International Development CommitteeSupplementary written evidence submitted by Efua Dorkenoo, OBE, Advocacy Director, Equality Now

FGM: UK/International Context—Why They are Linked

Migrants who have settled in the UK do not cut off their links with extended family relatives from country of birth. A classic example is demonstrated by the substantive amounts of money now counted in countries GDP, which y Africans in the Diaspora transfer to relatives in country of birth each year or to parents’ country of birth. It is often to Africa and parts of the Middle East that British girls are taken to undergo FGM. Therefore if we want to stop FGM in the UK then we need to address FGM at its source in the developing world as well.

The problem of FGM is growing partly due to increased migration of refugees from high FGM areas settling in the UK. With the opening of the borders of the European Union, refugees and migrants originally from FGM practising countries who had settled in other parts of Europe (for example, the Netherlands, Sweden, Spain and France) are moving to live in the UK. There is no doubt numerous reasons for immigrants in Europe moving to the UK but an anecdote is that the UK is viewed as a soft spot on FGM in Europe.

Cross-Department working on FGM in the UK. What are the respective responsibilities of the different Departments? What should be done differently?

In the years following the passing of the Prohibition of Female Genital Circumcision Act in 1985, much work on FGM in the UK focused on African women promoting dialogue and raising awareness amongst affected communities but by the end of 1990, it became clear that in addition to community engagement, FGM could be prevented by involving authorities who had contact with children and could potentially protect them. This included frontline professionals in health and in education (as FGM generally occurs during the primary school period), as well as in Social Services, the police and immigration.

Some progress have been made in promoting the elimination of FGM in this country in the last three decades, evidenced by 15 NHS specialist clinics1 promoting access to obstetric and gynaecological care for women with FGM and numerous community groups from affected communities promoting outreach work in their communities against FGM. The silence surrounding FGM in the UK is gradually broken and more young people (second generation) are openly speaking out against FGM.

At central policy level, FGM is gradually moving from the cultural ghetto which it was assigned to; and is identified as a form of Violence Against Women and Girls (VAWG) in the “Call to End Violence Against Women and Girls”2 which reflects the government policy and vision on VAWG, although FGM is marginalised with respect to actions in the government Action Plan on VAWG.3

The government recognises that FGM affects women in specific communities and cannot be tackled by one agency alone; and that it is something that “needs a cross-partner response which, if possible, involves the communities concerned”. The government also identifies FGM as a form of child abuse4 which should be dealt with as part of existing child protection structures, policies and procedures.

Since 2011, the governments departments—Foreign and Commonwealth Office, the Home Office and the Department of Health have increased their activities on FGM as evidenced by the following actions:

The government published a Multi-Agency Practice Guidelines on FGM guideline is aimed at providing advice and support to frontline professionals on FGM. The Home Office is currently reviewing the use of the guidelines by frontline professionals.

The Home Office launched an FGM Fund. This was initially £25,000. It had been increased to £50,000. The purpose of the fund is to support community projects to tackle FGM. Applicants are able to bid for grants of £2,000 to £5,000 to support community engagement projects. This is quite low in comparison to the scale of the problem.

The Department of Health sent an alert to the NHS to ask all health professionals to familiarise themselves with the actions they need to take where they have reason to believe that a girl has undergone, or is at risk of FGM (Central Alert System, Female Genital Mutilation) following the Sunday Times media revelations that FGM could be occurring in the UK.

A training meeting on FGM had been held in Ethiopia to brief embassy staff from British Consulates from across Africa on FGM.

To support young girls and families resident in the UK who go abroad to resist extended family pressure, the Home Office produced a Statement Opposing FGM (“Health Passport”). The Statement is signed by the Minister of State for Crime Prevention, Home Office; Parliamentary Under Secretary of State, Minister for Victims and the Courts, Ministry of Justice; Parliamentary Under Secretary of State (Children and Families); and the Director of Public Prosecutions(CPS).

NHS Choices produced a short film on FGM commissioned by the Department of Health. The aim of the film is to raise the awareness of the public and health professionals on FGM.

The Home Office hosted a Round Table Meeting on FGM lead by the NSPCC. The purpose of the roundtable was to bring together key professionals working with children and to explore how professionals can work together to detect potential victims of FGM and deter those considering carrying out the act.

Despite the effort cited above, girls continue to be at risk of FGM in the UK. A major gap in the government response to FGM is the fact that its work on FGM is largely crisis-driven and reactive. This sends a negative signal to the local level and to frontline workers that the government does not know what it is doing on FGM or that there is no political will to grapple with the issue. A national co-ordinator’s post on FGM that functioned under FCO was abolished by the Coalition Government. A cross-governmental/NGO Forum which had been operating under the Home Office was also abolished and the issue was integrated into the Violence against Women stakeholder’s Group which dilutes the focus on the issue. Without central government leadership and steer, policy implementation on FGM at local level is at best patchy. The government Multi-Agency Guidelines on FGM which is intended to set out a multi-agency response and strategies to encourage agencies to cooperate and work together is not a statutory document but rather an awareness raising document. Given the fact that the fact that there is no current data on FGM (the estimates on FGM quoted by the government is based on 2001 statistical estimates) and several frontline professionals are reluctant to be engaged with FGM as they view FGM as a sensitive cultural practice and fear being accused of racism,5 FGM continues to be marginalised at Local Authority level and by NHS professionals. The multi-agency joined up work which is required to address the issue is not functioning. FGM is primarily a safeguarding issue but the Department of Education has been the least to participate in any of the government meetings on FGM.

The key actions to be taken to strengthen current approaches to address FGM in the UK include:

Strengthening Systems and Procedures That Prevent FGM

A more proactive and a comprehensive national preventative strategy is necessary to identify and respond to potential risks, involving multi-agency joined-up work between health, education and social care sectors, as well as community outreach. As the FGM cross governmental/NGO Forum had been dissolved, another potential avenue for developing this work is the Vulnerable Group Forum co-ordinated by the Home Office in collaboration with Health and other sectors of the government.

Equality now is very encouraged by the DPP/CPS’s “Action Plan” to address the barriers to prosecutions on FGM. For the first time, the action plan will lead to an outcome that could be the single most important strategy since we started discussing or campaigning on this issue.

We cannot escape the fact that there are other government departments that need to step up their actions to match what could be a turning point framework—the NHS, DfE, health and social care professionals, professional regulatory bodies etc.

For health, for example, there is currently no mechanism to ensure that information gathered by one NHS body about a woman who has herself been subjected to FGM and has female children is communicated to any other part. For example, if a woman identified by a maternity unit as having undergone FGM gives birth to a daughter; there is no means by which that information can be passed to her GP and health visitor who have closer and longer contact with the woman, her family and the female children. Therefore, the opportunity for these key health professionals to take preventative action in relation to that family is lost. If education and child safeguarding measures are to be effective, the Department must ensure that information about the risk to occurrence of future FGM is communicated to those in a position to take action to safeguard girls at risk. Most of the initial FGM is performed on minors often between 7 to 8 years thus Education has a Lead role in safeguarding but currently most primary school safeguarding leads have limited knowledge on FGM.

At central government level, Education is currently disengaged from the work on FGM. The current Working Together document on Safeguarding has also dropped the reference to FGM which was a source of reference for professionals. Since PSHE is no longer compulsory, the potential avenue for empowering young people with information on FGM and VAWG schools is missed.

Strengthening the Evidence Base

There are still no complete and overall data on the prevalence of female genital mutilation in the UK. The available estimates of the prevalence of FGM for England and Wales from secondary data show that 66,000 African women resident in England and Wales in 2001 had undergone female genital mutilation and more than 23,000 girls largely from African communities under the age of 15 were at risk of FGM or may well have undergone FGM. The numbers of girls and women affected by FGM are likely to have increased since 2001, as reflected in the increase in the estimated percentages of all maternities which were to women with FGM from 1.06% in 2001 to 1.43% in 2004. More recent interim estimates, which did not take account of mothers’ ages, suggest a rise from 1.04% in 2001 to 1.67% in 2008, reflecting the rising numbers of births to women from FGM-practising countries. This underlines the need to update the FGM prevalence data. The practice of FGM intersects gender, race and ethnicity. Such complex issues are at risk of being sidestepped at local level by mainstream services without reliable data.

Reliable data on FGM are needed for planning and commissioning of services, to inform maternity, gynaecological and psycho-sexual care provision as well as other support services that are needed for girls and women with complications of FGM, for targeted advocacy with affected communities; and to monitor progress (trends) towards ending FGM in the UK.

Although the Department of Health has indicated its interest in including FGM in the new maternity and children data set, this does not start till April 2013. The Department acknowledges that FGM is currently not in the approved data collection so it will have to wait until a refresh of the data set in 2014.We will then have to wait till 2015 before an audit of FGM would be done. A proposal for updating the current FGM estimates which uses methodology that has been peer reviewed by researchers across Europe had been submitted by Equality Now and the City University to the Home Office since October 2012; but to date there had been no response from the Home Office, despite funding an initial research methodological workshop to determine the prevalence of FGM and requesting for the proposal. See the Addendum for further explanation of data recorded at birth and maternity care.

DFID’S work on FGM: effectiveness of work with other Departments’. Effectiveness of outreach to diaspora groups

DFID Lead staff members on FGM sometimes attend cross governmental/NGO meetings on FGM. At policy level, there is a disconnect between the terminology (FGM) used in the UK by FCO, DH, Home Office and that by DFID which uses FGM/C –an apologetic term whereas WHO, European Union, UN Women, CEDAW, Commission on the Status of Women, UN General Assembly,6 African Union and African women activists use the term FGM. The use of the term FGM/Cutting reflects DFID’s insecurity in upsetting developing country governments which does not bode well for its plan to take global leadership on the issue.

DFID is developing a specific initiative on FGM and has involved Diaspora groups in the initial consultations on the Initiative with a view of setting a Civil Society Challenge Fund to support civil society actions in the African region. The Diaspora groups have welcomed this but have recommended that DFID does not put all its eggs in one basket but to make funding available to African women activists advocating for change against FGM in their communities. In each country where FGM persists, there a numerous local women’s rights organisations working to bring about change. Equality Now believes, it is the growth of local and regional movements that can bring about social and systemic change on issues round discrimination and violence against women.

FGM in developing countries: role of legislation, why this has worked in Burkina.

Like other forms of violence Against Women, prevention of FGM requires a holistic approach that involves prevention, provision of care, protection and justice outcomes. A strong legal framework is a vital component in tackling discrimination against women and girls, including FGM. DFID’s policies can only go so far if there is state sanctioned impunity.

A key indicator for reduction of FGM is to compare the prevalence between older women (age 35–39) with that of younger women (age 15–19).

In Burkina Faso, where the law is applied alongside public education, there is significant decline in the prevalence of FGM (27%) when the prevalence of FGM between the older women age 35–39 (85.20 %) is compared to the prevalence of FGM in younger women age 15–19 (57.70 %) in the DHS 2010 for Burkina Faso (See Table A and Graph below).

Table A

RECENT PREVALENCE DATA BY AGE COHORT

Country	Age 15–19	Age 35–39
Benin DHS 2006	7.90%	16.30%
Burkina Faso DHS 2010	57.70%	85.20%
Cameroon DHS 2004	0.40%	1.20%
CAR MICS 2008	18.70%	29.80%
Chad DHS 2004	43.40%	46.20%
Djibouti MICS 2006	89.50%	94.70%
Cote D’lvoire MICS 2006	28.00%	43.80%
Egypt DHS 2008	80.70%	96.40%
Eritrea DHS 2002	78.30%	92.60%
Ethiopia DHS 2005	62.10%	81.20%
Gambia MICS 2005/6	79.90%	79.50%
Ghana MICS 2006	1.40%	5.70%
Guinea DHS 2005	89.30%	98.60%
Guinea Bissau MICS 2006	43.50%	48.60%
Kenya DHS 2008/9	14.60%	45.10%
Mali DHS 2006	84.70%	84.90%
Mauritania MICS 2007	68%	75.40%
Niger DHS 2006	1.90%	2.90%
Nigeria DHS 2008	21.70%	33.90%
Senegal DHS 2010/11	24.00%	29.00%
Sierra Leone DHS 2008	75.50%	96.40%
Somalia MICS 2006	96.70%	98.90%
Togo MICS 2006	1.30%	9.40%
Uganda DHS 2011	1.00%	1.30%
Tanzania DHS 2012	7.10%	21.60%

Factors Influencing FGM Decline in Burkina Faso7

Numerous factors have contributed to the declining practice of FGM. Major elements include the following:

Political will. The government of Burkina Faso has endorsed the abandonment of FGM since the 1983 revolution, and continues to advocate strongly against the practice. Creation of the CNLPE in 1990 and of its permanent, government funded secretariat in 1997, as well as the adoption of a 1996 law banning the practice, have been key elements of the decline in the practice.

Multiplicity of interventions. In addition to the enforcement of anti-FGM laws, the involvement of advocates from many sectors—religious leaders, policemen, medical professionals, teachers, youth, and women’s associations—has ensured broad diffusion of messages encouraging the abandonment of FGM. Additionally, anti-FGM messages were mainstreamed within existing development and reproductive health programs.

Outreach. A range of resources and outreach programs—including awareness campaigns by mobile police and army teams, information, education, and communication projects, media exposure, and a free “SOS Excision” hotline for denouncing those who cut girls—supported public dialogue about the issue of FGM.

However, clandestine excisions are still continuing; and most older informants still support FGM. Factors supporting continuation of the practice include deep convictions about the practice of FGM and continuing myths or beliefs about the clitoris and about the “uncontrollable” sexual drives of uncut girls.

Very young girls, between ages 1 and 5, may now be at greater risk, in part because they are more likely to be compliant and can be cut in secret.

Utilization

CNLPE-the National government secretariat overseeing the work of FGM has used the study findings to develop a new action plan for achieving the abandonment of FGM.

Working With Communities as in Senegal—An Evaluation8

In 1998–99, a village empowerment programme was implemented in the Thiès/Fatick and Kolda regions of Senegal by the non-governmental organization Tostan. This report is the qualitative component of an evaluation conducted at the request of UNICEF to assess the impact of this programme several years after its implementation. The overall responsibility of the evaluation was given to Macro International. The Human Development Research Centre (CRDH) implemented the quantitative component and the Population Council implemented the qualitative component, with funding from USAID through its Frontiers in Reproductive Health program. In 1998, the Tostan program was organised around the following modules: problem solving; basic hygiene; oral rehydration therapy (ORT) and vaccination; resource and financial management; leadership; feasibility studies (income-generating/micro-credit projects); women‟s health (sexuality, pregnancy management); child development; democracy; and sustainable management of natural resources. The ultimate goal of the programme was to mobilise communities to hold public declarations in support of abandoning harmful traditional practices, including FGM and child marriage. The objectives of this evaluation were to assess the:

Overall impact of the program implemented by Tostan on the daily life of women and men in several communities in Senegal.

Post declaration phase of the program, in order to evaluate whether it is associated with actual abandonment of FGM and to estimate the magnitude and pace of abandonment.

Abandonment of child marriage as it is associated with FGM.

The methodology used to conduct the qualitative component of the evaluation was based on conversations and observations in two categories of villages: type A villages, which participated in the program and held a public declaration abandoning FGM; and type B villages, which had only attended a public declaration, without prior participation in the program. The Population Council conducted interviews in 12 villages, ten type A and two type B villages; this was because all other villages originally identified as type B participated in the program later. A total of 150 individual interviews were conducted among the following groups: women who had participated in the program; women from both types of villages who had not participated in the program; facilitators who had taught the program; and leaders and other resource persons in these localities. Inclusion of input from male and female leaders could result in a bias with respect to the perceptions, effects, and knowledge acquired through the program.

The program was introduced in the villages in several participatory phases: dialogue, identification and selection of participants, and implementation of the program itself. Tostan set a number of criteria for village selection, having to do primarily with the village leaders‟ willingness to feed and accommodate a program facilitator, prepare lists of program recipients, and construct a classroom facility. Some informants mentioned the abandonment of FGM as a condition for being accepted within the program but this has been reported as marginal.

After delivery of the education program, it is reported that numerous changes took place in the villages. Informants reported that the program improved knowledge of rights and responsibilities among both participating and non-participating women, particularly with respect to the place and role of women in the community. The organization of public declarations evolved significantly over time, even as early as 1996—2000. The idea of a public declaration was initially suggested by Tostan and acted upon later by the women of Malicounda, the first village where this process took place. However, changes occurred later in the process of organizing the public declarations. In Medina Cheriff, another village that participated in a subsequent program, several other parties played an active role in the public declaration and mobilization efforts to abandon FGM.

This change was guided by recognition that the implementation of the decisions announced at the public declaration required the involvement of several social groups in the villages. Information from the interviews indicates that collective determination on the part of the communities to honour these commitments, along with the support of leaders, committees and women, influenced how effective the declaration would ultimately be. However, type B villages were not truly associated with the public declarations. Some people in these villages simply heard that festivities were being held in a neighbouring village, so a few representatives decided to attend. They learned of the public declaration to abandon FGM only after their arrival. Although the dangers of early marriage were not clearly grasped in all the villages, those villages that received the full education program had a greater awareness of the dangers of FGM. This prompted the communities to call for a public declaration to abandon these practices, which was perceived as the ultimate objective of the Tostan programme. The information gathered from the communities indicates that many said they have stopped the practice following a public declaration, although residual resistance does exist in some villages. Some respondents indicated that early marriages are less frequent now, but the factors influencing this decline cannot be attributed solely to Tostan.

Village committees were formed in the villages prior to implementing the educational programme. In some areas, public declarations seem to have played a role in bolstering these groups’ efforts to monitor the enforcement of decisions taken at the declarations. However, at the time of the evaluation seven years later, these groups/committees no longer exist. The lack of systematic follow-up and basic infrastructure in the villages is preventing the populations from making full use of their new capacities and is a significant barrier hindering their ability to apply.

Implications of the Two Approaches for DFID.

The decline of the prevalence of FGM in the most recent data in the DHS/MICS between older (35–39) and younger (15–19) women in Burkina Faso is very stark27% when compared with that of Senegal 5% and with other countries where there is no presence of Senegal programmeBenin (8.4%), CAR(11.1%), Cote D’Ivoire(13.80%), Eritrea(14.2%), Ethiopia (Kenya (30.50%), Nigeria (12.20%), Sierra Leone (20.90%), Togo (8.10%), Tanzania (14.50%). These results might indicate that there is something going on more than the Senegal community programme which leads to faster reduction of the prevalence of FGM in countries.

The Burkina Faso approach employed a Violence Against Women and Girls Framework in—perspective, prevention, protection and justice outcomes. The Senegal approach could be described as a component of prevention within the VAWG framework. It does not address the “core resistors” as shown in the evaluation results. These may be the key decision makers in the continuation of the practice. There is a danger of seeing festivities and Public Declarations as an end in itself and moving on without leaving lasting structures to maintain sustainability of programmes. Moreover, the Senegal approach may inadvertently be disempowering to African women as it reinforces the traditional view that African women cannot take individual decisions to protect themselves and their daughters against FGM without community agreement and consensus—a problem faced by African women within customary laws.

Policy Implications

In Burkina Faso the progress of social and behavioural changes related to FGM has resulted from long-term support from many social and government sectors. Sustainability of these changes will require continuing commitment to ensure the enforcement of laws and collaboration among the stakeholders and sectors that are seeking elimination of FGM. DFID should support other African governments to develop policy frameworks and mechanisms based on the Burkina Faso model to address FGM and VAWG.

To accelerate community action on FGM and to build strong lasting local institutions challenging FGM and other forms of harmful practices and promoting the rights of African women, DFID should fund local women’s rights organisations as well as development agencies that are working at community level that have potential in integrating FGM prevention in their programmes (eg Comic Relief, Action Aid, Oxfam, Plan etc)

In areas where FGM is highly prevalent, DFID should insist that countries receiving development assistant aid for maternal, reproductive and primary health programmes mainstream FGM prevention into these programmes.

DFID should prioritise funding to advance the education of girls in FGM practising areas.

22 February 2013