Struggling to end female circumcision in Uganda
Posted: 3 January 2010
Today, female genital cutting (FGC) affects 130 million girls and women mainly in Africa, Asia and the Middle East, leaving many suffering long-term, physical and psychologial damage. Despite this long-standing traditional practice, beliefs are slowly beginning to change, says Don Hinrichsen, who visited Uganda to report on the work of one remarkable organisation called REACH.
"I remember that awful day as if it were yesterday," she says in a barely audible voice. "I did not want to be circumcised, my husband did not want me circumcised, but the rest of the community did and so I was tied up and held down while the 'cutter' did her business. It was the most horrific experience of my life."
Paralysed for life
The 'operation' did not go as planned. Betty bled a great deal over the course of the next few weeks. She was too weak to get out of bed. When the wound finally did heal up, Betty discovered that she was unable to walk. The cutter had paralyzed her, along with two other young women who were circumcised the same day.
"A few months later my husband abandoned me and I have been living alone in this shack for almost three decades," says Betty. "Only my mother helps me out."
Her two girls have families of their own and have moved away and her two boys seldom come around.
Betty barely ekes out a living selling simple household supplies and a few drugs, such as aspirin. "I was just 22 when they cut me," she says, a deep sadness in her eyes. "I had a life then and they took it from me. No girl or woman should have to endure this gruesome practice."
Out of misfortune, Betty has found a new calling. She is now a vocal advocate for eliminating female genital cutting (FGC) in this remote, mountainous region through a programme called REACH (Reproductive Education and Community Health) launched by UNFPA in the mid-1990s. She is part of a growing network of women and men who are working for the complete elimination of this harmful practice, which leaves many suffering incontinence, excessive bleeding, urine retention, paralysis and even death during childbirth, as well as psychological trauma. In addition, girls and woman are more at risk from HIV and other infections.
REACH has reached out to communities in the region in a way never before attempted. Its approach is community-based and multi-sectoral. "We work on many levels here," explains Grace Mwanga, a nurse at the local youth-friendly health clinic in Kapchorwa. "We mobilize people at the community grassroots level, work with church leaders, village elders, local politicians, youth and most important of all, the women who perform circumcision and depend on it for their livelihoods."
Advocacy activities are aimed at a broad cross section of the population. "This integrated approach works well," points out Jackson Chekweko, co-ordinator of the project for the Family Planning Association of Uganda (FPAU), one of the implementing agencies. "It has allowed us to change attitudes and practices in a very conservative, traditional region in a relatively short period of time."
Currently, the World Health Organization (WHO) estimates that 130 million women worldwide have undergone some form of female circumcision, from light cutting to complete infibulation. This thousand year old tradition stubbornly persists across much of Africa and the Middle East. In sub-Saharan and North Africa, 28 countries routinely practice female genital cutting, with prevalence rates varying from 5 per cent in the Democratic Republic of Congo to 98 per cent in Somalia, the Arabian Peninsula and the Gulf States. In Egypt, some 97 per cent of married women aged 15-49 have been circumcised. WHO reports that every day some 6,000 young girls are subjected to female circumcision (or over 2 million girls a year), often in unsanitary conditions with "dirty" instruments.
According to George William Cheborion, who, at 76, is Chairman of the Village Elder's Association of Kapchorwa, REACH is rooting out the practice one village at a time. "Today less than 50 per cent of the entire population of this region practices FGC," he says with a satisfied grin. "And even in those communities that still allow the practice, it is getting rare. We were able to affect real and lasting change through our community outreach efforts."
The model developed by REACH is being replicated in other regions, even neighboring countries. "We are collaborating with groups in Tanzania and Kenya who are also working to eliminate FGC," points out Cheborion.
Chekweko agrees. "Community advocacy has really made the difference," he observes. "But the project got a big shot in the arm in 2002, when the African Youth Alliance (AYA) joined the fight to end female circumcision." AYA is funded by a generous grant from the Bill and Melinda Gates Foundation, and is administered by three agencies: UNFPA, PATH and Pathfinder International. Like REACH, AYA's approach is youth-oriented and community-based. "It was a good marriage," says Chekweko, who is also the AYA focal point with the FPAU. "We needed more advocacy with young people and more health services designed for youth, and AYA provided that strategic support."
In some communities change has been swift and dramatic. In the remote village of Cheptuya, buried at the end of a valley and reachable only by a washed out road, FGC dropped from 90 girls in the mid-1990s to 30 girls in 1999/2000 to zero by 2002. "There the village elders stamped it out," says Chelangat.
'Circumcision too cruel'
Now that Kokop has ceased being a cutter REACH is helping her find alternative sources of income. She may get a small micro-loan to raise chickens. Though her standard of living has dropped, Kokop has no regrets about giving up circumcision. "This practice has to end," she says with finality, "it is too cruel."
Shara's decision not to get circumcised was reinforced by school-based sessions, which emphasised life-planning skills. Most schools in the region have introduced life skills planning as part of the informal curriculum. Meanwhile, advocacy efforts by village elders, religious leaders and parents have reinforced the rejection of the practice among young women.
As a testimony to the success of the initiative, REACH received UNFPA's annual Population Award in 1998. "It certainly hasn't been an easy road," says Chekweko, "but we will persevere. We have momentum now and the will to change is visible."
Betty Cheboi has found some comfort in the fact that in her village and neighbouring areas the practice has been stopped. "I speak out against female circumcision every chance I get," she says almost breathless. "And many young women listen to me. When I see that my words have reached them it is the only time I feel like smiling."
Don Hinrichsen is a Contributing Editor to this website.
- REACH Programme in Uganda
- UNFPA - Ending Female Genital Cutting
- WHO - Female Genital Mutilation site
- IPPF - FGM briefing paper
- IPPF - Uganda Reproductive Health profile
- FORWARD - Foundation for Women's Health, Research and Development
- Goodbye to Planet 21
- Voices from Planet 21
- Faith leaders lend support to family planning campaign
- Melinda Gates helps family planning make a fresh start
- COMMENTARY: The case for family planning that Rio+20 forgot
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- We must stabilise the human population says Royal Society
- 215 million women still have unmet need for family planning
- COMMENTARY: World must wake up to the coming crisis in the Sahel
- UN calls for more support for family planning
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- More investment in youth needed, as world population tops 7 billion
- COMMENTARY: Overpopulation is too big a problem to ignore
- Population growth in Zambia: a view from the slums