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FGM performed in clinics can make it dangerously attractive

7 February 2018
It is great to have FGM banned under the law, but what is important is to make sure the laws are implemented, says Dr. Enshrah Ahmed

Dr. Enshrah Ahmed is the Regional Advisor for Gender, Human Rights and Culture with the United Nations Population Fund - Arab States Regional Office (ASRO). She spoke to ASRO website, coinciding with the International Day of Zero Tolerance for Female Genital Mutilation.

 

1.      How widespread is Female Genital Mutilation (FGM) in the Arab region, and which countries does this practice affect the most?

FGM is widely prevalent in some Arab countries: it affects 87 percent of women and girls in Egypt and in Sudan, 98 percent in Somalia, 93 percent in Djibouti and 19 percent in Yemen. These rates cover women and girls aged 15-49 today, and most of them underwent the mutilation at the hand of medical personnel (a doctor, a nurse or health worker) - this is what we call “medicalization of FGM”: 78% in Egypt and 77 percent in Sudan.

2.      In the face of such high prevalence rates, how do you define progress in eradicating FGM? Can you give examples?

A lot of progress has been made against FGM in the Arab Region. In Egypt, UNFPA, in collaboration with the National Population Council, played a crucial role in the work leading towards the 2016 amendment of the law prohibiting Female Genital Mutilation. The new amendment makes the practice of FGM a felony rather than a misdemeanor, increasing the penalty to range from 5-7 years, with a maximum sentence of up to 15 years, if the practice leads to death or permanent disability. In addition, any person who accompanies the girl to undergo the procedure, will also be sentenced from 1 to 3 years. In Sudan, 2017 witnessed 107 new community declarations of the abandonment of FGM, which UNFPA has supported. This means that approximately 11,000 families/68,000 members declared to leave their girls uncut. The total number of public declarations of abandonment in Sudan, exceeded 1,054 communities (cumulative) for the period 2014-2017. In Djibouti, UNFPA, in collaboration with the Ministry of Women and the Djiboutian Women’s Union, developed a referral protocol for the management of FGM cases and defining the role of the social, judicial and medical sectors. Somalia has seen a significant decline in infibulation – type 3 of FGM (also known as pharaonic); this represented a critical shift in the norm. Whilst all this does not represent “total abandonment”, these steps have nevertheless reduced the harmful impact of FGM on girls, with qualitative data suggesting a sharp decline of the practice in urban areas, as well as in some rural areas. The dissemination of information on the health impacts and risks of infibulation, particularly when Ministries of Health are involved usually have huge impact on religious and community leaders, convincing many that this practice is also in violation of Islam.

Somalia has seen a significant decline in infibulation – type 3 of FGM (also known as pharaonic). © UNFPA/Georgina Goodwin

 

3.      What are the key challenges to eradicating FGM in the Arab region?

FGM is a strongly established and celebrated practice in the communities that perpetrate it. It is a deeply rooted social norm that is often falsely justified with health and religious arguments. FGM is generally not considered a priority issue for policymakers in the affected countries, and even less so when a conflict hits the country, such as Yemen, Somalia and (intermittently) Sudan and the Kurdistan region in Iraq. During conflicts, lack of access of social and health workers to communities contributes to perpetration of the practice. Situations of political and economic instability often delay the implementation of activities that focus on anti-FGM policies and legislations. In addition, the almost systematic association of FGM with Islam, and the vulnerable status and role of women in society and within the national laws remain a challenge. Despite many religious leaders openly advocating for the total abandonment of FGM, citing religious texts to demonstrate that FGM is a cultural rather than a religious requirement, there are still strong, vocal groups of traditional, religious and political leaders who advocate for Sunna FGM (type 1), arguing that it is a less-invasive and religiously required procedure.

4.      You mentioned the term “medicalization of FGM”, what is this and how does UNFPA address it?

 

Indeed we are very worried about the increasing medicalization of FGM: when healthcare providers are involved in the performance of FGM, this is likely to create a sense of legitimacy for the practice. It gives the impression that the procedure is good for health, or at least that it is harmless; this can further contribute to the institutionalization of the practice, rendering it a routine procedure and even leading to its spread into cultural groups that currently do not place it. UNFPA advocates for real implementation of the laws in place: it is great to have FGM banned under the law, but what is important is to make sure the laws are implemented and perpetrators receive punitive measures. The involvement of health workers is particularly dangerous as families feel safe in their hands, whereas the practice is harmful with or without a medical staff member! We at UNFPA work with ministries of health and doctors syndicates to reiterate that medical staff should stand adamantly against practices that are dangerous to the health of girls and women, and absolutely not encourage their perpetration.

FGM affects 87 percent of women and girls in Egypt and in Sudan. © UNFPA Egypt 

5.      Despite the progress, some medical workers still do the procedure, what in your opinion should be done to end this sort of medicalization of the procedure?

To end the medicalization of FGM, medical syndicates and midwives associations need to participate in community awareness programs, to raise the awareness of the grave health consequences of FGM and its harmful impact on the lives of women and girls. Medical doctors need to be equipped with the knowledge and information on the laws and legislations against FGM and its medicalization, and the penalties of performing this harmful practice, on the medical personnel. Information on the medical and social consequences of FGM, needs to be mainstreamed in medical schools’ curriculum and medical doctors’ on-the-job training programmes, in order to raise the awareness of medical doctors and to prevent them from performing FGM, as well as o allow them to engage in the community awareness programmes that address FGM, in accordance with the ethics of medical profession and Human rights. The medical community needs to support the issuance of laws and make recommendations to the concerned authorities to penalize any member of the medical syndicate/council/association, who was proven to have performed FGM; penalties could reach the dismissal of the member from these bodies and the withdrawal of the medical license.

 

6.      UNFPA has been using different way to address the problem, including theatre-based techniques, are such techniques effective and do they produce direct results that can be measured?

Theatre-based techniques have proven to be extremely effective when addressing FGM, as it is a powerful tool for social change and FGM is considered a social norm. Interactive theater gets the audience involved in the show so it gives them a bit of distance from reality during the time they are performing, which makes certain set ideas more amenable to be discussed. Theatre can strengthen the emotional and psychological appeal of messages and provide a believable and interesting way to explore sensitive issues, particularly with young people. Watching a carefully designed show can change the way a person thinks and possible the way she/he acts, as it involves the audience’s emotions. It is this ability to touch the emotions that allows theatre to influence attitudes in ways that traditional instruction, cannot. Theatre establishes new channels for the dissemination of messages and theatre techniques can provide opportunities to inform the audience about services that exist in the community, whether these services are accessible to young people, and whether staff will respect their right to confidentiality, this can yield measurable results