This information was gathered during the Conference on November 27th 2018 « Mainstreaming efforts to end Female Genital Mutilation », as well as during our thematic discussion on Mainstreaming FGM. The information comes directly from the members mentioned
> In Belgium: getting general practitioners involved
(Dr. Patoulidis, general practitioner)
The work of Dr. Athena Patoulidis on the management of FGM by GPs in Belgium highlighted several obstacles to a real investment of practitioners on this issue: lack of knowledge and practical tools as well as fear of addressing FGM with patients and preferring to ignore the issue.
GPs can, however, play a fundamental role in the prevention and care of girls and women who have undergone FGM. Dr. Patoulidis therefore set up training for practitioners based on the gaps identified in the study. She teaches general practitioners how to use the available tools as well as to know when and how to refer to other medical doctors as well as to specialized NGOs.
Above all, the Belgian author emphasizes : as a general practitioner one should not dodge the subject by discomfort or feeling embarrassed… Patients are often willing to address the issue but will dare to do so only if the practitioner takes the first step.
To know more:
- Patoulidis, A, Female Genital Mutilations in Belgium: « Assessment of the Current State of Knowledge and Practice in General Medicine », 2016 (French) and « Assessment of Medical Expectations and Needs of Concerned Patients », 2018. (French)
- Interview conducted by the Concerted Strategies against FGM, Belgium: Prevention and management of FGM in general practice
> In Burkina Faso: integrating FGM into family planning programs
(Dr. Kaboré, General Practicioner, Ministry of Health)
In Burkina Faso in the Tougan district, a promising program was launched by the Ministry of Health and the UNFPA. This project, now extended to twelve districts, consists of integrating the themes of forced marriage and FGM into family planning programs.
In this district, promotion of FP was facing a lack of funding on one hand and a limited social mobilization on the other, particularly low community participation.
To stimulate the involvement of local population in the implementation of contraception promotion activities, an approach which uses a local cultural/traditional event as advocacy support was developed in 2013. This approach was initially called “Journées du Djandioba de la PF” because it used the “Djandioba” as a vector of advocacy and social mobilization. The Djandioba is a local rejoicing dance to the sound of traditional music organized in various circumstances. Its feminine cultural dimension was an asset for FP promotion: https://www.ncbi.nlm.nih.gov/pubmed/?term=djandioba.
Later, at the time of its extension to others health districts of the country, this approach was re-named “Journées culturelles de la PF” to take into account the national cultural diversities and facilitate up-scaling.
It’s in 2017 that the fight against child marriage and FGM was associated with the FP. The community leader is the first to be sensitized to the themes of forced marriage and FGM. Within the district, an organizing committee is then set up and trained by health professionals. Gradually, they retire and leave the members of the organizing committee to train household members of the community on issues of family planning, forced marriage and FGM. This same organizing committee is also in charge of organizing the closing party symbolizing the success of the awareness program.
Mainstreaming Female Genital Mutilation in an endogenous cultural activity prevented “cultural barriers” usually encountered in this kind of programs. Indeed, knowing that « FGM has rarely been abandoned when program to eliminate them were perceived by communities as an attack or a critique of their culture and local values » (WHO, 2102).
“Culture is an antidote for violence, because it encourages us to understand the other and fertilizes tolerance“Renaud Donnedieu De Vabres
Working with communities with a particular focus on respect and understanding of their culture offers a great chance to succeed in putting an end to these forms of human rights abuse.
To know more:
- Burkina Minister of Health, Training Manual for Prescribers
- Chapter 09 « Put it all together » on the example of Burkina Faso in « 17 ways to
end FGM / C », UNFPA-UNICEF, 2017
> In Spain: Integrating FGM into sex education programs
(Louisa Antonin Villota, UNAF, the Spanish Union of Family Associations)
UNAF has set up workshops for migrant women. Over a period of 3 hours, the speakers address the theme of sexuality using a holistic approach and promoting a participatory method.
The participating women are often in precarious economic and social situations, and their sexual rights may appear secondary to the need to meet their primary needs. However, experience shows that once they get started on talking about sexuality, the participants don’t stop !
Themes such as gender norms, rules about female sexuality, sexual and reproductive rights in Spain are addressed and women are encouraged to talk about their bodies, their experiences, their sexuality. In these workshops, where speech is free and encouraged, FGM is approached as an essential theme of sexual and reproductive rights.
What has worked: main successful points?
Workshops with Women: Empowerment of women through information, knowledge, self-reflection about our bodies and sexuality, promoting Sexual and Reproductive Rights and gender based violence prevention:
· Fostering from the beginning strategies of self-care, self-confidence and self-acknowledgment of ourselves as women. « How do you feel? What would you like to do to feel well? Which are your passions? Trying to connect women with their inner self, confidence and strength. »
· Facilitating reflexion about what Sexuality means to us women, promoting the concept of Sexuality as a human quality, an innate characteristic present in all people from the day we’re born until the day we die; including aspects like interaction, pleasure, affection, emotions, desires and reproduction. It includes biological and psychological aspects; also social aspects, as our sexuality is equally defined by the historical, social, political and cultural context in which we’re educated and live. Introducing also Sexual and Reproductive Rights.
· Building knowledge and awareness from gender based socio-cultural mandates which define our bodies and sexuality as women and also in contrast with men, reflecting also on how we have learned these mandates and through whom… Here women bring about the subjects of menstruation, chastity, virginity, pureness, maternity, obedience, silence, shame, sin, beauty canon…
· Giving information about anatomy and physiological processes, our internal and external genitals, with graphics illustration of the vulva and the clitoris, talking about health, pleasure, reproductive cycle (menarche, menstruation, pregnancy, menopause,…); emphasizing the importance of self-care, paying attention to the importance of women pains which traditionally have being considered “normal” and they are not; the relevance of going to the doctor when we need…
· Providing information about our rights in Spain, Sexual and Reproductive Rights, access to health services, changing specialist if we don’t like, law, rights and protection from gender based violence, FGM.
· We use a participative methodology, starting building collective knowledge from the knowledge we all have as individuals. What is sexuality for us when we hear this word, what ideas come to us? What are gender based social mandates on the body and sexuality of women and men? How do we learn about them? Who is teaching us?
· An added motivation to women is sexual education to their children, both girls and boys.
What has not worked: challenges faced ?
· The situation of vulnerability and precarity of women, and the fact that they are survivors as well from other gender based violence such as: forced marriages, male partner violence, women trafficking for sexual exploitation, sexual violence; obstacles to put into practice in their lives the knowledge and reflections they have gained and elaborated. Access to information not always guarantee the possibility of action.
· Difficulties in finding ways of working more closely and co-ordinately with African women leaders who are key actors in defending human and women rights, fighting also FGM in Spain.
· Reinforcing work and awareness with men, not easy to organise workshops on sexual and reproductive rights (taboo, « not their issue », also other priorities…)
· Lack of gender lens and analysis of professionals, prejudices and stereotypes about sexuality and culture; lack of enough resources from public policies.
Possible solutions to overcome these challenges
Fostering and strengthening coordination among different stakeholders and social agents, being able to work from an integral perspective and on a long term period; mapping resources, providing itineraries to women so they know where to go if they need. Working at community and local level. Empowering leaderships, respecting times and processes, being allies on equal terms.
Long term: advocacy to include gender analysis and feminist perspective in all levels of education (also university); short term: training to professionals to prevent FGM with a gender perspective, linking with strategies to prevent other gender violence; also intercultural communication abilities.
What you would not do again?
Taking into account the modality of workshops we are able to do, (a punctual activity in coordination with another NGO, association which convene the group of women or men, 2-3 hours long).
They suggest not to work with mixed groups, women and men at the same time; they have faced the case and they tried, as at that precise context they didn’t want to exclude anyone, but finally men leaved the workshop at the middle…
It is important also that women in the group share more or less a common social situation. They have faced sometimes workshops with women that are suffering trauma (just arrived by boat, survivor of several sexual violence; trafficked women…) and it has been difficult to handle, they finish with a feeling that we couldn’t give the support and information needed to anyone.
> In Ireland: Integrating FGM into religious discourse
(Salome Mbugua, AkiDwA)
Religious leaders are highly respected within their communities in Ireland and are thus able to influence behaviors such as social norms within these groups.
Therefore, the Irish organization AkiDwA trains religious leaders on the theme of FGM as to make them real actors of change. Although the hierarchical nature of the religious structures may have given them some difficulties, the association has today been able to invest nearly 70 religious leaders in the fight against FGM. They now intend to continue the debate in religious forums, major events gathering many religious stakeholders in Ireland.
> IN SOMALILAND : Integrating MGF in economic empowerment projects
(Maria Väkiparta, ISF, International Solidarity Foundation)
ISF is a human right based non-profit organization which has been in operation since 1970. ISF has a head office in Finland and country offices in Kenya, Somaliland and Nicaragua. ISF strategy concentrates on addressing violence against women and girls, particularly FGM, and on promoting women’s economic empowerment. ISF work is implemented by local CSOs with whom ISF builds long-standing partnerships to enhance local ownership and sustainability of its work.
In rural and/or internally displaced people’s communities in Somaliland (since 2001), ISF’s core strategy is to mainstream the FGM prevention activities in economic empowerment projects. Especially in the rural areas of Somaliland, FGM is deeply rooted and often misunderstood to be mandated by Islam. It remains a taboo and a culturally accepted means to guarantee the ritual ‘purity’ (virginity) and thereby marriageability of girls.
Engaging communities in FGM prevention through income generation activities helps ISF and its local partners to build trust and legitimacy. Gradually, interaction on sensitive issues can be carried out. On the longer run, the mainstreaming approach also addresses one of the root causes upholding FGM, women’s socioeconomic subordination and dependency on marriage for their social security and status. As they support the women’s income generating opportunities and thereby their status in the family and community, they challenge the rigid gender roles and enhance women’s self-determination.
- With their partner Candlelight ISF have piloted a FGM component to be mainstreamed in their livelihood projects in several regions of Somaliland (funded by different donors). The concept includes engaging the local Community Management Committee (CMC, including local religious leaders) and putting FGM in CMC agenda, and training a local facilitator based in the community to support the CMC in addressing FGM.
- With other partner SOYDAVO ISF incorporate the FGM awareness raising in the ca. 20 established women’s self-help groups (SHG) and the related cluster level association (CLA) addressed by SOYDAVO supported by another funder. With some of the SHGs they start with literacy and numeracy classes to support petty trader women’s income generating skills.
- Also, in their FGM prevention work in Kisii, Kenya (since 2015), ISF are planning to mainstream the work in the livelihood support activities starting in 2020. Currently, their local partners Manga Heart and CECOME sensitize and support the teachers to incorporate the topic in their curricula, and aim to identify groups/platforms/arenas where people gather naturally, e.g. barazas, congruencies, existing women and youth groups where they train peer trainers from inside those groups.
> In Sudan: Integrating FGM at the Governmental and Institutional Level
(Alaa Ellidir, NCCW)
The National Council for Child Welfare (NCCW) is a platform bringing together representatives of several Sudanese government ministries. Created in 1991 as a national mechanism concerned with planning and coordination for all child-related action in Sudan and to follow-up the enforcement of the international and regional child conventions ratified by Sudan (topped by the Convention on the Rights of the Child (CRC)), it ensures since 2014 that the issue of female genital mutilation is brought to the agendas and integrated in the programs of all the represented ministries, through the Coordination Mechanism of the Abandonment of FGM in Sudan.
Why the coordination mechanism was established?
At some point, NCCW and its partners realized that their efforts in FGM abandonment were not sufficient. They soon realized that this was due to protesting from specific groups against the movement and a lack of coordination between the partners which caused scattering of efforts. The council then got to work to establish the mechanism.
Established in 2014 at a national level (NTF), it presently has 40 members. These members were carefully selected from different cross-cutting ministries that could join forces with NCCW to bring about FGM abandonment. After the success of NTF, in 2015 we established a STF in all 18 states of Sudan. In 2016, we started establishing LTFs. These task forces helped NCCW to mainstream our efforts in ending FGM.
Main successful points?
NCCW put together an administrative decree that ensured that the head was the secretary general of NCCW and the vice president was a member of MoH, to organise the mechanism. The rest of the members have been selected from various ministries including the ministries of: (social security, justice, guidance, media, education, culture and interior). There are also members who are freelance experts, parliamentarians, university professors and members from the National Centre of Curriculum and Assessment, and members from UN agencies and INGOs (who provide funding and help them to make their plans). There is not a big difference between the members of STFs but since LTFs are made up of communities, they have a completely different board of members compromising of mayors, sheikhs, leaders and midwives headed by the chief of the locality.
- One of the reasons why this mechanism has been successful is that all the members are decision makers in their respective ministries and therefore have a say in changing their ministry’s policies to mainstream ending FGM.
- Also, the mechanism went smoothly due to our quarterly meetings where the plans of FGM mainstreaming and achievements of each ministry are discussed and also the responsibilities of each sector are allotted.
- A very important factor of this mechanism is that NCCW is consulted about any decisions (such as new approaches, strategies and policies) related to ending FGM before they are taken. Of course, NCCW also consults the board before taking any decisions. For example, we present the board of the mechanism with Universal Periodic Reports before sending them to human rights councils.
The challenges faced?
- The main challenge we face is the mentality of the members of some sectors. Instead of participating in the mechanism, they believe it is better for them to work independently and this delays the mainstreaming of FGM abandonment.
- Also, the Ministry of Health believes that FGM is solely a health issue that should not be dealt with by other sectors.
- To this day, some groups are against FGM abandonment, especially midwives as they make an income from the illegal practice of FGM. These midwives would commonly fight against the mechanism.
- Another challenge they face is the neglect of protection network groups. These groups are volunteers who work with communities and grassroots to raise awareness about many negative practices such as VAC, HIV/AIDS, MR, RH and of course FGM.
The possible solutions to overcome the challenges
- They have had ice-breaking sessions with the MoH to make sure that it is on the same page as NCCW. The MoH then became the vice president of the mechanism due to an administrative decree.
- Another problem is the protesting of midwifes. They now have a member of the National Midwives Committee as a representative of Sudanese midwives on the board of the mechanism. They have been working with these midwives to inform them of the danger of practicing FGM and engaging them in small projects so they can still earn an income.
- They are planning on working alongside network protection groups in the future as they are an important means of raising awareness in various sectors.
- Faces the problem of the duplication of research related to FGM, they have established a Research Advisory Group made up by the members of the NTF, which reviews all research on FGM before publication.
- Their vision in 2019 is to introduce the topic of FGM into primary school curricula as a first step, and then into the curricula of medical schools. They are currently working on this as one of the members of the mechanism is from the National Center of Curriculum and Assessment.
They suggest doing
It would be useful to have the ministry of cooperation involved, as it is responsible for all UN agencies and their work in Sudan. Another crucial ministry is the ministry of foreign affairs because with its help, the members of the mechanism could take part in regional and international conferences and this would further help the mainstreaming of FGM abandonment as it would increase the capacity for discussion and the exchange of ideas.
=> The NCCW is a good example of the kind inter-ministerial commitment needed to promote the abandonment of FGM. The expansion of the platform is underway, with the inclusion of the Ministry of Cooperation and the Ministry of Foreign Affairs.