Abolishing FGM/C: implement effective social marketing campaigns, do not medicalise it

A wide range of intervention strategies have been implemented with the goal of accelerating the abolishment of FGM/C.

Over the last four decades, global efforts to end female genital mutilation-cutting (FGM/C), have intensified through combined efforts of both international and non-governmental organisations, governments, religious institutions, and civil society groups. The international commitment to ending FGM/C was reaffirmed in 2012 when the UNGA adopted a resolution calling for global efforts to end the practice.
A wide range of intervention strategies have been implemented with the goal of accelerating the abolishment of FGM/C. Initially, the most common approaches used information and education campaigns that sought to educate people about the adverse health outcomes associated with FGM/C. These previous approaches led to the assumption that as people became increasingly aware of negative health risks, they would weigh this against the perceived positive aspects, and become motivated to abolish the practice.
An early comparative overview of data on practitioners of FGM/C from the demographic and health survey data, drew attention to the problem that in certain settings FGM was being increasingly performed by health care providers. It also characterised declines in FGM/C prevalence as "limited and slow," with the practice still supported by large segments of the population. This led to speculation that health approaches motivated its medicalisation more than its abolishment.
Population Council reveals research findings to support abolishment of female circumcision in Egypt
Accordingly, the Population Council conducted a research to support the abolishment of female circumcision in Egypt, through a study to eliminate the phenomenon of FGM in Egypt, and the study called "No to circumcision: designing and implementing more effective social marketing campaigns to support the abolishment of FGM/C in Egypt". The two studies were conducted in coordination with the Ministry of Health and the National Population Council.
The results of the studies revealed that the rates of female circumcision in Egypt are declining, where the percentage of circumcisions reached 92% among married women between the ages of 15-49. The percentage dropped to 85% among young women in the 20-25 age group, and 72% among girls in the 13-17 age group, as reported by the youth and population survey in Egypt.
However, there is a significant increase in the percentage of girls being circumcised by healthcare providers, reaching 65% among girls aged 13-17 years-old, compared to 31% among married women between the ages of 15-49 years-old.
FMG: End it. Don't Medicalise it
Country Director of the Population Council in Egypt, Nahla Abdel Tawab, told DNE, that it is important to spread sufficient awareness in order to eliminate the phenomenon of female circumcision, especially the practice of female circumcision by health care providers, which is the medicalisation of FGM.
She explained that although most doctors are aware that circumcision is illegal, some of them conduct the surgery under other names, or suggest other doctors.
Abdel Tawab added that doctors and nurses' information on sexual health is very limited, and that they are not sufficiently aware of the psychological and health damages caused by female circumcision.
Although previous campaigns against FGM, succeeded in reaching a large percentage of the population, especially females, and were equally successful in raising awareness of the harms of circumcision and its negative health and psychological effects, as well as created social dialogue among target groups, Abdel Tawab explained, however, she asserted that personal contact has proven to be more effective in changing behaviour to overcome the fear of societal consequences, which can result from the abolishment of female circumcision, as well as conflicting views among influential community individuals, such as doctors and religious folk.
Hence, the focus of the next phase is on empowering families to overcome concerns about the abolishment of FGM and creating a supportive environment for achieving it.
Abdel Tawab stressed on the need for consolidated efforts to work towards eradicating FGM/C, urging all governmental and non-governmental organizations to incorporate in their plans and programmes efforts to decrease the medicalisation of FGM/C, as well as to reduce the demand for circumcision by raising the awareness of families of the long – and short-term negative impacts of FGM.
Most of the activities against FGM/C did not sufficiently target men and young people, despite their indirect role which affects the decision to circumcise females, she pronounced.
As for Secretary General, National Population Council, Hossam Abbas, he stressed on the need to eliminate the phenomenon of female circumcision in Egypt, which is one of many forms of violence against women, especially in the age group under 18.
He pointed out that despite the efforts exerted by the Ministry of Health, represented by the national programme against FGM during the past years to reduce this crime, there is yet a clear need for more consolidated effort to spread awareness about the threat of FGM to the health and wellbeing of women and girls, as well as the psychological and social impact, which are not less serious.
Abbas also pointed out to the importance of applying the law related to the penalties for practicing FGM against girls as a “crime” in the penal code, which condemns the practice of this crime by all participants, whatever their status or role.
In the same context, Professor of Public Health & Community Medicine at Assiut University, Omaima El-Gibaly, and one of the authors of the study which was conducted to eliminate the phenomena of FGM, revealed to DNE that the growing consensus surrounding the definition of FGM/C as a human rights violation, however, underscored that concerns are not limited to the degree of harm or minimising health risks, but rather extend to broader rights claims surrounding child protection, consent, bodily integrity, and discrimination against women.
"The belief that campaign messages on medical risks may encourage people to turn to trained medical practitioners rather than abandon the practice contributed to critiques and reappraisal of the health framework for opposing FGM/C," she recounted, adding that as medicalisation debates unfolded throughout the ‘90s, where there were fundamental revisions for opposing FGM/C, shifted from a focus on healthcare to human rights.
"This shift was linked to pivotal historical changes in the global movement to fight violence against women (VAW) through legislation, and the classification of FGM/C as a form of VAW," she related.
Exposure to messages against FGM
Salma Abou Hussien, one of the main researchers who conducted the study, "No to circumcision: designing and implementing more effective social marketing campaigns to support the abolishment of FGM/C in Egypt", informed DNE, that in recent years, there has been a marked decline in the community's exposure to FGM/C.
The results of the Health Demographic Survey indicate that the proportion of married women aged 15-49 who have been exposed to FGM dropped from 80% in 2005, to 72% in 2008, and to 35% in 2014.
She added that in 2014, the TV was the main source of information on FGM followed by relatives and friends, while other sources such as seminars and home visits by health workers and health service providers in clinics and hospitals combined did not exceed 8% .
Several interview participants reported how they prefer community seminars because they provide space for direct communication and discussion, as well as room for asking questions and immediate answers, she recounted.
The coordinators specifically mentioned that presenting actual examples of reality, as well as participatory plays, inspired participants to consider abolishing circumcision.
Quantitative analysis of the health population survey data also disclosed that married women who attended FGM seminars were more supportive of giving up FGM/C, she added.
Finally, Associate and Senior Technical Advisor, Evidence to End FGM/C Programme, Population Council, Kenya, Caroline Karibu, told DNE, that the research findings were part of the research programme for the abolishment of FGM, was carried out by the population council with the support of the UK's Department for International Development (DFID) in seven countries: Egypt, Ethiopia, Kenya, Nigeria, Senegal, Somalia, and Sudan.
Karibu also highlighted that through high-quality research, and the creation of a vibrant South-North research consortium, significant challenges in measuring FGM/C can be addressed, and abolishment interventions, resulting knowledge and evidence—which can help shape FGM/C investments, policies, and programmes to become more effective and scalable—can be achieved.