Female genital mutilation is still prevalent in some Arab countries, but new research in Sudan shows that educational interventions at the secondary school level are successful in convincing teenage girls that the practise has serious health consequences. It is too late for many of those girls to protect themselves from the procedure, but the researchers hope they may grow up to not perpetuate it on their own children.
Others working to end female genital mutilation, or FGM, hope that such school-based health education efforts will be part of the fight against the practice.
The World Health Organization defines female genital mutilation—also known as female circumcision—as a violation of human rights in which parts of the female genitalia are intentionally altered or removed for no medical reason. This can involve the amputation of the clitoris, labia majora and or labia minora. Sometimes the procedure also includes the repositioning of these organs through cutting and stitching.
The consequences vary person to person and depend on the severity of the procedure. In the short term, bleeding and shock due to pain are not uncommon and if the mutilation is done without sterilized blades, an infection is likely. In the longer term, childbirth can be difficult and risky to both mother and child. Sexual intercourse can also be painful and, depending on the age at which a girl is cut, she may also suffer mental-health problems as a result of the trauma if she can remember the event.
Those who are trying to reduce the practice say it’s an uphill battle because there has been little achievement in replicating successful interventions from one country to another.
“We don’t have a sense of what is a good intervention against FGM. What works in one country or region doesn’t necessarily work in another,” says Sarah Hayford, a professor of sociology at Ohio State University. “It’s hard to know where to invest resources, which is why it’s important to do these small localized studies to know what works.”
Hayford was not involved with the Sudanese research, but her work in the past has focused on the prevalence of female genital mutilation in Egypt.
Reaching Girls in Sudan
In the new study, published in the World Health Organization’s Eastern Mediterranean Health Journal, public health experts conducted an educational intervention in two secondary schools in Sudan, targeting 154 girls between the ages of 14 and 17 who had consented to be part of the research. Close to one-third of those girls had already been subjected to female genital mutilation.
The intervention involved a video in which a girl who had been subjected to the procedure described its complications and long-term effects, and a lecture with visual aids delivered by a medical expert on the issue. The participants completed questionnaires about their attitudes toward female genital mutilation before the intervention and then six weeks after.
“Education is the first stage, it’s a good starting point.”Nahla Abdel-Tawab
Director of the Egypt branch of the Population Council
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Additionally, the surveys were carried out with students in schools where no intervention took place. The results showed that negative opinions toward female genital mutilation were significantly increased by the education outreach programs.
“We have proved that statistically we can change attitudes and it didn’t take more than one day from us,” says study author Esra Mahgoub, a public health researcher at Al-Neelain University, in Khartoum. “If we can change ideas in one day, imagine if we added more days to the program as part of their science curriculum.”
Mahgoub hopes that by educating teenage girls about the risks and negative impacts of the practice, they will make more informed decisions when they come to have children. “In a few years they will be parents and they will decide if their daughters have FGM or not,” she says.
No Single Solution
The precise number of girls and women who have undergone female genital mutilation has not been determined, but UNICEF estimates the figure is at least 200 million spread across 30 countries, mainly in sub-Saharan Africa and Arab countries. Somalia and Djibouti have the highest prevalence of the practice in the Arab region, with 98 percent and 93 percent, respectively, of girls and women above the age of 15 having been subjected to the procedure. In both Egypt and Sudan that figure is 87 percent, and in Mauritania it is 69 percent. The practice is less common in Yemen, at 21 percent, and Iraq, at 9 percent. (See a related article, “Research—Latest Weapon Against Female Genital Mutilation.”)
While public health campaigners say that Mahgoub’s research is valuable and provides much needed information and data, they warn it isn’t a silver bullet.
“Education alone is not enough,” says Nahla Abdel-Tawab, director of the Egypt branch of the Population Council, an international nongovernmental organization that produces research papers on health and developmental issues, including female genital mutilation. “Education is the first stage,” says Abdel-Tawab. “It’s a good starting point.”
Educational efforts need to be accompanied by a suite of other actions to stand any hope of reducing rates of female genital mutilation, she adds, such as proper law enforcement. In Egypt, for example, the procedure was criminalized in 2008 but it remains commonplace and is even carried out by medical doctors and nurses in a medical setting.
“We need doctors to say it’s not needed,” Abdel-Tawab said. That would empower women to tell their mothers-in-law or their husbands that they had seen a doctor to ask whether the procedure was needed for their daughters, “but that doesn’t work if the doctors are saying yes,” she said.
In Sudan the practice is also against the law, and while it may be widespread, Mahgoub says it’s almost unheard of for a medical professional to do the procedure. They would risk being banned as doctors, she says.
This simultaneous similarity and difference between two neighbouring countries illustrates why it’s so hard to replicate successful case studies from one country to another, says Abdel-Tawab. “You can’t copy and paste, unfortunately.”
That’s why more research like Mahgoub’s is needed, because experts say it will take a tailor-made approach to eradicate the practice in communities throughout the region.
In some countries, such as Sudan, it’s often the father’s decision rather than the mother’s when it comes their daughters and female genital mutilation. For that reason, Mahgoub would welcome more participation from men in the fight against the practice, but she says it would be culturally impossible for her to conduct the same educational interventions for teenage boys.
“It would be acceptable if the person delivering the information [to boys] was a man.” But she says the vast majority of people fighting against female genital mutilation are women—so finding a suitable candidate to educate teenage boys isn’t easy.
For now, Mahgoub wants to do a larger version of the study, maintaining a focus on girls. “I am planning in the future to do the same concept of research, but maybe three- or four-day programs, and to follow the same students for three years of evaluation,” she says.
That approach is welcomed by other experts. “I’d be interested to see if the girls adhere to their decisions and opinions over a longer period of time,” says Abdel-Tawab.