Twenty-five years ago, participants of the International Conference on Population Development (ICPD) sat in a convention hall here in Cairo and watched a video depicting 10-year-old Nagla undergoing female genital mutilation. The graphic footage sent shockwaves that are still reverberating today, pushing forward the fight against female genital mutilation in Egypt as UNFPA marks the 25th anniversary of the ground-breaking conference. The public outcry that followed the video prompted then Egyptian Minister of Health to decree that the procedure should be performed only in certain state hospitals. Shortly after, in 2007, another decree was issued to close the loophole, banning the practice altogether in governmental and non-governmental hospitals and clinics. On my very first visit to a community project in the governorate of Assiut, I engaged in discussions about female genital mutilation with mothers and fathers of the community. I asked what challenges remain to combat it, and the most common answer I received was that the problem lies in the physicians. The physician is regarded as an authority in some communities, rendering the practice legitimate. Efforts to end female genital mutilation are faced by an increased demand for medicalization – whereby female genital mutilation is practiced by a health care provider – which adds to the complexity of this social norm rooted in cultural traditions and beliefs. Overall, 92.3 percent of ever married women aged 15-49 in Egypt have undergone female genital mutilation, 61 percent of girls aged 15-17 years, according to the latest Demographic and Health Survey (DHS). Medicalization is most common in Egypt, where 82 percent of cases of female genital mutilation were performed by medical personnel. When comparing mothers and daughters, trends of medicalization appear to be increasing sharply, whereby 37.9 of mothers had the procedure performed by a medical professional, compared 81.9 percent of daughters. The increased demand for medicalization results from a mistaken belief that when performed by a medical professional, the procedure is “safer.” While they opt to avoid any risk of health consequences, parents ignore the potential long-term effects on reproductive health the procedure may have, as well as psychological and social damage it causes. Female genital mutilation is a form of gender-based violence and a violation of human rights, rooted in gender inequality, along with religious misinterpretation and cultural beliefs. Since it is a multifaceted practice and it is thus important that we tackle female genital mutilation through a holistic approach. UNFPA works on building consensus in communities through enhancing the capabilities of religious leaders, empowering girls, community mobilization, and engaging with young people to raise awareness and advocate against female genital mutilation. We are also committed to supporting the government of Egypt to end female genital mutilation, specifically the medicalization of the practice. UNFPA, in collaboration with the National Population Council supported advocacy efforts to integrate female genital mutilation in the national medical curriculum at higher education level in universities. In 2017 the Supreme Council of Universities granted the approval to integrate the issue in the curriculum. UNFPA also works to raise the capacity of healthcare providers at primary health care units and supports the capacity building for outreach workers. It is also important to take a step back and highlight the direct link between female genital mutilation and population growth, and why we at UNFPA address them in a comprehensive manner. A big majority of families who expose their daughters to female genital mutilation are also marrying them off early, which translates into a longer reproductive period and into more children. A recent report by the World Bank estimates that a girl marrying at 13 will have on average 26 percent more children over her lifetime than if she had married at 18 or later. If a girl marries at 17, she would still have on average 17 percent more children versus marrying at 18 or later. Considering the rates of FGM and early marriage and the characteristics of the girls who marry early, ending it would reduce the national rate of total fertility by 11 percent, a rather large effect. New estimates from UNFPA linking female genital mutilation and global population dynamics also indicate that even if the rates stays constant in Egypt for example, more and more girls will still be affected each year due to the underlying population growth. This proves that more efforts are needed to curb these directly proportional trends. In 2018, the UNFPA-UNICEF Joint Programme has launched a third phase, focusing on accelerating the rate of elimination of the practice, thanks to generous contributions of the European Union, the government of Norway, among other donors. On the International Day of Zero Tolerance for Female Genital Mutilation, we reaffirm our commitment to end this harmful practice. Together with the government, we have a responsibility to galvanizing political will, ensure the enforcement of legislation, and strengthen the monitoring and accountability system. Eliminating female genital mutilation is a critical step towards realizing other Sustainable Development Goals. Unless we act now, another 68 million girls around the world will have undergone female genital mutilation by 2030. *Dr. Aleksandar Bodiroza UNFPA Representative in Egypt
