Ending Female Genital Cutting: Lessons From a Decade of Progress

"Interventions should focus on holistic, integrated, and multisectoral approaches that bring together the advocacy, policy-level work, and community-level transformation of social norms."

This is one recommendation from a 24-page report that reflects on and discusses efforts to promote the abandonment of female genital mutilation/cutting (FGM/C) over the last decade. It synthesises lessons learned from interventions and outlines insights to strengthen future programmes. It is intended to provide policymakers and advocates with perspectives on how to better move forward to create the conditions needed to end FGM/C. Overall, the review and interviews suggest that there has been significant progress in building momentum for change, with particular successes in advocating for improved policies and laws. There have also been positive efforts to engage communities, including chiefs, religious leaders, and other community influencers, in support of women and girls' rights.

The report looks at how donors such as the United States Agency for International Development (USAID) have incorporated FGM/C into their development agendas, while regional and international high-level conferences and working groups, as well as the United Nations, have addressed the topic as a priority issue. At the same time, there have been wide-ranging initiatives on the ground that create awareness, provide alternatives to this traditional practice, and involve whole communities in constructive dialogue. This report is based on a desk review of resulting evaluations, studies, systematic reviews, and donor and project reports since 2000, as well as key informant interviews with those who have been part of this movement.

The report outlines how some early interventions, such as medicalisation and alternative income-generating activities for excisors, did not result in the intended benefits. Other, more promising, approaches are noted, with the observation that approaches may not be successful across contexts. For example, the Alternative Rites of Passage (ARP) approach first introduced in Kenya in 1996 was found to offer a new kind of "coming of age" ceremony, rather than cutting, but only worked alongside intense community awareness-raising in local languages that took part in communities where FGM was conducted as part of a public ceremony (not in areas where the practices was considered a private practice that happens in the home). Similarly, the Positive Deviance approach, which centres on individuals within local communities who choose not to practice FGM/C, offers some promising results, but mobilising larger social networks and adding a strong media component could support greater reach of such approaches.

The report states that the most promising practices are those that recognise FGM/C as a social norm, which requires nuanced understanding of the reasons behind the practice, while also recognising the multiple possible influencers in a community. There is a need to create conditions in which communities can make collective changes in central social norms, rather than rely on individual families to effect change on their own. The actors playing a part in change include: men, women, grandmothers, boys, girls, and community, religious, and political leaders. The case study of Tostan in Senegal is discussed. This programme is designed to empower communities through education on human rights, hygiene and health, literacy, and project management, leading to social change. "Tostan uses an organized diffusion approach to maximize the spread of information and ideas from program participants to others within the community and to neighboring communities. Fundamental to the organized diffusion approach is the use of public declarations when communities decide to abandon harmful traditional practices, such as FGM/C and early marriage. Although abandonment of FGM/C was not an original objective of the program, more than 6,000 communities have declared their abandonment of FGM/C."

Other approaches have included fostering dialogue - for example, among religious leaders about the religious understandings around FGM/C, among generations. "The Intergenerational Dialogue approach, promoted by GTZ [German Organisation for Technical Cooperation] and implemented in Mali, Kenya, and Guinea, is a participatory approach to engaging members of the community across sexes and generations to feel empowered to change behaviors. The goal of this approach is to build people's communication skills and confidence to articulate viewpoints and learn how to bring about collective change."

According to the report, media campaigns can play a crucial role in informing communities, promoting dialogue, and changing social norms, particularly when they are part of larger abandonment efforts. A campaign launched by The Tanzania Media Women's Association's (TAMWA) in 2002 used television and radio spots, posters, and newspaper and magazine articles to raise awareness and dialogue. An information kit was produced to sensitise and educate journalists around the issue, as well as to guide them in addressing it with strong but resonant positive and non-judgmental messages.

Reflecting on the findings, a number of other lessons learned are outlined, including the importance of evaluation and research. It is noted that changes to the practice of FGM/C have also been seen in the context of larger gender programmes, which seek to improve the education, health, and socio-economic status of women and girls. There is also a need to have greater focus on engaging men and boys, as they often have less support for the practice and can influence what happens in the family. However, overall, there is a need for greater data and understanding about how, when, and by who decisions are made when it comes to FGM/C.

The report offers the following recommendations related to communication, among others:

• "Interventions should focus on holistic, integrated, and multisectoral approaches that bring together the advocacy, policy-level work, and community level transformation of social norms." Social change is more likely to occur when it is community driven, and this requires engaging family and community influencers across various levels in sustained, constructive, and critical dialogue. This should also be considered when advocating for legal change at the local level in order to ensure the readiness of the practicing communities.
• "FGM/C must be addressed as part of broader gender." Some believe that changing gender norms and FGM/C abandonment must be linked. Providing communities with opportunities to discuss gender equity and the practice of FGM/C can result in the issue being raised more organically by the community itself.
• "Governments must commit to comprehensive implementation of the law." The implementation of laws banning the practice of FGM/C suggests significant progress, but there is a need for this to be supported by implementation at the local level, which includes intense community awareness-raising about both the law and the advantages of ending the practice.
• "Women who have been cut have health issues that need to be addressed." There is a need to educate healthcare providers on the health needs of women who have already been cut. These efforts can also be combined with engaging with healthcare providers as potential agents of change.