Access to care services

Health and social care advocacy means supporting people who are unable to ensure their best interests are being taken care of. The ultimate objectives in health and social care advocacy for FGM survivors are to ensure that:  

1. Their voice, views and experiences are heard and treated with appropriate respect  

1. They are receiving equal and fair treatment as the rest of the people, and one that covers their specific needs, including mental healthcare 

1. The survivor is fully aware of their rights under current legislation and can make informed decisions based on the advice provided and has no barriers when it comes to accessing the needed care. 

Based on the statement above, we should ask ourselves if FGM survivors get access to the care services they need, and if their communities, governments and other organs have done the absolute necessary to provide the needed care.  

The answer to this question is NO. FGM survivors do not have access to the care services they need. This is the reason why advocacy programs working on this issue should be promoted.  

An organisation titled Care Counceling talks about three kinds of advocacy include 1) self-advocacy 2) individual advocacy and 3) systems advocacy. These categories can also be looked at when we talk about FGM.  

Every violence against girls and women is deeply rooted in the power imbalances between genders that robs the victims of their voices and their ability to express themselves. This is the same case as FGM, hence the focus on the individual and the system change advocacy instead of self-advocacy. Expecting only the victims to speak up without substantial change in the system would not yield the results we want to see. 

Self-Advocacy: Be Your Own Advocate. 

Being your own advocate is a classic example of self-advocacy. It is all about speaking up for oneself—advocating for what you need. Self-advocacy also includes being able to speak up for what you desire such as hopes and dreams. Getting to know yourself, “finding” your voice, and gaining the confidence to effectively use your voice are empowering steps toward becoming your own advocate. On this, the expectation on the FGM survivors to be the only ones who would speak up to drive the decline of FGM is unrealistc.  

Individual Advocacy: Be an Advocate for Others 

Individual advocacy involves speaking up and advocating for those who are vulnerable. Those who are in a caretaking role for the vulnerable are advocates and those who are in a professional role to help individuals and families connect to resources are also advocates. Individual advocates can take the form of informal or professional support.  

This may speak specifically to activists or other people, formally or informally working to end FGM.  

Systems Advocacy: Be an Advocate for Systemic Change 

Systems advocacy involves actively working towards change at the local, state/region, and national levels to impact change within public policy. This involves working to reduce barriers through changing the laws or rules that impact individuals. Systems advocates are often involved in collecting and using data to influence research and funding. Systems advocacy is like a powerful, collective voice of self-advocates and individual advocates working together to impact positive change. This is the case of registerd community organisations, national or regional organisations that may work individually or in consortium to influence policy on FGM at micro or macro levels. 

What should be done?  

UNICEF shows that approximately, ¼ of girls who have undergone FGM were cut by a health care provider.  

First, push for the ban of FGM with rules and laws at nation and global level, joining the effort of UNFPA. As reported by the UNFPA Each year, too many girls bleed to death after being cut. If a cutter uses the same instrument for several girls, the risk of HIV infection increases. People living with HIV/AIDS face lifelong health issues or death, especially if they are unable to attain treatment. As one former cutter in Uganda explains, “I used the same knife on seven girls. The first had HIV/AIDS, so all seven got it. Now they’re all dead.”   

At the COP, we previously had a discussion on laws and FGM. Advocating for national laws that promote the abandonment of FGM is very key. Although having the law alone isn’t enough. Community mobilization and improvement in the whole ecosystem such as the health system, the judicial and the social economical systems change are key to bringing the practice down. 

Second, use research and case studies to advocate for better case management. During the discussion on innovative financing to put an end to FGM, one of the recommendations that were mentioned by members, and by UNICEF during the option paper presentation was the use of data to advocate for better allocation. The World Health Organisation under its Human Reproduction Programme has developed various tools that can be used to advocate for better care of FGM survivors. Among those, The FGM Resource Kit for the Health Sector that includes the global strategy to stop health-care providers from performing female genital mutilation. There are other tools such as the FGM cost calculator that useful for policy makers, programme planners and managers, the donor community, advocates for FGM abandonment and anyone interested in learning more about the impact of FGM on health and economies. 

Among the highlights on this discussion on access to care services for FGM survivors was to advocate for midwives to perform minor but important surgery such as defibulation. Depending on countries jurisdictions, some midwives might be allowed to perform a number of surgeries. For example, in Switzerland, midwives are allowed and encourage to perform defibulation for FGM survivors during the gynecological visits or while getting ready to give birth any time after the second trimester. This however isn’t the same case for the midwives in Belgium.  

Thirdly, run programs for survivors to be aware of their right and ask for services. A member of the COP expressed that the access to care services for FGM survivors is important, but more important for the survivors to know that they need those services. This was supported by another member, FGM survivor, who said that for a long time, she had no idea that she was carrying the trauma that goes with undergoing FGM and that it took a very long time to learn about the internalized trauma and eventually do something about it. Advocacy campaigns that involve the community, with a sexual and reproductive lens would shed more lights on the changes that FGM might have produced on girls and women bodies so that they know to ask for help should they see those symptoms.  

Training sessions for medical personnel to treat women and girls holistically so that they get a chance to talk about FGM and of the consequences it might have had on the body and sexual health. 

Any advocacy program should serve to help people concerned find their voice. Even though the main point of this discussion is about advocation for holistic care for the survivors of FGM, the idea is that all these efforts eventually lead to the abandonment of the practice.  

For civil society organisations and activists with the plans of leading advocacy programs for better access to care services for FGM survivors, there are a few important elements to consider.  

• Initiation of direct talks with decision makers at all levels. From the village, the community and national levels. These are the people who are sometime gate keepers of the harmful practices or those who have a strong voice in the communities and are able to suggest or enact laws that would protect the voiceless. 
• Every advocacy plan needs political will and political action to be effective. Laws to be voted in at national level, for the ministry of health to create protocols for health care services and for other players in the  country’s governance to create access and affordability for other types of care services.  
• There is need to work with grassroot levels as a form of giving the power back to the communities. There is no better plan that working with those who are immediately effected. FGM survivors and those at risk need to be heard and their ideas to be added at the heart of the advocacy plan. 

For a general advocacy for access to holistic care for FGM, it is important for the players involve to know to understand and be aware of all the facts, a good analysis of what had worked elsewhere that can be adapted or contextualized in their communities, create bridges to the survivors and those at risk to listen to them, create engagement with the communities and build relationships with other players such as regional and international organisations, activists, like minded organisations, government, health care professionals, community leaders and everyone interested in ending FGM in this generation.