Survivors of FGM facilitate discussions to end the practice

By Martha Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure.

Chifra, Afar, 23 January 2018 – “I had severe period pain, and my labour was a life and death situation,” says Fatuma Abdu, 28, who had undergone Type III FGM/C as a child. Fatuma has two daughters, a 4–year-old and a 20-months-old.

She recalls her first pregnancy experience saying, “I was very weak during my first pregnancy. I was in labour for 24 hours before they took me to the hospital. I gave birth at the hospital. However, because of our tradition, I have stitched again. My menstrual cycle pain was agonizing. I got pregnant again, and it was worse than my first experience. I was in labour for three days until I was unconscious and found myself at Mille Maternity hospital.

The doctor told me I would have suffered from fistula had I stayed home longer than that. I had a stillbirth.  I was physically and emotionally hurt. My third pregnancy was much better because of the surgery at the hospital.”

Zahara Mohammod, 28 discusses about FGM/C with “Unmarried Adolescent Girls’ Club” at Mille Woreda, Afar. © UNICEF Ethiopia /2018/Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure. She explains how it was difficult to convince her husband on her decision saying, because “The day I went through all that because of my FGM/C procedure was the same day I made that decision. My husband disagreed because we had always thought we were right to practice FGM/C. Mind you, even though he knew how much I have suffered, he still could not make up his mind. I told him I would sue anyone who would touch my daughters and that was it.”

The UNFPA-UNICEF Joint Programme has been working in collaboration with Bureau of Women and Children Affairs (BoWCA) to accelerate the abandonment of FGM/C in Afar region since November 2008. During the implementation of its first phase that ended in 2013, the programme targeted six districts out of the 32 districts in the region, which have declared abandonment of FGM/C presently.

According to the assessment made at the end of this first phase, the programme has resulted in substantial changes in belief and practice of FGM/C in target districts, with a practice decline from 90 per cent in 2008 to 39 per cent after five years of intervention. The second phase of the programme is currently implementing social mobilization interventions in three districts with the aim of improving community knowledge, attitude and practice. The programme heavily focuses on the engagement of community and religious leaders who are the most influential persons in the community. Additionally, the programme promotes community conversations through various discussion groups to create awareness and empower community members for a lasting change.

Fatuma is among the trainers who have been selected to facilitate discussion groups in their communities. The UNFPA-UNICEF Joint Programme has trained 176 facilitators for community conversation and dialogue from 3 districts on FGM/C and early marriage. This community conversation and dialogue on FGM/C is inclusive of girls, boys, men, women, and the youth in the community.

“I hope everyone listens to our suffering and refuses to undergo the FGM/C procedure.”

Sharing her experiences with the training, Fatuma states, “The training was such an eye-opener. I was challenged regarding my wrong beliefs, and it helped me speak up for others.”

According to Sheikh Mohammod Dersa, President of the Islamic Affairs Supreme Council in Afar, the FGM/C intervention by UNFPA-UNICEF has brought a behavioural change in the community.

He states, “We are grateful for what UNFPA and UNICEF have done in our region. We have been working with them hand in hand. But, we still need to work harder, because the issue is deeply rooted in social and religious norms. Social norms are powerful. We need to know that this is a generational issue, as well. It takes a lot of effort and collaboration to challenge communities and achieve the goal of ending FGM/C. We are always ready to teach our community, and we hope the programme continues and expands to other districts.”

Women Volunteer Their Time to Help Eradicate FGM/C

By Esete Yeshitla

Zahara Ali, a volunteer social worker for Aseita Primary Hospital, Afar regional State.
Zahara Ali, a volunteer social worker for Aseita Primary Hospital, Afar regional State. Zahara serves her community by teaching about FGM and the consequences after taking training. Zahara advises women with FGM complications including Fistula to come to the hospital for treatment. Zahara does the advocating job without being paid. Aseita Woreda, Afar regional State. UNICEF Ethiopia/2017/Mersha

AYSAITA, AFAR, 18 May 2017 –Even with her sun-stricken skin and tired eyes, one can feel the vibrancy and strong personality of Zahara Ali. Zahara is a volunteer social worker who dedicates herself to helping her community without any compensation. With some broken Amharic mixed with a translated Afari language and a smile on her face, she starts to explain how she ended up serving her community.

“My first daughter was lucky not to get mutilated,” explains Zahara, “I was sensitized about FGM/C at that time.” However, her second daughter was cut. “I was heavily pressured by family and neighbours.”

Zahara allowed the traditional cut to be done on her daughter at seven days old, not knowing that it would end up being the most ‘incorrect and terrible procedure’. Facing complications and enduring pain, her daughter had to be brought to Aysaita Primary Hospital for corrective surgery.

After that experience, Zahara became much stronger and committed to teach others about the harm of FGM/C. When a community FGM/C sensitization programme was started in her town, some volunteers were deterred due to the lack of compensation, but for Zahara, that did not matter. “After going through the pain with my second daughter, I decided to work as the hospital’s social worker. I am convinced that I have to help mothers with FGM/C complications and make a difference in people lives,” says Zahara.

“The hospital contacts Zahara to sensitize the community,” says Dr. Hatesy Abraha, the gynaecologist at Aysaita Primary Hospital who has been hired through UNICEF’s FGM/C programme. He adds, “It is sort of demand and supply. The hospital provides treatment while utilizing people like Zahara to sensitize and convince mothers. Otherwise, it is not common for mothers in the Afar region to go to the hospital.”

Zahara was trained on FGM/C by the community sensitization programme, which was launched by UNICEF and the Regional Health Bureau. She then goes into her community with volunteers like her to teach about the symptoms of FGM/C complications. That is when women with FGM/C complications and other gynaecological needs seek treatment from the hospital. Zahara brings in mothers who have medical cases such as fistula or urinary complications. She advices pregnant women to have antenatal care and institutional delivery.

Medibo Ahmed,60, Aseita woreda, Afar regional State.
Medibo Ahmed,60, Aseita woreda, Afar regional State. Medibo was infibulated each time after she gave birth. The FGM was the cause for her complications. She had deinfibulation and vaginal prolapse repair and uterus removal at Aysaita Primary Hospital. She is happy with the procedures she had. UNICEF Ethiopia/2017/Mersha

While visiting the hospital with Dr. Hatesy, we met patients who had undergone such corrective procedures. One patient was Ebo Ahmed, a 60-year-old who has had many complications due to the type III FGM/C that was performed on her years earlier. Ebo has been stitched after every birth of her five children. Now, she has had vaginal prolapse, a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel or the vagina itself begin to fall out of their normal positions. In addition to repairing the prolapse, the medical team removed her uterus as well, all done in effort to ease complications from her FGM/C.

Ebo says, “I used to visit the hospital frequently as I was in severe and constant pain.” This constant pain was due to repeated urinary tract infections and other complications she had due to the FGM/C.  Ebo is determined to advocate and teach her community by sharing her experience. “I will advise, if they give me their ears,” she declares. As she prepares for discharge, she expresses her gratitude for the medical procedure, which was nearly free of charge thanks to UNICEF and partners.

Aysaita Primary Hospital is one of the hospitals in Afar region that was upgraded from a health centre in 2014, providing services for a majority pastoralist population of approximately 100,000. Through UNICEF support, the hospital employed a gynaecologist in May 2016. Following his assignment, the hospital started providing inpatient and outpatient management for FGM/C complications and different gynaecologic and obstetric cases.

The hospital has five trained health providers on clinical management of FGM/C victims and has two admission wards with a total of 10 beds. In 2017, they treated 292 cases, up from zero in 2016. With efforts from community members such as Zahara and Ebo and treatment from medical staff such as Dr. Hatesy, the goal is that one day again, the cases will be at zero – this time as a sign of tremendous progress towards eradicating the FGM/C practice.

The Brutal Reality of Female Genital Mutilation and Cutting

By Esete Yeshitla

Erbeti, Sfar, 17 May 2017 – Muna*, like many other girls in Afar region, was subject to type III female genital mutilation and cutting (FGM/C), a removal of the clitoris and the labia minora as well as infibulation: the narrowing of the vaginal opening through the creation of a covering seal. In her first few days of life, she was irreversibly changed; the fate of 98 per cent of females in Afar according to the 2016 Demographic Health Survey.

Years later she began experiencing unending pain. “It is just not how I expected my life would be,” Muna explained. It began at the age of 13 when she had her first period, which quickly became her monthly nightmare. In fact, it was only the beginning of a brutal reality.

At the age of 15, Muna entered into an arranged marriage. Sexual intercourse is another painful experience. “I have never enjoyed sexual intercourse with my husband,” said Muna.

She soon became pregnant. Going to a health facility to give birth is considered taboo in her community; a woman showing her private parts to a man is ‘unacceptable’. Rather, women are to give birth at home. It was no different for Muna.

“I had a really horrible labour and birth experience; I was bleeding and was in dire pain. I felt I was dying,” Muna said. “I truly believe I would have died I had not been taken to the hospital,” she added. Health extension workers in the community came to her house and took her by ambulance to the hospital.

She recovered in the hospital, but that was not the end to her agony. Infections and bleeding continued for weeks. All this led Muna to make up her mind that she would never let her new born daughter go through life like her.

As accustomed in her community, when her daughter was less than one month old, her family started planning for her FGM/C. Muna strongly refused: “I do not want her to go through the same pain. My husband almost made me leave the house, but I was persistent,” said Muna.

Community efforts supported Muna’s tough decision. The Government of Ethiopia, together with UNICEF, implements a multi-sector FGM/C eradication programme, with prevention, protection and care components each respectively managed by the Bureau of Women and Children’s Affairs, the Bureau of Justice and the Regional Health Bureau. Communication committees are one of the interventions, comprised of local religious leaders, clan leaders, health extension workers and police officers. Each fully integrated into their communities, they keep alert for three types of situations: child marriage, instances of FGM/C or a woman whose husband is refusing her to give birth in a health facility. They are reported to the appropriate sector office for further action. The committee also organizes training, supported by UNICEF and the Bureau of Justice, for community members on harmful traditional practices, with an emphasis on FGM/C.

Asrat Belayneh, a teacher at Erubeti Woreda, Afar Regional State.
Asrat Belayneh, a teacher at Erubeti Woreda, Afar Regional State. Asrat is passionate about her career. She teaches the girls about FGM/C. In addition, she communicates incidents such as early marriage and FGM/C practices to the concerned bureau in Erubti Woreda. Erubeti Woreda, Afar Regional State. UNICEF Ethiopia/2017/Mersha

Asrat, a communication committee volunteer, is also a teacher who is passionate about improving the lives of girls and women. “If I were to work in a modern community, I would not be satisfied. Helping to rescue young girls [from FGM/C] is fulfilling,” she says with tears in her eyes, “This issue is often a matter of life and death for them.”

Muna is happy that she saved her daughter from FGM/C and grateful for the education her community is receiving through the FGM/C programme. “Because of the awareness and training, my husband accepted my decision. Otherwise, it would have been impossible,” she said.

Enhancing knowledge to bringing social norm change

Sheikh Mohammed Dersa, the president of the Afar Region Islamic Supreme Council, started to combat FGM/C 25 years ago. He believes that FGM/C is a harmful practice that risks the life of young girls and has no basis in Islamic law but rather is Pharaonic. “When it comes to protection of girls from harmful tradition practices such as FGM/C, our challenge is lack of knowledge,” Sheikh Mohammed said.

Sheikh, Mohammed Dersa, the president of the Afar Region Islamic Supreme Council speaks of his role in preventing FGM in their community.
Sheikh, Mohammed Dersa, the president of the Afar Region Islamic Supreme Council speaks of his role in preventing FGM in their community. Religious leaders such as himself, motivate community members to participate in community dialogues in order to reach a general consensus that the practice is not a religious duty. Erubti woreda, Afar regional State. UNICEF Ethiopia/2017/Mersha

Years ago, Sheik Mohammed and other religious and clan leaders who were against FGM/C, were highly resisted by the community and some religious leaders; it was unimaginable to stop the practice. Hence, they started advising people who practice type III FGM/C  to reduce the practice to type I, as type I is considered the less painful than the other FGM/C practices (where a girl’s clitoris is ‘only’ cut or removed). The FGM/C practice used to be celebrated with a feast, but nowadays it is done behind curtains, an indication of the progress made.

Through partner collaboration, UNICEF is sensitizing the community gate keepers such as religious and clan leaders to support the effort; engaging the community through regular community dialogue, involvement of adolescent girls in the change process and implementing various sensitization events. Thus, it is believed a critical mass across the community is being built to support the change of social norms and end the practice.

Another facet of eradicating FGM/C is the strengthening and enforcement of legal frameworks, as the Ethiopian Government has passed laws to deter the practice. To this end, consultations to endorse the draft family law, enhancing legal literacy of the community, building the capacity of law enforcement bodies and the establishment and strengthening of community surveillance mechanisms are among the key interventions.

Ending a practice which has been long engrained in a community cannot be done with a single, short-term intervention. With the support of international donors, UNICEF is undertaking this extensive, multisector approach alongside the Government of Ethiopia to ensure that progress continues until no girl and no women are subject to the brutal reality of FGM/C.

*Name has been changed

UNICEF commits to speed up its efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C) 

Addis Ababa, 06 February 2017 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF Ethiopia commits to accelerate its efforts to end the violent practice of FGM/C through strengthened partnerships with key actors in support of the national theme, “Let us keep our promise and fulfil our commitment by ending FGM/C.”

“FGM/C is a harmful practice inflicted on girls which deprives them of their rights to sexual and reproductive health, endangers their health by causing complications during delivery and even untimely death,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “In order to fast-track the elimination of the practice once and for all, we need to work at grass roots level, at scale and hand in hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders who are influential communicators with the potential to reach the hearts and minds of millions of people. We also believe that it is equally important to address health and psychological complications caused by FGM/C- by providing the necessary health services for survivors to help them lead a healthy life.” 

According to the 2016 Ethiopian Demographic Health Survey (EDHS), FGM/C among the age group of 15-49 is most prevalent among the ethnic groups of Afar and Somali regions (98 per cent and 99 percent, respectively), followed by Welaita and Hadiya (92 per cent for both). In addition, 54 per cent of urban women have experienced FGM/C as compared to 68 per cent in rural areas. FGM/C is less prevalent among women with higher education and those in the highest wealth quintile. The 2016 EDHS shows a decreasing trend in FGM/C nationwide with the prevalence in 15-19 year olds down to 47 per cent as compared to 65 per cent in the 15-49 age group.

UNICEF supports the Government’s efforts through enhancing capacity to implement both preventive and responsive programmes at scale, and strengthening coordination mechanisms at different levels. UNICEF works with the National Alliance to progress ongoing roadmap development to end FGM/C and Child Marriage. It also, supports the involvement of faith based, traditional and community leaders, as communities usually link this harmful traditional practice to cultural and religious norms. In this regard, UNICEF signed a Memorandum of Understanding (MoU) in August 2016 with major religious institutions in the country to improve the lives of children, women and adolescents by promoting positive behaviour and social norms and to bring about the necessary societal shifts in communities.

UNICEF supports the Government in the health sector in the Afar and Somali regions to address FGM/C related complications by providing training to health workers; raising the communities’ awareness on health risks caused by FGM/C; identifying girls and women affected by FGM/C; developing training materials; recruiting gynaecologists and equipping selected hospitals with basic FGM/C care equipment.

Providing gynaecological services to Ethiopian women scarred by FGM/C

By Endale Engida

AYSSAITA, AFAR REGION, 24 November 2016 – Asiya’s marriage was meant to be a joyful occasion, but on her wedding night, this 18-year-old found only pain.

Like nearly all young girls in Ethiopia’s Afar Region, she had undergone Female Genital Mutilation/Cutting (FGM/C) at a very young age and trying to consummate the marriage with her husband brought only pain and bleeding.

In the Afar region, a particularly severe form of FGM/C known as Type III or infibulation is practiced whereby the vaginal opening is partially sewn shut, condemning generations of women to pain.

Asiya’s husband, Burhan Helen, was determined to help his wife and he asked around and discovered that the hospital in their woreda (district) had recently set up a gynaecological unit specialized in opening up women who had been subjected to infibulation.

Female Genital Mutilation in Afar
“FGM should stop, I have seen the problem myself, I always struggle when I am on my period, my period doesn’t flow normally so it was very painful. I won’t cut my future daughter. I am very happy to have gone through surgery and I am thankful for the organization working on this.” – Asiya Ali, 18, undergone FGM and currently following up at Ayssaita primary hospital, Afar region, after her surgery. ©UNICEF Ethiopia/2016/Tadesse

FGM/C has long been outlawed in Ethiopia, but is still widespread in the country with an estimated 65 per cent of women between the ages of 15 and 49 (EDHS 2016) having been cut – down from 74 per cent in 2005 EDHA

However, those numbers mask regional variations. In regions like Afar and the Somali it can reach up to 90 per cent while other areas have a much lower prevalence due to different cultural norms in the diverse nation of Ethiopia.

In regions where it is practiced across eastern Africa and up into Egypt, it is believed FGM/C is necessary to ensure a woman stays a virgin before marriage, and many men say they would not marry a woman who hasn’t been cut.

In 2014, the Government of Ethiopia committed to ending the practice by 2025 and has been working on discouraging it through public information campaigns. Penalties for carrying it out range from three to ten years in prison.

For those like Asiya who have already undergone the procedure, the new gynaecological unit established in May 2016 at the Ayssaita Woreda hospital is a life saver.

Female Genital Mutilation in Afar
Dr. Hatse Abrha is a gynaecologist at Ayssaita primary hospital, Afar region. Dr. Hatse Abrha has been assisting girls and women with health complications due to FGM, a project under UNICEF Ethiopia. ©UNICEF Ethiopia/2016/Tadesse

Thanks to the funds from Foundation Espoir through the Luxembourg Committee for UNICEF, the hospital now employs Dr. Hatse Abreha, the only gynaecologist in the hospital.

The hospital, which serves a mostly pastoral population of 90,000, can now treat gynaecological and obstetric cases, including FGM/C reconstructions. By October 2016, the hospital was treating 200 FGM/C cases a month. In many cases, patients can be discharged the same day after the surgery.

Dr. Abreha diagnosed Asiya’s condition and also noted that in addition to pain during intercourse, she suffered discomfort and slow flow during menstruation. She and her husband were counselled about the procedure and then she received the deinfibulation surgery.

“I want to see these innocent girls and women no longer be victims of FGM/C, though these kind of interventions are only part of the solution and will not solve the root cause of the problem,” he said.

After a careful period of outpatient monitoring, Asiya was pronounced cured.

“We have special gratitude to Dr. Hatse Abreha for his friendly care and follow up,” she said during a follow up visit. “We are here to teach our community not to practice FGM/C on their girls and our own children will not be victims of FGM/C.”

 

Girls’ Empowerment Race in Samara to end Female Genital Mutilation/Cutting (FGM/C)

Children race held on the event Girl's Empowerment Regional race
Start of the Children race held as part of Girl’s Empowerment communication campaign in Gonder, Amhara region, Ethiopia © UNICEF Ethiopia 2015/Tesfaye

Addis Ababa, Samara, 1 October 2015 – UNICEF Ethiopia, in partnership with the Afar Bureau of Women Children and Youth Affairs (BoWCYA), the Afar Sport Commission and the Great Ethiopian Run, is organising a mass participation 5 km race in Samara on Sunday 4 October 2015, to promote Girls’ Empowerment. The theme of the run in Samara is “Ending Female Genital Mutilation/ Cutting.”

Despite a steady reduction in Female Genital Mutilation and Cutting (FGM/C) nationally over the past decade, most recent official data from the 2011 Welfare and Monitoring Survey indicates that one in every four girls (23 per cent) is subjected to the practice. In the Afar Region, there has also been a steady decline, however, still an alarming 60 per cent of girls under the age of 14 years are subjected to female genital mutilation/cutting, placing the region second after Somali.[i]

In Afar, girls are subjected to an extreme form of the practice – infibulation – which involves total cutting of the genitalia followed by stitching. This practice usually happens when girls are between seven and nine years old, but in some districts in Afar this practice even occurs when girl babies are only a few days old. 

The Government, recognising that the abandonment of female genital mutilation requires a human-rights based approach and coordinated joint action by all actors, has adopted a National Strategy and Action Plan on Harmful Traditional Practices against Women and Children (2013) and established a National Alliance to End Child Marriage and FGM/C.

The Government of Afar with UNICEF and other partners is implementing interventions to address FGM/C around 3 pillars: prevention, protection and provision of services. Regarding prevention, girls’ empowerment programmes are underway through girls clubs, incentives to keep girls in school and social mobilisation activities, including this race. In addition, religious leaders and communities are working together in social mobilisation initiatives through community conversations and public declarations on the abandonment of the practice coupled with health extension workers’ awareness-raising efforts with communities on the negative health impact of the practice. Police, judges and prosecutors are being trained and specialised police units have been established to better respond to cases of FGM/C and to provide protection and child-friendly justice to girls. Health practitioners are increasingly providing services to girls who are suffering from complications resulting from FGM/C.

Through the ‘UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change’,  UNFPA and UNICEF support the Government of Ethiopia and other partners such as the Afar Pastoralist Development Association (APDA) and Rohi Weddu to strengthen legislation outlawing the practice and to carry out activities enabling communities to make a coordinated and collective choice to abandon FGM/C.

FGM victim Ten year old Sadiye Abubakar in Mille, Afar, Ethiopia
Ten year old Sadiye Abubakar, admitted to Barbara May Hospital in Mille, Afar with her mother Sofya, unable to pass urine for more or less a month. ©Ethiopia/2013/Colville-Ebeling

“FGM/C is a violation of a girl’s right to health, well-being and self-determination,” says Gillian Mellsop, UNICEF Representative to Ethiopia. “FGM/C may cause severe pain and can result in prolonged bleeding, infection, infertility and even death. FGM/C is also harmful to new-borns due to adverse obstetric outcomes, leading to perinatal deaths.  The challenge now is to let girls and women, boys and men speak out loudly and clearly and announce they want this harmful practice abandoned,” she added.

A total of 2000 adults and 500 children are expected to participate in the mass mobilisation race, while over 5000 thousand spectators are expected to attend the community outreach programme. In addition, a photo and art exhibition, which is open to the public, and a media roundtable discussion will take place on the eve of the race. 

The events will be attended by high-level government dignitaries, representatives from the UN, NGOs, CSOs and members of the media. In addition, Thomas Gobena also known as “Tommy T”, international bass player for Gogol Bordello Band and who will be appointed as a National Ambassador to UNICEF Ethiopia this month will attend the activities in Samara. Other renowned artists and sport personalities will also attend the event to support the messaging around Girls’ Empowerment.

National Girl Summit to Reiterate Ethiopia’s Commitment to End FGM/C and Child Marriage

A Muslim girl prays at the mosque at the Semera Girl's Boarding School

Child Marriage and Female Genital Mutilation/ Cutting don’t just cause physical and emotional pain. The practices reflect the value of girls and women in society that have been passed from generation to generation. Such values in turn limit their contribution in society thereby sustaining the cycle of poverty.

The good news is that things are changing. In communities across Ethiopia more and more people are saying no to FGM/C, child marriage and other harmful traditional practices. But there is much more to do.

In July, 2014 at the Girl Summit in London, the Government of Ethiopia committed to achieving the total elimination of FGM/C and Child, Early and Forced Marriage by 2025 through a strategic, multi-sectorial, girl-centred and evidence-based approach.

On 25 June, 2015 the government of Ethiopia will host a National Girl Summit to reiterate its commitment. The summit will provide an opportunity for key actors including girls to renew their vow to end the practices through concerted actions. We can end FGM/C and child marriage within a generation – but only if we work together.

Let girls be girls!

During and around the summit, together with partners we will bring our messages to social media using #GirlSummit follow us and join the conversation.