The hush-hush time

Most UK schools start their holidays at the end of July, and that marks, in certain communities, the start of of the hush-hush time.  It's the time that many immigrant families take their children back home for a long summer holiday.  Nothing hush-hush about that, but what may happen to their girls when they are out of this country most certainly is.

Anything from 500 to 2000 schoolgirls will be "cut" over the summer and then in September return to school with scars that are not only physical but mental too.  The Female Genital Mutilation Act 2003, makes it against the law for FGM to be performed anywhere in the world on UK permanent residents of any age and carries a maximum sentence of 14 years imprisonment.

So far, no prosecutions have been made under this law, though interventions have.  Project Azure, a unit in the London Metropolitan Police, intervened in 39 situations in 2008, 59 in 2009 and so far 25 this year.

There are 16 clinics in the UK to deal with FGM.  In 1997 there were two.  The reconstructive surgery that Papillon decided to have is not offered in the UK, though sometimes surgery can be done to reverse the procedure for Type III. 

But wouldn't it be better if none of this was necessary, if the message is clear of what can happen, physically, mentally, and also legally, if the girls are taken away for this procedure.

Read the whole article in the Observer.
Read the effect on Papillon and her efforts to reconstruct her life.

Senegal: Total End of Female Genital Cutting Now in Sight

If any of you have read Papillon's story, you will know she is of Senegalese descent and that this post means that in the furture there is every chance that no other will have to go through what she had to endure.

Last night I received the following email from Tostan, which I reproduce in full.

 Government of Senegal launches major national action plan to seize on momentum created by local communities and the NGO Tostan to end the practice by 2015

DAKAR, Senegal, 18 February 2010—Building on a massive grassroots movement for the abandonment of female genital cutting (FGC) which has seen thousands of communities in Senegal join its ranks in recent years, the Government of Senegal will announce tomorrow the launch of a comprehensive strategy for achieving its goal of nationwide abandonment of FGC by 2015.

The strategy, to be announced at an event attended by Senegalese Prime Minister Souleymane Ndéné Ndiaye, is largely based on the human rights approach developed by Tostan, an NGO working in Senegal since 1991. Through Tostan's respectful, cross-cutting model of engaging communities, over 4,200 communities in Senegal have publicly declared their abandonment of the practice since 1997. A recent UNICEF study confirmed the long-term abandonment of FGC in communities that participated in the Tostan program.

The National Action Plan for FGC Abandonment 2010-2015 will focus on three key components of the Tostan strategy: implementing empowering education programs in national languages, engaging extended social networks through an "organized diffusion" model of communication, and supporting public declarations for the abandonment of FGC.

The Action Plan also stresses the importance of working with populations in the regions where FGC is most commonly practiced, Saint Louis, Matam, Kaolack, Tambacounda, Ziguinchor, and Kolda─regions which are among the poorest of Senegal.  

The launch event will recognize the local community leaders who have led this movement from infancy to its current tipping point. Special recognition will be given to the first community to publicly declare abandonment of FGC in 1997, Malicounda Bambara. The Tostan organization and staff will also be recognized for their dedicated work on this and other development issues over the past 19 years. Khaldiou Sy, Director of Tostan Senegal, will speak at the event. 

The launch event comes just days before a massive public declaration of all 256 communities of the Kedougou Region of Senegal, where, on Sunday, February 21, participating communities will declare an end to the practices of FGC and child/forced marriage on a regional level, marking one of the largest such events to-date. The event will be attended by the Minister of Women and the Country Representative of UNICEF in Senegal.

 # # #

About Tostan: Tostan, a US 501c3 organization that was founded in 1991, currently has over 1,000 full-time staff and community facilitators, and is working in over 800 communities in eight countries in Africa. Over 99% of Tostan’s staff is African. The organization’s US office is based in Washington, D.C.  Tostan has been the recipient of several awards including the 2007 Conrad N. Hilton Humanitarian Prize, the UNESCO King Sejong Prize for Literacy, and Sweden’s 2005 Anna Lindh Award for Human Rights. For more information, please visit www.tostan.org.

 

Dr Madzou in Angers

As outlined in an earlier post, Dr Foldès is now far from being the only surgeon to practice reconstructive surgery to repair female genital mutilation.  One of the surgeons he has trained is Dr Madzou in Angers who says the technique used is straightforward for a surgeon to learn and uses no specialist equipment.  He has trained 20 surgeons in Burkina Fasoas well as operating there himself.

To answer an enquiry I've just received, the contact details for Dr Sébastien Madzou are as follows.

Tel. Rdv consultations : +33 (0)2 41 35 44 59
Fax : +33 (0)2 41 35 42 54
Email : SeMadzou {at} chu-angers {dot} fr

The Cut

The cut - a traditional rite of passage into womanhood: genital cutting.  Or an issue that should concern us all.
 
Some of my longer-standing readers will remember Papillon's story which I translated from her French blog. It was all about her quest to have reconstructive surgery for the genital cutting she had suffered at the age four.  If you haven't read it, please at least consider reading the first two or three posts which tell of how it happened.  "When I was 4 my mother had me circumcised. It ruined my life". 

It was over two years ago when I found the blog and asked her if she would allow me to translate it so that young English speaking women could benefit from her experiences.  Since then, I've had numerous enquiries from people asking if the surgery is available in the UK (no), and how to go about contacting Dr Foldès, the surgeon who developed the procedure.

Recently I've heard that a Spanish surgeon, Pere Barri of the Instituto Dexeus, has spent some time in Paris with Dr Foldès, and now operates two or three times a month.  Not only that, he is hoping to share the knowledge and skills with other clinics in Spain so that more women "can leave their ghosts behind".

The practice of FGM used to be more or less confined to sub-Saharan Africa and a few parts of the Middle East and Asia but nowadays, with migration and population movement, the incidence in Europe and elsewhere has been increasing.  It is illegal to carry out the practice in Europe but it is so very hard to counteract traditional beliefs.

There are various initiatives in progress.  One in the UK is a survey which is funded by the Health Department to increase knowledge and understanding about FGM and to try to find out how much training might be required by health practitioners.  France had an informative and educational campaign in April.  There are initiatives in a number of African countries: Ethiopia, Burkina Faso, and several others.

Now from Norway there is a project to educate and raise awareness which has produced a documentary film called "The Cut".  This, the first episode, shows two girls from different villages in Kenya where FGM is still practised in spite of its being illegal.  One girl has rejected the practice and is actively working to help educate people, the other is about to undergo this traditional but harmful rite of passage. It goes some way to explaining the tradition, incidentally showing unequivocally that it isn't specifically an Islamic practice, and suggests a way it can be eradicated.

If you wish, you can download the film, less than 15 minutes in length, from the project website.  It doesn't make the most pleasant viewing, but nor does it go out of its way to shock.

Campaign against female genital cutting and forced marriage

I was first alerted to this campaign by my friend Max, from Clarity2009.  His post made me look further into what was going on.

The motivation behind the drive is to raise awareness. 100,000 posters and brochures are being distributed to  organisations concerned with women's rights, equal opportunities, and the information covering FGM is being given to centres for mother and child welfare.  In both, the legal situations are outlined and in both they implore young women to break the taboos and the silence.  The graphics were chosen with care and are deliberately austere.  The brochure "L'excision est un crime" describes clearly the procedures of FGM and the medical consequences.

France does address these problems quite well.  According to the brochure it is the only country to have taken cases of FGM to court, the first time in 1979.  In addition French administration has agreed that the costs of reconstructive surgery will be covered by the state.  Dr Pierre Foldès is no longer the only surgeon to offer this service.  He has trained doctors who now perform the same operation in other parts of France, and also in Africa.  The procedure is mentioned in the leaflet being distributed.

The UK has had campaigns specifically against FGM, most notably two years ago when the police offered a reward of £20,000 for information regarding anyone involved in FGM.  It was conducted in the summer when so many girls are taken back to Africa for this mutilation.  Unfortunately though, there is no recognition for reconstructive surgery, and the best the National Health Service can offer is reversal, which can be very helpful in some cases but it's not the same thing.  Anyone unconvinced that reconstructive surgery is needed, should read Papillon's story about why she decided she would go through with it.  It gives a real insight into the psychological consequences that she suffered as a result of her mutilation as a child.

In the USA, Clitoraid.org does offer the reconstructive surgery, currently for $1000.  Dr Marci Bowers has trained with Dr Foldès and now practises in Jamaica and the USA.  I am rather uncomfortable that Clitoraid was founded by the Raelian movement, you know, the people who claimed to have cloned human beings.  That does worry me.

For all the publicity, I'm not convinced that the French campaign will address the issues so very successfully.  The way they are presented, they seem to be preaching to the converted.  What they have to do is win over the hearts and minds of the parents of the girls who will suffer.  Distributing leaflets to women's groups doesn't seem the best way, although it's a step, but I'd be happier if they were making efforts to speak not only to those who may spot the abuse but also to the people who ultimately are the decision makers for their daughters.

Fighting back

Mount Kenya
Photo from Flickr/Kalense Kid. Creative Commons licence.

Among the Yiaku, one of Kenya’s smallest ethnic groups, 98% of women aged over 30 have undergone female genital cutting (FGC), sometimes referred to as female genital mutilation (FGM). Those that have escaped being cut are ones born to fathers from outside communities.

Custom has it that girls are circumcised aged between 9 and 15 during April and December, about 1000 per year. Immediately after that local schools report that the number of girls attending school drops by 40%. There is a high rate of illiteracy.

Little is known about the Yiaku, a people with limited exposure to the outside world. They are believed to have settled in Mukogodo Forest about 4,000 years ago, apparently after migrating from Ethiopia. Their cultural beliefs have been dominated by the Maasai, but they are now trying to revive their own traditions and language Yiakunte. Very few, approximately 1.5% speak the language fluently, and they are elderly.

A campaign has begun among the Yiaku to eradicate FGM. Over the last year 200 girls have been given alternative rites of passage, and are given training on their rights, health issues, reproduction and HIV/Aids. At the first session, 40 girls were expected, but 72 turned up. Two weeks ago, 82 attended.

Slowly but surely progress is being made. The girls who have escaped the cut will be able to continue at school, contribute to their communities, and educate future generations.

This work is supported by MS, a Danish organisation, in Kenya.
Information from The Standard, Nairobi.

Other posts on this subject include:
Papillon's story, a young French woman tells of the effects it had on her
Aminata's story
Senegal, Tostan and FGM

International Day Against Female Genital Mutilation

Quoted directly from the United Nations Population Fund (UNFPA) site:

Message of Thoraya Ahmed Obaid, Executive Director, UNFPA

06 February 2008

Today UNFPA, the United Nations Population Fund, calls for stronger commitment to end female genital mutilation. We call on governments to protect the rights of women and girls.

We call on leaders to take action to end female genital mutilation in line with the United Nations resolution adopted last year. In the resolution, governments reiterated that female genital mutilation violates the rights of women and girls. They said the practice constitutes an irreparable, irreversible abuse. They cited mounting medical evidence that female genital mutilation poses a serious threat to the health of women and girls, increasing their vulnerability to HIV, raising the risk of maternal and infant mortality, and harming their psychological and sexual and reproductive health.

Despite these findings, an estimated 100 million to 140 million women and girls worldwide have undergone the practice and 3 million more girls are at risk each year. Many women and girls are traumatized by the experience and suffer in silence, afraid of being excluded from their communities.

In line with the resolution, UNFPA calls on governments to develop effective policies for the elimination of female genital mutilation. We urge all decision makers, at all levels, to play leadership roles in eliminating female genital mutilation. We call on national and community leaders to support the development of prevention and educational programmes, which take into account local beliefs and realities.

Intensified efforts are urgently needed to stop the practice in all its forms. Today, UNFPA pledges to increase support for efforts to end female genital mutilation. We call on governments and other partners to contribute to the UNFPA/UNICEF joint programme and trust fund to end the harmful practice in one generation in 17 high-prevalence countries.

At UNFPA, we remain committed to women’s empowerment and gender equality and the right to sexual and reproductive health.

I can never forget the pain

Another woman who suffered FGM as a child is campaigning against the practice in her own country. Nhima Cisse, now a women’s rights advocate, was elected to parliament in Guinea Bissau in 2005.

She tells of her experience at the age of eight, and how it continues to influence her life. She lost her first child after 24 hours and she herself suffered haemorrhaging which resulted in a hospital stay of almost three weeks. Three subsequent babies survived, thanks to being able to have them in hospitals abroad.

She herself still suffers considerable pain, in spite of operations to reduce the scarring.

Ms. Cisse is committed to continuing to fight for FGM/C. “I am not afraid,” she says. “I will do whatever it takes to have this traumatizing practice stop. This razor blade caused more than physical wounds in a woman’s life.”

More details in the UNICEF report.

Papillon

Anyone going through Papillon’s blog will see from the comments that her story has resonated with many people who have had different experiences. One person, Little Ms Dalu, a Sudanese student in America, has written a very compelling post on this subject and how she has identified with a lot of what Papillon has been through: "her writings speak to me and give me some comfort and I feel less alone".

That particular article was primarily about “Body and Soul” but another one I know many women relate to is “The Great Femininity Mystery”. I know I do. I spent miserable times when I was young thinking I wasn't up to the standard I saw as a requirement of femininity, primarily long-STRAIGHT-blonde-hair. I know, it seems ridiculous now and I have come to realise that femininity comes from within and not from external props.

Anyway, I’d like to join with Ms Dalu in thanking Papillon for her articulate and honest writing.

Burkina Faso succeeds in reducing female genital mutilation

From AFP

In 1996 Burkina Faso banned female genital mutilation when it was estimated about 80% of girls were subjected to the procedure. Now, ten years later, the prevalence is estimated at 45%.

While there is still a long way to go, and 45% of girls is still a very large number, it is remarkable progress in such a period of time, far less than a generation. Excellent news for once, and demonstrates what can be done.

Aminata

My thanks to Janeway for having pointed me in the direction of this article.

There have been reports recently originating from an Associated Press article about a French woman of Senegalese descent, who suffered FGM at the age of six.

It sounds familiar to anyone who has been following Papillon’s story but while there are similarities (they are even the same age), there are also differences. Aminata suffered this mutilation in Paris, in a basement of a dormitory for immigrants. There is a fairly graphic description on this site.

There are one or two points in the article which I think are off the mark.

It cites a BMJ article (without the reference) saying “The British Medical Journal recently raised the question of whether requests for cosmetic surgery on the genitals may be a smoke screen for mutilations” but, if I have the correct one, the author actually says that the cosmetic surgery is just as much a mutilation: “It is Western medicine which, by a process of disease mongering, is driving the advance of female genital mutilation by promoting the fear in women that what is natural biological variation is a defect, a problem requiring the knife.”

It also quotes a British midwife as saying that every year she alone treats 500-600 victims. The implication is that 500-600 girls are still being subjected to the mutilation, whereas these cases could date back many years. In fact it is probably only when young women leave home or reach child bearing age that anything is done about it, because it’s unlikely to be the parents who instigate treatment. That means they date back over 20 years in most cases and could easily be 30 or more.

There is a further point made that “in France, tough surveillance is thought to have all but eradicated genital mutilation for girls aged up to 6, so the procedure is simply performed at a later age”. I can find no reference to support this, nor does it seem very logical. The trend, if anything, is to perform the procedure at earlier ages, and I’m not aware of any medical examinations that stop happening at the age of 6 (but correct me if I'm wrong).

Cultural sensitivity

According to this article, the "fixation on cultural sensitivity is changing the debate around female genital mutilation, with a growing number of professors and women's rights activists becoming hesitant to condemn the practice".

My response to this has to be, would they have been, are they still, equally hesitant to condemn slavery? (it still exists, it is a well established tradition in some areas). Would they have had difficulty in condemning foot-binding in Chinese culture?

There is an interesting post on Global Voices about the tradition of over-feeding women in Mauritania where it is sexy for women to be fat. A commenter on an earlier post had said "but it is not their fault, this is how they were educated". Similar arguments apply.

Being aware of cultural issues and sensitivities cannot mean that harmful practices should be condoned. And I notice that the majority of these issues are harm caused to women.

Senegal, Tostan and FGM

I mentioned the organisation Tostan's work in Guinea last April. They work primarily in West Africa having started up in Senegal, but they also have programs in Sudan and Somalia.

Today they have been awarded The Hilton Prize, awarded annually to an organisation making extraordinary contributions toward alleviating human suffering anywhere in the world. It is worth $2 million (£750,000) which must be going to make a huge difference to their work.

It is especially good to hear this news because only last Friday IRIN published a report saying that female genital mutilation (FGM) was continuing in Senegal 10 years after villagers had claimed to abandon it. In fact, reading further in the article will reveal that a 2006 survey shows a 60% drop in the rate of FGM in villages which had been in the Tostan programme. That seems to be well on course for the UNFPA's aim to eliminate the practice within a generation, and for which the UN is setting up a $44 million fund.

It seems unrealistic to expect to change views which have developed over centuries in a relatively short time. They have been doing incredibly well to have achieved what they have so far but the prize money will allow them to do so much more. I would hope that the people administering the new fund will look at their successful methods.

Reconstructive surgery after FGM - counterproductive?

There is a report in the Voice of America, telling the story of a woman, Abi Sanon, who has had reconstructive surgery after having been circumcised as a one week old baby. The surgeon who performed the reconstruction was Michel Akotionga, one of the doctors trained by Dr Foldès.

Apart from Abi Sanon's own story, there is a quote from Benjamine Doamba. She was circumcised herself and campaigns against FGM. She says she feels no less a woman for having had it done and has no need to have reconstructive surgery, but fully supports anyone who does.

She raises an interesting point by saying that she worries that the publicity surrounding reconstructive surgery deflects attention from the more important campaign to eradicate the practice. Additionally, she is afraid that if parents are in two minds about whether to have the procedure done on their daughters, they may have it done anyway, because it's reversible later on anyway.

I can understand how that thought could come about, but if the education which must be part of the campaign against FGM is done well, parents will realise that they could be inflicting years of physical and mental pain in the meantime. Reconstructive surgery can only do so much.

Read Papillon's story.

FGM contacts in the UK

Hospitals and Clinics in the UK offering Specialist FGM (Female Genital Mutilation) Services

Taken from Forward

African Well Women's Clinic
Guy's & St Thomas's Hospital
McNair Centre
London SE1 9RT
Tel: 020 7188 6872
Contact: Ms. Comfort Momoh
Mobile: 07956 542576 / 07956407063
Pager: 0870055500 (Ask for 881018)
Open: Mon-Fri 9.30am - 4.30pm
Email: comfort.momoh@gstt.sthames.nhs.uk

African Well Women's Clinic
Antenatal Clinic
Central Middlesex Hospital
Acton Lane, Park Royal
London NW10 7NS
Tel: 020 8965 5733
Open: Thursday 9am - 12pm
Contact: Mr Harry Gordon

African Well Women's Clinic
Antenatal Clinic
Northwick Park & St Mark's Hospitals
Watford Road
Harrow
Middlesex HA1 3UJ
Tel: 020 8869 2870
Open: Friday 9am -2.30/3pm
Contact: Jeanette Carlsson

African Women's Health Clinic
Whittington Hospital
Level 5, Highgate Hill
London N19 5NF
Tel: 020 7288 3482
Open: Last Wednesday of each month (all day)
Home visits or you can attend the hospital
Contacts: Joy Clarke or Shamse Ahmed

Women's and Young People's Service
Sylvia Parkhurst Health Centre
Mile End Hospital
Bancroft Road
London E1 4DG
Contact: Dr. Geetha Subramanian
Tel: 020 7377 7898
Open: Mon-Fri 9am-5pm
Email: geetha.subramanian@thpct.nhs.uk

African Women's Clinic
The Elizabeth Garret Anderson and Obstetric Hospital
Huntley Street,
London, WC1E 6DH
Tel 020 7387 9300 ext. 2531
Contact: Maligaye Bikoo
Email: egappts@uclh.nhs.uk
Email: maligaye.bikoo@uclh.nhs.uk

Multi-Cultural Antenatal Clinic
Liverpool Women's Hospital
Crown Street
Liverpool L8 7SS
Tel: 0151 702 4175
Open: Wed: 5.30pm-7pm and Fri: 9.30am- 11am
Contact: Dorcas Akeju

Chelsea and Westminster
Gynaecology & Midwifery Departments
369 Fulham Road
London SW10 9NH
Tel: 020 8846 7926
Contact: Gubby Ayida
Email: gubby.ayida@chelwest.nhs.uk

Community Health Project
Kirkdale House
7 Kirkdale Road
London E11 1HP
Tel: 020 8928 2243 / 020 8928 2244
Contact - Jennifer Bourne, Specialist Nurse or Dr Faduma Hussein

St Mary's Hospital
Gynaecology & Midwifery Departments
Praed Street
London W2
Contacts: Lynne Pacanowski/ Judith Robbins
Tel: Lynne: 020 7886 6691/ Judith: 020 7886 1443

Birmingham Heartlands Hospital
Princess of Wales Women's Unit
Labour Ward,
Bordesley Green East
Birmingham
Tel: 0121 424 3514
Contact - Alison Hughes or Teresa Ball
Email: alison-aggathea@yahoo.com

African Women's Clinic
Women and Health
4 Carol Street (Camden)
London NW1 OHU
Tel: 020 7482 2786
Women can self refer for services
Contact: Maligaye Bikoo (CNS)

Acton African Well Woman Centre
Mill Hill Surgery
111 Avenue Road
Acton W3 8QH
Tel: 0208 383 8761
Open: Tues: 2.00 pm-5.00pm
Contact: Sucaad O'Nielsen
Email: sucaad.o.nielsen@ealingpct.nhs.uk
No appointment necessary and women can self refer

Salimata Badji-Knight

Salimata Badji-Knight and three of her sisters work together against the practice of female circumcision, otherwise known as female genital mutilation (FGM).

She was born in Senegal where she was circumcised at the age of five. One of the worst things about the circumcision she says, apart from the pain and the crying, was that the girls were tricked into thinking they were being taken on a picnic.

She moved to Paris at the age of nine where she was amazed to find that not every girl was circumcised, and even more horrified when girls were taken back to Africa for a "holiday" only to be circumcised when they were there. Since then most of her adult life has been spent campaigning against FGM. She now lives in Dorset in the south of England, and works for FORWARD, the Foundation for Women's Health Research and Development.

You can read her story at The Forgiveness Project.

Combating FGM - UK and Norway

There have been a number of recent news reports about Female Genital Mutilation in Europe.

It started off in Norway with a flurry of newspaper articles.

First there was uproar in Norway over a television broadcast highlighting the fact that Norwegian born girls are taken back to Africa to be circumcised: "an alarming number of young girls born or living in Norway have been taken back to Somalia during school holiday periods and subjected to circumcision." There has been a law against FGM in Norway for 11 years.

Next there was a report to say that over 250 girls and women have asked for help over the last three years at Oslo's largest hospital after problems resulting from FGM. How many more are suffering in silence?

Thirdly, a piece saying that politicians want to put emergency measures in place. One of these proposals was to be mandatory genital screenings for girls at risk, but that must be approved by Parliament, which is currently on summer recess.

Then today two fairly similar news reports from the BBC.

The first is about Somali born Waris Dirie, now a top model, giving her account of being circumcised at the age of five, and, not unlike Papillon, her all-consuming anger:

Every day I still struggle to understand why this has happened to me - this cruel and terrible thing for which there is no reason or explanation - whatever they tell you about religion or purity. I can't tell you how angry I feel, how furious it makes me.

She has set up a foundation to work against FGM.

Next an item about the police putting up a £20,000 reward for information leading to the arrest of anyone involved in FGM. They have timed this to coincide with the start of the school holidays, when they consider girls to be most at risk of being returned, mainly to Africa, for the ritual. The law in the UK to prevent girls being taken elsewhere for the purpose was passed in 2003 but so far no-one has been prosecuted.

The police are hoping they will get co-operation in this from the public because they don't want a situation to arise whereby girls returning from Africa are routinely screened.

That last is good news to me. Much as I am fiercely against FGM, the thought of young girls being screened as they return to the UK or Norway or anywhere else, worries me. I can't help but think it would be equally appalling for a girl who has been subjected to FGM as for one who has not, to be examined in that way.

Dr Bogaletch Gebre

Bogaletch Gebre grew up in rural Ethiopia where girls were not encouraged to attend school. In an effort to continue her studies she had to pretend to be fetching water when she went to lessons. Eventually she won scholarships and studied in Israel and the US, then started raising money to set up a women’s self help group, Kembatti Mentti Gezzimma, in Ethiopia. Her aim has been to empower people to make their own decisions, to strengthen women’s rights and combat female genital mutilation (FGM).

Rather than imposing solutions to problems, the group provides health, vocational, and environmental programmes which enable women make informed deicions for themselves. It is important to remember that people in rural villages may be illiterate, but that does not mean they are not intelligent.

Dr Gebre herself suffered FGM as a child, and two of her sisters died in childbirth as a result of complications caused by it. She says that fundamentally people do not want to cause any harm to their children so that when you get people talking about FGM they will ultimately reject it. Reform is achieved by addressing it as a problem not only for the individual, but also for the family and the community as a whole. The approach is based around community discussion groups.

Dr Gebre believes that gender discrimination is as harmful as racial discrimination and that educating women will lead to a far better society:

Mothers are primary educators whether or not they are so recognized, and whether or not they live in a literate or an oral society, or in something in between. If we truly desire to build a peaceful society, women as primary educators of young children are in the best position to begin the nurturing of peaceful people. But to be effective as teachers of peace they must be respected as women, and have access to education themselves.

From a recent article in The Lancet. Registration is required to read the article but it is free. It is also well worth while reading the longer account of how the self-help group started.

Dr Sébastien Madzou

Dr Pierre Foldès, although probably the most well know, is not the only surgeon in France to perform reconstructive surgery for women who have undergone female genital mutilation (FGM): in Angers there is Dr Sébastien Madzou.

He had originally read an article about Dr Foldès in a women’s magazine. Although Dr Madzou originally comes from the Congo, where FGM is not practised, he frequently comes across circumcised women in his gynaecology clinics so he got in touch to find out more. Dr Foldès asked if he would like to be trained in the technique and now Dr Madzou himself trains others.

The first surgeon he trained was a colleague, Dr Ouedraogo, with whom he had studied in Tours. Dr Ouedraogo suggested Dr Madzou go with him to Burkina Faso where he has now trained about 25 surgeons in the technique. Of these, 6 or 7 are women, though there appears not to be any concern amongst patients over having a male surgeon.

In an article by Habibou Bangré on Afrik.com (in French), Dr Madzou tells of his time in Burkina Faso. His patients of all ages came from all levels of society, having heard about the operation by word of mouth. Although he worked without charging fees, there nevertheless was a cost to the patients, however it was obviously considerably less that travelling to France. He even had one patient from Belgium who travelled specifically for the operation, and another from the USA who happened to be visiting relatives when she heard about it.

In France he works at Centre Hospitalier Universitaire d'Angers, 4, rue Larrey 49933 Angers. His own contact details.

Girl dies undergoing FGM in Egypt

An eleven year old girl died on Thursday in Egypt while undergoing female genital cutting in a private clinic. This happened in spite of the procedure being banned in Egypt.

If anything good can be said to have come of it, it is that the leaders of both the Islamic and the Coptic Christian groups in Egypt have made statements to say that neither the Koran nor the Bible mention female circumcision.

The full report from Reuters also states "The practice is performed on both Muslim and Christian girls in Egypt and Sudan, but is extremely rare in most of the rest of the Arab world. It is also common in Eritrea, Ethiopia and Somalia."

On 2 June 2007 Mustafa Afifi, in The Lancet, says "Research from Egypt has shown that highly empowered women were eight times less likely to intend female genital mutilation (FGM) for their daughters than those less empowered" and that while there is "strong evidence of the link between the first Millennium Development Goal (MDG-1) of poverty reduction and MDG-3 of women's empowerment, it is not enough."

He also says that talks in churches and mosques would be more likely to have a positive effect on women's attitudes than mass media campaigns (this includes television programmes aimed at persuading parents not to continue the practice), and that passing a law forbidding the practice will not change entrenched values, so "the battle cry should start from the community".

Although this is a very powerful means of communication, no one line of attack is likely to be heard by everyone who has any bearing on the matter, so all of them must be used. Different things influence different people. As Che Guevara said "let it be welcome if our battle cry has reached even one receptive ear and another hand reaches out to take up our arms".