As the committee has just heard from Ms McCambridge, FGM is a deeply ingrained practice which, unfortunately, makes it immensely difficult to eradicate. Going through the literature, I found cases of people trying to eradicate the practice since the 12th century but still today 6,000 women and girls undergo FGM.
What needs to be done to bring about a change in people's attitudes to FGM in the areas where it is practised? It takes more than just letting people know about the harmful effects of FGM on a woman's health or on her human rights. FGM is embedded in the society so for change to come about, there must be a critical mass of support for its abandonment. For a women or mother in Africa, this means she must know she can refuse FGM for herself or her daughter and be sure this will not affect her chances of marriage or her social status in the community.
We are talking about rural patriarchal Africa where generally a women's social status and livelihood are dependant on finding a husband and producing children. For these women, FGM is not just a health issue. The woman's whole future is at stake. For a woman to make the decision to refuse FGM, there must be firm family, social and political support for her decision — in other words, she must have what is commonly referred to as "an enabling environment" for her to make and maintain that decision to abandon FGM.
The good news is that according to social convention theory, the likelihood of a woman, who has not undergone FGM, getting married will gradually increase as the number of non-cut women increases. When a critical mass of women and men abandon the practice, very rapid change will take place with full FGM abandonment. This was seen in China with foot binding. This critical mass does not even need to be a majority and the more genuinely influential the individuals, the fewer needed. The tricky part is reaching this critical mass and World Vision has found it takes time and the co-operation of a wide range of people to achieve it.
What is World Vision doing about FGM? Over the past three years, we have supported an FGM eradication project in Somaliland which is a relatively stable province in northern Somalia. We have also conducted research on FGM in Kenya and supported the Sierra Leone office to kick-start its programming response to FGM in a country where there is still marked distrust and sometimes even hostility towards anyone who speaks out against FGM. All three projects have been made possible with Irish Aid funding and all are in high prevalence areas.
FGM in Somaliland is virtually ubiquitous and the majority of girls undergo the most severe form — type 3 — mostly at around six to eight years of age. Our project there has been running in approximately 30 villages and we are trying to achieve the critical mass needed to bring about change by partnering with a wide range of stakeholders. These include religious leaders, women's groups, school children and teachers, men and boys, FGM practitioners, health workers and traditional birth attendants. We are also working with the government and community leaders as they can be very influential in encouraging abandonment.
It has been an uphill struggle but we are seeing changes. On beginning this project, our staff were struck by the total silence that surrounded FGM. No one spoke about it openly. They also noted that approximately 65% of people had heard of some kind of negative health consequence of FGM. They might have heard something on radio or seen a poster in the local health centre but most just thought this was a woman's burden.
Since the project started, we have reached hundreds of men, women and children with messages on FGM as well as information on child and women's rights. This has been achieved through large-scale community awareness meetings, training for community and religious leaders and business people and talks in schools.
The result is that people are beginning to speak about FGM which is helping to debunk some of the myths and mystery that surrounds the practice. As a result, we are beginning to see shifts in behaviour. People have moved from practising type 3 FGM, which is the most severe form, to type 1, which is less severe. While this is a good start, our aim is to ensure that every form of FGM is eradicated and we are delighted to report that some families have promised to completely abandon FGM and not cut any of their daughters, which is a major change. We are linking these families together to form groups, as it is not easy being the only family to say it will not cut its daughters, and to speak out about FGM. The aim is to bring about a critical mass of families who will come forward to publicly renounce FGM. Step by step we are getting there, although the families are still a little afraid their daughters might be raped or remain unmarried if they step forward too soon. However, the signs are positive and if we can continue to engage with these communities, we expect that within the next few years, we will have achieved the critical mass needed to abandon FGM.
Our project there is in its third and final funding year. In Somaliland and other areas where FGM is widespread, a sustained long-term engagement is needed for success and we would strongly recommend a minimum of a five-year engagement. Therefore, we request that the Government continue to support overseas development aid programmes working on FGM eradication and sustain and build on current funding levels. Already our Somaliland programme and FGM work in Sierra Leone and Kenya will be strongly affected by the funding cuts. Unfortunately, we are unable to continue our project in Kenya this year.
Another interesting development in our Somaliland project is that we found that many men were very shocked to discover what FGM actually involves as they had very little knowledge of the practice. One young man reported that his marriage to his young wife was severely strained because of his wife's type 3 FGM, which is also known as infibulation. Type 3 FGM involves the stitching of the genitalia to create a barrier and this makes intercourse and child birth immensely difficult. After several unsuccessful attempts to consummate their marriage, his wife went to hospital to be deinfibulated or opened up and she bled for 15 days afterwards. He said that even now, they do not enjoy their marriage because of the fright. He said before this experience, he did not know what FGM involved and is glad that the subject is now being talked about because many young couples are in the same position as they are.
Many women are afraid to come forward for medical treatment despite suffering needlessly from problems related to FGM. One example of reproductive problems linked to FGM is fistula. Fistula is a rupture in the birth canal caused by prolonged labour which, unless treated, leaves women permanently incontinent. The smell of leaking urine or faeces is uncontrollable and humiliating and often these women end up being divorced by their husbands and isolated by the community. Obstetric fistula occurs disproportionately among impoverished girls and women, especially those living far from medical services, and is compounded by FGM and early pregnancies. The World Vision project in Somaliland is working to promote awareness of the medical consequences of FGM and to encourage women to seek treatment for these problems. This has encouraged some fistula victims to come forward.
A girl called Nimco's story is a good example of the need for fistula repair. At just 15, she suffered from vaginal fistula due to complications during delivery. While her baby survived, she was deserted by her husband. She was isolated in a small room and ignored by her community. Only her mother visited her to help her and her baby. As one can imagine, it was absolutely devastating for her. When World Vision heard about her case, we brought her for surgery which, fortunately, was successful. Surgery has literally changed her life. She has now been accepted back into her family and is able to attend public meetings and meet her friends. She is now looking to the future and is interested in starting a small business so that she can support herself and her baby. Through this Irish Aid-funded project, World Vision has managed to treat Nimco and 50 other women who have suffered from fistula, which has helped to restore dignity to their lives and enabled them to begin again.
From this experience, World Vision strongly recommends that FGM eradication projects in areas with poor medical services incorporate a component of medical care, including the establishment of referral services for fistula repair. Projects should also include training for traditional birth attendants and medical practitioners on the identification and treatment of complications related to FGM and early pregnancy.
While the majority of women understand there are health risks associated with FGM, often they do not relate their own health problems to having undergone FGM themselves, usually because it has been performed on them when they were children. They may not remember how life was different before or even be aware that they have undergone it.
I have spoken to several women who have undergone type 3 FGM and who were subsequently opened up in preparation for marriage. They told me that since being deinfibulated, urinating had turned from a ten minute ordeal into a one minute experience and said that their periods had dramatically shortened. They literally could not believe the difference.
Sadly, many women still fear being deinfibulated before giving birth and request that they are reinfibulated after giving birth in case they are perceived as loose or easy targets for rape. There are many advantages to being deinfibulated or opened up. It eases child birth, as well as more mundane functions like going to the bathroom. It is brilliant that there are guidelines on FGM for health care professionals working in Ireland stating that reinfibulation should not be performed. However, this is just a guideline. We request that the Government legislates against reinfibulation so that all doctors working in Ireland are left without doubt that this procedure is completely unacceptable.
One of the most interesting aspects of our projects was our work with FGM practitioners, in other words, the women who performed the cutting. These women often earn good money for performing FGM in poverty-stricken communities and hold positions of relative power and influence in the community. In our project in Somaliland we have involved these women in our abandonment work. We provided them with information about the negative consequences of FGM and we initially encouraged them to abandon the practice by providing them with an alternative source of income in the form of goat-keeping.
Ten FGM practitioners officially abandoned FGM in a ceremony, during which they handed over their blades and publicly declared that they would discontinue practising FGM. We employed this initiative as it was a best practice promoted by other NGOs. However, we found that this has not had a significant impact on reducing FGM prevalence in the area. This is because FGM is a demand-driven practice, in that women want their daughters to undergo FGM and are willing to pay high prices for the procedure and travel to where it can take place. We found that families were travelling from as far away as Europe to ensure their daughters underwent FGM in Somalia. Within Somaliland, families who could not avail of FGM in their local community would travel to a neighbouring community to ensure that there daughters would undergo FGM.
By focusing resources on the supply side or, in other words, on reducing the amount of female FGM practitioners in a community, one is not getting to the root of the problem. One female practitioner can easily be replaced by another, especially when large sums of money are offered for the service. We recommend that FGM practitioners are targeted in programmes with knowledge and awareness on FGM and its related issues, however providing them with income generating activities does not appear to be a suitable option for promoting FGM abandonment in a community.
We found that working with community leaders and politicians can have a significant influence on the discontinuation of FGM. By enacting legislation against FGM and developing political support to ensure its implementation, a government can help create the enabling environment needed to encourage families to abandon FGM.
In our projects, we try to bring politicians on board to discuss FGM, but it is often difficult to secure their co-operation. Many fear that speaking out against FGM will cost them votes. In Kenya, a former colleague of mine told me that when she worked on another FGM project with a different agency she brought a local MP to speak against FGM to his Maasai constituency. He first spoke in Swahili and told them all to abandon the practice. He was met with hostility and as a result switched to Maasai and told them all to ignore what he said and that they should continue with this great cultural practice. My poor staff member did not know what was being said because she did not speak Maasai.
It is clear that FGM is a prerequisite to obtaining power or influence in some communities, especially in rural areas. World Vision has been repeatedly trying to engage the Somaliland Government on completing its policy on FGM abandonment and participating in awareness raising, but it has been reluctant to commit.
World Vision sincerely thanks the committee for its recent questioning of the Foreign Affairs Minister from Sierra Leone. This scrutiny clearly shows African governments who have not yet enacted domestic legislation or action plans to eradicate FGM that the world is watching and is calling on them to fulfil their commitments. We ask the Irish Government to continue to raise the issue of FGM in international fora and during political talks with other countries, as it has planned in Ireland's national plan of action on FGM.