Challenges To Eradicating Female Genital Mutilation: Activists, Officials, Adulthood, Men, Water, Subsistence And Dangers

The difficulties we (all) face in trying to #EndFGM have concerned and deeply engaged me for several years.  Why is it such a tough assignment, regardless of continent, location or ‘culture’?
My guess, as a sociologist, is that despite the admirable efforts of many campaigners and workers we have yet to look as hard as we might at all the contexts in which FGM occurs, and in which we seek to eradicate it. There must surely be underlying realities and life experiences which continue unobserved to shape people’s understandings of the interactions, meanings and impacts of FGM.

It was good therefore to be invited to speak at the Research Colloquium on Female Genital Mutilation, at Lady Margaret Hall, University of Oxford, on 9 December 2024.  The focus of the event is reflection on the Routledge International Handbook of Harmful Cultural Practices (2024, eds. Jaschok, Jesmin, Levin von Gleichen & Momoh), in which my chapter (12) was ‘FGM STUDIES  Economic, Public Health and Societal Well-Being’. In this 9th December Oxford research colloquium presentation I focus on aspects of ending FGM which lead us to consider difficult wider issues.

The ideas below on the socio-economic and environmental contexts of FGM and its eradication are what I want to share:

You can read this website in the language of your choice via Google Translate.

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Challenges to Eradicating FGM: Socio-economic and environmental contexts in a patriarchal world

The contexts in which the fight against FGM occurs are much more complex than some imagine.  This presentation will seek to unravel some of the relevant factors, and consider how they are, or can be, brought meaningfully into effective strategies to make FGM history.

So, firstly, a brief look at how people and interest groups who want to end FGM may actually operate in the real world…

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Logistics and strategies: Community activists, organisations, professionals, state officials and politicians

Activists: That activists and campaigners on the ground are essential is obvious to anyone who wants to eradicate female genital mutilation (FGM).  There are traditional locations where community and neighbourhood knowledge is absolutely critical in efforts to reach those whom we hope to persuade, and there is little scope for ‘outsiders’ to come in and lecture people who are probably quite reasonably uncomfortable about strangers coming to tell them what (not) to do.

The first thing to say about any #EndFGM campaign is that local activists are not only irreplaceable but also they must be properly respected and supported – in ways which do not place them in any difficulty, or even danger. And, beyond that, activists embedded in their communities need to know they are valued and listened to by EndFGM programme staff, in the same way that other members of the formal / professional team are heard and understood.  There is no excuse for paid officials who choose simply to instruct and supervise (probably very vulnerable) activists-on-the-ground, in reality often unpaid, volunteers, without seeking out the lessons of their direct experience.

Organisations: Many volunteers and officials working to end FGM are affiliated with groups or organisations supporting that ambition.  Sometimes the organisations simply help to build contacts and find support for the activists; other times they are large, and carry significant overheads which require constant focus on efforts to secure funding and other needs.  Both types of grouping may find themselves in competition with other similar set ups, diminishing opportunities for collaboration and openness.

Sometimes the larger especially groups may also venture in other directions, if funding might be available.  Perhaps we need to consider more carefully where the lines between serious ambition to end FGM and similar objectives are crossed in efforts to continue to pay overheads and staffing etc, whether via charitable bodies, government or something else.  When does opportunistic bidding for new ‘topics’ begin to lessen focus on FGM?  What is the most effective balance of different programmes in different circumstances?

Professionals: Likewise, there are professionals – lawyers, clinicians, educators etc – for whom ending FGM may be one of several aspects of their job.  All of them have vital roles.  The delineations and boundaries of professional roles are however not always clear, particularly between medical and legal domains.  The unintended distractions of a turf war may lurk in the shadows, as neither profession fully considers or appreciates the challenges facing the other.

And then there are teachers and community educators whose role is both to inform and to protect vulnerable girls and women, whether in ‘safe space’ schools, in general education or as part of e.g. health promotion programmes.  Routes between the attentions of various professionals for victims and potential victims (for formal ‘victims’ of a crime they are, albeit many brave women prefer to adopt the role of ‘survivor’)  may or may not be evident and clearly demarcated, not least because the availability of funding and relevant professional role holders can be sporadic.

State officials:  Given that FGM is implicitly or expressly illegal in almost all countries, the role of the state in its eradication can (and should) be vitally important. Officials of the state however are usually constrained in how they allocate sanctioned (agreed) activity, funding and other support by the need for them to exercise close scrutiny and caution.

There are instances where a failure of funding results directly in harm – such as when police in Kenya were unable to attend to stop FGM occurring until volunteers raised money to provide fuel for their cars.

‘Wasting’ public funds can have serious consequences for all involved.  Accountability and measurement of outcomes are required. For these reasons public officials are unlikely to encourage experimental approaches to eradication; and they demand complex record-making.  Of course these features of accountability in the use of public funds are vital, but they can disenable imaginative or promising but risky new ways to tackle the challenges of FGM abolition, and for obvious administrative reasons they favour larger organisations over smaller groups.

Politicians:  Ultimately, support or otherwise for efforts to end FGM is usually the choice of politicians.  In some contexts political leaders may be very keen to make progress; in others there is serious pressure (often ‘cultural’ or ‘religious’) against even tackling FGM at all.

The point is that the ‘buck’ (responsibility for results) must stop somewhere, on the desk of someone in significant authority who will be directly accountable for the outcomes of end FGM efforts.  For that reason amongst many the often vaunted appertaining model of ‘multi-agency’ approaches has limits.  If no-one, a single named person, at the top is willing to make clear decisions about who / which bodies will do what, with which agreed and observable outcomes, a lot of time, energy and failures of collaboration will be directed towards efforts to secure influence and funding, rather than just to ending FGM.

And in a broader context, whilst for some politicians navigating the routes to eradication is straightforward; for others this can even be personally (as well as politically) perilous.

In either case the positioning of government (local, or national) is critical. There are international bodies -WHO, UNICEF and so on – who can help here.  Someone at the ‘top’ in a position of power and influence needs to say emphatically that ending FGM must be done, with due process and without fear or favour.

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Economics, adulthood and autonomy  

It is easy in the determination to eradicate FGM to under-appreciate issues around economics and the impacts that access to income and investment have on the autonomy and status of women and girls. Without these their capacity to resist bodily (and social) harm is lessened.

Economics:  FGM in some practising communities has big economic impacts.  ‘Celebrations’ are sometimes lavishly funded (maybe from successful crop harvesting – hence FGM events regularly at specific times in the year), ‘cutters’ are paid, bride prices are negotiated for ‘pure’ (i.e. mutilated) girls; and parents in effect buy old age care via the sale of their daughters to husbands with resources.

In the context of centuries of tradition around any, let alone all, of these factors, the suggestion that cutters should trade the knife / sharp shell / finger nail for a business on the basis of, say, a couple of goats, is a nonsense; as is in some contexts the idea of a different non-invasive ceremony in which the unharmed girl is pronounced ‘pure’ and worth a high bride price.  Of course not all FGM is predicated on such beliefs and traditions, but whilst they and their underlying economics continue, total eradication everywhere becomes difficult.

There has recently been some work on the costs of medical care for women with FGM (see the WHO FGM cost calculator), but what may have greater future leverage is an emphasis in political decision-making on the much wider costs to local and national economies of FGM and related harms.

These are matters which can be addressed publicly, without intimate detail and embarrassment, by anyone, woman or man, who wants to end FGM.  They are important political, not clinical or ‘cultural’, issues.  FGM harms those who have it and their children, families and communities; but how often is this acknowledged?

Adulthood:  As a general rule, adult status for men is achieved across the globe simply by ‘growing up’, the passing of the years.

(Yes, we know that in some communities this transition to adult male status is accompanied by rites of passage which may include at physical harm, including MGM (male genital mutilation / ‘circumcision’) – which with many others I fundamentally and actively oppose; it must stop. But, whilst cruel, dangerous (sometimes tragically so) and unnecessary, MGM does not inflict direct intergenerational harm via the birth process, or ‘justify’ practices akin to bride price, the commodification of bodily ‘purity’ as a selling point in negotiations when a girl-woman is passed from father to suitor. MGM must and will also be eradicated but male virginity / ‘purity’ is not in question.)

Put simply, FGM and other harmful practices are in some communities an economic, transactionable condition of girls achieving adulthood, an economic transaction which increases dependency and diminishes the contribution the girl-woman can thereon make to her society.  FGM reduces the independent opportunities (including education) a woman will have in any modern sense to increase her own influence and economic sufficiency, as this first attempt to test the concept of FGM as an economic deficit may suggest.

Likewise, for some girls and women in western diaspora communities FGM in effect delivers positioning in an unempowered underclass – girls may disappear from schools, they become in effect child brides in a social system ruled by tradition and custom, not formal law, they may be constrained within their group even to the extent that they cannot attend for medical care without permission from their husband or male ‘supervisor’. But, in such western societies, how much effort is put into locating these human hostages to history, thereby enabling them to become part of the open, modern nation in which currently they live unseen?

Even when post-FGM adult status is granted however, women in some places have few rights to the commodities which would enable their economic independence.  Land is often the preserve of men (or ‘granted’ to women on specific conditions), inheritance goes to other male family members, not the deceased husband’s wife, marriage may in any case be an arrangement between one man and two or more women, with all the economic inequities this entails.

None of these hard facts can be addressed directly by FGM campaigners in the field; and often the residue of these customs and understandings remains long after the issue itself may have been at least partially resolved.

These matters require the attention of researchers and politicians, not activists alone.  Community beliefs are rarely changed simply and solely by altered realities, or even changed locations, as perhaps when people move via the diaspora.

Autonomy:  Adult status may be achieved via FGM but that status does not necessarily bestow for women economic and personal autonomy. Is it sometimes unrealistic to expect that simply stopping FGM will make the personal experience of (again, some) girls and women ‘better’?

To support the achievement of autonomy – and thereby over time a belief that FGM is not required in order to be adult? – may require not only greater equity in income, but also legal innovation and community and social investments in quite practical change, even just chairs for women farmer’s meetings, to give one example.

Of course chairs alone won’t change embedded traditional beliefs and behaviours, but generalisations about what women ‘need’ are probably not particularly helpful.  There are many relatively inexpensive and low- / middle-tech implements, tools and social adjustments which might alleviate the workload for women struggling to make ends meet in agrarian and other mostly primary, or basic secondary, sector economies; and in each instance it is likely that different items are optimal.  The point is that enabling women’s adult autonomy, and hopefully supporting them to eschew FGM, is a matter requiring multiple and various approaches.

As I suggested in a recent editorial paper, there are at least three essentials for any long-term effective eradication of FGM:

• Committed, supported advocates ‘on the ground’ who can talk with direct experience of FGM, as survivors, family members, or (‘even’) past ‘cutters’ who have now realised what FGM really entails; and add to that, where possible, the advice of teachers and clinicians working in the community.

• A legal system in which it is clear that FGM (and other violence against women and girls) is illegal and will actually be punished.

• And, very importantly, a socio- economic system which enables women to conduct their lives as adults, autonomously, with education, their own (adequate) income and freedom to make their own choices.

It is this third element which, despite a rapidly growing understanding at least of the criticality of proper education, is perhaps most often missing from the eradication equation.

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Wider eco-socio-economic and environmental contexts and challenges

Decent agricultural tools and the like are not however always an answer to situations in which women continue to find themselves eking out a living in difficult circumstances, dependent on their menfolk even for basic economic resources such as access to land.

More fundamental still are issues around social stability and environmental contexts and change.

Socio-economic contexts:  The world in which we all live is changing rapidly because of territorial and resource disputes, war, climate change and similar macro global shifts.  For some of us these shifts are relatively manageable (so far), but for those with the least they are not.  Increasing numbers of dispossessed people across the globe find themselves needing to relocate, sometimes frequently, as the world which they know crumbles around them.  Many such people, women and children amongst them, become migrants or refugees, sometimes fleeing with nothing to they know not where.

Women and children may fare especially badly in such scenarios. They may not have recourse to personal dignity and , often alone without a husband or other male protector, they may be raped or otherwise harmed, perhaps by fighting men (see e.g. here, p.22 Table 8 re risks during flight).  As this November 2024 news item on Sudanese women refugees seeking safety in Chad reports, they may also be subject to FGM in flagrant disregard of the laws of both nations.

Damage, distress and ensuing disadvantage surely continues even long after the intended harm.  But only rarely to we hear about this.  FGM is sometimes inflicted to demark tribal or group affiliation in testing times, or as a punishment, or to ‘prevent’ rape; and these physical and mental impositions are likely to influence the beliefs and customs of future communities which asylum seekers or refugees eventually reach.  Such matters are difficult to acknowledge and address, but awareness of them in seeking to end FGM is important.

Environmental issues:  We have already recognised the many ways in which contestations around shifting circumstances can shape some behaviours.  Environments can however influence behaviours around dependency and status even when static.

Water is an absolutely critical resource everywhere.  Nobody can ignore it, and in places it is scarce.  About 200 million hours every day are devoted to fetching it; most of this is done by women and girls.  One phenomenon noted by a campaigner in Kenya in 2014 was that, of 63 local tribes 60 practised FGM.  The only three which didn’t are located nearby adequate water supplies.

In my discussion a while back of water and how it may correlate in some instances with FGM I suggest the time has come to explore possible connections between aspects of the natural environment and harmful practices.  Perhaps technical work to identify local aquifers (and maintain them – always a challenge over time) so that life is at least better for the women who collect water, and possibly also a means of removing the ‘need’ for FGM.  And perhaps the same possible relevance can be found regarding other natural features of a community, if we only look?

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Epidemiology and patriarchy

Epidemiology:  As the public health thought leader Devi Sridhar insists, there are persuasive reasons to include epidemiological analyses when we consider the interconnections of human and natural environmental issues.  Let us therefore consider just one more possibly critically important question around FGM:  Does FGM cause the often personal and socio-economic disaster of inter-generational (child) stunting?

I have made the case for this possibility here, because I fear that the damage inflicted by FGM on one generation of women is then passed down to the next via matters such as difficult births; and this then passes again to the next generation via the probably FGM-related stunting of some babies, and so forth.

Further, the very fact that a woman has FGM, especially if it is untreated, suggests her health may be compromised and her work tasks and family care cannot be delivered optimally.  Given the enormous personal, community and wider economic impacts stunting can have, is it not time for a serious study to consider such possible impacts?  Stunting is an almost entirely preventable harm, just as FGM is.  Are they sometimes interconnected?

And so to…

Patriarchy:  Many of the matters considered above might be resolved if more attention were paid to the situations and plight of women and girls.  That they are not suggests to many that some sort of patriarchal system underlies and obfuscates the ways that society operates.

This may not surprise many readers here, but it is perhaps worth noting that #PatriarchyIncarnate – the imposition of (some) men’s will on the bodies and minds of women and girls – is more ‘even’ than a fundamental feature of FGM alone.

It is impossible to understand the ways at base that FGM and other harmful gendered practices work without acknowledging the imposition, whether directly or at one remove, of male power over women.  In doing so however it needs always to be recognised that far from all men wish to control women in these ways.  There are many men of goodwill who are as concerned about controlling harms to women as are women activists and campaigners.

This brings us to one further ‘challenge’: how can we, men and women together, both acknowledge the power of patriarchy and dismiss it?   A conversation remains to be had about whether, or if, men or women find this challenge – to patriarchy – harder.  Do we see it, and its potential resolutions, in the same way?  (Maybe not?)

How can we harness to best effect the already varied perceptions and approaches each of men and women across widely disparate communities to eradicate FGM and other harm?  Until ways forward between these multiple understandings are reached, it is unlikely that we can put FGM firmly behind us.

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This post relates to four posts here I wrote in February and March 2024, looking at the way my perceptions around the contexts of eradicating FGM have changed (hopefully, developed?) over the past decade:

Eradicating Female Genital Mutilation: Identifying Tensions And Challenges (February 6 – International Day of Zero Toleration for FGM)

Eradicating Female Genital Mutilation: Looking At Practical And Low-Tech Ways Forward (March 8 – International Women’s Day)

Men As Policy-Makers Must Support #EndFGM – Enable Women To Gain Respect As Adults Via Fair Social And Economic Contexts (14 March – Commission on the Status of Women, CSW68)

World Water Day – And Why It Matters For #EndFGM (March 22 – World Water Day)