I have written a few times on this blog about the practice of FGM as a horrific violation of women’s bodies that, apart from stripping them of bodily integrity, also has many long and short term health risks. Today I want to think not about why it must stop now (duh) but about how it can stop, what we can do to actually make it stop. Fine words and awareness-raising are just so much hand-wringing unless we actually get out there and make something happen.

The most obvious step is to change the laws. There are still many countries where FGM is lawful or where only the most extreme forms are prohibited. And we need to ensure that no country will refuse asylum or refugee status to a girl or woman fleeing from FGM. It is only very recently that even in the UK the risk of being subject to FGM has been recognised as giving a girl or woman the right to be granted refugee status here.

But legal changes can only ever be a small part of the solution. There is no point in changing the law unless people will comply with the law. This means either rigorous law enforcement or more realistically (especially but not only in countries where police forces are overstretched, underfunded, uninterested or plain corrupt) voluntary abandonment of the practice by the communities where it is currently entrenched.

How can communities be persuaded to abandon FGM? The obvious answer is to tell them that FGM is dangerous, and a violation of women’s human rights and human dignity, that it can kill. But many adherents to the practice know that already, and they still do it. So telling them again and highlighting the dangers as best we can might help, slowly, in some cases: but it won’t eradicate FGM any more than telling people that smoking is bad for them will eradicate smoking.

So telling them not to do it doesn’t work. Telling them how bad it is doesn’t work. Why not? Clearly there are reasons people want to carry out FGM on their girl children which go deeper than “because we’ve always done it”. These communities experience benefits from FGM which outweigh the health risk to the child, which outweigh any right to wholeness that she may have, which outweigh any risk of legal repercussions.

The Population Council has an FGM (FGC) page with lots of resources about anti-FGM actions that have been tried, and evaluation research that has been carried out to identify the best approaches to FGM eradication. I’m not even going to try and summarise the various reports and assessments on there, but having read through a number of them I can suggest that a few common strands do emerge.

One is that the most successful approaches were participatory, involving the whole community in discussing FGM and thinking about their own behaviour, with a view to making and sustaining a voluntary commitment to changing the behaviour.

Another is the importance of projects being focussed on specific, whole communities. The admirable organisation Rainbo has developed a framework (which it calls “Women’s Empowerment and Community Consensus”, or WECC) which recognises that communities cling onto FGM because they get something out of it and that we must therefore do more than threaten or preach: we must also understand the community needs that FGM satisfies, so that we can help the women and men who “benefit” from FGM to find alternative ways of satisfying those needs.

This approach can be seen in the following two reports, which aimed at designing an approach to FGM eradication focussed on specific communities by looking at the reasons why FGM is practised within those communities:

  • A 2004 Frontiers report found that the reasons for cutting in the Islamic Somali community in Kenya included “religious obligation, family honor, preserving virginity as a prerequisite for marriage, prevention of extramarital as well as premarital sex, and aesthetics” (but not as an initiation rite). The approach recommended was then a religious-based approach, combined with medical information, to show that this is a traditional practice that is contrary to Islamic dictates because of the harm it does.
  • A similar report focussed on the Christian Abagusii community in Kenya where the reasons cited were “tradition, cultural identity, symbolic maturity, control of women’s sexuality and fidelity, and marriageability” and where it was found that despite being illegal, most cutting is performed (albeit unofficially) in clinics by nurses and midwives. Here the approach recommended was to mobilise health workers by educating them about legal and medical issues, addressing the financial incentives they have for performing FGM (they are well paid), and encouraging them to advise their clients against the practice. The involvement of health workers and education about health risks was already having some benefits in reducing the severity of the cutting, and in some cases limiting cutting to a symbolic prick of the clitoris.

Finally, sadly, it is clear that FGM abandonment is a lengthy process, that does not happen overnight.

One model for this process is the progressive diffusion of anti-FGM attitudes. For example, this might involve “converting” community members and encouraging them to go out and “convert” their own family and friends so that eventually the tiny minority who are prepared to stand up against FGM within that community grows and grows, with the expectation that eventually not cutting will be the norm. There is evidence of some success at this approach, although no evidence of any community where this approach has made a dramatic impact even over the long term.

A different model is to involve a whole community, a whole village, so that the community arrives together at a decision to stop FGM – each member of that community lending support (and peer pressure) to the change. This again cannot be done overnight. First, you have to get the whole village involved in actually thinking about and questioning FGM – using medical and human rights information distributed through health and literacy programs; encouraging religious leaders and other influential individuals including health workers to openly condemn the practice; and empowering grassroots anti-FGM advocates. The next step is to support people through the transition from thinking about change to actually making the change, with an element being to address fears of social exclusion for uncut women: alternative rites is one strategy; another is to bring whole villages to make an “FGM-free” declaration that will help to reduce fears of ostracism. There is evidence that this whole-community approach can work in the longer term.

So what can we do? It is frustrating that the process is slow, it is frustrating that there is no easy answer, no quick fix. No petition to sign, no angry letter to write, no big corporation to boycott. What can we do? As outsiders, it seems to me that all we can do is to support the grass-roots movements and projects, to support people who are actually out there doing it. Donating what we can, and hand-wringing otherwise.

It seems so little, and meanwhile the cutting goes on.