Four years ago February 6, the internationally recognized day against female genital cutting (FGC) was barely marked in the press; this year there will be a huge outpouring of comment, discussion and awareness raising across the globe. The movement that had been envisaged by so many campaigners for so many years is finally happening.
The theme this year is "Mobilization and Involvement of Health Personnel to Accelerate Zero Tolerance to Female Genital Mutilation". It's all a bit of a mouthful and might make some people pause -- surely no health personnel would support or participate in the forcible removal of a girl's external genitals? It may shock you to know that in fact, 18 percent of all FGC globally now takes place in a medical environment.
There are 3 million girls a year at risk of being cut. This means that in 2015, more than 540,000 girls are at risk of being cut by health personnel, who in turn are probably earning an income from practicing FGC. That's the sort of fact that really keeps me awake at night.
In Egypt, the statistics say that 77 percent of all FGC is carried out by health personnel. This was tragically highlighted by the death of 13 year old Suhair al-Bata'a who died from complications after being cut, and the consequent conviction of Dr Raslan Fadl for "manslaughter, negligence, endangering the child's life ... and for performing FGM". This conviction only happened on appeal, as a result of an outcry from civil society and it shows how much work is needed to address the issues around the medicalization of FGC.
Aziza Kamil, leader of the Cairo Family Planning Association's project on FGM, is one who has argued strenuously against recent attempts to promote less extreme forms of FGM, performed under medical supervision: "No action will entrench FGM more than legitimising it through the medical profession."
More Than Just an African Issue
We know too that in parts of Asia and the Middle East, where we unfortunately have less data, the medicalization of FGC is on the rise. In June last year, the Indonesian Government appeared to repeal medical guidance, which laid out in startling clinical detail how to cut young girls.
Closer inspection showed a deliberate muddling of terms, trying to make a distinction between "circumcision" and "mutilation". This in itself was simply misleading. The circumcision as defined in the guidelines is clearly still FGC, given that the WHO prohibit, "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons".
At Orchid Project, and across civil society, the stance remains firm: FGC is a human rights violation and every girl has the right to remain free from cutting in any form.
Who Are the Health Personnel Who Carry Out FGC?
"Health personnel" is a wide term and could mean many different people across the care spectrum. From a time a girl is born she is at risk of being cut and so midwives, nurses, doctors and carers can all either prevent FGC or ensure that it is done. In many communities, traditional birth attendants are also the cutters. This shows the pivotal role that health workers play. It is vital that everyone has access to training and support to understand the implications and consequences of the practice. This was demonstrated in the UK this week with the acquittal of Dr Dhanuson Dharmasena, charged with carrying out FGC -- the judge commented, "It is no doubt in this case that Dr Dharmasena had been badly let down by a number of systematic failures which were no fault of his own."
Ending FGC begins with a community-led response, as we know that it is at this level that change happens. Just as importantly, human rights-based education allows communities to come to an understanding of their own rights and collectively make the decision to abandon cutting. This work should be supported by other elements, such as training and support for healthcare personnel, political support and awareness-raising. It is not sufficient to simply focus just the health benefits of not cutting, otherwise communities might choose or justify FGC on the basis of health mitigation.
Equally if only health personnel or cutters abandon the practice, without the community also deciding to abandon, all that happens is that parents simply look further afield for someone willing to perform FGC. We therefore must support health care workers to be a part of wider, community level change.
Building on Momentum
When I founded Orchid Project almost four years ago, I could not have dreamt how much progress would be seen on this issue. There has been a UN General Assembly Resolution to end FGC, investment both domestically and overseas by the UK Government, thousands more communities abandoning across Africa and a much greater, broader willingness to engage on the issue at every level.
But more is needed.
We call on international organizations and others to step up. We need WHO to show leadership to act on their global guidelines for ending medicalization of the practice; we need medical professional bodies to ensure their members also adhere to guidelines. We say FGC can end in the next generation, but once the practice is legitimized like this, it becomes more and more of an uphill task.