Progress in reducing female genital mutilation

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?

Diop: Exactly.

PRES: Nafissatou Diop is the coordinator of the joint UNFPA/UNICEF programme against female genital mutilation in Africa.

Duration: 7'13"

'By 2015 Female Genital Mutilation Will Be No More'

December 19, 2009 By Madinah Tebajjukira - The New Vision

Kampala — Parliament last week passed the Prohibition of Female Genital Mutilation Bill, which was tabled by Kinkizi East MP Dr. Chris Baryomunsi. The law outlaws the practice which is mainly carried out in eastern Uganda among the Sabiny in Kapchorwa and Bukwo districts and the Pokot in Amudat District. New Vision asked Dr. Baryomunsi about the law...

Recently Parliament passed the Anti-Female Genital Mutilation Bill. It now awaits presidential assent to become an Act of Parliament. What is Female Genital Mutilation (FGM)?

It is a procedure involving partial or total removal of the external female genitalia for non medical or therapeutic reasons. It is an age-old tradition sometimes referred to as female circumcision or female genital cutting. It's mainly done in the name of culture but it's a practice which dehumanises women and clearly lowers their status in society. It has no benefit at all and it's associated with many health risks.

What is its origin?

It is not clearly known, but available literature traces FGM to have started in Egypt. It is suspected that Egyptian kings promoted the practice of circumcising Israeli women to make them infertile so as to reduce the population of the Israelites. This cruel practice moved across the countries because of migrations.

FGM which predates Christianity, Islam and other religions is also practised in the neighboring countries of Kenya, Tanzania, Sudan and northern DRC.

Currently, over 28 countries in Africa practise FGM. It is also practised in the Middle East and Asian countries. To the western world, the practice is carried out mainly by African and Asian migrants.

In Uganda, the practice is prevalent among the Pokot, Sabiny, Tepeth, Nubians and Somali women. It is believed that these ethnic communities that practise FGM moved southwards from around Egypt centuries ago, settled in the Abyssinian area moved to Kenya and some came to Uganda.

The Sabiny, Pokot and Tepeth are all Kalenjin and are ethnic cousins to the Masai of Kenya and Tanzania. The Tepeth live on the top of mountains Moroto and Nyapak and in Kaabong District, where they are called the Teuso.

It is also said that the Sabiny men used to go on hunting expeditions and they would leave their wives at home for as long as two to three months. In order to stem the risk of women engaging in adultery and promiscuity, they started cutting their spouses' clitoris in order to reduce the women's sexual desire and libido.

What pushed you to table the FGM Bill when the practice is not prevalent in your constituency and region?

FGM is an abuse of women's rights. It violates their rights, and actually its violence against women. As a medical doctor, I have a professional duty to save life. An MP is a national leader who must be concerned about issues even beyond his or her constituency. Torture to a woman anywhere is a concern to me. Besides, our constitution empowers us as backbench MPs to initiate legislation on any matter for the peace, order, development and good governance of Uganda.

Why didn't you leave it to the area MPs to push for a law? Why are you more concerned than the affected?

True, this practice is not in Kanungu but I am also affected. This is a national concern and I worked with all the political leaders, including the MPs from that area. There was no competition at all; we worked together throughout the process. They all supported the bill and it is not true that they didn't move the bill because they feared a political backlash. Actually, politicians in these areas will be safer if they discourage female genital mutilation today. The President himself has been a strong public advocate for the abandonment of this harmful practice.

What makes FGM dangerous?

FGM involves the cutting of external female genital parts and there are no benefits associated with the practice. It is done by local women who use locally made knives and sometimes sharpened stones. These cause a lot of injury and may facilitate the transmission of infections such as tetanus and HIV/AIDS. The extent of damage depends on how much tissue is cut. There are different types of FGM based on how much tissue is severed. The cruelest form is when the mutilators cut the clitoris and the vaginal lips and then stitch the genitals to leave a small orifice to allow for urine and menstrual blood. This is called infibulation or pharaonic circumcision. There are many complications that occur and include severe bleeding, shock, infections, ugly scars, urinary retention, failure to heal, maternal and child birth difficulties, permanent disability, difficulty in having sex, uncontrolled leakage of urine and death. Others include feelings of anxiety, fear, bitterness and betrayal, panic disorders, feelings of incompleteness, loss of self esteem and difficulty with body image. The list is long. Female genital mutilation is practised to mark the transition from childhood into adulthood and is, therefore, associated with early marriages and high school drop-out rates for young girls.

So what if it is stopped?

Because it involves the inflicting of injuries and harm on women, if it is stopped, women will no longer be subjected to the above complications. The women will remain complete human beings. The only problem is the social pressure. Uncircumcised women used not to be allowed to milk cows, climb the granary or clear cow dung from the kraal. This is being abandoned now and we have also outlawed this discrimination and stigmatisation.

In Uganda, we have a set of laws that have not been implemented for years. What strategies are you going to employ to ensure that the Anti-FGM law will be implemented?

The implementation and enforcement of laws is the responsibility of the executive arm of the government. But in this particular case, the law was demanded by the communities where FGM is practised and, therefore, implementation and enforcement will be easy since the communities appreciate the law. The Government is committed to ensuring that FGM becomes history. This financial year sh200m was allocated for the campaign. We hope to raise this figure in the next budget.

Many partners including UNFPA, UNICEF, the US and Dutch governments among others have been supporting the campaign and I expect them to continue. The President, the Deputy Speaker of Parliament, Rebecca Kadaga, Dora Byamukama of East African Legislative Assembly and many others are very keen on having FGM eradicated soon. We shall also organise awareness and sensitisation meetings for law enforcement agencies like the Police and the Judiciary. The Ministry of Gender, Labour and Social Development is finalising an implementation plan that I hope it will be funded. My assurance is that by 2015, we shall have recorded no case of female genital mutilation in Uganda.

How soon are these trainings?

The mobilisation has been on since the early 1990s. We are continuing with the campaign. Those who think that we just passed the law without community education are wrong. This has been an ongoing campaign mainly by the REACH programme and the Sabiny Elders Association. The President, accompanied by his wife, on July 1 launched a national campaign to eradicate this practice at Amudat. Since then the Pokot are excited and have committed to abandon the practice. Recently, young girls from Amudat challenged us to give them schools since we have convinced them to abandon the practice and go to school. In addition to the sensitisation, we must provide social services to these communities.

There are women who believe that to prove they are adults, they must be circumcised. If they don't get someone to circumcise them, they do it themselves. How will you ensure that the practice is completely wiped out when others can do it in their houses?

Legislation cannot stop the practice overnight, but it is part of the social engineering process. Implementation and enforcement of the law will go alongside continued education and sensitisation of the communities. Since early 1990s the practice has been going down.

Actually, most Sabiny young girls have abandoned the practice. Two decades ago, thousands were being cut annually but now it's about 400 Sabiny girls who face the knife yearly. As we continue to educate people, women and girls will abandon it. Besides this, the law clearly states that carrying out FGM on oneself is criminal and attracts a penalty of imprisonment not exceeding 10 years. We think this is deterrent enough to dissuade the young girls and women from carrying out FGM on themselves Is the community ready to receive the FGM law?

It took a long time to have this law in place because the Government and other agencies first invested in community advocacy and education on the dangers of FGM. The affected communities have over time understood that the practice has no benefits at all. There have been demands from the local communities, especially among the Sabiny for a national law prohibiting FGM and that is how I came in to prepare and table the bill. I was assisted by LAW Uganda, a civil society organisation headed by Byamukama. All sub-counties in Kapchorwa have passed by-laws prohibiting it and Kapachorwa District Council passed an ordinance also prohibiting it. This shows that the communities fully understand the need to abandon the practice, and the legislation will support this process.

Is there a strategy to popularise the anti-FGM law?

There is already a national alliance of organisations and institutions that are spearheading campaigns against FGM and I will continue supporting their work. Like I pointed out, a national implementation plan is being finalised by the Ministry of Gender, Labour and Social Development. We shall make sure that we allocate sufficient resources to implement the plan. I am also hopeful that partners will support these efforts. The United Nations Population Fund (UNFPA) for instance has consistently supported the campaigns since the late 1980s.

Does the law provide for an education campaign?

The law and other existing laws, including the Constitution put an obligation on the State to educate the people about the dangers of harmful practices such as FGM. It is good that there are other partners involved. By 2015, female genial mutilation will be no more in Uganda.

For any campaign to succeed there must be incentives to entice people embrace the campaign. Is there any such in regard to FGM?

As I said, there have been advocacy campaigns going on. Through the UNFPA supported programmes, health centres were built to help women. There have also been efforts to encourage and promote the girl child education and special scholarships have been given to the Sabiny by the Government. The infrastructure has been improved like the Mbale-Kapchorwa road which is one of the best. The road to Bukwa is going to be tarmacked soon. The President has also pledged to have girls boarding secondary schools constructed in each of the communities. There is also need to find alternative sources of income for the mutilators who abandon the practice as it is a lucrative business for them.

Away, from FGM as the year ends how do you rate the performance of Parliament in 2009?

In my view, Parliament has performed very well. It has been very vibrant. We have passed many bills and many motions, although we still have a challenge of appreciating the multiparty dispensation. But I hope things will improve as we move on.

What about your party's performance for this year?

My party, National Resistance Movement (NRM), has performed very well. The party has been able to implement most of the promises stated in the manifesto. For example Universal Secondary Education (USE), rural electrification programmes, tarmacking of roads, pacification and development of the conflict affected areas among others.

The attendance of MPs in both plenary and committee has greatly, deteriorated. Do we expect any business in Parliament next year given the fact that we are nearing the 2011 elections?

Parliament will not close, but there will be a challenge of mobilising members to attend. The party whips have to work very hard. The main problem is that even though we are under multiparty politics, the parties are not doing much to support their members at constituency level. The parties want to own us without doing much to strengthen us at constituency level. So the members have to be in their constituencies so as to be voted into Parliament again. In countries where multiparty politics is developed, the parties have a duty to explain to the constituents how their MPs are performing and this would reduce pressure on individual MPs. The unfortunate bit is that in Uganda, we find some parties fighting their own MPs.

But critics say your party has not performed well. Are you sure your party will be voted into power again?

I believe the party will even get even bigger support in 2006. In the last elections, we were just beginning multiparty politics under the new constitution. The excitement of multiparty politics made some people vote opposition parties. However, the opposition parties have performed poorly since and more people, including those who had voted the opposition are likely to put their confidence in the NRM. That is why you hear many people crossing from opposition to the NRM.

The opposition has failed to provide alternative policies and programmes that can convince the public that their ideology is superior to that of the NRM. Even in Parliament, the opposition has failed to make a mark. So the NRM remains the only party that can hold Ugandans together and ensure sustainable development and prosperity.

As an MP how do you plan to come back in 2011?

I believe I have been a performing MP, both at national and constituency level. I have lobbied and brought development programmes to Kinkizi East constituency and Kanungu District.

During my tenure, I have lobbied for many programmes such as the extension of electricity to Kanungu, Rugyeyo and Kambuga. I have lobbied for construction of major bridges at Birara and Hamurwa, the tarmacking of Rukungiri-Kanungu road which is due next year, and so many others. I have also used the Constituency Development Fund and my other earnings to promote poultry, food security interventions, promoted tea growing, supported churches, mosques, women and youth groups and groups of people with disability.

The NRM is locked in the mismanagement and misappropriation of CHOGM funds. How is the party handling it?

NRM policy is zero tolerance to corruption. Those who misappropriated CHOGM funds did so as individuals and must answer individually. I hope the NRM leadership won't come out to support those who will be implicated. The "Temangalo effect" should not apply again. We should implement the talk of corruption even when it comes to our own.

How is the party handling conflict within the party?

This is a major challenge facing NRM as a party. The problem is that the top leaders of the party are sometimes the ones involved in conflicts, intrigue, and blackmail and backstabbing of fellow party leaders and members. This to me has hampered the process of instilling discipline among the members. However, disciplinary committees have now been constituted at various levels including at district level. As we strengthen the party structures, I do hope these committees will begin to function.