11/24/2014 02:33 pm ET Updated Jan 24, 2015

Female Genital Mutilation

Nivo Kisenge RN was training 10 Maasai women to be birth attendants. Their village of Nadaruru was about eight miles away and the women walked both ways daily and usually they were accompanied by Mama Maria, the elder woman of the tribe. Despite her arthritis Mama Maria wanted to learn what these women were learning. Her prestige had been instrumental in getting approval for this project, designed to reduce the high rate of maternal and infant mortality and she wanted to be sure that this knowledge would help the women of the tribe.

One day, Nivo was describing Female Genital Mutilation and its short term and long term negative consequences. This is an ancient custom among the Maasai in which a young girl's clitoris is removed. Women are strongly in favor of this mutilation, at least in part because girls who do not have this procedure are considered unsuitable for marriage. Not only is the procedure extremely painful, but there is immediate risk of severe bleeding or infection. Long term consequences resulting from scarring can be sterility or difficulty in vaginal delivery.

As Nivo was completing this discussion, Mama Maria said, "Stop. I will be right back." She returned a few minutes later with Chief Isaiah of the Nadaruru Maasai. He has been a progressive leader who built a primary school for the tribe's children and even allowed the girls to attend classes. He also supported the Birth Attendant training program. When Mama Maria and the Chief arrived, she told Nivo, "Say that again."

After Nivo repeated her lecture on the immediate and long term risks of FGM, the Chief said, "There will be no more of these." He canceled three of them that were to be done during the next week, saving these young girls from this disfiguring procedure.

When Nivo told my US team this news, we asked Chief Isaiah and Mama Maria if they would be willing to talk to other tribes about the dangers of FGM. They agreed and they developed a plan for visiting five nearby villages. Because Chief Isaiah and Mama Maria have high status in this part of Tanzania, they were received by the elders of each of the villages and the men listened respectfully. The presentation focused mainly on family planning but there was also a focus on the problems associated with FGM. Each village selected two representatives who would go to Nadaruru for additional discussion and training which will happen soon.

While this was a positive development, we realize that it will be difficult to end this ancient custom. Likely the main opponents will be women who want their daughters to be acceptable to men as marriage partners. We also expect resistance from the person, usually a woman, who gets paid for doing these procedures. This will be a long-term effort, but we are determined to change the minds of Maasai men about the acceptability of women who have avoided FGM as wives. If we can do that, the mothers will be less anxious about forcing their daughters to undergo FGM. The remaining obstacle will be those women who perform the procedure. Perhaps we will overcome this obstacle by taking a leaf from the US Department of Agriculture and pay them for not performing FGM.