February 5, 2010
By United Nations Radio
TRANSCRIPTS FROM AN INTERESTING INTERVIEW (Nafissatou Diop, UN Population Fund) FEATURED ON UN RADIO (to listen to the interview, please visit the original website by clicking on the title of this post).
Despite recent progress in reducing the incidence of female genital mutilation, the UN estimates that 3 million young girls each year remain at risk of undergoing FGM. Bissera Kostova spoke to Nafissatou Diop of the UN Population Fund to find out how UN agencies and governments are trying to overcome this harmful traditional practice.
Diop: In 2010, some recent data show that there is a decrease of the practice when you look at the prevalence of female genital mutilation cutting among older women aged from 35 to 39 and you compare them to those aged from 15 to 19 years old - there is a decrease. For example, in Kenya the prevalence among the younger group is 15% compared to 35% among the older group. In Cote d'Ivoire we have 28% for the younger group, compared to 44% for the older group. I can give Ethiopia example also, which is a very, very successful story where the younger group prevalence rate is 62% compared to 81%. Even in Egypt, where we know that female genital mutilation is widely used, we can find a decrease from 96% in 2005 to 81% among that young age group.
Kostova: And how has this success been achieved. What has worked?
Diop: First of all, during the past ten years, we have seen more and more commitment from the government of those countries, or at least in Africa, there is much more commitment from the policy level, with a lot of countries - 17 countries now out of 28 - that have laws that specifically prohibit female genital mutilation cutting. But in addition to that, I do need to say that at community level, a lot of NGOs are working since 20 years, but recently we can see an acceleration, because we have now better comprehension of what works. And what works is the collective abandonment of female genital mutilation cutting. This is a social norm and as a social norm, we know that the abandonment can happen individually, but it's going to be very slow, so the abandonment in a collective way using education on human rights, using a dialogue to let the people themselves understand and think about this practice and really denounce it and decide that this is something that they can really abandon is probably the way to go. And we can we can give the successful example seen in Senegal with an NGO named Tostan and a recent evaluation shows that in villages where these programmes were implemented there was a decrease on the prevalence rate of 65% compared to other villages where the programmes were not implemented. And we are seeing public declarations of abandonment in now 4,000 villages out of 5,000 that are practicing FGM in Senegal, for example. So we do know now what works and we do want also to accelerate the strategies that we think do work.
Kostova: For those girls, who still go through the procedure - what does it mean for them, what are the health consequences?
Diop: There is a lot of health consequences. For the physical aspect, there is of course severe pain, hemorrhaging, tetanus, infection, possibility of infertility, cysts and abcesses, urinary incontinence. There is also an increased complication in child birth. Those who have been cut, who have undergone the procedure of female genital mutilation cutting have a higher risk of morbidity, mortality, much more hemorrhaging and the newborn also has a higher risk of low birth weight and mortality. So that one has been clearly demonstrated in 2006 with a study conducted in six African countries, including Sudan. And what is less documented is the psychological and sexual problems.
Kostova: The World Health Organization has said that some of the cutting is done by health care providers, and they have come out against this. Why is that so, wouldn't it be better for the girls that it be done in a hygienic way?
Diop: Actually, you know, this was debated several years ago, and of course, there were some voices in eastern countries - Somalia, Sudan and Djibouti and some parts of Kenya, where there are some Somali communities. There were some debates that maybe we should encourage, first of all a less intrusive practice. Moving from infibulations, when the woman has been stitched -- cut, but also stitched -- and there is a small hole that is left for of course, menstruation, and when the woman has to give birth she needs to be opened, and then deliver, then she will be sewed again. So this is what we call re-infibulation. So there were some voices that were saying that we can encourage moving from this infibulation practice to less intrusive practice like cutting of the clitoris. Some other voices also you know, defended the fact that maybe if this is done by a health professional in a health facility using some hygienic instruments, but also using anesthesia and all, that will be more acceptable for the woman. But I think that this debate is not anymore accurate. Everybody recognizes today that even if it is done by health professionals this won't reduce the risk for childbirth, for example. Of course, it may reduce the immediate consequences like pain, like shock, like hemorrhaging, like death. It may, we don't know. But the long-term consequences, the consequences on sexuality, the psychological consequences wont' be reduced even if it is done by a health professional. So WHO and most institutions, including UNFPA and UNICEF, working on that issue really took a strong stand against the medicalization of female genital mutilation. And we really do not want to see health professionals engaged in this practice. Unfortunately this is still happening, but there is a global today that has been developed by WHO in partnership with UNFPA and UNICEF to really fight against this trend of involvement of medical professionals and also we need to remind the Hippocrates ceremony and all that providers shouldn't harm and this is a harmful practice, so they shouldn't be engaged in this practice.
Kostova: The Hippocratic oath, you mean?
PRES: Nafissatou Diop is the coordinator of the joint UNFPA/UNICEF programme against female genital mutilation in Africa.