In Ethiopia, the Ethiopian Orthodox Church, the Evangelical Church and the Ethiopian Islamic Supreme Council officially and formally stressed that female genital mutilation is not a religious requirement, and originates in practices that precede religion. They also pledged to integrate relevant messages into their religious teachings.
In 2013, the OHCHR office in Guinea Bissau supported and provided technical assistance to the national non-governmental organization Djinopi in the organization of an Islamic conference on combating female genital mutilation, involving Islamic professors from Egypt, Mali and Senegal. The conference resulted in a declaration on the abandonment of the practice by the imams of Guinea Bissau. To reinforce the outcome of the conference and the declaration, Djinopi published a “golden booklet” with short Islamic statements against female genital mutilation, which has been disseminated to neighbouring countries and countries with high prevalence rates.
In Mauritania, dialogues with religious leaders have led to the development of a model sermon and a collection of arguments against female genital mutilation based on religious documents, which was launched in February 2013 and distributed to 500 imams.
E. Other initiatives to address societal attitudes and support for female genital mutilation
In 2008, the Government of Colombia, with technical assistance from the International Organization for Migration and UNFPA, initiated a project called “Emberá Wera” aimed at changing discriminatory social and cultural patterns of violence against women. The project resulted in a public rejection by Emberá women and community leaders of female genital mutilation as harmful to women and having no basis in culture. The project has enabled women, both in Emberá and among other indigenous communities, to be agents of change.
The involvement of older women who may themselves have undergone female genital mutilation in programmes to eliminate the practice has proved successful. German development cooperation has created intergenerational dialogues designed to empower target groups to change behaviour. The dialogues have been used in several countries.
In Mali, the “child-to-child and “child-to-parents” approach adopted by the organization Plan International has allowed girls to promote their rights with their parents and communities, through acting, drawing, poetry and songs. The “child-to-child” approach recognizes children as effective agents of change, since they communicate more effectively than adults, are often more literate than their parents and look after younger siblings. This has helped many girls to express themselves in public and share their experiences without fear and embarrassment.16
As fathers, brothers, husbands, community and religious leaders and politicians, men hold many of the decision-making roles that allow the practice to continue and can play a role in ending female genital mutilation and other harmful practices. Challenging dominant norms of masculinity is an important step towards ensuring that men and boys are strong advocates for tackling the practice and for changing attitudes and behaviours in communities and society at large. In Egypt, Plan International has used an innovativenon-formal education programme called “New Visions” that encourages the development of life skills and increases gender sensitivity and reproductive health knowledge among groups of boys and young men aged 12–20. The same concept has been used for girls through a similar programme called “New Horizons”, to increase self-confidence and demystify and communicate essential information on basic life skills and reproductive health. These groups have helped to break the silence, promote attitudinal and behavioural changes among men and women, as well as reduce the social pressure that gives rise to the practice. Plan International has found that community dialogue and discussion is crucial for greater ownership of the project by the community.17
UNHCR has established an advocacy group called “Men against female genital mutilation” comprising 300 men in the Dadaab refugee camp in Kenya. The group members undertake peer education activities, acts as role models and work in close cooperation with the police and other agencies.
In the Sudan, and later in Somalia and Egypt, the “Saleema” initiative promoted the association of positive values with women who have not undergone female genital mutilation. Saleema is an Arabic word that means, inter alia, “unharmed”. One of the key objectives of the initiative was to model and popularize the use of the world Saleema itself as a positive terminology for describing women and girls who have not undergone the practice. In 2014 alone, over 340 communities in the Sudan participated in community dialogue activities as part of the Saleema initiative, and approximately 95 communities organized public declarations for the abolishment of the practice using the initiative “Saleema Al Taga”.
F. Political leadership
The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children has identified political will as “the centre of achieving zero tolerance to female genital mutilation.” Evidence shows that statements by politicians condemning female genital mutilation are essential to challenging support for the practice and that, in many countries, they have led to greater engagement of religious, tribal and community leaders against it, as well as an increase in human and financial resources allocated for this purpose.18 Throughout 2014, Guinea-Bissau saw strong statements of support for the abandonment of the practice by political parties, the Government and influential leaders. In addition, the country has appointed a national ambassador for the abandonment of female genital mutilation, and has mobilized key national musicians and media figures to participate in cultural events to advocate for its abandonment. Senegal’s national action plan provides for an active role for parliamentarians, in particular female parliamentarians, in terms of speaking out against the practice in their constituencies and working with religious leaders.
G. Promoting alternative rites of passage
Women who undergo female genital mutilation have reported feelings of empowerment and social acceptance and those who have refused report feelings of exclusion, shame, stigmatization and loss of honour and social position.19 Alternative rites of passage are important to address these feelings and perceptions.
In Kenya, the UNFPA-UNICEF Joint Programme supported alternative rites of passage among practicing communities, who viewed the new practice as culturally acceptable and marking a girl’s entry into adulthood. The alternative rites of passage involved community participatory education on local culture, life skills, communication skills, self-awareness, family relationships, sexuality, coping with adolescence, sexually transmitted infections, HIV/AIDS and gender-based violence. The Young Women’s Christian Association of Kenya implements an alternative rites of passage seminar for girls at risk. Teachers and parents identify girls, who are taught a series of modules based on a training manual covering sexual and reproductive health education, female genital mutilation awareness, myths around the practice, legal implications and children’s rights and protection from it.
In the United Republic of Tanzania, OHCHR supported a UNFPA-led special event where over 1,000 children chose an alternative rite of passage over mutilation. The alternative rite of passage involved a one-month training course on human rights, reproductive health and the culture of their local community, which concluded with a graduation ceremony. Similar alternative rites of passage activities have been conducted in the Gambia.
H. Cross-border, regional and international cooperation initiatives
Efforts at the regional and international levels aim at promoting awareness and information-sharing on female genital mutilation. Countries of origin and migrant communities in destination countries are increasingly forming partnerships and engaging in coordinated approaches to prevent the practice.
Togo is currently developing cross-border programmesto combat female genital mutilation with neighbouring countries. Similarly, since 2011, Burkina Faso and Mali have collaborated in a joint project on preventing its cross-border practise.
I. Protection and support services
Girls and women who have undergone female genital mutilation need quality health care and psychosocial and sexual care. Eritrea, Mauritania, Kenya, Burkina Faso, Ethiopia, Mali, Somalia and Uganda have all strengthened the capacity of health personnel to address the practice and its consequences. In Ethiopia, health workers are operating outside the clinical setting and offering support to schools, women’s groups and faith networks.
In Finland, the National Institute of Health and Welfare raises awareness and provides information on female genital mutilation in maternity and child health clinics, hospitals and health centres; and schools and student health centres. In September 2014, University College Hospital in London opened its first specialist clinic for child victims of female genital mutilation, offering medical treatment and psychological help to girls up to 18 years of age who have suffered or may be at risk of the practice. Somalia has integrated female genital mutilation-related issues in its midwifery training curriculum in its South Central, Puntland and Somaliland regions, including in antenatal care, neonatal care and immunization services. Similarly, Burkina Faso has integrated the practice into reproductive health programmes and set up a specialist clinic to address the complications of female genital mutilation.
The World Health Organization is updating clinical guidelines for health providers to support evidence-based care. In Ethiopia, the Addis Ababa Fistula Hospital is dedicated exclusively to providing free obstetric fistula repair surgery to women, and a community called Desda Mender is dedicated to the lifelong support of women whose fistulae are irreparable.20 Specialized clinics for victims of female genital mutilation have also been opened in Germany. In Switzerland, the University Hospital of Geneva operates specialized consultations led by female doctors on female genital mutilation. The programme offers various services, including a personalized prevention information review and deinfibulation for cases of type III female genital mutilation.
In addition to health services, several civil society organizations are engaged in providing protection services to girls at risk. In Kenya, the Tasaru Ntomonok Initiative provides shelter for girls trying to escape female genital mutilation, including with a view to ensuring they remain in school and supporting their integration into their communities.21 Burkina Faso has established a free child line for the public to report suspected cases and for survivors or other affected parties to receive counselling. In Ethiopia, child protection networks provide support to girls who have been mutilated and have established links between child protection officers, the police, schools, community groups and faith organizations to share information to identify proactively those girls at risk of the practice.
J. Addressing female genital mutilation in minority communities
Specific issues may arise in addressing female genital mutilation when it is practised only by minority communities, such as refugee women and women migrants. Measures to address the practice in this context have focused on legislation, strengthening the capacity of the relevant professionals to effectively address the practice through training and guidelines, as well as awareness-raising among targeted communities.
In addition to information campaigns, a growing number of countries have developed action plans that contain practical guidance on targeted interventions, including on how front-line professionals can challenge the social norms that drive the practice, as well as how individuals and communities can themselves contribute to changing the social norms that underpin the practice. Finland’s action plan on the prevention of female genital mutilation for the period 2012–2014 requires local authorities to provide sufficient training on the practice for employees and to carry out self-monitoring.
Since 2000, Norway has implemented four successive action plans to prevent and combat female genital mutilation. The current action plan for the period 2013–2016 against forced marriage, female genital mutilation and severe restrictions on young people’s freedom contains 22 measures, including on the roles of schools and the foreign service missions, the need for safe housing and improved cooperation and expertise in the public sector.
Similarly, in Portugal, the Government has implemented two action plans involving actors from several sectors and with different expertise, so as to address the different perspectives on female genital mutilation, including health, reproductive and sexual rights, justice, immigration, gender equality, development cooperation and education. Members of the group come from public administration bodies, international organizations and non-governmental organizations. The Government produced various materials on the practice for health-care professionals, patients and police officers, as well as a post-graduate course on female genital mutilation for health-care professionals who intend to work in high prevalence areas and who are expected to act as focal points in their community’s health centres and hospitals upon graduation. Under the action plan, Portugal has created a biannual award, entitled “Against female genital mutilation – change the future, now”, which offers immigrant associations support to develop awareness and prevention projects about the practice in the communities at risk, especially those associations that are very effective in their communities but do not have access to national or European Union funds.
In an attempt to reach out to affected communities, the Danish Ministry of Children, Gender Equality, Integration and Social Affairs has developed a mobile application on how to tackle “honour-related” conflicts, including in relation to female genital mutilation. The application targets ethnic minority young people, as well as professionals, informing them that the practice is illegal, and that persons conducting or contributing to it (also outside of Denmark) risk prison sentences.
In March 2014, the United Kingdom adopted a national action plan based on a multi-agency approach to providing support and care services for women and girls living with female genital mutilation or for women and girls at risk of the practice. It also established a female genital mutilation unit to coordinate cross-government policy, to collect and disseminate best practices and to provide outreach support on the practice. It published multi-agency guidelines on female genital mutilation to support and assist front-line professionals, such as teachers, health professionals, police officers and social workers. In April 2014, it became mandatory for any health-care professional to collate and submit basic anonymized details about the number of patients treated who have undergone the practice.
The Government of Spain has created a national strategy to eradicate violence against women for the period 2013–2016, which describes female genital mutilation as a form of violence against women, and has developed a protocol on medical action against the practice.
In 2011, the Government of the Netherlands developed an official document to help parents withstand pressure from their families. The document, entitled “Statement opposing female circumcision”, outlines the health consequences of female genital mutilation and relevant Dutch legislation. It has been translated into several languages and is handed out to parents who attend children’s health-care centres and also to school doctors.
In March 2013, partner organizations of the European End Female Genital Mutilation campaign – including the Mediterranean Institute of Gender Studies, the Family Planning Association of Portugal, the Italian Association for Women in Development and AkiDwa of Ireland – launched an e-learning tool, offering information and practical advice on female genital mutilation in Europe. The campaignʼs e-learning course aims to raise awareness and enhance the skills of health professionals and asylum officers and social welfare officers. The training is supported and endorsed by UNHCR and is available in English, Portuguese and Italian.
A number of countries, including Germany, Japan, Norway, Sweden and the United Kingdom, have implemented cross-country programmes to address female genital mutilation. In 2010, the European Parliament launched a campaign against the practice, and in 2014 the Council of Europe, with Amnesty International, produced a guide for member States on how to design policies and measures to better address the practice, based on the Council of Europe Convention on preventing and combating violence against women and domestic violence.
IV. Challenges in addressing female genital mutilation
Submissions received reveal a number of constraints and challenges that States face in their efforts to meet their obligations to respect, protect and fulfil the rights of women and children to live free from female genital mutilation.
Legislation in most countries provides for large fines and prison sentences for those who engage in the practice. However, effective enforcement is often inadequate, particularly in States with plural legal systems and even more so where customary, traditional or religious norms may appear to support female genital mutilation. Furthermore, prosecutions remain rare. This is partly due to the nature of the practice, which poses particular investigation challenges to law enforcement officials. The ceremony is often deeply taboo, usually performed in the privacy of the family or community and shrouded in secrecy. It is also not immediately obvious that a woman or a girl has been subjected to female genital mutilation, and law enforcement officials often lack accessibility to rural areas where it is carried out. In a number of places, the enforcement of laws against female genital mutilation and the punitive legal approach has driven the practice underground.
There is also a gap in the protection afforded by existing legal frameworks. Most States have criminalized female genital mutilation when it takes place on national territory or when a girl is taken abroad for mutilation if she is a citizen or permanent resident of the State. This fails to recognize the obligation of States to protect all children within their jurisdiction and does not take into consideration the mobile, transnational character of practicing communities. A further challenge is insufficient collaboration among Governments across borders. Girls living near border areas are most vulnerable, particularly if they are living next to countries with weaker legislation against the practice than their own.
There is evidence that the medicalization of female genital mutilation has risen. However, reliable data on medicalization is difficult to obtain. Allowing medical professionals to perform the practice is often the logical response of parents who are under social pressure to have their daughter undergo female genital mutilation, but who want to minimize harm. Medicalization can also act as an additional source of income for health-care workers and can undermine efforts to eliminate the practice.22
United Nations and regional human rights mechanisms have raised concerns with regard to genital surgeries on intersex infants and children for non-medical reasons.23 The Committee on the Rights of the Child has called upon States to ensure that no one is subjected to unnecessary medical or surgical treatment during infancy or childhood, to guarantee bodily integrity, autonomy and self-determination to children concerned and to provide families with intersex children with adequate counselling and support.24
The collection of reliable data on female genital mutilation in countries where minority communities perform the practice remains a major challenge, as do the lack of capacity of relevant officials and the absence of standard guidelines. Many front-line professionals, such as teachers, medical professionals and child protection officers, are not trained in or may not understand the law, or may be unfamiliar with the issue and fail to record cases. Similarly, while there is empirical evidence showing that female genital mutilation can result in deaths, many Governments do not collect or maintain official data on deaths associated with the practice, and hospitals do not have policies of recording female genital mutilation-related deaths.
Despite the commitment of Governments to address the practice, in many instances support in the form of shelters and other services for victims and girls at risk are inadequate. Very few countries make provisions in law or policy to offer protection following allegations of female genital mutilation. The practice does not fit easily into systems to prevent violence against women or child protection systems. For instance, in several European countries, agencies that typically report on suspected child abuse cases do not report female genital mutilation as they are often unaware of its occurrence. Furthermore, most domestic violence shelters do not accommodate children, constraining many girls to take refuge in schools or in the home of community leaders, at times with limited access to food or sanitation and exposure to further risks.
In the area of service provision, a key challenge is the lack of evidence on effective interventions and strategies to mitigate the health consequences of female genital mutilation. This includes a need to improve the knowledge base about obstetrical and gynaecological consequences.25
The persistence of social norms that perpetuate female genital mutilation, differences in the underlying reasons for the practice and cultural environments where it takes place make it particularly challenging to eliminate the practice. However, the positive results of programmes to prevent female genital mutilation demonstrate that attitudes in support of the practice can be successfully addressed.
V. Conclusions and recommendations
States have the obligation to respect, protect and fulfil the right of women and girls to live free from female genital mutilation. Good practices in a number of countries should be supported, increased in scale and replicated. They include:
(a) The establishment of comprehensive policies, such as action plans, involving all relevant ministries and other stakeholders, including religious and community leaders, teachers, health providers and the media;
(b) The adoption and implementation of legislation that prohibits female genital mutilation, in accordance with international human rights laws;