Politicsay: Interview with Nankali Maksud, Senior Child Protection Specialist at UNICEF
What are the latest global data points on the number of girls being cut?
At least 200 million girls and women alive today living in 30 countries have undergone Female Genital Mutilation or Cutting (FGM). Available data from large-scale representative surveys show that the practice of FGM is highly concentrated in a swath of countries from the Atlantic coast to the Horn of Africa, in areas of the Middle East such as Iraq and Yemen and in some countries in Asia like Indonesia, with wide variations in prevalence. The practice is almost universal in Somalia, Guinea and Djibouti, with levels over 90 percent, while it affects only 1 percent of girls and women in Cameroon and Uganda.
See data.unicef.org and within the latest publication Female Genital Mutilation/Cutting: A global concern
What are some of the initiatives or policies that UNICEF is implementing in order to reduce the practice globally? Additionally, what are some of the challenges from an organizational perceptive in creating and/or enforcing the said policies?
UNICEF’s Global Initiative to End FGM
In 2008, 10 UN agencies issued an interagency statement calling on all States, international and national organizations, civil society and communities to uphold the rights of girls and women by supporting the abandonment of FGM. In 2007, UNICEF and UNFPA launched the largest global programme to address FGM, the UNFPA-UNICEF Joint Programme on FGM: Accelerating Change, with the goal of ending the practice in one generation. Today the programme works in 17 countries: Burkina Faso, Djibouti, Uganda, Egypt, Ethiopia, Eritrea, Gambia, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Nigeria, Senegal, Sudan, Somalia and Yemen.
UNICEF is also supporting programmes focused on eliminating FGM in eight additional countries that are not part of the Joint Programme. They are: Togo, Niger, Chad, Sierra Leone, Liberia, Central African Republic, Côte d’Ivoire and Niger.
There are numerous social drivers and root causes of FGM stemming from gender inequality including: a desire to control female sexuality, supporting religious narratives, ritual marking of a girl’s transition to adulthood, limited access to education and economic opportunities for girls and women, and assurance of girls’ or women’s social status, chastity or marriageability.
The Joint Programme includes three key interventions for ending FGM:
- The development and implementation of anti-FGM policies and legislation.
- Access to health, education, and legal services that support prevention and protection for girls at risk of FGM, as well as provide care for girls and women who are affected by FGM.
- Social norms change that involves working with families, communities, and religious and community leaders to shift attitudes that support the end of FGM.
What challenges do UNICEF and the global community face in eliminating FGM
There are several challenges that we face in the global elimination of FGM.
Firstly, there is a gap in the protection afforded by existing legal frameworks. Most countries have criminalized FGM 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 country. This fails to recognize the obligation of countries to protect all children within their jurisdiction and does not take into consideration the mobile, transnational character of practicing communities. A further challenge is an 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.”
Another major challenge in ending FGM is the rising trend of medicalization in countries such as Egypt and Sudan where health professionals are often complicit, performing the procedure themselves. Within the Joint Programme, there are seven countries in which more than one in 10 girls who have undergone FGM are cut by health professionals: Egypt, Sudan, Guinea, Djibouti, Kenya, Yemen and Nigeria. In these countries, more than 20 million girls and women have undergone FGM at the hands of a health professional. This wrongly legitimizes the practice and creates the inaccurate impression that it is beneficial for girls’ and women’s health, violating the fundamental ethical code that requires that physicians, nurses, and midwives “do no harm” to any patient. Allowing health professionals to perform the practice is often the logical response of parents who are under social pressure to have their daughter undergo FGM, 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.”
Additionally, there are challenges in the standard measurement of FGM prevalence which is the percentage of girls and women aged 15 to 49 who have undergone FGM. The issue with this indicator is the time lag between when the cutting occurred and when it is reported. The time lag will vary depending on the current age of the respondent and the age at which she is cut. For example, in a country in which the mean age at cutting is one month old, respondents aged 15 to 19 are reporting on an event that took place an average of 15 to 19 years before the survey. In this case, the impact of recent campaigns aimed at ending FGM will not be reflected. A second challenge in evaluating the prevalence of FGM is the degree to which the practice, and the interventions to prevent it, are localized. While interventions may address areas in which the practice is concentrated, the extent to which the target population represents the national practicing population will affect the potential impact on national prevalence.”
The majority of FGM-prevalent countries (22 of 30) are least-developed countries, and the population of the least-developed countries is expected to reach over 1.9 billion by 2050. All 30 FGM-prevalent countries with available data are experiencing high population growth and a young age structure, with 30 percent or more of their female populations under the age of 15. As a result, one in three of all girls worldwide will be born in the 30 countries with national FGM prevalence data by 2030. This means an increase in the number of girls globally at risk of FGM. Overall, the observed reductions in the prevalence of FGM are not sufficient to offset the expected population growth.
Which countries or regions have been more receptive to removing the practice?
While the exact number of girls and women worldwide who have undergone FGM remains unknown, at least 200 million girls and women have been cut in 30 countries with representative data on prevalence. These 30 countries include: Tanzania, Togo, Ghana, Kenya, Burkina Faso, Iraq, Benin, Cameroon, Uganda, Niger, Eritrea, Côte d’Ivoire, Guinea-Bissau, Ethiopia, Senegal, Yemen, Central African Republic, Indonesia, Nigeria, Liberia, Mauritania, Sudan, Djibouti, Chad, Egypt, Gambia, Somalia, Sierra Leone, Guinea, and Mali.
In 21 countries of these countries, there has been an overall decline in the practice over the last three decades, but not all countries have made progress and the pace of decline has been uneven. Fast decline among girls aged 15 to 19 has occurred across countries with varying levels of FGM prevalence including Burkina Faso, Egypt, Kenya, Liberia and Togo. In the following seven countries, levels of FGM are at least as high among adolescent girls as among older women: Somalia, Djibouti, Mali, Gambia, Guinea-Bissau, Senegal, Uganda, and Niger. Yet, in most countries in Africa and the Middle East with representative data on attitudes, in 22 out of 29 countries, the majority of girls and women think FGM should end.
Since the launch of the Joint Programme, 13 of the 17 countries have legal and policy frameworks banning FGM – Burkina Faso, Djibouti, Uganda, Egypt, Ethiopia, Eritrea, Gambia, Guinea, Guinea Bissau, Kenya, Mauritania, Nigeria, and Senegal. Of the four countries that do not have anti-FGM legislation, Sudan and Mali are close to adopting similar laws, whereas Somalia and Yemen face unstable security situations and challenging humanitarian crises making policy reform difficult. Capacity development of the judiciary system and law enforcement led to about 700 cases of the enforcement of FGM legislation.
National government coordination mechanisms, which facilitate collaboration between all stakeholders including government, civil society, communities, and donors, have been established in 17 countries, and decentralized committees are actively monitoring the practice. The following 12 countries have established budget lines to specifically address FGM: Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Guinea, Kenya, Mali, Mauritania, Senegal, Sudan and Uganda. Introducing a budget line on FGM in the public budgeting process is an important tool, making it possible to measure the scope of public policies on girls and women at risk of and affected by FGM.
In all Joint Programme countries, policies and plans of action related to gender, sexual and reproductive health, and gender-based violence have integrated FGM.
In what ways do local governments support your initiatives? Do you receive significant opposition?
Governments play a key role in developing and implementing national action plans and establishing a national budget line for addressing FGM; developing and implementing policies and legislation for ending FGM, and ensuring access to quality services for girls and women at risk of and affected by FGM. Governments in countries that are part of the Joint Programme are committed to ending FGM. The question is often whether they have the capacity and resources to meet the needs of girls and women at risk and affected by FGM.
As Member States to the UN and signatories to the Universal Declaration of Human Rights (UDHR), the Convention on the Rights of the Child (CRC), and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), governments are responsible for protecting the rights of girls and women including the right to health and bodily integrity. Additionally, Member States unanimously adopted the 2030 Agenda for Sustainable Development which includes a Sustainable Development Goal (SDG) on gender equality, Target 5.3 which specifically commits Member States to ending FGM. This inclusion is a major result of years of effort by the Joint Programme, in partnership with a broad coalition of governments, civil society organizations, and activists and advocates for girls’ and women’s rights. Target 5.3 is more than words on paper – it commits governments to ending FGM, and it means that progress in this area will be closely monitored for the next 15 years.
What are the biggest health risks that come from procedure?
FGM has no known health benefits. On the contrary, it is known to be harmful to girls and women in many ways. First and foremost, it is painful and traumatic. The removal of or damage to healthy, normal genital tissue interferes with the natural functioning of the body and causes several immediate and long-term health consequences. For example, babies born to women who have undergone female genital mutilation suffer a higher rate of neonatal death compared with babies born to women who have not undergone the procedure.
The practice often compromises the natural functions of girls’ and women’s bodies and has a profoundly detrimental impact on the health of women and girls, including their psychological and sexual and reproductive health. The short-term consequences of FGM can include death from hemorrhaging and severe pain, trauma and infections that may result from the procedure. Long-term consequences can include chronic pain, infections, decreased sexual enjoyment and psychological consequences, such as post-traumatic stress disorder. The practice is also associated with increased risks of birth by caesarean section, postpartum haemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant, low birth weight in infants and inpatient perinatal death.
From your experience, is the practice growing or diminishing? Are attitudes changing?
Overall, the practice of FGM has been declining over the last three decades. In the 30 countries with nationally representative prevalence data, around 1 in 3 girls aged 15 to 19 today have undergone the practice versus 1 in 2 in the mid-1980s. However, not all countries have made progress and the pace of decline has been uneven. Attitudes are changing. As previously mentioned, the majority of girls and women in countries with data on FGM prevalence believe the practice should end. Of the 18 countries that are capturing data around the attitudes of men and boys towards FGM, in 12 countries the majority of men and boys believe the practice should end. The challenge for UNICEF is to translate these attitudes into action which requires addressing the complex social dynamics associated with the practice that is intergenerational and socially entrenched.
Again, population growth means more girls are at risk in some of the poorest countries in the world. Although FGM is decreasing in many countries, these declines are being outpaced by demographic growth. If current trends continue, the number of girls and women undergoing FGM will continue to increase, and the absolute number of girls that have gone through the practice will be higher by 2050 than it is today.
What are some achievements worth mentioning in regarding to FGM and women’s empowerment?
Joint Programme Achievements in Supporting the End of FGM and Girls’ and Women’s Empowerment
For UNICEF, ending FGM lies at the heart of girls’ and women’s empowerment, giving girls and women a basic and fundamental choice to protect their health and their future. Girls and women who remain intact are healthier, more likely to finish school and avoid early marriage. Over the last ten years, working in partnership with governments, civil society, development partners and communities, the Joint Programme has made significant progress in eliminating FGM by:
- Reducing the prevalence of FGM: The practice is declining in all of the Joint Programme countries.
- Promoting community-led engagement: More than 25 million individuals in over 18,000 communities in 15 countries in the last 10 years made public declarations of abandonment of FGM increasing the chance that these girls will remain intact.
- Strengthening political commitment: 13 countries have legal and policy frameworks banning FGM. Almost 700 enforcement cases have been reported in the last four years.
- Increasing government ownership: 17 countries have a national mechanism to coordinate FGM responses in place; 12 countries established budget lines for related services and programmes.
- Improving access to appropriate and quality services: More than 2.3 million girls and women benefited from FGM-related protection and care services (in the last four years of the Joint Programme). FGM prevention information has also been mainstreamed into the curricula of schools, from primary to tertiary, and in some countries, in medical, paramedical and social worker training programmes.
Current UNICEF Campaigns for ending FGM
As a result of global efforts such as the Joint Programme, critical progress is being made in ending FGM. Today, a girl is about one-third less likely to be cut than 30 years ago. A major challenge is sustaining the achievements that have been made while addressing the population growth that puts more girls at risk of being cut. By 2030, more than one in three girls worldwide will be born in the 30 countries where FGM is prevalent, with projections that as many as 64 million girls aged 0 to 15 will be at risk of FGM.
In January 2018, UNICEF and UNFPA will be launching Phase III of the Joint Programme to strengthen the involvement of regional political bodies to create a more enabling environment, increase political accountability at the national level, harness the potential of youth to enhance gender equality and end FGM, and scale up the social movement to end FGM. Such interventions are critically needed to accelerate the ongoing effort and achieve meaningful impact in addressing the practice of FGM.
The launch of Phase III marks a critical juncture and opportunity to consolidate the considerable gains made by the programme in the last nine years while also addressing the growing number of girls and women affected by and at risk of FGM. Through the Joint Programme, UNICEF will help accelerate the elimination of FGM by elevating attention, resources and accountability so that girls and women may realize their rights, contributing to the health and productivity of their families and communities and improving prospects for the next generation.
What are some of the actions regular citizens can take to help reduce this practice?
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