Female genital cutting: not even a 'nick'

The American Academy of Pediatrics backs away from an ill-conceived move to relax its rules on the practice.

May 29, 2010
The Los Angeles Times

Late last month, 330 villages in Senegal held a ceremony to announce that they would end the practice of female genital cutting. That brought the number of Senegalese communities to abandon the practice to 4,229, and when the number reaches 5,000, complete eradication will be achieved. Similar pronunciations and celebrations are occurring in other countries — in Gambia and Somalia, and in Mauritania, where on Tuesday 78 villages participated.

The growing movement to end the ancient practice of slicing off part or all of a girl's clitoris and/or labia — historically done to prepare her for adulthood and marriage — is the result of years of work by local and international activists. Particularly noteworthy has been the success of the nonprofit Tostan, which means "breakthrough" in Wolof. The organization spends almost three years teaching villagers about health and human rights. Thus, when a community opts to end genital cutting, it is generally because of a recognition that cutting not only endangers girls' physical well-being but runs counter to the universal right to stewardship of one's body. And that understanding leads to other changes: As villagers learn about the health effects of childbearing, girls are less likely to be married off as children and more likely to go to school. And as women become better educated, they are more likely to participate in the economy and open businesses.

Into this delicate international effort, the American Academy of Pediatricians blundered with all the finesse of a water buffalo, suggesting last month that the ban on genital cutting in the United States be relaxed so that physicians could accommodate immigrant parents and "nick" the clitoris of young girls. A symbolic procedure performed stateside, the academy maintained, might spare a girl a brutal experience outside the country.

The outcry against such a misguided proposal was immediate. That doctors wanted to save girls from greater harm was commendable, but this policy was potentially disastrous. First, when "minor" cutting has been embraced in Africa, it has often provided a cover for more severe cutting. Second, the purpose of genital cutting is to diminish or destroy female sexual desire; it is the first step toward a girl's subjugation to family honor, to a father's authority and a husband's mastery. Even a symbolic nick is a violation of a girl's human rights. And lastly, fine distinctions about "nicking" could easily have been lost in translation; the new message to the Middle East and Africa would have been that American doctors will cut girls.

Thursday, the academy retracted the proposal and reaffirmed its opposition to all forms of female genital cutting. We commend it for heeding the pleas of activists in the field and women who have survived being cut. Pediatricians have an important role to play as well, but it is to explain to parents why cutting is forbidden here — detailing the health problems it creates for girls and emphasizing the legal consequences parents face by having it done to their daughters.

Copyright © 2010, The Los Angeles Times

May 27, 2010
By Ghana News Agency

Chiefs in Mamprugu area in the Northern Region, have called on the Mamprugu Traditional Council to as matter of urgency asked the District.


Assemblies in the area to enact a by-law to ban negative cultural practices, especially Female Genital Mutilation (FGM).

The 36 chiefs made the call in a communiqué issued at the end of a seminar on FGM organized by the Ghana Association for Women's Welfare (GAWW), at Gambaga in the region.

The statement, which was signed Wuni Grumah, Tarana, N F.Y Wari, Bukpenaba, and Naa E.D. Mahami, Nagborana, some of the chiefs of Mamprugu, said that FGM was against fundamental human rights and could also affect the health of women and girls who were forced to undergo such negative cultural practices.

The communiqué said girls who experienced FGM could suffer psychological and reproductive health problems which could increase their vulnerability to HIV and adverse obstetrics and prenatal outcomes.

It reminded the public that the practice of FGM was an offence under the laws of the country.

The communiqué called on individuals and organisations to support efforts aimed at eliminating obsolete cultural practices from the Mamprugu Traditional Area.
The East Mamprusi District Director of the Ghana Health Service (GHS), Mr. Thomas Sennor appealed to traditional rulers in the area to work as a team to end negative cultural practices.

He said that the GHS would collaborate with GAWW to eradicate FGM from the area.

The President of GAWW, Mrs. Florence Ali said that some communities continued to practice FGM due to lack of effective structures to deal with the problem and pledged that the association would work hard to stop FGM.
She said GAWW in collaboration with chiefs in the Wa area supported the Assemblies to pass by-laws on FGM which had helped in curbing the practice.

GNA

Pediatricians now reject all female genital cutting

May 27, 2010
By Stephanie Chen - CNN

The American Academy of Pediatrics has rescinded a controversial policy statement raising the idea that doctors in some communities should be able to substitute demands for female genital cutting with a harmless clitoral "pricking" procedure.


"We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world," said AAP President Judith S. Palfrey.

The contentious policy statement, issued in April, had condemned the practice of female genital cutting overall. But a small portion of statement suggesting the pricking procedure riled U.S. advocacy groups and survivors of female genital cutting.

In the April statement, the group raised the idea that some physicians should be able to prick or nick a girl's clitoral skin in order to "satisfy cultural requirements." The group likened the nick to an ear piercing.

We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting.

--Judith S. Palfrey, AAP president



On Thursday the AAP stated the group will not condone doctors to provide any kind of "clitoral nick." The AAP also clarified nicking a girl or woman's genitals is forbidden under a 1996 federal law banning female genital mutilation.

"I cried and told them how grateful I am," said Soraya Mire, a Somali filmmaker and survivor of female genital cutting. "Thank you for understanding us survivors and hearing our voices."

Equality Now, an international advocacy group fighting to end female genital cutting, echoed a similarly appreciative response.

"We welcome the AAP's decision to withdraw its 2010 policy statement on FGM," said Lakshmi Anantnarayan, a spokeswoman at Equality Now. "This is a crucial step forward in the movement to raise awareness about female genital mutilation."

Up to 140 million women and children worldwide have been affected by female genital cutting, according to the World Health Organization. Any process that alters or injures female genitalia for non-medical purposes is considered to be female genital cutting, the group says.

Female genital cutting -- also referred to as female genital mutilation and female circumcision -- is a ritual dating back thousands of years. It's typically practiced in parts of Africa, Asia and the Middle East. In some communities, it's strongly believed that genital cutting marks a woman's journey to adulthood. The WHO reports that cutting typically occurs between infancy and 15 years of age.

Several types of female circumcision exist and may differ in each community, according to the WHO. The most brutal type of cutting requires stitching together the inner or outer labia. It's a procedure notoriously performed in parts of Somalia and Egypt. Other less-severe forms of genital cutting may require excising the entire clitoris or part of the clitoris.

Mire, the Somali filmmaker and survivor, received the most severe type of circumcision when she was 13 years old in her home country. She now lives in Los Angeles, California, where she helps African immigrant families in the United States, who she believes may be subjected to the pressures of female genital cutting.

While the female circumcision is outlawed in the United States, Mire and other advocates believe there are American girls in immigrant communities at risk of being sent overseas to have the procedure completed. The AAP's original policy statement increased the threat of cutting among immigrant and refugee girls in the U.S., advocacy efforts say, because the group suggested a "pricking" compromise was acceptable.

In the U.S., an estimated 228,000 women have been cut -- or are at risk of being cut -- because they come from an ethnic community that practices female genital cutting, according an analysis of 2000 Census data conducted by the African Women's Health Center at Brigham and Women's Hospital.

Last month, Rep. Joseph Crowley, D-New York, and Rep. Mary Bono Mack, R-California, addressed concerns of female genital cutting being planned on U.S. grounds. The legislators proposed an amendment to the existing law that would imprison parents who send their daughters overseas for the procedure.

Mire said she was in disbelief when she first read the AAP's original statement about six weeks ago. She couldn't sleep. She couldn't eat. She's dedicated her time to calling legislators, survivors and advocacy groups to pressure AAP to change its original policy statements.

Her efforts worked, she learned on Wednesday from a personal phone call from the academy.

"I slept so well last night," she said. "I woke up smiling."

Female circumcision affects girls in U.S., too: parents send daughters overseas for genital cutting

May 26, 2010
By Rosemary Black - NY Daily News

Female circumcision isn’t only endured by young women who live in other parts of the globe.


Though illegal in the U.S., an estimated 228,000 women either have undergone genital cutting or are at risk of it, according to 2000 Census data that was gathered by the African Women’s Health Center at Brigham and Women’s Hospital.

Not uncommon in some areas of Asia, Africa and the Middle East, female genital cutting still is traditional in some Muslim and African immigrant families in the States. Though it’s rare for a case to be documented here, cutting typically occurs overseas as families send their daughters back to their native country for the procedure. It’s likely that cutting is moving underground here and abroad, according to doctors and advocacy groups.

Some 140 million women and children around the globe have been affected by the practice, according to the World Health Organization. The WHO defines it as a process that injures or alters a female’s genital organs for no medical purpose.

When Somali immigrant Fatima Mohamed was faced with the question of whether to have her daughter circumcised, the answer was easy. She’d gone through the horrible experience herself growing up in Africa, and strongly opposed putting her 11-year-old through it.

Yet not all families in her African community think the same way, since it’s a cultural ritual important to a woman’s identity, Mohamed told CNN. Those who want to keep to the traditional ways don’t understand why women like Mohamed aren’t having their daughters circumcised.

“They say they don’t want to hear it,” she told CNN. “Some think I’m disrespecting my own culture. Some will say, ‘You act like an American now. You forgot about who you are.’ ”

Mohamed is hoping to eliminate the practice by reaching out to other Somali women in her community. Last year, spearheading a group called the East African Community Outreach, she helped educate women about genital cutting.

“I would never do it to my daughter,” she told CNN. “I don’t want it. This has nothing to do with religion or culture. I believe nobody should control my child.”

AAP updates its position on female genital mutilation? Really??

May 2010
By Julia Lalla-Maharajh - End FGM Now


The AAP have issued the following:

1. AAP Reaffirms Its Opposition to Female Genital Cutting
In airing the controversy on female genital cutting (FGC) in its April 26 policy statement, the American Academy of Pediatrics (AAP) may have left an erroneous impression that a ritual nick is acceptable as a means of avoiding the barbaric and life-threatening FGC procedure. The AAP reaffirms its unalterable opposition to FGC and to female genital ‘nicking.’
Which is welcome.

However, I cannot find any alteration to the substance of its position.  It appears to be the  same 26 April 2010 statement with this new statement as a preface.

Whilst the clarification is welcome, I’m still worried at the overall language throughout the entire guidance.  I’m particularly confused that the AAP say in their new statement that “the AAP reaffirms its unalterable opposition to FGC and to female genital nicking.”

Yet this sentence in the guidance still exists: “It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.”

How can the AAP be opposed to genital nicking and then say it would be more effective if state law enabled pediatricians to offer a ritual nick?

It still seems beyond belief that they use language still ike this: “This is no more of an alteration than ear piercing.”
They also have not changed their recommendations

You can see the helpful comparator with the 1999 recommendations which were updated, which I’ve reproduced from the very good Intactivism site here: http://www.circumstitions.com/AAP.html

RECOMMENDATIONS 2010	1999 RECOMMENDATIONS
The American Academy of Pediatrics:	The American Academy of Pediatrics:
1. Opposes all forms of FGC that pose risks of physical or psychologicalharm.	1. Opposes all forms of female genital mutilation (FGM).
2. Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.	2. Recommends that its members actively seek to dissuade families from carrying out FGM.
3 Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.	3. Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGM.
4. Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.	4. Recommends that its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents.

Whilst I appreciate that they have not meant to cause a storm over this, the language remains very worrying and I doubt this new statement gives much comfort.  If the AAP is genuinely unalterably opposed to FGM, then their language needs to reflect this much more strongly.

I’m hoping that I’ve been given an old link to the 26 April 2010 statement, and that in fact, the entire position has been updated….

Watch this space….

Why are American doctors mutilating girls?

May 2010
By Ayaan Hirsi Ali - The Daily Beast

A new proposal by the American Academy of Pediatrics would have doctors assisting families in the ritual of female circumcision, but activist and Nomad author Ayaan Hirsi Ali says they’d just be complicit in perpetuating a grave injustice. 
 
The American Academy of Pediatrics recently put forward a proposal on female genital mutilation. They would like that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls born into communities that practice female genital mutilation.
Female circumcision is a custom in many African and Asian countries whereby the genitals of a girl child are cut. There are roughly four procedures. First there is the ritual pinprick. This is what Pediatrics refers to as the “nick” option. To give you an idea of what that means, visualize a preteen girl held down by adults. Her clitoris is tweaked so that the circumcizer can hold it between her forefinger and her thumb. Then she takes a needle and pierces it using enough force for it to go into the peak of the clitoris. As soon as it bleeds, the parents and others attending the ceremony cheer, the girl is comforted and the celebrations follow.
There is a more sinister meaning to the word “nick” if you consider the fact that in some cases it means to cut off the peak of the clitoris. Proponents compare “nicking” to the ritual of boy circumcision. But in the case of the boys, it is the foreskin that is all or partly removed and not a part of the penis head. In the case of the girls, the clitoris is actually mutilated.
Then there is the second method whereby a substantial part of the clitoris is removed and the opening of the vagina is sewn together (infibulation). The third variation adds to this the removal of the inner labia.
 Finally, there is a procedure whereby as much of the clitoris as possible is removed along with the inner and outer labia. Then the inner walls of the vagina are scraped until they bleed and are then bound with pins or thorns. The tissue on either side grows together, forming a thick scar. Two small openings roughly equal to the diameter of a matchstick are left for urination and menstruation respectively.
Often these operations are done without anesthesia and with tools such as sharp rocks, razor blades, knives or scissors depending on the location, family income, and education. It is thus more accurate—as does the World Health Organization—to speak of female genital mutilation (FGM) instead of the obscure and positive-sounding “circumcision.”
According to the American Congress of Obstetricians and Gynecologists, more than 130 million women and girls worldwide have undergone some form of female genital cutting. Some immigrant parents from countries like Egypt, Sudan, Somalia, and others in Europe and the United States, where FGM is common, continue this practice in the West even though they know that it is criminal. Some of them sneak their daughters out of the country during the long school summer vacation so that they can be subjected to any one of these forms of FGM.
Congressman Joseph Crowley (D-NY) recently introduced a bill to toughen federal laws by making it a crime to take a girl overseas to be circumcised. He argued, rightly, that FGM serves no medical purpose and is rightfully banned in the U.S.
While the American Academy of Pediatrics agrees that FGM serves no medical purpose, it argues that the current federal law has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation. The pediatricians say that “it might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.”
But is this plausible? I fear not.
I am familiar with this debate in two ways. First, I come from a culture where virtually every woman has undergone genital cutting. I was 5 years old when mine were cut and sewn. Second, while serving as a member of parliament in the Netherlands, I was assigned the portfolio for the emancipation and integration of immigrant women. One of my missions was to combat practices such as FGM.
To understand this problem, we need to begin with parental motives. The “nicking” option is regarded as a necessary cleansing ritual. The clitoris is considered to be an impure part of the girl-child and bleeding it is believed to make her pure and free of evil spirits.
But the majority of girls are subjected to FGM to ensure their virginity—hence the sewing up of the opening of the vagina—and to curb their libido to guarantee sexual fidelity after marriage—hence the effective removal of the clitoris and scraping of the labia. Think of it as a genital burqa, designed to control female sexuality.
When the motive for FGM is to ensure chastity before marriage and to curb female libido, then the nick option is not sufficient.
Moreover, the nick option does not address the main problem in Western liberal democracies where FGM is outlawed, which is that it can almost never be detected, so that few perpetrators are brought to justice. Even if we were to consider tolerating it in its most limited form, how could we tell that parents who want to ensure that their daughter will be a virgin on her wedding night will not have her (legally) nicked and then a few months later (illegally) infibulated? I applaud the compassion for children that inspires the pediatricians’ proposal, but they need to eliminate this risk for little girls.
Legislation is only a first step and even with that there is no uniformity. Some states have passed bills that define FGM in all its manifestations and punish it. Some states have none, but place FGM under existing laws of child abuse. So Rep. Crowley’s next move should be to push for uniform enforcement of his bill.
But even once the legislative flaws are fixed, there remains the really difficult question of detection.
For the law to have any meaningful effect in eradicating FGM in the U.S., we need to work out a way of knowing when a girl has been mutilated. As a legislator in the Netherlands, this was for me the thorniest issue. In the United States, where civil liberties are even more jealously guarded, the thorns are likely to be sharper still.



Ayaan Hirsi Ali was born in Mogadishu, Somalia, and escaped an arranged marriage by immigrating to the Netherlands in 1992. She served as a member of the Dutch parliament from 2003 to 2006 and is a research fellow at the American Enterprise Institute. Her autobiography, Infidel, was a 2007 New York Times bestseller.

Pressure for female genital cutting lingers in the U.S.

May 2010
By Stephanie Chen - CNN


(CNN) -- Fatima Mohamed, a 45-year-old Somali immigrant living in America, was faced with a question most parents will never worry about: Should my daughter be circumcised?The United States has outlawed female genital cutting, but cultural and religious pressures to circumcise girls linger among some African and Muslim immigrant families. Mohamed says the decision was an easy one for her to make after going through the painful experience herself in Africa as a child. She strongly opposes the idea of cutting her 11-year-old daughter, an American-born Somali with long curly hair, who plays soccer and likes watching "American Idol."
But not every family in her African community in Massachusetts feels that way. Nor can they they swiftly make the decision to reject circumcising their daughters, because it's a cultural ritual integral a woman's identity, she says."They say they don't want to hear it," Mohamed says. "Some think I'm disrespecting my own culture. Some will say, 'You act like an American now. You forgot about who you are.' "
Female genital cutting is often a coming-of-age ritual practiced in various parts of Africa, Asia and the Middle East, but the procedure isn't just invoking concerns in the developing world. Religious and cultural beliefs fueling female circumcision often follow immigrants and refugees who move to America. Rarely have cases of female genital cutting been documented in the U.S., but much more likely, cutting has moved underground in the U.S. and overseas, advocacy groups and doctors say.
In the U.S., an estimated 228,000 women have been cut -- or are at risk of being cut -- because they come from an ethnic community that practices female genital cutting, according an analysis of 2000 Census data conducted by the African Women's Health Center at Brigham and Women's Hospital. The Census reports there are roughly 150 million women living in the United States.
The World Health Organization estimates up to 140 million women and children worldwide have been affected by female genital cutting. The WHO defines female genital cutting as a process that alters or injures female genital organs for nonmedical purposes.
There are several types of female circumcision. The most severe types require the inner or outer labia to be sewn together, a procedure performed in parts of Somalia and Egypt. Other forms include excising the entire clitoris or part of the clitoris.
Genital cutting dates back at least 5,000 years, says Marianne Sarkis, a professor of international development at Clark University in Worcester, Massachusetts. Some women desire the procedure because they believe they are dirty or unmarriageable if they are not cut, she said. There are cultures that begin cutting women as early as infancy, while some wait until adolescence.


Communities divided

Not all families in communities where female genital cutting is commonplace will want to participate. In Mohamed's immigrant community in Massachusetts, families are divided, she says. Some refuse to allow the procedure, as she does. Others say they want it, and many remain silent.
Occurrences of the practice have been documented in the U.S. In March, a Georgia mother was charged with female genital mutilation after the father noticed an infant's genitals "appeared to be have been circumcised," according to the Troup County Sheriff's Office. Officers wouldn't comment further on the family.
Several advocacy workers say the more common scenario involves sending girls back to their home country to have the ritual performed. Over the past few years, Taina Bien-Aimé, president of the women's advocacy group Equality Now, has heard several anecdotal stories of girls being sent back to have the procedure.
With summer vacation approaching, one 34-year-old mother from Senegal, living in New York City, says she knows several African families in limbo about genital cutting. One of her female friends abandoned her husband earlier this year when he asked for their 6-year-old daughter to be cut in Africa this summer. The friend, who speaks little English and is jobless, fled to a shelter with her daughter.
"A lot of them, it doesn't matter if they [the daughters] were born here, they want the procedure done," said the mother, who declined to be named out of fear of being ostracized by her community. She was also cut in Africa as a child.
National surveys determining U.S. immigrant attitudes toward female genital cutting are nonexistent, because cutting affects few American families, advocacy groups say. Neither have studies been completed to track whether parents are sending their girls to their country of origin to be circumcised. Conducting such studies, doctors and advocacy groups say, would be near impossible since most families remain hushed about the taboo topic.


Legislators, doctors get involved

In response to suspicions of genital cutting being planned in the U.S., Rep. Joseph Crowley, D-New York, and Rep. Mary Bono Mack, R-California, proposed an amendment to close a loophole in the 1996 federal law banning female genital mutilation. The legislation, introduced in April, would criminalize parents who force their daughters to have the procedure abroad.
This spring, the American Academy of Pediatrics released a contentious policy statement suggesting that some physicians who work with immigrant communities that want the procedure should have the ability to prick or nick a girl's clitoral skin in order to "satisfy cultural requirements." The academy says the pricking procedure is harmless, like an ear piercing.
The pricking method is illegal in United States, but it could be effective in certain African communities in reducing harm, said Douglas S. Diekema, a Washington physician and former chair of the bioethics committee at the academy.
"We are very disappointed," said Asmaa Donahue, senior program officer at the Sauti Yetu Center for African Women in New York. "By offering to a person to do it, it undermines the education and advocacy work being done to stop it."
Despite the mixed feelings about the pricking procedure, both advocates and the American Academy of Pediatrics agree that the pressure for American girls in some immigrant communities to undergo genital cutting is a reality.
"It's naive to think they don't have some equivalent of a Jewish mohel," or person who performs a circumcision, said Diekema, the academy's former bioethics chairman. "Not all circumcisions are done in the medical setting, either."


Reaching out to the immigrant community

Soraya Mire, a Somali film director and activist, works with the African immigrant population in the U.S. and knows that the pressures exist. Her 1994 documentary "Fire Eyes" chronicles her experiences with female circumcision when she was 13.
From her Los Angeles, California, home, Mire has counseled hundreds of genital cutting survivors and immigrant parents by letters and phone calls, including a few who have contemplated sending their daughters abroad to be cut. She sleeps with her cell phone tucked under her pillow, so she can answer at all hours.
"You don't have a right to do this to your children," Mire tells the immigrant community. "You are continuing the abuse."
Mire has received death threats from the Somali community. Some threats stem from her role in helping law enforcement officials in Atlanta, Georgia, prosecute the first case of female circumcision in the U.S. In 2006, Khalid Adem was convicted of aggravated battery and cruelty to children for cutting the genitals of his 2-year-old Ethiopian daughter. He is incarcerated and tentatively eligible for parole in 2012.
Back in Massachusetts, Fatima Mohamed's recollection of the genital cutting at her grandmother's rural Kenya home is clear: Her grandmother's wise voice telling her the procedure was for her own good. Sitting in a chair as the strange women pulled her legs apart. The pain of the incisions.
She was only 9 years old.
"I just thought it was something that had to be done," said Mohamed, who added that she was lucky because many Somali women undergo more severe circumcisions in which their labia are sewn together.
"They go through hell," she said.
Mohamed, too, is reaching out to Somali women in her Massachusetts community. The first step to eliminating the genital cutting, she knows, is discussing the topic. She spearheaded an organization last year called the East African Community Outreach, where part of her job is educating women about the dangers of genital cutting.
Her 11-year-old daughter is too young to comprehend genital cutting, Mohamed says. Instead, they discuss her daughter's dreams to become a pediatrician. Perhaps in a few years, Mohamed will tell her the truth.
"I would never do it to my daughter," she said. "I don't want it. This has nothing to do with religion or culture. I believe nobody should control my child."

War Against Female Circumcision Hits Snag

May 4, 2010

By Catherine Bekunda

Kampala — EFFORTS to end female genital mutilation have hit a snag after the Government failed to provide sh400m for compensating the practitioners.
The money is meant for start up capital for over 400 promoters of the practice, said labour state minister Emmanuel Otaala.

"The ministry is proposing to compensate them with sh1m each for the lost income as a result of eliminating the practice," Otaala explained.

 

"These people are also looking for survival. Since the female genital mutilation Act was passed, they have been out of business."

The ministry also seeks another sh200m to support the Reproductive Education and Community Health programme in Kapchorwa, Bukwo, Kabong, Nakapiripiti, Amudat, Moroto, Kotido and Moroto districts.

Female genital mutilation allowed in America

May 11, 2010
By Julia Lalla-Maharajh -Enf FGM now

This article was submitted for publication in the Huffington Post on 30 April 2010

So, I’m sitting here in London, getting ready for the World Economic Forum meeting next week in Tanzania.  It’s a time of reflection as I think about how to address female genital mutilation with African leaders.
Twitter is with me on my laptop and a sideways glance shows me that on 26 April, the American Academy of Pediatrics released updated guidance on what it now calls “Ritual Genital Cutting of Female Minors.”
What strikes me on first reading, is that this is no guidance at all.
It shows its own interior confusion: on one hand, a strong document that invokes the links between human rights and FGM, discusses the terror felt when girls go through FGM and noting that it is illegal and constitutes child abuse in the US.
On the other hand, the final page suddenly states:
“The ritual nick (pricking or incising the clitoral skin) is no more of an alteration than ear piercing.”
I am not a doctor, yet as a woman, I distinctly know that my clitoris is entirely different from my ear lobe. It goes on to state:
“Offering a ritual nick is a possible compromise to avoid greater harm.”
Yet nowhere is this sourced, nowhere is it stated why such a Faustian compromise should be allowed to take place. There is no evidence that medical involvement is a form of “harm limitation” as is claimed.  The group Equality Now also point to the contradictions in the statement, saying:
“A reduction in the severity of a human rights violation does not minimize the gravity of such a violation.”
How does this constitute medical guidance? When I ask for thoughts from a doctor friend, she says:
“The key thing is that it is not within the scope of the work or duties of doctors to be involved in cultural rituals or rites of passage … just as there is no medical indication to expose a child’s genitalia to a stranger (which the doctor is, as the child is not a patient with a problem) and same for breaching the skin — whether a small nick or actual cut.”
So why this sudden lunge in a different direction? Why has the AAP “updated” its guidance in such a distinct way? The answer comes in the next paragraph, which states that the “ritual nick is … much less extensive than routine newborn male cutting.”  Ah. Revealed for what it is. This is a way of trying to tread carefully through a highly complex debate of why, in the US, it’s considered right to circumcise boys to the extent that they are.
When I first had my eyes opened to the enormity of female genital mutilation, I lived in Ethiopia. Back home, I started educating myself about it.  The scale is remarkable — over 140 million women live with horrendous health and psychological consequences as a result of their genitals being forcibly removed when they were children.
I was also shocked at how, primarily in the US, the main discourse around female genital mutilation is not as an issue in its own right, but as a comparator for the anti-male circumcision lobby. It’s only more recently through reading that I’ve begun to understand how much more invasive the form of male circumcision is in the US, where in many cases, the whole foreskin is removed.  This is extremely unusual in Europe where only the tip of the foreskin is removed.
This new guidance is a severe compromise of medical principles and a shocking one. As Naana Ooto-Oyortey, Executive Director from the well respected organisation FORWARD commented today:
“FGM carried out by medical professionals gives a legitimate and acceptable face to a practice which damages women’s and girls’ reproductive, sexual and psychological health.”
Equality Now are very clear too that they wish to see a retraction of part of the statement that, “In effect promotes changes in US federal and state laws to enable physicians to ‘nick’ girls’ genitalia.”
I am still so shocked that a bioethics committee are making this distinction and suggesting a change in US federal and state law — and that the best comparison they can come up with is that pricking the clitoris is of the same magnitude as ear-piercing.  I wonder if a small girl, perhaps the age of four or five would think the same?
I think my visit to Tanzania will be much more straightforward – at least many African countries are striving to educate their communities about the harm done through FGM. The US on the other hand are making a mockery of their own “guidance” which is in fact opaque and a way of fudging the issue even further.
Like FORWARD, I would call on the AAP to revert to its earlier, caveat free 1998 policy statement that ‘opposes all forms of female genital mutilation’.  It was a hard-fought battle to get to that place — let’s please not take a regressive step.

Group Backs Ritual ‘Nick’ as Female Circumcision Option

May 6, 2010
By Pam Belluck -The New York Times

In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision.
The academy’s committee on bioethics, in a policy statement last week, said some pediatricians had suggested that current federal law, which “makes criminal any nonmedical procedure performed on the genitals” of a girl in the United States, has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation.
“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the group said.
But some opponents of female genital mutilation, or F.G.M., denounced the statement.
“I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether F.G.M. is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said Representative Joseph Crowley, Democrat of New York, who recently introduced a bill to toughen federal law by making it a crime to take a girl overseas to be circumcised. “F.G.M. serves no medical purpose, and it is rightfully banned in the U.S.”
Georganne Chapin, executive director of an advocacy group called Intact America, said she was “astonished that a group of intelligent people did not see the utter slippery slope that we put physicians on” with the new policy statement. “How much blood will parents be satisfied with?”
She added: “There are countries in the world that allow wife beating, slavery and child abuse, but we don’t allow people to practice those customs in this country. We don’t let people have slavery a little bit because they’re going to do it anyway, or beat their wives a little bit because they’re going to do it anyway.”
A member of the academy’s bioethics committee, Dr. Lainie Friedman Ross, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said the panel’s intent was to issue a “statement on safety in a culturally sensitive context.”
Dr. Friedman Ross said that the committee members “oppose all types of female genital cutting that impose risks or physical or psychological harm,” and consider the ritual nick “a last resort,” but that the nick is “supposed to be as benign as getting a girl’s ears pierced. It’s taking a pin and creating a drop of blood.”
She said the panel had heard anecdotes from worried doctors.
“If we just told parents, ‘No, this is wrong,’ our concern is they may take their daughters back to their home countries, where the procedure may be more extensive cutting and may even be done without anesthesia, with unsterilized knives or even glass,” she said. “A just-say-no policy may end up alienating these families, who are going to then find an alternative that will do more harm than good.”
Currently, more than 130 million women and girls worldwide have undergone female genital cutting, according to the American Congress of Obstetricians and Gynecologists. It is mostly performed on girls younger than 15 in countries including Ethiopia, Sudan and Somalia. Consequences can include severe complications with pregnancy, childbirth and sexual dysfunction.
The academy’s statement acknowledged that opponents of the procedure, “including women from African countries, strongly oppose any compromise that would legitimize even the most minimal procedure.”
Dr. Friedman Ross said, “If you medicalize it and say it’s permissible, is there a possibility that some people will misunderstand it and go beyond a nick? Yes.”
But she said the risk that people denied the ceremonial procedure, usually on the clitoris, would opt for the more harmful one was much more dangerous.
And the statement said that, “in some countries where FGC is common, some progress toward eradication or amelioration has been made by substituting ritual ‘nicks’ for more severe forms.”

New Legislation to Protect Girls from Female Genital Mutilation

April 26, 2010
By UNFPA

(Washington, DC) – On April 26, 2010, Congressman Joseph Crowley (D-NY) and Congresswoman Mary Bono Mack (R-CA) announced the introduction of new, bipartisan legislation to crack down on the practice of female genital mutilation (FGM). FGM refers to removal of all or part of the female genitalia The Girls Protection Act (H.R. 5137) would make it a federal crime to transport a minor outside the United States for the purpose of FGM.
FGM has been illegal in the United States since 1996. Breaking the existing law or conspiring to do so constitutes a felony which could result in a prison sentence of up to 5 years. Sadly, however, many minor girls are forcibly taken outside the United States for the purposes of carrying out FGM.
Despite global efforts to promote abandonment of the practice, FGM remains widespread in many countries including Africa and Western Asia. It has spread to other parts of the world, including Europe and North America, where some immigrant families have settled.
FGM is internationally recognized as a violation of the human rights of girls and women. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment.
It is estimated that globally 130 million girls and women alive today have undergone genital cutting, with at least 2 million females each year —6,000 each day—undergoing the procedure.
UNFPA and UNICEF, through a joint program launched in 2007, are working to end to this persistent violation of the human rights of girls and women globally. FGM is considered to be a right of passage to adulthood; UNFPA addresses FGM in a holistic manner by funding and implementing culturally sensitive programs, including alternative rights of passage.
The Girls Protection Act would extend current U.S. laws to ensure that the same penalties that exist for domestic FGM apply to those involved in the transport of a minor abroad for the purpose of FGM. H.R. 5137 is modeled after the laws governing those engaged in international child prostitution.
“Female genital cutting is a violation of women’s rights that transcends many level,” says Anika Rahman. “I applaud our members of Congress for prioritizing this legislation to further protect the health and dignity of girls.”
“This is a matter of protecting fundamental human rights,” said Congressman Crowley. “No girl should be forced into this cruel procedure. Most of Europe has already made it illegal to force minor girls abroad for FGM – it is time we do the same.”

Ending FGM to promote achievement of Millennium Development Goals

May 2010,
By Amnesty International

The Millennium Declaration represents the international community’s commitment to further development in line with an agreed framework of eight Millennium Development Goals (MDGs) to be achieved by 2015.
In the UN General Assembly’s High Level Forum on 20-22 September 2010, the progress on these goals will be reviewed. The European Union has stated a strong commitment to this framework in the European Consensus on Development, which represents the common values and principles held by the European Commission and the EU Member States.
On occasion of Mother's Day, END FGM European Campaign has released a document that explores the importance of raising female genital mutilation as an underlying cause of the lack of progress on the MDGs and makes recommendations to the EU in this regard.

Read Ending FGM to promote the achievement of the Millennium Development Goals here

ABANDON DE L’EXCISION : M’Bagne prend le parti des femmes

May 4, 2010
By Sahara Media Agency

Les populations de Garlol Niabina et partant de tout le département de M’Bagne comptent indiquer la voie en faisant la première déclaration sous régionale d’abandon de l’excision, des mariages précoces et forcés. Ainsi, une cérémonie de déclaration solennelle et  publique d’abandon de l’excision et de la détermination des communautés à mettre un terme à cette pratique qui atteint la dignité des jeunes filles se déroulera, le 25 mai prochain à M’Bagne.

Les 30 communautés bénéficiaires issues de la région du Brakna, les villages adoptés ainsi que des délégations venant du Mali, de la Gambie, de la Guinée conakry, de Bissau et du Sénégal  prendront part à cette cérémonie, une première en Mauritanie. La décision de ces communautés vise à contribuer au mouvement national en faveur de la défense des droits humains, et à la promotion de la santé de la femme.

Une initiative encouragée par les autorités gouvernementales et  l’ONG Tostan. Le rêve est permis de voir la Mauritanie arriver à l’abandon total  de l’excision comme voulu dans le plan d’action 2010-2015.

Par le biais de cette déclaration, les communautés prendront la ferme volonté de tourner définitivement le dos à l’excision en déposant les couteaux et les lames. La déclaration participe au «renforcement du mouvement national pour la promotion des droits humains en Mauritanie, en Afrique et partout dans le monde, la convention pour l’élimination de toutes les formes de discrimination à l’égard des femmes, et contribue à l’atteinte des Objectifs du millénaire.»

En prélude à l'évènement, l'ONG  Tostan a organisé  une rencontre villageoise ayant regroupé  à Garlol les facilitateurs et les superviseurs de la trentaine de communautés du Brakna, bénéficiaires du projet « Education des droits humains et promotion de l’abandon des pratiques néfastes telles que l’excision ». Ledit projet a été mis en œuvre, depuis trois ans, par Tostan, en partenariat avec l’UNICEF et le Ministère des affaires sociales, de la famille et de l’enfance au sein de trois zones d’intervention (Bababé-M’Bagne ; Boghé-Dar El Barka et Aleg-Magta Lahjar). Le choix de la commune de Garlol pour abriter ce forum inter villageois s’explique, selon Tostan, par « le dynamisme de ses habitants qui ont œuvré  à la promotion de l’abandon des pratiques néfastes telles que l’excision et les mariages précoces ».

Selon TOSTAN, "cette déclaration est le résultat de plusieurs années d'efforts continus dans la région du Brakna et représente aussi une étape importante de son travail" dans cette partie du Mauritanie où on note des « retombées positives dans le changement des comportements, de droits humains et de règlement de conflits ».

Le Sénégal veut être le premier pays à abandonner l’excision d’ici 2015 (ONG)

May 9, 2010
By Agence de Presse Senegalaise

Tambacounda, 9 mai (APS) - Le Sénégal veut être le premier pays à abandonner l’excision d’ici 2015, avec l’appui de l’UNICEF, a indiqué Thierno Diallo, coordonnateur régional de l’ONG TOSTAN.

‘’C’est un combat du gouvernement, appuyé en cela par l’UNICEF dans la protection des droits de l’enfant, pour que d’ici à 2015 le Sénégal soit le premier pays à abandonner l’excision’’, a dit M. Diallo lors d’un atelier de partage sur un nouveau programme de l’ONG TOSTAN dans la communauté rurale de Gabou.

Il s’agissait d’expliquer aux leaders d’opinion religieux, politiques et coutumiers, le contenu du Programme de renforcement des capacités des communautés initié par l’organisation, et dans lequel la lutte contre l’excision et les ‘’mariages précoces et/ou forcés’’ figurent en bonne place.

Le programme est prévu pour 30 mois avec différents volets sensibilisation, droits humains, hygiène, santé, alphabétisation et gestion des microprojets. Il intègre l’usage du téléphone portable, afin de permettre aux bénéficiaires d’envoyer des messages dans leur propre langue ‘’jusqu’au niveau de la diaspora’’, a expliqué Thierno Diallo.

‘’Former les populations à être responsables de leur développement afin de se développer à la base’’ est l’objectif de cette ONG, d’après son coordonnateur régional.

Etaient présents à cette rencontre présidée, samedi, par le sous-préfet de Moudéry, Souleymane Ly, des leaders religieux et chefs de villages de Gabou. Les autorités sanitaires, éducatives et coutumières étaient également représentées aux côtés des élus locaux.

‘’Ensemble, nous allons sensibiliser pour que les gens soient au courant de l’évolution de notre planète. Aujourd’hui, l’excision est une tradition qui remonte à plus de 2000 ans comme d’autres traditions qui ont été ici et qui ont disparu’’, a ajouté M. Diallo.

Plusieurs actions ont été menées dans le cadre de ce ‘’combat’’, a-t-il dit, relevant que l’imam de Médina Baye Cheikh Assane Cissé est un ‘’pionnier dans ce combat’’. Il s’y ajoute, a-t-il dit, le professeur Mohamed Ibrahim Diop, secrétaire général de la Ligue des Oulémas du Sénégal et du Maroc.

Pour transmettre son message, l’ONG TOSTAN présente au Sénégal depuis les années 1970, a ‘’choisi les zones les plus reculées’’, y compris ‘’jusque dans le Sadatou, vers la frontière avec le Mali’’, a poursuivi M. Diallo. ‘’On a senti, a-t-il noté, la nécessité de sensibiliser ces populations-là qui sont coupées du reste du monde’’.

Selon lui, le nom TOSTAN (éclosion, en wolof) a été donné par le professeur Cheikh Anta Diop qui défendait l’idée selon laquelle les pays africains ne pourront se développer que lorsque les populations apprendront à écrire leur propre langue. D’où la décision de l’ONG d’inclure dans son action l’alphabétisation, en plus de la sensibilisation sur les droits des enfants et de la femme et la vaccination.

‘’Les leaders traditionnels ont leur point de vue’’ sur la question, a dit le sous-préfet Souleymane Ly. Selon lui, ‘’certains restent conservateurs’’ et sont ‘’campés sur leur position (pensant) que nos valeurs traditionnelles et coutumières sont des valeurs sûres qu’il ne faut jamais abandonner’’. En revanche, ‘’d’autres, a-t-il poursuivi, ont tendance à évoluer avec le monde’’.

Face à cette situation, ‘’la loi est la loi. Nul ne sera au dessus de la loi et elle sera applicable à tout moment, en tout endroit et en tout instant’’, a-t-il assuré.

Il a relevé que cette rencontre a peut-être amené les populations à comprendre ce que dit la loi à propos de l’excision. ‘’Peut-être y aura-t-il toujours des réfractaires, mais on va continuer le travail, on ne s’arrêtera pas aujourd’hui, on va continuer à les sensibiliser ‘’, a-t-il promis.

Dakar Inter-parliamentary Conference: Final Declaration calls for adoption of a UN resolution banning FGM within a year

May 4, 2010
By No Peace Without Justice

Read the Press release in French, Italian

The Dakar Inter-Parliamentary Conference “Harmonisation of legal instruments prohibiting female genital mutilation (FGM): Sharing successes - Consolidating achievements - Pursuing advances!Towards a United Nations ban on FGM”, organised by the Ministry of Family Affairs of Senegal in partnership with the international NGO No Peace Without Justice (NPWJ) and the Senegalese organisation La Palabre, and with the financial support of Italian Cooperation, UNOPS, UNFPA and the Municipality of Rome, concluded today with the adoption of a Final Declaration stressing the need to work for a universal ban on FGM which, as a wide-scale and blatant violation of the human rights of women and girls, represents a challenge for the international community.

The Conference, which saw among others the participation of Emma Bonino, Vice-President of the Italian Senate and founder of NPWJ, gathered parliamentarians, civil society activists and government representatives from Senegal and the other 27 African countries affected by the practice of female genital mutilation (FGM), as well as representatives of the African Union, the Pan-African Parliament, the ECOWAS Parliamentary Assembly, the East African Legislative Assembly, and the relevant United Nations specialized agencies.

Among its main recommendations, the Final Declaration calls for the adoption of a resolution explicitly banning FGM worldwide as a violation of human rights of women and girls during the 65th session of the General Assembly of the United Nations and calls on all African States as well as the Economic Community of West African States (ECOWAS), the East African Community (EAC) and the African Union to promote the adoption of this resolution within 2010.

Statement by Emma Bonino, Vice President of the Italian Senate and founder of No Peace Without Justice:

“In the struggle for the prevention and elimination of female genital mutilation (FGM), there is no miraculous solution but a complex strategy to implement. The adoption of effective national laws, their harmonization and the implementation of coordinated strategies to address the issue at regional and international level is essential to put an end to this brutal practice which violates the personal integrity and dignity of millions of women and girls worldwide.

Given its dissemination and impact, FGM is a real challenge for the international community. As the Final Declaration states, we must urge all affected States to take a leading and active role in the drafting and advocacy for a United Nations General Assembly Resolution explicitly calling for a global ban on FGM. Such a UN resolution could spur greater and more cohesive political mobilisation among activists, parliamentarians and governments mobilized in Africa and will help to create the foundations of a real and strong international alliance to defeat FGM once and for all”.

Download the Final declaration
Download the Final Communique

For further information please contact Alvilda Jablonko, Coordinator of the FGM Program, on ajablonko@npwj.org / phone: +221 77 209 3583/ +32 494 533 915 begin_of_the_skype_highlighting              +32 494 533 915      end_of_the_skype_highlighting or Nicola Giovannini on ngiovannini@npwj.org or +32 (0)2 548-39 15 begin_of_the_skype_highlighting              +32 (0)2 548-39 15      end_of_the_skype_highlighting. Check also our website: www.npwj.org

Ending Harmful Practices through Community-led Social Change in Senegal

April 20, 2010
By Kristin Helmore - UNFPA

Many organizations are working to eliminate female genital mutilation/cutting in Africa. But the organization that has been most successful in this, Senegal's Tostan, was not originally focused on this particular harmful practice.
"We didn't set out to end FGC," says Molly Melching, who founded Tostan in 1991. (The name Tostan means "breakthrough" in Wolof, a main language of Senegal.) "This is a holistic programme. The goal was simply to empower communities to make their own decisions about everything, including the things they've always taken for granted."
Villagers have come to the decision to abandon FGM/C on their own after learning some basic facts about the harm the practice inflicts on women and their children and, just as important, coming to the realization that people have the right to abandon a pervasive, deep-rooted, centuries-old tradition if that tradition is contrary to their best interests, she explained.
Ms. Melching prefers the term female genital cutting (FGC) to female genital mutilation because she finds the latter too accusatory. "We don't talk about mutilation because mutilation means cutting with the intention of harming," she says. "Women do not want to harm their daughters; they want them to succeed – to be marriageable, to be welcomed into society – that's why they do it."
Because of Tostan's remarkable success in ending the practice in Senegal, the UNFPA-UNICEF Joint Programme on FGM/C is also supporting the organization in the Gambia, Guinea, Guinea Bissau, Djibouti and Somalia.

Learning and passing on knowledge

Tostan's carefully designed community empowerment approach is rigorous and intensive. It is based on learning and on communicating knowledge within Senegal's extensive social networks. When Tostan comes to a new community – and nowadays this is always by invitation from local people – separate groups of around 30 adults and 30 adolescents volunteer to form two classes. The classes, which are instructed by trained Senegalese facilitators, meet three times a week for two to three hours each session for a period of three years. The curriculum broadly focuses on governance, education, health, the environment and economic growth. The total cost for 60 students for three years is approximately $330 per student, or about $20,000, which is covered by donor funds.

Women celebrating at a public declaration ceremony announcing the abandonment of FGM/C in Nemanding, Senegal.

From the beginning, each class participant is recruited to pass on what he or she is learning to another person, who, in turn, will pass it on to someone else. This system of disseminating information and ideas has been especially effective among the loquacious Senegalese. When each student passes along the information, at least 120 people are instantly involved and they, in turn, reach out to others. This reinforces the learning process and creates a ripple effect where learners become teachers and knowledge achieves a critical mass.
Most members of the classes (about 70 per cent are women) have never been to school. The first year, the curriculum consists of discussions about human rights, democracy, problem-solving, health and hygiene. Simply telling people that changing their habits, traditions and beliefs will improve their lives is not enough: they have to come to this conclusion on their own. That is why the word 'discussions' is so critical. Learning in the Tostan classes is achieved through an approach that allows students to learn by talking about curriculum topics in the context of their own lives, experience and, often, what they already know without realizing it.
The second year focuses on literacy in the local language and math. (Tostan currently works in 22 African languages.) "After a year of the other classes, they're very anxious to learn to read and write because they understand how it can help them," says Ms. Melching. Literacy is taught using a device that gives tangible, potent meaning and impetus to the process of learning to read and write: cell phones capable of short message systems texting. In the third year students apply their new skills to more advanced texting and navigation. They also learn the principles of microfinance for business development, how to do business feasibility studies and project proposals (thus allowing them to qualify for loans). And they learn management skills, record-keeping and how to write financial reports – all in the context of their own circumstances and aspirations.

Contextualizing and texting about human rights

Communication is the driving force of the programme. "We teach reading not merely with letters and symbols but through using themes like human rights," says Ms. Melching. "We use the cell phone because we want the students to use their literacy skills doing what they do best: communicating. The oral tradition is very strong in Africa. In our programme, people learn about their human rights through discussion and dialogue."
In discussing human rights – a brand-new concept for many – the Tostan facilitators begin by asking participants to share their ideas about their own futures and what kind of community they want to live in. Invariably, says Ms. Melching, the students come up with the components of a human rights-based society, without ever having heard of the concept before. They mention health, education, freedom from hunger, freedom from violence, equal opportunities, work and access to social services.
At this point the stage is set to tell the students that these things are, in fact, the individual rights which they share with everyone on earth. "We tell them, 'These are things that the United Nations has identified as principles for every human being,' " says Ms. Melching. "We give them the opportunity to discuss individual rights and decide if they think they are relevant to their own situation. It's very exalting because they begin to understand that they're part of a world-wide movement and they're very proud to learn that the Universal Declaration of Human Rights has been adopted in their own constitution." These are ideas that ignite in people a compelling new sense of both possibilities and expectations.
When people learn for the first time that they have clearly identified rights, it is also important that they recognize that they are responsible for implementing and protecting these rights. "We not only want to inform our students about human rights," says Ms. Melching, "but to have them engage in a self-educating process by discussing these rights among themselves, and to think about them in the context of their traditional culture and religion, which in Senegal is Islam. Once people do this, they begin to see that their rights can be, and must be, a part of their everyday lives."

Human rights are an integral part of the curriculum

Rights soon emerge as an integral part of the sessions on health. Within this framework, participants learn about the risks of infection and of complications in childbirth caused by FGM/C. (In Senegal, all forms of female genital cutting are performed including the most extreme.) They learn that the practice plays a significant role in the high rates of maternal and infant mortality their communities' experience. They come to understand that genital cutting is neither required nor sanctioned by Islam, that it confers absolutely no health benefits, and that its abandonment will improve the health of women and increase the likelihood that newborns will survival.
However, in a society where everyone practices FGM/C, no one person or group of people can decide to abandon the practice and still be accepted as members of the community. To be accepted, the decision to eliminate genital cutting must be a collective one involving not only all the members of the local community but, crucially, all the communities with which the original group intermarries. FGM/C renders girls marriageable, so if a community decides to abandon the practice, the groups with whom this community intermarries must be prepared to abandon it as well.

Communication leads to collective decisions

Public declarations are a time for singing and dancing.

The first Senegalese village whose people collectively decided to abandon FGM/C did so in July 1997. The village publicly announced the decision, even inviting journalists to cover the event. Predictably, the surrounding communities were shocked and incensed by this break with the past. A village chief and religious leader, Demba Diawara, a participant in the Tostan programme, explained to Melching what the problem was.
"He said the reason the community is having so much trouble is that they did this alone," recalls Melching. Communities intermarry within large networks of villages, and one village alone cannot abandon the practice without facing ostracization by the wider community. Diawara's advice: work respectfully toward the goal with the entire community of marriage-affiliated villages and hold public commitment ceremonies marking the abandonment of FGC. He then volunteered to walk throughout all the villages in his community's network and spread the word that the practice was being ended.
As a result of Diawara's communication efforts, the first inter-village declaration of FGM/C's abandonment occurred in February 1998 when 13 villages came together as an extended social network and collectively rejected the practice. Other villages began to take notice. "When people saw the example of some villages standing up and abandoning FGC," says Ms. Melching, "they thought, 'OK, if others can do it, then we can too.'" Five months later, 18 more Senegalese villages, all of which had gone through the Tostan programme on human rights, decided to end FGM/C. Since then, the process has taken on a life of its own. Of the 4,500 communities in Senegal and elsewhere that have abandoned FGM/C so far, not all participated directly in the Tostan programme. "Often, a community learned that others were giving up the practice and then reached out to their own intermarrying communities in order to take the same step," Ms. Melching explains.
The second stage of the Tostan programme involves reaching beyond a single village where change has germinated and influencing entire multi-community social networks through traditional means of communication: theater, song, dance and poetry, both within that village and at meetings and informal contacts with other villages. Senegal's traditional communicators, called griots, are central to this process. Lately, Tostan participants have even been making films about ending FCM/C; these are shown on improvised screens from the back of a motorcycle.

Texting to solve problems

The final stage of communication, which begins in the second year of the Tostan programme, focuses on text messaging with cell phones. Interestingly, many villagers already had cell phones before they got involved in the programme. (Tostan distributes phones to those who need them.) But in the past, they rarely used the phones because talking is expensive and few people knew how to read and write, so texting was precluded for most. Becoming literate is always challenging, especially for adults, but under the Tostan programme, texting has proved to be an extraordinarily potent motivator.
A vast amount of knowledge about a wide range of issues is shared including:

• Problem solving: anything from how to repair irrigation pumps and plant woodlots to how to use fuel-efficient stoves.
• Hygiene: for example, how to prevent infection, keep the environment clean, build latrines and filter drinking-water.
• Health: among other things, how to prevent diarrhea and malaria, the need to vaccinate children and the dangers to women's health of FGM/C and child-marriage.

And, thanks to cell phones and texting, the communication network now extends to the African Diaspora: to immigrants living in Europe and the United States who are often still very much a part of the decision-making processes in their home villages. "The expatriates are still very connected to their villages," says Ms. Melching. "If they are not included in decisions, they could block everything you're trying to do. They can come back with their money and their power and their influence and move people back to the old ways."

Understanding – and upholding – the law against FGM/C

Although Senegal enacted its law banning FGM/C in 1999, enforcement has been very difficult. Even when people knew the law existed, very few understood its purpose. "We teach the law by bringing people through a process of understanding the reasons behind the law," says Ms. Melching. "FGC is a social norm which everybody accepted. But suddenly the law says it's no longer accepted. Why? Why would this age-old practice be against the law? So people discuss it among themselves and then they reach out to the rest of their community and they say, 'What do you think about this?' And they come to the conclusion, 'Yes, it's true, this should not be allowed because it can be harmful and we do not have the right to harm others.' This community-based process is very powerful and it's worked everywhere. Even the most conservative communities – in Somalia for example – have declared that they're abandoning the practice. People are open to this because it makes sense."
A recent UNICEF-funded study found that, after ten years, 77 per cent of communities that had said they were abandoning FGM/C had actually done so. According to Ms. Melching, as such things go, this is an extraordinarily high percentage. She believes that it's only a matter of time before the remaining 23 per cent of communities will follow. "What counts is building a critical mass of action," she says. "In any social transformation, you never have a 100 per cent result all at once. But as the critical mass grows and more and more people say, 'Yes, this is the right way to go,' more people buy into it and it becomes an essentially spontaneous, self-perpetuating movement."

The human rights approach becomes national policy

In Senegal, many government agencies and non-governmental groups have been working since 1999 to encourage FGM/C abandonment by a variety of means – many of them judgmental. But that is about to change. In February 2010 the government launched a new 2010-2015 Action Plan to End Female Genital Mutilation/Cutting. What is different about Senegal's new plan is that it establishes the human rights approach to ending FGM/C as government policy. Implementation will be based on three major steps: empowerment through education for the people themselves; organized diffusion of information whereby the people reach out to their social networks; and public declarations of abandonment of the practice. Ten United Nations agencies have published a statement endorsing this approach.
The reason Tostan has been so successful is that the decision to abandon FGM/C is not being imposed on anyone from outside. People are coming to this decision on their own, because they now have information and have been empowered to act. According to Molly Melching, this is a sign of true development. "Development is the ability of people to make the best decisions for themselves based on correct information," she says.                       

A Poem about Module 7

In the early days of Tostan, in 1988, Module 7 was the part of the Tostan curriculum that focused on human rights and women's health, including FGM/C. A woman participating in a class at that time wrote this poem in praise of Module 7. This is an excerpt.

Ah! Module 7!
You came to Ngaparu and chased away illness from our families
Come Module 7!
Help our Senegalese women know their rights,
Especially their right to health.
Help them to learn about their bodies.
You, women of Ngaparou
Share your knowledge with your daughters, Especially at puberty.
Speak to them about menstruation, about sexuality
Don't be ashamed any longer!
Women of Senegal, answer Module 7's call
And she will inform you about pregnancy,
Helping you to learn How to have a successful pregnancy.
Answer Module 7!
She will tell you about childbirth and the importance of planning your childbirth.
You will understand That Female Genital Cutting
is violence towards our daughters
So you will stop and ask our sisters and brothers
To abandon such harmful traditional practices!

FORWARD Condemns the American Academy of Pediatrics’ amended policy on Female Genital Mutilation (FGM), which suggests conducting ritual nick of genitals as “compromise”

May 6, 2010
By Women in London

On 26 April 2010 the American Academy of Pediatrics (AAP) released a revised “Policy Statement – Ritual Genital Cutting of Female Minors” which significantly weakens their commitment to health and well being of infants and children. The AAP is endangering rights of young girls at risk of FGM by suggesting the performance of Type IV* FGM as ‘a possible compromise to avoid greater harm’. FGM, in all its forms, is a violation of human rights and poses immediate and long-term health consequences to girls and women.
FORWARD is deeply concerned at this weakening of policy on FGM and is calling on the AAP to revert to its caveat free 1998 policy statement that ‘opposes all forms of female genital mutilation’.

“All forms of FGM are a clear breach of a girl’s human rights and this practice should not be perpetuated by health professionals, whose duty is to care and protect the girl. FGM carried out by medical professionals gives a legitimate and acceptable face to a practice which damages women’s and girls’ reproductive, sexual and psychological health. Performing FGM in sterile conditions does not alleviate the long-term effects of FGM and international bodies such as the World Health Organisation have consistently opposed such a move,” states FORWARD’s Executive Director, Naana Otoo-Oyortey.

The AAP has downgraded its recommendation to ‘oppose all forms of Female Genital Mutilation’, as stated in the 1998 recommendations, to ‘oppose all forms of Female Genital Cutting (FGC) that pose risk of physical or psychological harm’. It has qualified the recommendation that ‘its members actively seek to dissuade families from carrying out FGM’, by now applying it only to ‘harmful forms of FGC’. Most seriously, it has also erased altogether the 1998 recommendation that ‘its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents’.
In effect, the new AAP policy promotes changes in US federal and state laws that would ‘enable pediatricians to reach out to families by offering a ritual nick’ for example ‘pricking or incising the clitoral skin to satisfy cultural requirements’.

About FORWARD
FORWARD is an African Diaspora women’s campaign and support charity. Our work responds to the need to safeguard dignity and advance the sexual and reproductive health and human rights of African women and girls. We work with individuals, communities and organizations to transform harmful practices and improve the quality of life of vulnerable girls and women.
FORWARD envisions a world where women and girls live in dignity, are healthy and have choices and equal opportunities to fulfil their potential. http://www.forwarduk.org.uk/
 
*The World Health Organisation identifies the following four types of FGM:
Type I: Excision of the prepuce, with or without excision of part or the entire clitoris (clitoridectomy).
Type II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulations).
Type IV: All other harmful procedures to the female genitalia for no medical purposes, for example: pricking, piercing, incising, scraping and cauterisation