Articles on Shifting Sands
Ethiopia is making steady progress on FGM
My recent holiday in Ethiopia afforded me an opportunity to consider the types, prevalence and incidence of FGM there and to talk with frontline healthcare workers about their perception of the progress being made in reducing the practice there.
My assessment is that steady progress is being made, particularly in urban areas. This is best understood in the context of social progress, improved access to education, economic development and better employment opportunities.
Ethiopia is Africa’s second most populous nation of approximately 90 Million people. Although largely agricultural, it has one of the fastest growing non-oil economies in Africa with a rapidly growing urban population. Just as London streets were once thought to be paved with gold, the influx of rural dwellers hope that the streets of Addis Ababa are also.
The capital’s urban sprawl bears testament to its growing attraction as a potential source of employment opportunities due to industrialisation, manufacturing and infrastructural development, much of it as a consequence of Chinese investment.
Cities like Dire Dawa, Harar, Dessie, Nazret, Bahir Dar and Awassa are similarly expanding and are attracting people from rural areas.
The country has also seen a welcome and dramatic increase in educational access in recent years with attendance at elementary school now estimated at over 90 per cent. Secondary school attendance is also increasing and is free. Tertiary education is popular and is paid for by the state. Once employed, graduates are expected to repay associated costs.
In regards to FGM, headline figures suggest that Ethiopia’s rates are high and are considered second only to Egypt, in Africa. It is practiced by people of most religions, in particular orthodox christians and muslims. The majority are considered to have undergone less severe forms and only eight per cent, infibulation.
A welcome decline in prevalence from 80 per cent in 2000 to 74.3 per cent in 2005 was reported by the WHO. This coincided with an associated decline in support for the practice: down from 60 per cent in 2000 to 31 per cent in 2005. Reported more recently is a trend, in areas where infibulation used to be common, for some to practice a less invasive form.
A National FGM Network was established in 2002 under the auspices of Norwegian Church Aid. The network had strong government backing from the outset as well as involvement from the Ministry of Women, Children and Youth Affairs, NGOs, faith-based organisations, civil-society organisations, UN agencies and the WHO.
In 2006, the Ethiopian government crminialised the procedure. To help enforce the law, the UNFPA-UNICEF Joint Programme of FGM began facilitating conversations about the tradition in the hope of challenging entrenched ideas.
According to 28 Too Many, support for FGM halved from 60 to 32 per cent between 2000 and 2005. Data on the prevalence of FGM from a Welfare Monitoring Survey in 2011 suggested it was a little less than 1:4 women nationally, acknowledging considerable urban, rural and regional variations.
Recently, a report by Norwegian Church Aid and Save the Children International (2015) indicated that Ethiopia has maintained steady progress in reducing FGM. The report cites a number of national surveys which indicate that the practice has been reduced by 30-40 per cent during the past 15 years.
The health care workers with whom I spoke said this reduction concurs with their frontline experience. They reported that FGM has been a live topic in the country for many years now and that despite the practice being banned, Government policy is disseminated not through the enactment of the law and via prosecutions but through the media – the press, TV and radio. Campaigns that explain why the practice is unnecessary and undesirable are thought to be increasingly well tolerated. These measures, they believe, are having a positive impact as well as a lasting effect.
They say anti-FGM campaigns have been most effective in urban areas, where educational and employment opportunities are greatest. This has resulted in fewer women and girls undergoing FGM and fewer presenting with associated healthcare problems generally and among ante-natal and maternity patients specifically.
Although regional FGM networks were established by 2012 and interventions shaped by local as well as national campaigns, they are not considered to have achieved as significant a reduction as the urban ones.
An end-term review of the Strategic Partnership between Norwegian Church Aid and Save the Children International for the Abandonment of Female Genital Mutilation (2011-2015) produced a positive progress report recently. The partners found that there are a good number of reasons to believe that FGM has nearly been abandoned in all of the sites visited by them.
They cite high numbers of men and women participating in a variety of initiatives regarding the practice: community conversations, radio programmes, mass campaigns and young males participating in awareness-raising sessions.
Large numbers of girls were reported to have declared they would not be cut (112,878 were registered as uncut in Dec 15), boys saying they intended to break with tradition by marrying uncut girls, and community groups declaring they will support ending the practice. In group discussions, there was general agreement that FGM is becoming exceptional.
The information given by community members was corroborated by task force members and representatives of the Bureau of Women, Children and Youth Affairs.
They suggest the control mechanisms in place now make it difficult for girls to be cut in secret. Families expecting a baby and/or who have small children are monitored by government and NGO representatives. If parents are preparing to have a girl cut, this is reported to the police and action taken to stop them. That few cases had been reported to the police is interpreted as an indicator that FGM has become rare.
They accept however that this finding must be interpreted with caution.
This is probably wise in light of a recent report from neighbouring Kenya where FGM is reported to have ‘returned with a vengeance’ in Marakwet. There, in December 2015, 1,200 girls ranging in age from 10-16 years, voluntarily underwent circumcision. This signified the resurgence of a practice that was assumed to have ended due to the work of campaigners.
Ironically, this happened while a lead anti-FGM campaigner was receiving an award in Mauritius for her ‘resilient fight against the practice’ in Marakwet. She was unsurprisingly upset at this set-back, which she interpreted as a stab in the back, saying “It simply served to ridicule my achievement and the reward I was given.”
Perhaps this rejection of a perceived top down, coercive or legislative approach to the practice, in the absence of widespread support, educational or economic opportunities, is unsurprising?
Meanwhile, back in the UK, Border Officers remain alert, searching out potential FGM ’victims’ and ‘cutters’ at immigration points. For example, all passengers on my inward flight from Addis Ababa to London Heathrow were met on disembarking by a team of Officers.
We each had to produce our passports for inspection before proceeding to the official immigration checkpoint. But the officers, probably representing Operation Limelight which targets ‘high risk’ flights, were almost certainly only interested in a minority of passengers, but had to be seen treating us all equally?
The Odyssey of Counter-Cultural Movement Headed for 2025 by Bereket Sisay, explored the legacy of FGM in Ethiopia. It was published in the Ethiopian Herald on Jan 28th 2016.
About the Author - Bríd Hehir
Bríd is a retired health professional. She started her career as a nurse and midwife in Africa where she worked for almost four years. She encountered FGM/C in Ethiopia. She then moved to London where she worked in the National Health Service as a midwife, community nurse, health visitor, reproductive and sexual health nurse and manager over a period of 30 years. She did not encounter FGM/C during that time despite working with immigrant communities who are reported to practice it still. She is puzzled by the current reported prevalence of the practice, the official response and associated activism. And is worried that they might cause more harm than good.