Supplement to Population Reports, Meeting the Needs of Young Adults, Series J, No. 41, Vol. XXIII, No. 3 October 1995. Published with support from the United States Agency for International Development. For additional copies contact Population INformation Program, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202-4012, USA; fax (410) 569-6266; e-mail PopRepts@welchlink.welch.jhu.edu.

Governments are urged to prohibit female genital mutilation wherever it exists and to give vigorous support to efforts among non- governmental and community organizations and religious institutions to eliminate the practice. (486)

Many heads of state including those of Benin, Burkina Faso, Egypt, Kenya, and Senegal have spoken out against the practice. There are specific laws against FGM in Belgium, Ghana, Sweden, and the United Kingdom (52, 138, 222). In France and Canada, the operation is illegal under existing child abuse laws (168, 213, 214, 222). The governments of Sudan and Djibouti have laws that allow clitoridectomies but not infibulation. There is some type of regulation against FGM in Burkina Faso, Kenya, Uganda and possibly other African countries (138). Legal options are under review in Australia and the US (213, 222, 332). In Eritrea recent civil reforms have banned FGM and early marriage (139).

Because FGM is so entrenched in some societies, legal decrees and policy statements alone are unlikely to abolish it. For example, resolutions against the practice were signed in Egypt in 1959 and a law was passed by the British colonial government in Sudan in 1946, and yet the practice persists (284). Changes in social norms are necessary for long-lasting results.

Grassroots movements, community education, and advocacy groups have taken the lead in ongoing reform efforts. Although these groups often are small and staffed primarily by volunteers, they make up for these limitations by their commitment. The largest of them, the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC), received the 1995 United Nations Population Award in recognition of its work (494). There are national IAC committees in 25 African countries (213), and it is chiefly the efforts of this group that has led to adoption of the term "female genital mutilation." The IAC has courageously championed anti-FGM work through regional conferences, educational efforts, advocacy, and research at the national, regional, and community levels all over Africa.

Educating the public. Education has been an important component of effort to eradicate FGM. For example, in Burkina Faso the governments National Committee Against Excision has used broadcast media, video, film, and other education materials to reach the public (213). In Kenya the largest women's organization, Maendeleo Ya Wanawake Organization (MYWO) is at the forefront of anti-FGM activities. With assistance from the Program for Appropriate Technology in Health (PATH) and Population Action International (PAI), MYMO has conducted research on FGM in various areas and is now conducting a public education campaign (331, 389). Similar anti-FGM activities have taken place in Mali (213), Tanzania, Sudan (139, 213), and Somalia (332). In Nigeria the local IAC affiliate spearheads anti-FGM work, training traditional birth attendants who in turn train their colleagues all over the country. The National Association of Nigerian Nurses and Midwives (NANNM) has mobilized its members to educate the public through plays, skits, and other live performances (173, 213, 400).

Legislative change and advocacy. Although laws alone will not end FGM, they demonstrate critical governmental commitment and can create an avenue for legal action. In Burkina Faso the national government campaign to eliminate FGM began in 1988 (213). In Tanzania the Gender Health Risks Project has conducted workshops for community and religious leaders (213). In Egypt a television documentary about the circumcision of a 10-year old girl, broadcast during the ICPD after the president of Egypt had denied that FGM existed in Egypt, led to re-examination of its legality. Governmental commitment to eliminate the procedure was restrained by a fatwa issued by the Grand Sheikh of Ciaro, declaring FGM a duty for all women. In search of a compromise, the Ministry of Health This reversed its 35-year ban on FGM in government hospitals and established special days when health care providers could perform the procedure. Providers were instructed to counsel parents and try to talk them out of the procedure (150, 171, 576). Human rights groups and women's organizations objected to this policy, however, and in late 1995 the Ministry of Health re-imposed the ban. FGM remains legal in Egypt, nevertheless, and private practitioners can still perform the procedure (569). In Nigeria NANNM, with assistance from PATH, works to keep the attention of the news media focused on the issue (173, 213, 400). In Sudan the Babikir-Badri Association for Women's Studies and the local IAC affiliate lead advocacy efforts (139, 213, 412).

Working with health care providers. In Egypt anti-FGM initiatives are led by the Egyptian Task Force against FGM and the Egyptian Society Against Practices Harmful to Woman and Child, which have programs in nursing schools, women's associations, health care facilities, and the mass media (213, 475). Similar activities have been undertaken in Sudan (139, 213).

Alternatives to FGM. Some groups are encouraging communities to find healthy alternatives to genital mutilation without giving up its social and ritual aspects. For example, in Kenya a MYWO project will provide a rite of passage for adolescent girls, including the celebration, gift-giving, and recognition that are key to traditional passage into womanhood, while omitting the actual operation (412). In Sierra Leone the Kenema Project worked with opinion leaders of the secret circumcision societies to educate them about the harmful effects of FGM and to encourage allowing adolescents to go through the ceremonies without the harmful operations. This project also encouraged young men to pledge that they would not insist on marrying only circumcised women and young women to pledge that they will not circumcise their daughters (173, 332). To reduce opposition from practitioners by giving them alternative employment, one project in Ghana trains circumcisers to become traditional birth attendants, while another in Ethiopia trains them in sandal-making and bread-baking (27).

Working with immigrant and refugee communities. Organizations in Western countries are dealing with FGM among recent immigrants. In London the government-funded Foundation for Women's Health, Research and Development and the London Black Women's Health Action Project and, in France, Groupe Femmes pour l'Abolition des Mutilations Sexuelles (GAMS) and Commission pour l'Abolition des Mutilations Sexualles (CAMS) have put the issue of FGM on the agenda for national and international discussion. Along with public information and advocacy campaigns, they are active among migrant communities, providing information and counseling families (27, 138, 139). The UK has incorporated FGM prevention into its child protection laws, and this has been used successfully in the courts to protect some girls from genital mutilation (52). There is no special law against FGM in France, but CAMS has successfully used existing sections of the penal code on violence against children to prosecute circumcisors or parents who have submitted their girls to FGM (138, 168). In Canada a strong campaign supported by medical and health personnel is under way (214).

Research. Research is essential to understanding FGM and designing effective reforms. Recently, the Sudan and Yemen Demographic and Health Surveys have included FGM modules. Other countries including Central African Republic, Côte d'Ivoire, Egypt, Eritrea, Mali, and Tanzania are including questions on FGM in surveys (269). The IAC calls for research as part of any FGM intervention (223). Several US groups have studied FGM and supported efforts to eradicate it. Women's International Network (WIN), headed by Fran Hosken, was among the first and has published newsletter on FGM prevention activities since 1975 (213). The late Gordon Wallace of Population Action International Special Projects Fund supported many advocacy, research, and FGN eradication programs at the country level. The New York-based Research Action Information Network for Bodily Integrity of Women (RAINBO) has recently undertaken a comprehensive review of FGM and gives technical assistance in FGM research (477, 478). As programs expand, it will be crucial to include formative research and impact evaluation and to conduct operations research to identify what determines programmatic success or failure so that further efforts can be made more effective.

The practice of FGM is complex. Its prevalence, severity, and social rationale vary widely. For this reason grassroots organizations lead the way in fighting FGM and need the support of governments and as well as national and international organizations. Because FGM is often at the heart of a community's beliefs, the community first must acknowledge FGM as a detrimental and sometimes dangerous procedure before it will begin to change it. It is crucial, therefore, that members of the community be involved in designing and conducting any FGM eradication campaign.