Tuesday, 26 November 2013

Abandoning FGM: Key Elements for change


Concrete field experience, together with insights from academic theory and lessons learned from the experience of foot binding in China suggest that six key elements can contribute to transforming the social convention of cutting girls and encourage the rapid and mass abandonment of the practice.


·         A non-coercive and non-judgmental approach whose primary focus is the fulfilment of human rights and the empowerment of girls and women is needed.


Communities tend to raise the issue of FGM when they increase their awareness and understanding of human rights and make progress toward the realisation of those they consider to be of immediate concern, such as health and education.


Despite taboos regarding the discussion of FGM, the issue emerges because group members are aware that the practice causes harm. Community discussion and debate contribute to a new understanding that girls would be better off if everyone abandoned the practice.


·         Awareness on the part of a community of the harm caused by the practice is needed. Through non-judgmental, non-directive public discussion and reflection, the costs of FGM tend to become more evident as women – and men – share their experiences and those of their daughters.


The decision to abandon the practice as a collective choice of a group that intra-marries or is closely connected in other ways. FGM is a community practice and, consequently, is most effectively given up by the community acting together rather than by individuals acting on their own. Successful

transformation of the social convention ultimately rests with the ability of members of the group to organize and take collective action.


·         An explicit, public affirmation on the part of communities of their collective commitment to abandon FGM. It is necessary, but not sufficient, that most members of a community favour abandonment.

A successful shift requires that they manifest – as a community – the will to abandon. This may take various forms, including a joint public declaration in a large public gathering or an authoritative written statement of the collective commitment to abandon.


·         A process of organized diffusion to ensure that the decision to abandon FGM spreads rapidly from one community to another and is sustained is important.


Communities must engage neighbouring towns so that the decision to abandon FGM can be spread and sustained. It is particularly important to engage those communities that exercise a strong influence. When the decision to abandon becomes sufficiently diffused, the social dynamics that originally perpetuated the practice can serve to accelerate and sustain its abandonment.

Where previously there was social pressure to perform FGM, there will be social pressure to abandon the practice. When the process of abandonment reaches this point, the social convention of not cutting becomes self-enforcing and abandonment continues swiftly and spontaneously.


·         An environment that enables and supports change.

Success in promoting the abandonment of FGM also depends on the commitment of government, at all levels, to introduce appropriate social measures and legislation, complemented by effective advocacy and awareness efforts. Civil society forms an integral part of this enabling environment. In particular, the media have a key role in facilitating the diffusion process.


Together we can end female genital mutilation for good.

Saturday, 23 November 2013

Diversity awareness when redressing victims of FGM

Victims of FGM always suffer physically, mentally and psychologically and lack of support in some cases has left many in pain and distress of many kinds. There are things to consider when offering support.


Women and children who have had FGM may need access to a variety of services such as:

  • counselling and psychiatric support through statutory or voluntary services because of psychological trauma, relationship or psycho-sexual difficulties
  • infertility
  • uro-gynaecological services including surgical reversal of infibulation (known as deinfibulation being done in London)
  • an easily accessible interpreter service with workers who appreciate the problems facing children and women who have been cut, and also those of refugees and asylum seekers. It is very important that women do not find themselves relying on family members for interpretation when dealing with health care professionals.
  •  Children should never be used for interpreting purposes.
  • Communication with women, even if interpreters are not required, needs to be clear, using straightforward language and explanations.
  • Pictures or diagrams may help. It is important to listen without interruption, avoid rushing or providing too much information at once, and check that women have understood.

All services should be open with flexible access and collaboration between agencies.

Women may be very unwilling to come forward for help, or may be unaware of what is available, or not know how to ask. They may find it difficult to raise the topic with health care staff because they know that practitioners may have limited awareness of FGM, and may respond in a negative manner. For this reason, nurses and midwives who come into contact with them should to be alert to this, and take opportunities to enquire sensitively and offer support and referral to specialist clinics. Generally, women are likely to prefer female carers to male.

It is important for women and girls to have access to specialist services. Currently there are few specialist clinics available countrywide. This is why it is important for nurses, particularly those already working with these women and children, their families and communities, to have the appropriate specialist learning and skills to work effectively with this client group.

It is important to note that health care professionals may not need to provide all services. Support groups and organisations have a very important role to play.


Thursday, 21 November 2013

Female Genital Mutilation and Health Care Professionals


Things to think about:

Acting in discriminatory ways or from racist motivations are other reasons why it may be difficult to deal with girls and young women who need safeguarding because of FGM.


Children’s needs for protection are the same whatever their cultural background, saying ‘a child is a child regardless of COLOUR.


Raising awareness about the socio-cultural, ethico-legal, sexual health and clinical care implications involved in FGM is essential.


Education and training needs to be provided for all health and social care professionals who may work with affected women and girls and with their families.

It is also important to consider the issues of ethnicity, custom, culture and religion in a sensitive manner.


Professionals should explore ways of resolving problems about the continuation of this practice in ways that involve clients with their full participation.


Education of male partners and community leaders might reduce the number of children, young and older women who suffer in the future.


Practices like FGM have been ingrained for many generations, and will

require extensive cultural education to address the issues thoroughly and effectively.


FGM should be a part of sexual health education in all preregistration

and post-registration programmes for nurses, midwives and health visitors. It is equally essential to raise awareness and the seriousness of the issues among teachers, school nurses and social service staff.


Training around FGM should include the following:


  • overview of FGM (what it is, when and where it is performed)
  • socio-cultural context
  • facts and figures
  • UK FGM and child protection law
  • FGM complications
  • pregnancy, labour and postnatal periods
  • safeguarding children – principles to follow when FGM is suspected or been performed
  • roles of different professionals.




Women and girls who have been cut need particular and sensitive support and facilities to help them deal with the physical, psychological and social consequences.


Change can only take place to keep women and girls safe if practising communities are involved at all stages of child protection and service provision.

All professionals, the practising communities and the public have a role to play to make a difference.


Tuesday, 5 November 2013

Female Genital Mutilation: Origins of beliefs, values and attitudes

Beliefs, values and attitudes are formed and developed under a multitude of influences – our parents, families, society, culture, traditions, religion, peer groups, the media (TV, music, videos, magazines, advertisements), school, climate, environment, technology, politics, the economy, personal experiences, friends, and personal needs. They are also influenced by our age and gender.

The development of a value system

A value system is a hierarchical set of beliefs and principles which influence an individual or group’s outlook on life (attitude) and guide their behaviour. A value system is not rigid, but will be subject to change over time, and in the light of new insights, information and experiences.

Beliefs, values and attitudes and the practice of FGM

The practice of FGM is supported by traditional beliefs, values and attitudes. In some communities it is valued as a rite of passage into womanhood (For example in Kenya and Sierra Leone).

Others value it as a means of preserving a girl’s virginity until marriage, (For example in Sudan, Egypt, Ethiopia and Somalia). In each community where FGM is practised, it is an important part of the culturally defined gender identity, which explains why many mothers and grandmothers defend the practice: they consider it a fundamental part of their own womanhood and believe it is essential to their daughters’ acceptance into their society. In most of these communities FGM is a pre-requisite to marriage, and marriage is vital to a woman’s social and economic survival.

Behavioural scientists have demonstrated that in changing any behaviour, an individual goes through a series of steps .These are as follows:

1. Awareness.

2. Seeking information.

3. Processing the information and “personalizing” it –i.e. accepting its value for oneself.

4. Examining options.

5. Reaching a decision.

6. Trying out the behaviour.

7. Receiving positive feedback or “reinforcement”.

8. Sharing the experience with others.


According to this model, someone making the decision to reject FGM – whether that person is a mother, grandparent, father, husband, aunt, teacher, older sister, or a girl herself – will go through a process that starts with realising that rejection of FGM is an option. This will be followed by the person finding such a choice desirable; reaching the decision to reject FGM;

figuring out how to put this decision into practice; doing so and seeing what happens; and then receiving positive feedback from others that encourages the person to continue with their stand against FGM. The final stage is when the person feels confident enough in their decision to “go public” with it – i.e. share their reasoning and experience with others, thus encouraging them to follow the example. This is called the “multiplier effect”. At every step, and whoever the person is, there is the risk of failure, and individuals must struggle with the personal and wider repercussions of the choice they have made.

Community involvement

Community involvement means working with the people, rather than for them, to answer their needs and find solutions to their problems. It is a process whereby the community is encouraged to take responsibility for its problems and make its own decisions as to how to solve them, using its own resources and mechanisms.

Involving communities in the fight against FGM means working together towards changing their beliefs, values and attitudes regarding the practice. The objective is to allow people to reach their own conclusion that change is necessary and thus have a sense of ownership of this decision.

Strategies for involving individuals, families and communities in FGM prevention

The primary objective of community involvement strategies is to encourage ownership of any decision reached by an individual, a family, a group, or the entire community, to change behaviour regarding FGM.

Health professionals, Teachers and social workers are respected and listened to by individuals, families and communities and have a major role to play in promoting education against FGM. Some are already members of non governmental groups working to bring about change in their communities on the practice.

The first requirement is to learn about the practice and to be clear about the reasons given by people for practising it.

It should be remembered that FGM is not just a health issue but a gender and human right issue, therefore the solution to the problem lies not just in giving information on health consequences of FGM but to advising on the various dimensions of the problem. The ‘front-liners’ role is to contribute to the change process.

They can assist individuals, families and communities in the process of changing their behaviour and practice as regards FGM by:

Integrating education and counselling against FGM into day to day nursing and midwifery practice

Identifying influential leaders and other key individuals and groups within the community with whom they can collaborate and could be used as change agents

visiting individual people or groups in the community, as appropriate

establishing small focus groups for discussions. These discussions should be interactive and participatory, allowing the people themselves to do most of the talking

assisting the people to think through the practice of FGM and its effects on health and on human rights

identifying resources within the community that could be used in the prevention programme

● suggesting strategies for changing practice, e.g. a culturally acceptable alternative ceremony to mark the rite of passage (Kenya) and teaching women problem solving skills (Tostan, Senegal)

● supporting individuals and families to cope with the problems of FGM and with adjusting to change.

Remember to work with the community not against them. FGM is child abuse and violence against women and children. Let’s fight it. Any preconceived notions or insensitivity towards the practice may turn a community against outside help and therefore add to the difficulty of addressing the original issue.