February 6th marks the International Day of Zero Tolerance to Female Genital Mutilation/Cutting.
I am often asked why the Office of Population and Reproductive Health at the U.S. Agency for International Development (USAID) is engaged in programming that will eliminate female genital mutilation/cutting (FGM/C). “What is the connection with family planning?” I’m asked.
“Nothing… and a lot,” is my answer.
FGM/C is a striking example of women’s lack of agency—a graphic illustration of powerlessness to make their own choices about their lives. If a girl cannot make a decision not to be cut, she also likely will not have the right to make her own informed decisions about her health, her education, or decide when and whom she marries, when to start a family, and what size that family will be. The Office of Population and Reproductive Health is engaged in FGM/C because we care about providing girls and women with the ability to decide for themselves how they will live and thrive.
When USAID first began working on the issue in the 1990s, individuals and groups in both the developing and the developed world were starting to look at the issue through the prism of women’s human and reproductive rights, as well as health. International consensus statements and treaties such as the International Commission on Population and Development (1994), the Fourth World Conference on Women (1995) and more recently, the United Nations General Assembly adoption of a resolution banning FGM/C worldwide in 2012, have made strong statements on the need to combat violence against women, including FGM/C, and have called on governments to adopt policies to prohibit the practice and to support community efforts to eliminate the practice.
While FGM/C is clearly a violation of a woman’s rights, it is a health issue as well. Studies conducted by the World Health Organization (WHO) showed negative obstetric outcomes and a 2013 meta-analyses by the Norwegian Knowledge Center for the Health Services showed that prolonged labor, obstetric lacerations, instrumental delivery, obstetric hemorrhage, and difficult delivery are markedly associated with FGM/C. These results can make up the background documentation for health promotion and health care decisions that inform work to reduce the prevalence of FGM/C and improve the quality of services related to the consequences of FGM/C.
Since 1997, when WHO issued a joint statement with the U.N. Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) against the practice, international attention and effort has gone into counteracting FGM/C. Of the 28 African countries where FGM/C is practiced, 22 have passed laws or provisions banning it, as have 12 industrialized countries with migrant populations from FGM/C-practicing countries. While prevalence of FGM/C has decreased, for example, from 99 percent to 97 percent in Somalia and 89 percent to 84 percent in Mali, UNICEF reports that the percentage of girls and women who reportedly want FGM/C to continue has remained constant in countries including Guinea, Guinea-Bissau, Senegal and the United Republic of Tanzania. An increasing number of women and men in practicing communities support ending the practice, yet every year millions of girls still undergo this painful and demeaning procedure.
The same elements that will transform a culture from performing FGM/C on its girl children – the values, and norms that inform the expected and accepted ways that people behave in a culture – will also bring increased acceptance for the use of contraception and information on family planning. Our work in FGM/C is as much about empowerment as it is abandonment of a practice. To quote former Secretary of State Hillary Clinton, who spoke on Zero Tolerance Day in 2011, “All women and girls, no matter where they are born or what culture they are raised in, deserve the opportunity to realize their potential.”