably only have that much of a sphere of influence and that much capacity,” Elwan told Devex.

How can grass-roots organizations better engage with funders on FGM to effect long-standing change? Have your say by leaving a comment below.

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