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Let’s not tiptoe around the topic of FGM

In observance of the International Day of Zero Tolerance for Female Genital Mutilation on 6th February 2018, we are pleased to feature a piece by a women leader in global health, Her Excellency Mrs Toyin Ojora Saraki, about the work she is doing to champion accessible and affordable healthcare for everyone through her organisation the Wellbeing Foundation Africa (WBFA).

In millions of households in communities around the world every year, young girls will be summoned by relatives and prepared for a "ceremony" in hushed whispers, or excitedly firm tones. They will be shepherded to secluded rooms and enclosures, held down, and cut, in varying conditions and degrees, from the sanitary to the unsanitary. Despite their best efforts to compose themselves, there will be screams that emanate through clenched teeth, or howls of pain.

For those who hear the screams, whether muffled or not, the more curious will tiptoe towards the noise, in care or in curiosity, and then tiptoe back, silently, to whatever they were doing before the unseen but heard sounds of pain broke the peace, and a girl's autonomy, to pieces.

Why do we tiptoe around the topic of FGM?  For our Wellbeing Foundation Africa midwives there are no topics that are off-limits. The expectant mothers who come to our antenatal care classes have many questions about childbirth, nutrition and the health of their baby, but they are also provided with a safe space to discuss any other areas of concern. Every MamaCare midwife is committed to educating mothers, and their families, providing a continuum of respectful maternity care and counsel, from pregnancy, to birth, and age.

Mamacare midwives will not tiptoe around anything that affects our ‘Mamacare’ mothers and that includes the harmful cultural practice of Female Genital Mutilation. These ‘safe conversations’ about FGM with a pregnant woman or new mother can empower her to protect her newborn girl. In cultural communities where it is prevalent, infants and pubertal girls are the most likely to undergo FGM as a ritual or rite of birth or passage to adulthood– these are the times of highest risk, other than when an adult woman elects to have it herself. Equally important, therefore, are those safe conversations between midwives and adolescent girls, who become able to protect themselves.

The education that MamaCare midwives provide to mothers and girls is a two-way process. Our midwives listen to concerns, local trends and questions, and in return provide the facts that mothers need to know, including the long-term risks of childbirth complications and infertility. Misconceptions about FGM are not solely held by expectant mothers, of course, but some facts may surprise even well-informed readers. It is widely assumed that FGM is more prevalent in rural areas of Nigeria, for example, than urban areas. The opposite is true, by a measure of 13%.

Midwives become the local focal point for more than health concerns and can provide those safe spaces whilst educating the wider community. Whilst legislation is welcome, prevention in the case of FGM will work far more effectively than punitive measures, with an approach which combines ‘safe conversations,’ education and initiatives such as the Alternative Rite of Passage proving to be most successful.

The Alternative Rite of Passage programme set up by Nice Leng’ete in Kenya, for example, has helped 15,000 girls avoid FGM in the last seven years – demonstrating the importance of conversations within communities. Ms Leng’ete expanded conversations in her community from H.I.V. prevention to the health complications associated with teenage pregnancy, to FGM. At the launch of Amref Health Africa’s vision to eradicate FGM by 2030 last year, I called for more research to be undertaken on the cultural values perpetuating the practice and, therefore, a better understanding of how communities can most effectively end it.

Continuous reinforcement, delivered by midwives, teachers and community leaders, is an essential component of successful strategies. So too are partnerships within communities, in particular those that include men and boys. Today, on the International Day for Zero Tolerance of FGM, we should take stock of the facts and carefully analyze the approaches which are proven to work best. Whilst, according to the World Health Organization, 3 million girls are at risk of FGM worldwide every year, rates have fallen 14 percent in the last 30 years. Our MamaCare midwives will keep having thousands of safe conversations and reducing that number further – Governments, the international community and charities should follow these community and health-led approaches to eradicate the practice altogether.


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