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Ending Female Genital Mutilation

Ending Female Genital Mutilation

A three-pillar approach has a chance.

Mahnaz M. Harrison, Mark P. Lagon, Heather Marlow

Human progress often profoundly lags behind technological advancement. We can send probes, even humans to the heavens and electrify or automate cars—but we still tolerate the ancient practice of female genital mutilation (FGM), which injures and economically dooms millions of girls. Even though rates of FGM have declined in some parts of the world, the total number of victims has increased dramatically because of sheer population growth. Unless there is action to change the trajectory, the numbers will keep rising.

The UN General Assembly has declared February 6 an International Day of Zero Tolerance for FGM, and one of the UN’s Sustainable Development Goals (SDG) calls specifically for eradicating the practice by 2030; but FGM still takes place in the shadows worldwide—even in Western countries, if they are home to immigrant communities. Some 200 million women and girls have undergone the procedure. The crime continues.

One reason why FGM has become a focal point for international organizations is their recognition that ending the practice is not just an end in itself but a means to the broader goal of achieving another SDG, women’s and girls’ empowerment. FGM inflicts physical and emotional harm on girls, but its knock-on effects are larger: systemic economic inequality, education gaps, and early marriage. All these practices form a vicious cycle that perpetuates poverty, gender inequality, and power imbalances, especially in patriarchal societies.

FGM often takes place in hopes of securing a woman’s future by insuring a marriage or preserving family honor; but the consequences and complications are extremely dangerous—for the victims, their families, and even the communities in which they live.

The economic case for eliminating FGM is clear: The practice imposes a heavy and wholly unnecessary economic cost and weight on already-fragile health systems. FGM harms not only the gynecological, obstetric, and urological health of women and girls but their mental, sexual, and long-term health, creating waves of complications and costs. The World Health Organization (WHO) estimates that reversing these complications will require USD 1.4 billion per year globally. This translates into an average additional 10 percent of the entire yearly expenditure on health for individual countries. For some countries, the percentage rises to nearly 30 percent. As populations grow, more women are susceptible to the health complications of FGM.

WHO now predicts that the health care costs of FGM could increase to 50 percent by 2050 if it continues at its current rate. If the practice were abandoned now, 60 percent of this annual impact would be eliminated.

The economic toll of FGM is coupled with its social consequences. At its core, FGM is gender discrimination, a violation of human rights, and more. Girls who are subjected to “cutting” are typically between infancy and 15 years old; the consequences are life-long. FGM often leads to earlier marriages, which encourage girls to drop out of school.

Girls’ education improves health by lessening rates of mortality, reducing rates of childhood marriages and exploitation, and improving agricultural productivity.  In contrast, FGM keeps women and girls from reaching their full potential and, thus, prevents societies and economies from maximizing their full capacities. This is a problem of not just gender equality but economic development writ large.

Technology, Community Engagement, and Enforcement

If the human and financial costs of FGM are so high, and if more than forty-five organizations and UN agencies have prioritized its eradication (which they have), why does it remain a challenge even in countries where the practice is now illegal?

A 2021 report on “Effectiveness of Interventions Designed to Prevent or Respond to Female Genital Mutilation” notes that over the past decade (2010–20), despite intensified efforts to conduct global research on best practices in addressing FGM, the application of these practices at scale has not occurred. This is largely due to the limited application of existing evidence to refining program and policy implementation.

Moreover, evidentiary data should not just be diagnostic but must also be actionable in a way that prompts real-time intervention. Current approaches have not simultaneously addressed all aspects of the social-cultural system that enables FGM to take place. What is needed is a three-pillar approach, involving community engagement, that challenges the gender and social norms around FGM, the empowerment of women and girls individually, and the services that provide in-time intervention by social and law enforcement services.

Technology can be used to create the holistic approach needed to help end the pernicious and cruel practice of FGM. Indeed, technology is the glue that finally makes possible this three-pillar integrated approach, involving the girls at risk themselves, communities, social services, and law enforcement. A pilot program funded by the Grand Challenges Canada, in Kuria, Kenya, showed the effectiveness of the intervention using evidence-based data. The nonprofit Last Mile4D’s “VPack4Development” (V4D) was the catalyst that made it happen. V4D is an early warning system involving an integrated, solar-powered technology with an online platform that combines three main components: (1) education to motivate targeted communities to eradicate FGM, (2) periodic, real-time monitoring of the women and girls by trained field workers, and (3) crisis intervention, including a hotline, a law enforcement point of contact, and alternate, safe housing for girls who face imminent cutting. The online platform is designed for peer-to-peer dissemination of educational material, communication, and documentation; and it generates real-time data to inform programmatic solutions and identify and rescue at-risk girls from FGM.

Initial findings from a pilot program of V4D in Kuria, Kenya demonstrate its promise in addressing the need for real-time data on FGM, community engagement, and the potential to shift community norms and engage law enforcement. In 2019-2021, V4D was piloted in ten schools; and staff members monitored 1,096 girls ages nine through seventeen enrolled in the program over eighteen months. Of those girls, 9 percent had already been cut; 60 percent said they were at risk of being cut. This information surprised key stakeholders and prompted them to act. V4D sensitized parents, government officials, and leaders through a series of videos and community meetings. Thirty four percent of fathers of enrolled girls were sensitized about FGM, and 71 percent of mothers. After the program, 96 percent of parents signed declarations stating that they would not cut their daughters; 92 percent of the parents agreed to advocate for the eradication of FGM. Of more than 4,000 parents, authorities, and leaders participating in the program, 89 percent of this group improved their knowledge and attitudes about FGM. Through the monitoring of enrolled girls with V4D and the provision of prevention, there was an increase in girls’ confidence to speak out about FGM, from 46 percent at baseline to 99 percent at endline. Further, the proportion of girls who knew what to do if in danger of FGM increased from 53 percent at baseline to 98 percent at endline. One hundred and forty girls were sheltered. Over the course of the pilot, no participating uncut girls experienced FGM.

To date, alternative approaches to FGM prevention lack consistent or sufficient evidence to measure effectiveness, or they exclude girls’ voices or do not leave room for community stakeholders to read and act on the signs of an imminent community FGM event. Studies show that parents would often prefer to end FGM but are unwilling to subject their daughters to the social stigma of not undergoing it, signaling a demand for community-oriented participatory tools. The Last Mile4D team found that efficient data collection using V4D, coupled with constant contact with girls at risk of FGM, has allowed for intervention at critical points. Sheltering girls during the season when FGM risk is the highest (the December school holiday) delayed and ultimately precluded their exposure to FGM; this likely allowed most girls who otherwise would have been cut to remain in school for another year. The promising results of this FGM program indicate that community-engaged FGM programs with real-time monitoring benefit young girls and should be replicated elsewhere. V4D fills a need to integrate girls’ data with appropriate stakeholder education and the involvement of authorities in intervening and preventing FGM.

Because FGM is at once a health, social, and economic problem, on-the-ground interventions and technological solutions need to attack the practice from all three angles. Technology can be used to collect real-time, actionable data that will then be used to marshal community and law enforcement resources to save the girls. In many ways, the tools used to prevent FGM can also encourage young girls and support women’s agency within their communities, increasing the likelihood of reaching UN SDG 5. The more girls who are saved and see the benefits, the more advocates there are for changing the social, cultural, and economic norms that perpetuate the practice. The girls themselves become spokespersons in the battle against FGM. The catalytic use of technology, along with awareness-building, education, and social interventions, can make a dent in this pernicious practice and break the cycle, once and for all, that keeps women and girls mired in economic and social dependence.

Mahnaz M. Harrison is the founding president and CEO of Last Mile4D. Mark P. Lagon is chief policy officer of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria; former president of Freedom House, and former U.S. ambassador-at-large to combat trafficking in persons. Heather Marlow is a senior research scientist at the International Center for Research on Women.

Image: Jonathan Torgovnik/Getty Images/Images of Empowerment, Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)