FGM_Hearings_Report_00 by keralaguest

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									                All-Party Parliamentary Group on
  POPULATION, DEVELOPMENT AND REPRODUCTIVE HEALTH
                         Hon Chair: Christine McCafferty MP
                         Hon Vice-Chair: Viscount Craigavon
            Joint Hon Secretaries: Geoffrey Clifton-Brown MP, Martyn Jones MP
               Joint Hon Treasurers: Baroness Flather, Tony Worthington MP




 PARLIAMENTARY HEARINGS ON
 FEMALE GENITAL MUTILATION


REPORT OF THE PARLIAMENTARY HEARINGS HELD ON 23 AND 24 MAY 2000
                    PALACE OF WESTMINSTER




PUBLISHED BY THE ALL-PARTY PARLIAMENTARY GROUP ON
 POPULATION, DEVELOPMENT AND REPRODUCTIVE HEALTH

                         NOVEMBER 2000


           Parliamentary and Policy Advisor: Ann Mette Kjaerby
        Room 563 Portcullis House, Westminster, London SW1A 2LW
               Telephone: 0207 2192492 Fax: 0207 129 2641
                    Email: kjaerbym@parliament.uk
                   Website: www.appg-popdevrh.org.uk




                                         1
TABLE OF CONTENTS

     INTRODUCTION ………………………………………………..…………                              p.1

     RECOMMENDATIONS………………………………………….………...                             p.4

HEARING ONE:             UK ORGANISATIONS AND NGO‟s

    Chair’s Introduction………………………………………………………… p.13

Health Professional: Oral Presentation and Questions……………………     p.13
Comfort Momoh, FGM specialist midwife
Guy‟s and St. Thomas‟ Hospital Trust

               NGO Working at Training, Advocacy and Policy Level:
    Oral Presentation and Questions…………………………………………… p.16
Dr. Faith Mwangi-Powell, Acting Director
FORWARD

Social Services: Oral Presentation and Questions…………………………       p.19
Liz Davies, Assistant Child Protection Manager
Harrow Social Services

Trade Unions: Oral Presentation and Questions………………….……..…       p.22
Angela Marriott, Clinical research Nurse, Unison;
Mrs Hillary Pollard, Chairperson Equal Opportunities Committee
Association of Teachers and Lecturers

    Refugee Council: Oral Presentation and Questions……………….……….. p.25
Ekhlas Ahmed, FGM Project Worker
Birmingham Refugee Council

NGO Working at Grassroots Community Level:
Oral Presentation and Questions……………………………………………                 p.27
Mrs Shamis Dirir, Director
London Black Women‟s Health Action Project

    Discussion and Closing Remarks…………………………………………… p.30

HEARING TWO:             INTERNATIONAL AGENCIES AND NGO‟s

    Chair’s Introduction………………………………………………………… p.37

International UN Agency: Oral Presentation and Questions………………   p.37
Ms Virginia Osofu-Amaah, Director, African Division
UNFPA, USA

    Funding Oganisation: Oral Presentation and Questions…………………… p.40
Ms Susan Rich



                                           2
Senior Programme Officer
Wallace Global Fund, USA

International NGO: Oral Presentation and Questions……………………..                p.43
Dr. Nahid Toubia, Director
RAINBO, USA and London

International NGO: Oral Presentation and Questions……………………..                p.46
Dr. Olayinka Koso Thomas, Vice President
Inter Africa Committee

                 International Community-Based Grassroots NGO:
    Oral Presentation and Questions……………………………………………. p.49
Mrs Molly Melching & Monsieur Demba Diawara
TOSTAN, Senegal

    European Academic Institution: Oral Presentation and Questions………. p.53
Els Leye
International Centre for Reproductive Health, Gent, Belgium

European NGO: Oral Presentation and Questions…………………………                     p.55
Linda Weil-Curiel
Commission Pour L‟abolition des Mutilations Sexuelles, (C.A.Ms) France


        GLOSSARY……………………………………………………………………
             p.59


        APPENDICIES………………………………………………………………..
             p.59
Appendix I:      Members of the Female Genital Mutilation Hearings Steering Group

Appendix II:     UK Prohibition of Female Circumcision Act (1985)




                                                  3
This Hearings Report is dedicated to Mrs Josephine Bryant, affectionately called Jo, who died suddenly in
July this year. Jo was Chair of the London Black Women‟s Health Action Project, who founded a group
called “Support the Fight Against FGM” in Kent.

Jo lobbied and campaigned against the harmful practice of Female Genital Mutilation (FGM). She also
raised funds for FGM projects both in the UK and Africa and helped the London Black Women‟s Health
Action Project establish their international project called “Barako Family Health & Education Care
Centre” in Somaliland. Jo took part in completing the NGO's questionnaire for, and attended the
parliamentary hearings.

Jo will be sorely missed, but her work will not be forgotten.




                 “My point is that because of certain colonial undertones that
                 surround the subject where cultural issues are involved, my
                 feeling is that our job in the British Government should be to
                 support the work which is being done by black women in the
                 field…we have wonderful examples of good practice in
                 FORWARD and the London Black Women’s Group’s…they
                 have skills and techniques to form very good community
                 based and multi-agency thinking around this subject. If they
                 were given the kind of support by the Government to help
                 them go and do it throughout the country, we would have the
                 change of feeling that we are beginning to detect in our own
                 awareness group.”

                     Jo Bryant, Chair of the London Black Women‟s Health
                                         Action Project.
                                  Parliamentary Hearing‟s on
                            Female Genital Mutilation, 23 May 2000
                                Palace of Westminster (p.35-36)




                                                     4
                                                                        “If I had known what I know now, I would have
                                                                        started 10 years ago. I did not know the amount of
                                                                        suffering our women had gone through. I did not
    INTRODUCTION                                                        know that the women in the village who were sterile
                                                                        had infections after their operation. I did not know
This report is based on the Parliamentary                               that the girls who had died had died because of this
Hearings on Female Genital Mutilation (FGM)                             practice…We men never talked about it. We never
held by the All-Party Parliamentary Group on                            asked and we just never knew.” Pa Demba
                                                                        Diawara. Imman Village Leader, Senegal (p.50)
Population, Development and Reproductive Health.1

The Hearings were held on 23rd and 24th May 2000 in the Palace of Westminster. The
first Hearing was for witnesses from the UK and covered issues such as training, the
effectiveness of the law against FGM, support services and care available and work with
community based organizations. The second day of the Hearings was for witnesses
from Europe and beyond and covered activities in other EU countries with migrant
populations who are likely to practice FGM. Evidence was also taken from the
TOSTAN project in Senegal, RAINBO and the UNFPA.

FGM, also known as Female Genital Cutting (FGC) or Female Circumcision, involves
procedures which include the partial or total removal of the external female genital
organs for cultural or any other non-therapeutic reasons.2 It is estimated that 130 million
girls have undergone FGM and that 2 million girls are at risk of undergoing some form
of the procedure every year.3 The procedure is usually performed on girls between the
ages of four to thirteen, but in some cases FGM is performed on babies or on young
women prior to marriage or pregnancy. Most of the women and girls affected live in
Africa, although some live in the Middle East and Asia. Women and girls who have
undergone or are at risk of undergoing FGM, are increasingly found in Western Europe
and other developed countries, primarily among immigrant and refugee communities.

There is still a severe shortage of data about the prevalence of FGM. The aim of the
Hearings was to raise awareness of FGM in the UK and abroad and to generate support
for FGM prevention and eradication programmes. Government involvement in the
issue is crucial. In the past few years laws have been passed in a number of countries
against FGM, however, it is vital that these laws are fully implemented and that
Governments and agencies work together for the elimination of this practice.
We hope that the findings and recommendations in the report will be a tool for the UK
Government, as well as Governments overseas, to incorporate FGM issues as an integral
part of their policy agendas.

1
  This is the fourth in the APPG series on Parliamentary Hearings: 1995 – Women‟s Rights and Sexual
Health, 1997 – Development Strategies for the 21st Century: the South-South Partnership in Population
and Development, 1998 – Taking Young People Seriously: Improving Sexual and Reproductive Health
for the next Generation.
2
  WHO classification of the four types of FGM are: Type I: Excision of the prepuse, with or without
excision of part or all of the clitoris (clitoridectomy). Type II: Excision of the clitoris with partial or total
excision of the labia minora (excision). Type III: Excision of part or all of the external genitalia and
stitching/narrowing of the vaginal opening (infibulation). Type IV: Unclassified: including pricking,
piercing or incising of the clitoris and/or labia etc.
3
  “Female Genital Mutilation, Programmes to Date: What Works and What Doesn‟t – A Review” WHO
1999 (p.3)


                                                        5
UK GOVERNMENT POSITION
The panel welcomes the UK Government‟s commitment to bring the practice of FGM to
an end and also notes the work of the UK Select Committee on International
Development work on FGM in their Report “Women and Development.”4
The Department for International Development‟s Strategy Paper, “Poverty Eradication
and the Empowerment of Women – 2000,” states:
“The most shocking manifestation of women‟s inequality is violence. Women are at
risk from violence everywhere in the world, and in every walk of life. Practices like
FGM and other forms of physical disfigurement, remain a serious threat to many women
around the world.”5
George Foulkes MP, The Parliamentary Under-Secretary for State for International
Development said in a debate in the House of Commons on 30 March 2000:
“We strongly reject arguments that seek to legitimise women‟s oppression on the
grounds of culture and tradition. People have the right to their own culture, but not at
the expense of fundamental human rights. Human rights are universal and take
precedence over all other considerations. We will continue to support women who
challenge oppressive traditions and play our part in dialogue in the developing world,
aimed at changing attitudes in favour of women‟s equality.” 6

On the domestic front the Government is addressing FGM. In 1999 the guide “Working
Together to Safeguard Children” was issued jointly by the Department of Health, Home
Office and the Department for Education and Employment.7 Lord Hunt of Kings Head,
The Parliamentary Under-Secretary of State for the Department of Health, said in the
House of Lords on 23 March 2000:
“..education is central to eradicating the brutal practice of FGM. My department
continues to fund relevant voluntary organizations. In addition, the Government will
ensure that the findings of the All-Party Parliamentary Group on Population,
Development and Reproductive Health hearings on FGM are fed into the development
of our sexual health strategy.”8

STRUCTURE OF THE HEARINGS
It is in this context that the APPG undertook to produce recommendations for future
strategies on FGM. A number of questionnaires were sent out to leading organisations
working in the field in the UK and abroad, as well as local authorities, medical
practitioners, refugee councils, social workers and representatives from the UN and
WHO. Expert witnesses were then invited to give oral evidence to a panel of APPG
members. The recommendations in this report are formulated from evidence received.
A survey report and analysis of the questionnaires will be published separately.
4
  Select Committee on International Development “Women and Development” Session 1998-99, Seventh
Report, November 1999.
5
  Strategies for achieving the International Development Targets: Poverty Eradication and the
Empowerment of Women Consultation Document, DFID February 2000 (p.7)
6
  House of Commons Hansard, “Women and Development” 30 March 2000.
7
  “Working Together to Safeguard Children” December 1999. Equality in Practice – Cabinet Office
Publication for Beijing+5, June 2000 (p.20)
8
  House of Lords Hansard, Starred Question: Female Circumcision, 23 March 2000.


                                               6
OVERVIEW OF FGM
Before making our recommendations from the hearings, the Panel would like to draw
attention to the following observations on FGM:
 FGM is a fundamental human rights issue with adverse health and social
    implications. FGM violates the rights of girls and women to bodily integrity and
    results in perpetuating gender inequality.
 FGM is not sanctioned by either Christianity or Islam, and is not mentioned in the
    Koran or the Bible. However, FGM is practiced by followers of both religions, as
    well as by people of other traditions.
 International pressure is still an important motivator for FGM eradication
    programme initiation. In a number of declarations adopted at recent UN
    conferences, there is a strong condemnation of FGM.9
 In April 1997 the heads of three UN Agencies, the World Health Organisation
    (WHO), the United Nations Population Fund (UNFPA) and the United Nations
    Children‟s Fund (UNICEF) appealed to the international community and world
    leaders to support efforts aimed at eliminating FGM.
 The WHO has stated that FGM doubles the risk of the mother‟s death in childbirth
    and increases the risk of the child being born dead by three or four times.
 Mothers approve of their daughters undergoing FGM on the grounds that they love
    their children. FGM is part of the culture however cultures are only sacrosanct
    insofar as they are cultures which are consistent with human rights.
 Women who have undergone FGM have similar needs to other women in society
    and should not be seen as only having a problem with FGM they must be viewed in
    the context of addressing all forms of discrimination that impacts adversely on
    women and children.
 Everyone has a role to play in this fight to eliminate FGM however African women
    need to play a leadership role by defining the strategies and approaches.


                   “There are people like Germaine Greer who want to see us only as
                   ignorant village women who want to stay traditional. She never talks
                   to African women leaders. That attitude is arrogant, imperialist and
                   derogatory.” Dr. Nahid Toubia, RAINBO (p.44)




The All-Party Parliamentary Group on Population, Development and Reproductive
Health would like to thank the Wallace Global Fund for sponsoring these Parliamentary
Hearings.



9
 UN World Conference on Population in Cairo 1994 (5 year Review 1999) and United Nations
Conference on Women in Beijing 1995 (5 year Review 2000)


                                                7
                                                                  “Torture is not culture…if a white child
                                                                  is cut in France it would cause a
                                                                  scandal. Why should we be quiet if it is
      RECOMMENDATIONS                                             a black child? She does not suffer less.
                                                                  She is no less entitled to her physical
                                                                  integrity…you should not have to make
           (i)     LEGISLATION                                    any discrimination between women.
                                                                  What hurts a white child hurts a black
FGM is a human rights issue and protecting the rights of          child.” Linda Weil-Curiel, Advocate,
citizens is a primary responsibility of national Governments.     France (p.56)
Specific legislation is crucial in this context and conveys the
message that FGM is illegal and discriminates against women and children. However, it
is important that legislation is not seen as an imposition of values and should always be
culturally sensitive. The ultimate aim is for communities to abandon the practice of
FGM themselves.
                                                             “Yesterday I was speaking to a social worker
                                                             form Leicester. She told me she had a case of a
Members of the Panel:                                        mother with two girls who were both four weeks
                                                             old. The mother was intending to have them
Note that:                                                   circumcised and she was asking what she could
                                                             do. She is terrified, she does not even want to
                                                             talk to the woman.” Dr Faith Mwaangi-Powell,
1. There is a specific Law on FGM in the
                                                             FORWARD (p.18)
   UK: Prohibition on Female Circumcision Act,
   which entered into force in July 16 198510.
2. The 1985 FGM Act together with the 1989 Children Act provides the legal basis to
   investigate violations. The Children Act and most recently the Criminal Justice
   (Terrorism and Conspiracy) Act 1998 also empowers the Courts to prohibit parents
   from removing their children from the UK to have the operation done elsewhere.
3. FGM is performed almost exclusively on children who are unable to give consent, it
   should therefore be seen in the context of violence against the child.
4. Social workers, not police, are usually the first point of contact for UK FGM issues.
5. The Legal backdrop of an FGM law gives legitimacy to FGM eradication projects,
   but the adoption of legislation alone to ban FGM is not enough in both developed
   and developing countries and the formulation of FGM specific legislation is not as
   problematic as the enforcement of the law.
6. FGM prosecution in developed countries should not be perceived as racist. As
   legislation is based on he principles of human rights, enforcement of the law is the
   opposite of racism as black children are not distinguished from white children.
7. International law will not act in a direct way to legislate against FGM practice, but
   international law contains an obligation for states to adapt, improve or establish their
   own legislation.

Regret that:

  i. There have been no prosecutions in the UK to date.
 ii. “Working Together to Safeguard Children” does not specify FGM as a category of
     physical abuse to a child and provides no guidance to professionals about
     registration in these cases.

10
     Appendix II


                                            8
                                                                       “…. these documents do not specify any
                                                                       requirement on Area Child Protection
                                                                       Committee’s to include FGM within their
                                                                       local child protection guidance, policies
Recommend that:                                                        and procedures. There is no Government
                                                                       requirement for setting standards or
UK                                                                     auditing implementation….these documents
                                                                       are lost opportunities within this very
a) The UK Government undertakes a full assessment of                   important area of work.” Liz Davies, Social
                                                                       Worker, Harrow Social Services (p.19)
   local authorities provision and guidance of FGM,
   particularly with reference to child protection.
b) FGM should be mentioned specifically in all Child Protection data and integrated
   training programmes are established.
c) The UK Law on FGM is amended to ensure that UK residents who take girls abroad
   to have them circumcised, can be prosecuted under the UK Law on their return,
   regardless of the legal status of FGM in the country where the circumcision takes
   place.
d) The name of the Female Circumcision Act is changed to incorporate the term FGM.
e) Changes in UK Female Circumcision Act should require health professionals and
   other relevant authorities to report incidences of FGM.
f) Efforts are made to communicate the implications of the Female Circumcision Act
   to communities in the UK.
g) An information/media campaign targeting specific groups on awareness of the Act is
   developed and the Act is translated into different languages.
h) Supplementary Guidance to “Working together to Safeguard Children” is developed
   on FGM, along similar lines of the “Safeguarding Children Involved in Prostitution”
   Supplementary Guidance .11


INTERNATIONAL

i) International and national agencies and NGO‟s continue to work with international
   parliamentary forums e.g. Forum for African and Arab Parliamentarians to establish
   legislative frameworks on reproductive health rights, including specific FGM
   measures.
j) All legislation must be accompanied by sensitization programmes.
k) All draft statements from the Council of Ministers, European Commission and
   European Parliament legislation on violence against women should include
   reference to FGM.
l) Full support is given to programmes that use the process of public pledges as a way
   of developing a legislative approach, e.g. TOSTAN approach in Senegal.
m) Countries implement and ratify the Convention on the Elimination of all forms of
   Discrimination Against Women (CEDAW), which includes specific provisions
   applicable to gender based and sexual violence, and also the UN General Assembly
   resolution passed in 1997 on traditional or customary practices affecting the health
   of women and girls.

11
  “Safeguarding Children Involved in Prostitution – Supplementary Guidance to Working Together to
Safeguard Children.” May 2000, Department of Health, Home Office, Department for Education and
Employment.


                                                 9
                                                                            “It would be good if we had
                                                                            Government backing. NGO’s seem
                                                                            to really work on their own, doing
     (ii) EDUCATION                                                         their own thing with out proper
                                                                            support.” Dr Faith Mwaangi-
Education on FGM in the UK and abroad is vital to empower                   Powell, FORWARD (p.18)
women and communities. Education is key to inform
communities that FGM is not cultural if it is harmful to the girls. It is important to
educate and empower communities so that they can abandon the practice for
themselves.

Members of the panel:                                                “Some tend to keep their traditions even if
                                                                     they believe thy are wrong because they are
                                                                     scared they will loose them. They do not
Note that:                                                           want their daughters to be English. There is
                                                                     a fear that if they leave the girls
1. Legislation is achieved by Governments, but education             uncircumcised, they will loose their
   and social change is frequently left to national NGO‟s.           tradition.” Ekhlas Ahmed, Midlands
                                                                     Refugee Council (p.26)
2. Most FGM eradication strategies have focused on
   education.
3. In refugee communities in the UK many remain unaware that FGM is illegal.
4. The new UK Sex and Relationship Education Guidance makes clear that each
   school should have a member of staff to deal with child protection issues.12
5. The guide “Working Together to Safeguard Children” has been issued jointly by the
   Department of Health, Home Office and the Department for Education and
   Employment, and the issue of FGM was mentioned in the UK Government to the
   Beijing+5 Review.13

Regret that:

i) The new UK Sex and Relationship Education Guidance makes no reference to
   FGM.
                                                                  “I am aware that many teachers like me just
Recommend that:                                                   do not know anything about FGM, yet we
                                                                  might have children sitting in our classrooms
                                                                  who have been subjected to it.”
UK
                                                                  Hillary Pollard, Association of Teachers and
                                                                  Lecturers (p.23)
a) The Government provides funding to develop                     .
   women‟s leadership and literacy skills to enhance their ability
   to speak confidently on issues concerning their health and well being.
b) Specialist materials for teachers and children on FGM is developed.
c) FGM issues should be fully incorporated into DFEE Sex and Relationship
   Education Guidance, in an ethnically sensitive setting.
d) The appointed staff who deal with child protection issues in schools undergo full
   training on FGM related issues.


12
  Sex and Relationship Education Guidance, Department of Education and Employment, July 2000.
13
  “Working Together to Safeguard Children” December 1999. Equality in Practice – Cabinet Office
Publication for Beijing+5, June 2000 (p.20)


                                                10
                                                                               “I worked with a family
       (iii) GRASS ROOT COMMUNITY ORGANISATIONS                                for six months to
                                                                               educate them not to
                                                                               circumcise their
It is essential that work on FGM issues continue through
                                                                               daughter. Once we
NGO‟s and grass root organisations who are well known and have the             stopped that women, she
confidence of local communities. NGO‟s and grass root organisations            would stop another six
play a crucial role by training and raising awareness of FGM issues in         women, the community
order to stop the practice.                                                    is word of mouth.”
                                                                               Shamis Dirir, London
                                                                               Black Women‟s Health
Members of the Panel:                                                          Action Project (p.29)

Note that:

1. NGO‟s and grass root organisations form the back bone of work on FGM in the UK
   and overseas, but they are usually small and under funded.
2. Most successful programmes on FGM in the UK have either been done as pilot
   initiatives or confined to small sections of the country. To expand the work to more
   areas of the UK and inter-link with overseas NGOs, more funds are needed.
3. FGM is a community as well as women‟s issue, therefore it is important to involve
   the whole community.
4. Culture is a frequent justification for the continuation of the practice of FGM in the
   UK.
5. Community based ethnic minority groups are able to raise awareness of the issues in
   a culturally sensitive way.
6. In different settings in the UK and overseas, terminology is an important
   consideration. Female Genital Cutting (FGC) may be more appropriate to use than
   FGM, and the use of the word “abandoning” rather than “eliminating” or
   “eradicating” FGC.
7. Trade Unions are inherent grass root organizations in the UK.

                                                “We need to be able to run more workshops to raise
Recommend that:                                 awareness and involve people up and down the country. We
                                                felt it was an important role to begin by educating our men
                                                on the National Black Members Committee”
UK
                                                 Angie Marriott, UNISON (p.24)

a) The Government continues to support
   and commits itself to sustainable and increased funding of groups working on FGM.
   In order that financial support and technical assistance may be given to replicate
   good practices on a wider scale.
b) Working groups which involve religious and community leaders should be
   established to focus on training and education programmes.
c) Investment in the community is targeted to:
 Raising awareness of FGM and encouraging the involvement of men.
 Providing literature that is distributed widely.
 Sensitising communities to the legislative aspects of FGM.



                                           11
d) Members of the communities that practice FGM are encouraged to join social and
   community services as a profession, and work shadowing schemes should be
   introduced to encourage this.
e) Trade Unions are fully supported in their training programmes on FGM issues.


INTERNATIONAL                                      “I agree that FGM is culturally sensitive. That is
                                                   why activities also have to be culturally sensitive so
f) FGM projects take an integrated                 that interventions succeed…otherwise we shall not
   approach which includes a basic                 make an impact.” Virginia Osofu-Amaah, UNFPA
                                                   (p.40)
   education programme incorporating
   a strong human rights component.
g) Governments support Northern and Southern NGO‟s by increased sustainable
   funding for overseas projects addressing FGM.
h) NGO and Community work targeting religious and community leaders should be
   sustained.
i) Work should target men in order to overcome cultural prejudice misinformation and
   mobilise men so that their voice are heard speaking out against FGM.
j) The employment and rehabilitation of circumcisors is addressed.




               “I congratulate the British Government on the support they have
               given to grass-roots groups who are making a difference. These
               programmes work and matter and make a big impact on health and
               development. But many more groups are asking for support. I
               hope that the Government can amplify its support, fund
               strategically and thereby give African girls their rights and health
               for the future.”
               Susan Rich, Wallace Global Fund (p.42)




                                              12
                                                                      “The first law of medicine is to do no
                                                                      harm. Although these health professionals
                                                                      may think that they are improving the
           (iv) HEALTH                                                practice by doing it in an hygienic setting,
                                                                      the side effects can be just as devastating
FGM is a human rights issue, but with medical and                     as the traditional form.” Susan Rich,
                                                                      Wallace Global Fund (p.41)
social implications. Most women who have undergone
FGM require some form of medical care and as such
have a right to the highest standard of sexual and reproductive health.


Members of the Panel:

Note that:

1. FGM should not be medicalised and that health professionals should never carry out
   the practice of FGM because it legitimises the intrusion of women‟s bodily integrity.
2. Protocols, guidelines and strategies for medical professionals have been developed
   to combat FGM, but they have not been widely disseminated.14
3. In the UK women are increasingly presenting themselves to health care
   professionals, and specialist clinics in the UK are treating hundreds of women with
   FGM related complications.
4. There is a misconception that FGM services in the UK are available solely for
   expectant mothers.
                                                       “Since we started running the clinic (September 1997) we
                                                       have seen over 300 women with FGM related problems. It
Recommend that:                                        is a big problem. I can rightly say that it is a growing
                                                       problem in the UK.” Comfort Momoh, Specialist
UK                                                     Midwife, Guys and St Thomas‟s Hospital Trust (p.13)


a) The Department of Health set up a health co-ordination team to address an
   interagency approach to implement FGM good practice guidelines.
b) FGM is a component of the Governments Sexual Health common code of conduct
   on FGM is developed.
c) Each Health Authority and Trust should ensure that there is an FGM Specialist in
   the Trust who is responsible for training GP‟s, Family Planning professionals,
   midwives and other healthcare professionals in FGM prevention, treatment and
   counseling.
d) The Health Authority FGM Specialists should link with each other and with with
   FGM specialists in other sectors e.g. Social Services and education Departments.
e) The Royal College of Obstetricians and Gynecologists (RGOG) promote and
   distribute guidelines on FGM and address as a priority the education and training of
   doctors on FGM.
f) Communities likely to practice FGM are given information of services available and
   how to access primary services and information on reversal.
g) The care of women who have undergone FGM should not solely focus on expectant
   mothers but address the health and well being of all affected young women.
14
     e.g. Royal College of Midwives Position Paper 21 on FGM Guidelines, Comfort Momoh


                                                  13
h) All medical personnel must be trained on cultural sensitivity and how to meet the
   needs of women who have undergone FGM.
i) Special attention is given to refugee communities and also to professionals in the
   field of medical care and the care for refugees.


INTERNATIONAL

j) DFID takes a lead in the EU and among other donor states to link up initiatives to
   eradicate FGM and co-ordinate a global health policy on the issue.
k) The medicalisation of FGM is condemned globally.
l) Donor countries should make efforts to ensure that funding is not available to
   hospitals or medical centres that perform FGM.
m) FGM issues are fully incorporated into the Safe Motherhood Initiative.
n) The care for women who have undergone FGM forms part of the European
   Accreditation Scheme for training specialists in various fields of medicine that is
   currently being developed.




                “Women know that they must feel something and they are not
                feeling it. They presume they are not feeling it because the
                husband does not know how to make love to them. But that is not
                the case. It is because they have been genitally mutilated, When
                we tell them, they feel sad and depressed. It is not a nice thing to
                tell another woman that this is what she will be like until she dies.
                Mostly these women are only 22 or 23.”
                Dr Olayinka Koso-Thomas, Inter Africa Committee (p.49)




                                                 14
                                                        “We have received requests from the
                                                        Gambia to do the programme
       (v) RESEARCH                                     there…it is really a question of
                                                        funding…..I have had to say “no”
Research is the key to effective policy making          but I have told the women I am
and action, and is important to identify funding        looking for the funding.” Molly
                                                        Melching, TOSTAN, Senegal (p.52)
opportunities. However, research should not be
undertaken in isolation and must inform evidence
based policy decisions. In addition, all research that is undertaken must be culturally
sensitive and follow ethical protocols. Research initiatives must be evaluated to assess
their impact and determine what works best in different contexts.


Members of the panel:

Note that:

1. There is currently a severe shortage of data on the pravelence of FGM in the UK and
   overseas. Research has been limited to small scale or outdated data.
2. Whilst there may be data available on clinics in the UK on the incidence of FGM,
   there needs to be data collection on the nation wide prevalence of FGM in a
   coordinated manner.
3. Between September 1997 and September 1999, FORWARD were commissioned by
   the Department of Health to prepare a document on health authorities policies and
   procedures and came up with recommendations covering England and Wales.
4. Interagency co-operation is the key to work on FGM and this is crucial in the area of
   collecting relevant data.
5. There is a great deal of work currently being undertaken on with HIV and AIDS in
   some parts of sub-Saharan Africa, but the link with HIV/AIDS transmission and
   FGM has not been researched.

Regret that:

 i. The UK Department of Health appears not to have used the data it commissioned
    from FORWARD in its recent policy on FGM.

Recommend that:

UK

a) Funds are allocated for data collection and subsequent research into the incidence of
   FGM in the UK, collated by the Department of Health.
b) The Government incorporates data into core policy papers, e.g. the UK Sexual
   Health Strategy.
c) Inter-agency research involving the immigration services, refugee councils, health
   authorities and education departments is undertaken to map out needs in the UK.




                                           15
                                                  “To this day when we tried to review the
                                                  statistics in Europe there was nothing….The
INTERNATIONAL                                     information is not with the health sector, it is
                                                  not with the clinics, it is with immigration and
                                                  refugee services…it is very easy to get.”
d) The EU funded European Support                 Dr Nahid Toubia, RAINBO (p.44)
   Network on FGM collates data on the
   prevalence of FGM on European level.
e) Research is undertaken to examine link between FGM and HIV/AIDS.
f) Funding is required for the replication of best practice models for the abandonment
   of FGM e.g. TOSTAN in Senegal, and the development of alternative practices.




Christine McCafferty MP, Chair
The Lord Ahmed
Dr. Peter Brand MP
Baroness Gould of Potternewton
Alice Mahon MP
The Lord Rea
Baroness Rendell of Baberg
Dr Jenny Tonge MP




                                          16
PROCEEDINGS OF THE ALL-PARTY PARLIAMENTARY GROUP ON
POPULATION, DEVELOPMENT AND REPRODUCTIVE HEALTH
                    HEARING ON FEMALE GENITAL MUTILATION
                                         Tuesday 23 May 2000

                                           Members present

                                 Christine McCafferty MP, in the Chair
                                   Baroness Gould of Potternewton
                                     Baroness Rendell of Babergh
                                           Alice Mahon, MP
                                              Lord Ahmed
                                           Dr Peter Brand MP


                                               Chairman

First, I welcome everyone here this morning. We are pleased that so many of you were able to accept our
invitation to come to what are very important parliamentary hearings on an issue which I know is close to
the heart of many of those present.

Before we start the proceedings, I should like to do some “chairman‟s house rules” so that everyone
knows what is happening. I would be pleased if everyone here would sign the little black book at the
entrance. If you have not already done so, perhaps I may ask you to do that before you leave at one
o‟clock.

I should like to introduce the panel members to you. We have one member still missing but hopefully
Lord Ahmed will arrive in the not too distant future. On my far left is Dr Peter Brand who is a member of
the All-Party Parliamentary Group on Population, Development and Reproductive Health. On my near
left is my good friend and constituency neighbour, Alice Mahon, who is well known for her interests in
women‟s issues and also a member of the All-Party Parliamentary Group. On my near right is Baroness
Gould, again, a powerful advocate for women‟s right. On my far right is Baroness Rendell who is a
Member of the House of Lords and has spoken at length on the issue we shall discuss today. Regretfully,
Lord Ahmed has not arrived yet but hopefully will be here soon. Here he is. That is what is called a
really good entrance. Lord Ahmed now needs no further introduction.

The witnesses have all been asked to speak for five minutes. The members of the panel will ask questions
of each witness for a further 10 minutes. We shall have a break of approximately 15 minutes at 1055 am.
It may be slightly later than that now. There will be time for discussion and general questions at the end
which we hope to arrive at by 12 o‟clock.

The reason we are holding these hearings is because we are aware of the fact that in this country and,
indeed, in other European countries, the practice of FGM is a growing phenomenon. We feel that it is
important at this time to raise awareness of this issue and that we put pressure on our Government and,
indeed other governments, to take seriously the legislation already in place. Perhaps we can find ways to
help each other to do that and, indeed, save young girls and women from a cultural practice which has
severe health consequences. With that I shall ask our first witness, Comfort Momoh, to speak to us.

Comfort is a qualified nurse and midwife, who presently works at Guy‟s and St Thomas‟s Hospital Trust
as a specialist midwife dealing with FGM. She provides a support service for women who have
undergone FGM and plays an active role in the provision of maternity care for women within a
multicultural environment. Comfort cites her interests as research around FGM and other women‟s health
issues and developing information and good practice guidelines for professionals.



                                                   17
(Comfort Momoh) Good morning everybody. My name is Comfort Momoh and I work at Guy‟s and St
Thomas‟s. I am an FGM specialist midwife and I provide support services for women who have
undergone female circumcision. You might find that I say female circumcision or FGM; I switch from
one to the other.

The clinic started in September 1997 due to the increasing number of women presenting to LSL, which is
Lambert, Southwark and Lewisham Borough, with female circumcision-related problems. They presented
to the family planning clinic requesting family planning and smear tests. They also presented to the
delivery and maternity department and to the gynaecology department with various problems such as
urinary tract infections.

In 1996 LSL formed a multi-disciplinary working party to look at the issues surrounding FGM within
LSL, hence my post was advertised. I commenced my post in April 1997. The first thing I had to do at
that time was to conduct mini-research within the area to find out how big the problem was there and to
find out the knowledge within the health care professionals. The finding from the research was very
disturbing with comments such as, “Oh, it‟s not a big problem in this area”. Some midwives and doctors
were saying, “I‟ve been working here for the past 20 years and I have only seen two cases of FGM in the
hospital”. If that was the case, it was not a big problem, but since we started running the clinic in
September we have seen over 300 women with FGM-related problems. It is a big problem. I can rightly
say that it is a growing problem within the UK.

Unfortunately, we have only two clinics of this size in London. My clinic is called the African Well
Women‟s Clinic. It is based at Guy‟s Hospital at the maternity centre. The other clinic started a few
years before the African Well Women‟s Clinic first started at Northwick Park Hospital. It then moved to
Middlesex Hospital. It is run by Mr Harry Gordon.

As a specialist in this field I have managed to develop protocols within hospitals involving the production
of the Royal College of Midwives Position Paper (Position 21) which was launched two years ago. We
also provide reversal for women with circumcision. We do about 10 reversals every two weeks. By
reversal I mean that on women with type 3 circumcision who come in to have their baby we do a reversal.
We open them up for them to be able to have a normal birth.

I also provide educational awareness for health care professionals. I go to universities and hospitals and
link up with teachers. It is very important to give health awareness on FGM. I also link up with social
services. I work with organisations such as FORWARD, and London Black Women‟s Health Action
Group. The clinic is run by myself and a gynaecologist. We both perform reversals. The aim of my
clinic is to identify women as early as possible in pregnancy during ante-natal appointments. We also
offer ante-natal reversals, which means they can have their reversals done before they go into labour.
Years ago, and it is still happening in some hospitals which lack knowledge around FGM, women were
forced to have caesarean sections instead of a normal birth because sometimes doctors are not aware of
FGM. They do not have any knowledge and they think that FGM is some kind of abnormality. We
recommend that women have reversals ante-natally. Sometimes women say they prefer to have it done
during labour. In a nutshell, that is what I do.

                                                 Chairman

Thank you very much, Comfort. They were quite dramatic figures. We have 10 minutes for questions
from the panel. I shall start off by asking you a question to get your opinion on how you feel most health
professionals see FGM. Do they see it as their problem? I ask this because in order to facilitate these
hearings we sent out a very wide range of questionnaires. It seemed to us that FGM was being described
as a tradition, that many hospital trusts and health professionals do not see it as their problem and are
frightened of being seen as racist. I should like to know if that is your experience also. It clearly is not at
St Thomas‟s but is that your feeling about hospital trusts and health professionals in general and do you
think that there is a case for that argument?


                                                     18
(Comfort Momoh) There is a case for that argument. That problem is everywhere. The research which I
did before starting the clinic showed that many of the professionals were not interested in FGM. They do
not see it as a problem. Sometimes when a woman with FGM comes into the labour ward, some health
professionals will say, “It‟s only FGM. What‟s the big problem about that?” Because of lack of
knowledge, most of the professionals do not see it as a problem. It is rife. It is common in the NHS, or
even with other health care professionals that they do not see it as a problem at all.

                                            Baroness Gould

Comfort, what do you think is the role of Government, and in particular the Department of Health? We
had a question which was tabled by my colleague, Ruth Rendell, in the House of Lords about a month
ago. The Minister said that he was waiting for the result of these hearings -- so you do realise how
important they are – for the department to give them some consideration. I wonder whether you feel that
the department in itself should produce a code of conduct for health professionals to ensure that we
overcome the problem you have described.

Perhaps I might ask a supplementary question to that. You said in your introduction that it was a big
problem and is growing. Can you explain a little more why you feel that it is growing?


(Comfort Momoh) To answer your first question, I believe that the Government have a big role to play in
this growing problem. As I have said, we need more awareness of FGM. The Government need to have a
code of conduct such as you said. Obstetricians and gynaecologists have a code of conduct for FGM and,
as I have said, we have a position paper, Position 21. However, not all health care professionals have a
code of conduct. We need a common code of conduct for all the professionals. We therefore need the
Government to work on that. Everything comes down to money and resources. We need more education
and training for doctors, midwives and other health care professionals on FGM to raise awareness.

Could you repeat your second question, please?

                                            Baroness Gould

You said that it was a big problem which is growing.

(Comfort Momoh) Yes, it is a big problem and it is growing. When the clinic first started we had just a
few cases but now the numbers are growing. We go round to give talks in other hospitals to other health
care professionals and other organisations. It is a big problem. We now have lots of Africans and other
communities which practice FGM migrating to Britain because of domestic problems in most of the
African countries. It is, therefore, a growing problem. Figures from other hospitals, such as Harry
Gordon's clinic, show clearly that he sees over 500 cases every year.

                                             Alice Mahon

Comfort, we are being told that about 6,000 girls in the UK are at risk of FGM yet there is no targeted
funding for advocacy or any other kind of preventative work. What is the best way of tackling that and
who should pay for it?

(Comfort Momoh) The Government.

                                             Alice Mahon

Should it be the NHS solely or should it come out of a special budget set aside for what is a special
problem?



                                                   19
(Comfort Momoh) I think that it should come from the NHS. My post is being funded by Guy‟s and St
Thomas‟s as part of the maternity department. So, it should come from the NHS. Once it has been seen
as a definite problem, they need to deal with it. At the moment, the Government are looking into it but
people do not see it as a problem, so the finances and resources are not there.

                                               Alice Mahon

But should it be extra to what the NHS is receiving now? We have these hearings. The Government will
have to look at the problems.

(Comfort Momoh) There should be extra funding.

                                            Baroness Rendell

I should like to ask you about reversal. I know that reversals are only an interim measure until the
practice is finally stamped out. I have visited Harry Gordon‟s clinic. There, they do reversals not simply
ante-natally but for any woman who has had FGM who chooses to walk into the African clinic without
any sort of introduction from her GP or whatever. Do you also do that at St Thomas‟s?

My second question is do you think that that possibility is widely enough known among women, because I
do not. Do you think that enough women know that reversals are, on the whole, very successful?

(Comfort Momoh) No, that is the problem we have. Not many women know how to access primary
health care. Not many have information on where to go for help. Not many of them know about reversal.
At Guy‟s and St Thomas‟s we perform reversals either during pregnancy or on non-pregnant women.
Sometimes women come in and say, “I‟m getting married in two or three weeks‟ time. Can I have my
circumcision reversed?” We have an open clinic. We will see anybody. We get referrals from GPs or
self-referrals. Anybody can come in. We are aware that there are only two of this kind in London so we
take clients from all over the UK. We even have some women who come from Sheffield into the clinic.

                                               Lord Ahmed

My question follows on from that. You have women coming from Sheffield. You said that there are two
clinics in London. Are you aware of any other clinics in the country?

(Comfort Momoh) Yes.

                                               Lord Ahmed

You also mentioned awareness for doctors. How important is it to have more clinics as well as awareness
for doctors?

(Comfort Momoh) There are other clinics. There is one in Liverpool and another one starting in
Sheffield, which I am helping to organise. We need to raise awareness. As I said earlier, there are a lot of
communities coming to Britain. It is a problem that we need to deal with. Also, this is new to health care
professionals, especially obstetricians, doctors, midwives and nurses, so we need to raise awareness. We
also need to have more clinics. That would save women travelling long distances coming from Sheffield
to London. If there is a clinic there, or a central one, at least people from the Midlands could go there
rather than having to travel down to London. So, there is a need.

Sometimes when I go to give a talk, people say, “Oh, it‟s not a problem in Scotland because we don‟t
have that kind of people there”. I say, “But you do not know who will be your neighbour in future, so you
need to be aware.




                                                    20
                                                  Dr Brand

I should like to raise a similar point. I am not sure that you are aware of the true incidence of this. It is
only when you start offering a service that you start to identify the people who need that service. Are you
in contact with the other units who do similar work? It would be extremely valuable for us in putting
pressure on the Government to have some idea of what the demand has been in other areas. You have
obviously started a clinic which now attracts people from all over London or all over the country. It
would be interesting to see the experience of other units.

When I discuss this with my medical colleagues they tend to say, “That is an inner city problem. It‟s
nothing to do with us”. I suspect that they are wrong because of small pockets of the population. There
may not be large numbers in parts of the country but the effects are devastating on the people concerned.
It may be a small problem in numbers but it is a very large problem for the individuals. Are you working
with the other groups?

(Comfort Momoh) Yes, I link up with other groups. The only problem is that it is difficult to collect data.
It is only recently that women within this community have been able to come out and talk about their
problem. In some of the African countries or some of the communities, FGM is seen as a secret and
cultural thing. It is taboo and people are not allowed to talk about it. It is only recently that people are
coming out to talk about it. That is why it is very difficult to collect data. At my clinic I have been able to
collect data from the women to see where they came from and what problems they present with. Harry
Gordon‟s clinic collects similar data. Hopefully, if we have more clinics running, we will be able to
collect more data and do proper research.

                                                  Dr Brand

You are not aware of the Chief Medical Officer, for instance, collecting data on this?

(Comfort Momoh) No.

                                                  Dr Brand

Data must be around in the various clinics but it does not seem to get co-ordinated other than through
informal contacts, perhaps, with your colleagues. Obviously, we will touch on the cultrual issues later but
there are two separate issues here. One is the treatment of people who need the treatment. The other one
is how you feed that message back.

Do you have any evidence on how many of these girls and women have been circumcised in this country?

(Comfort Momoh) It is very difficult. One of the questions we ask women when they come in is when
and where they had their circumcisions. Most of the women we have seen so far have had it done back in
Africa. But then, because they are aware that it is illegal in this country, they might just say, “I had it
done”. Nobody will own up and tell you it was done here because they are aware that it‟s illegal. Another
question I ask women is, “If you have a daughter are you going to circumcise her?” Some will be honest
enough to say, “If I remain in this country maybe not, but I don‟t know what will happen if I go back to
my country”. Some will say, “No”, but you can only go by what they tell you. There is no way of
following that up. We are linked with health visitors who follow up children to age five.

                                                 Chairman

I shall have to stop you there, Comfort, because we have other witnesses to call. Thank you very much for
being such a good witness. Our next witness is Dr Faith Mwangi-Powell. Dr Mwangi-Powell is originally
from Kenya where she worked for a number of years as a District Community Health Officer. She
subsequently did a doctorate at the University of Exeter focusing mainly on sexual and reproductive



                                                     21
health behaviour among couples in rural Kenya. Faith joined FORWARD as the National Community
Development and Training Officer when she completed her studies in 1998 and is currently the Acting
Director of FORWARD. We look forward to hearing from you, Faith.

(Faith Mwangi-Powell) Good morning. It is nice to see so many of you here. As the Chair rightly said, I
am currently the Acting Director of FORWARD, although that does not mean that I have stopped being
the National Community Development and Training Officer, because that was my job when I was
employed in 1998.

My job in that capacity was to develop training materials for communities and professionals working
around the communities affected by FGM both in the UK and possibly in Africa. Currently, due to
financial problems, I am the Acting Director of FORWARD, so I am playing two roles, wearing two
jackets. I try as much as possible not to neglect the education component of my work because I think that
is most important.

FORWARD was formed in 1985, so we are now celebrating 15 years of good work, I hope you will
agree. We are currently looking at training or what we call FGM education. We look at research, both in
communities and local authorities, and at advocacy either through distribution of materials or policy
development. We also do a lot of public awareness work.

I shall talk briefly on those four areas of our work. The area of training is the main job I was employed to
do. That work was funded by the ethnic minorities access grant from the Department of Health. It is a
three-year programme and it is now half way through. We mainly organise training programmes for
professionals all over the UK. They may be in health, social services, police or teaching – anybody who
might be in direct contact with communities affected by FGM. We also train communities on the dangers
of FGM. We believe that education is a most important tool for combating FGM.

We conduct a lot of research. As Comfort said, it is very difficult to pinpoint the statistics for FGM in this
country. There are many estimates from 3,000 to 4,000 but it is difficult to give precise figures. When we
conduct our research we mainly look at knowledge, attitude and the practice of FGM among communities.
We want to establish whether people really know the dangers of FGM.

By looking at attitude, we want to know people‟s motivation. Why do people continue taking this practice
forward despite the fact that we have told them it is harmful? Next is practice. We mainly look at the
intention to continue. They may say, “Ok, I have had it done myself”. We ask, “Are you going to do it to
your daughter?” That is important because that determines whether FGM is likely to stop.

We have currently completed two case studies, one in Manchester and one in Birmingham. The most
surprising thing was that although 100 per cent of the people we interviewed in Manchester were
circumcised, about 88 per cent said that they will not circumcise their daughters. Again, as Comfort said,
we take their word. Whether they actually do it; whether they are telling us because that is the message
they think we want to hear or whether they are actually convinced that they are not going to do it is the
question.

The study in Manchester was mainly on the Somali Community. Therefore, we thought we would try to
do a little study of an integrated community in Birmingham. We looked at communities from Sudan,
Somali, other parts of Africa, and mainly Yemen. There has been a lot of controversy over whether FGM
happens in Yemen or not. We did that study and it was again surprising to find that 78 per cent said that
they will circumcise their daughters. There was some contradiction between the community in
Manchester and the community in Birmingham.

Three issues became clear. They said, “FGM is part of our culture and we are going to continue”. Next,
“It‟s part of our religion and we will continue”, and then there was a category of people who said, “My
grandmother did it, my mother did it and I will do it”. So, not a convincing reason to continue but they
were going to continue.


                                                     22
Based on all that information, we have tried to develop education materials tailored towards the findings
of our research to target those needs. We tried to talk about religion. What does religion say about FGM
and about the harmful effects of FGM? That is how we tried to work it through. We tried to invite all
those people to our own meetings, through seminars and national training. We have just had two national
training sessions in April. If finances are available, we are hoping to have more towards the end of the
year. The demand has been too high and we are not able to train everybody who wants to be trained.
There is a lot of interest in training, not just among the communities but even among the professionals.
We have been encouraged by the midwives. We have developed a protocol for midwives which we call,
“The Holistic Approach to an FGM Case”, whereby the midwife does not just look at the woman‟s
genitals, but rather at the woman as a whole and asks, “What are the problems of this woman and why
does she want to continue practising?”

In conclusion, we are moving forward on FGM. We are also looking at other harmful traditional practices
which affect women. Maybe it is not relevant to this hearing but it is good to point out that we have
realised that some of the women we work with experience domestic violence; some have no power for
decision-making. So, if we have to tell them to make a decision not to have themselves or their daughters
circumcised, that is a big task to ask them to do. We are trying to look at programmes to really empower
these women to be able to make their own decisions.


                                                 Chairman

Thank you, Faith. Perhaps we could go back to the question of research which you told us about. Clearly,
this is a secretive, taboo subject. It is difficult to discuss both within and without the community. I know
that there is some research and you have told us a little about some of it, which looks at the medical, social
and psychological implications. Can you tell us about the young women who have not been mutilated,
who have not yet been circumcised? You have told us about why the practice is being perpetuated and the
reasons for it. There are clearly three. Is any research being done to look at the protection of young
women or perhaps education in groups so that it will help parents to decide against having their daughters
mutilated in this way?

(Faith Mwangi-Powell) FORWARD have not done research among young people per se, but London
Black Women‟s Health Action Project, which Shamis Dirir will talk later about, has done research on the
attitudes of young Somali women in London. The findings of that research were very interesting.
Although the majority of them were not intending to have themselves circumcised, they were not aware of
the services available to them. There is this misconception that the services available are for expectant
mothers and not for anybody else. So, people feel that they just have to suffer the consequences of FGM
until they get married. There is that discrepancy in the knowledge of young people. There has also been
quite a big problem in reaching the young people, especially in schools.

We are also very worried and aware that dealing with the issue of FGM, due to its sensitive nature, can
create a lot of problems with schoolchildren because children tend to stigmatise others. So we have to be
careful over how we deal with it in schools. Currently, at FORWARD we have developed a small booklet
written in dialogue, a cartoon discussion group, trying to discuss FGM in a friendly yet unthreatening
matter. The lead person in the group is a young girl who asks all the questions and tries to make
everybody as inclusive as possible. We have just tested that and we have received good results. It is in
print and should be ready next week. That is the kind of thing we are doing, but as for research, very little
has been done.

                                                 Chairman

I suppose it was inevitable, but we are running late already. In order to put us back on track I shall take
two questions from the panel instead of from everyone.



                                                     23
                                             Baroness Rendell

As you know, the law against female circumcision in this country has been in place for 15 years and no
prosecution has ever been brought under it. In your work, do you ever have occasion to go to the police
to say, “Here is somebody”, a child or a young person, “who has obviously just been genitally mutilated
and can you do something about it?”

(Faith Mwangi-Powell) We have not really had cause to go to the police as such but in 1997 we did
undercover work called “The Black Bag” – I was not at FORWARD then –which identified four people
who were willing to perform female genital mutilation or circumcision, in Manchester, Sheffield and even
in London. The tape was given to the police giving evidence that these people were willing to do that. It
was interesting because during one of our training sessions we had a police officer. I asked her why this
case was never followed up. She told us that that was not evidence. Saying that you are intending to do
something and actually doing it is different. So, they could not do anything about that.

Yesterday I was speaking to a social worker from Leicester. She told me she had a case of a mother with
two girls who were both four weeks old. She was intending to have them circumcised and she was asking
what they can do. She said they had never seen such a case. She is terrified. She does not even want to
talk to the woman. She asked what they can do. Usually in such cases we advise them to work with the
social worker. That is the first point of contact. Our first point of contact is not usually the police. There
is a clear laid out procedure. Again, there is a lack of awareness. The professionals are not aware of this
procedure. Perhaps it is not as widely distributed as it should be. That is how we do it. FGM is not like
a case of somebody who has robbed a bank. You deal with it differently. You have to train people to be
sensitive and objective rather than subjective. We had that discussion yesterday. That was the second one
I have had this week. That just shows that FGM is actually going on in this country.

                                               Lord Ahmed

You mentioned education and training. One of the things you said is that when you question people they
said that it was because of culture, religion and family practice. Do you think that involvement of
religious leaders from those particular communities would help your training and education programmes
in awareness? Do you think it would be useful to have something like a working group from Government
which can send the message out and have hearings in various communities to say, “Are you aware that this
is illegal?” Do you think it would work in communities from Yemen, Sudan, Somali, or wherever, for
their religious leaders to come out and condemn this practice?

(Faith Mwangi-Powell) It is important to have religious leaders involved. I have seen people question
my own authority when I tell them that FGM is not required by religion. My authority is really based on
reading books, etc. So, people will not take my word for it. But if I had brought an Imam and said, “Can
you tell people where it says in the Koran that this is good or is not harmful?” people would tend to listen.
That is what we are trying to do. We are trying to involve as many as possible.

Yesterday we had a meeting with an Imam from Senegal. He is doing good work going from village to
village. We were talking in the group and saying that it would be useful to be able to identify such leaders
within the UK who can accompany and become part of a strategy group. FORWARD, for example, has a
strategy group formed by various professionals, but we do not have a religious person in the group.
Although many of us have all sorts of religious teachings, we are not authorities per se. it would be very
useful. It would also be good if we had government backing. NGOs seem to really work on their own,
doing their own thing without proper support.

                                                 Chairman

Thank you very much, Faith. Our next witness is Liz Davies. Liz is currently the Assistant Child
Protection Manager in the London Borough of Harrow Social Services Department where she has worked



                                                     24
for nine years. She is chair of the Harrow Area Child Protection Committee Training Group.

She has worked for over 25 years in social services in childcare and mental health and has written
extensively on those subjects. She has developed particular expertise in the area of the interviewing of
children under the Memorandum of Good Practice guidance.

(Liz Davies) I represent Harrow Social Services Department and Harrow Area Child Protection
Committee on this serious aspect of multi-agency child protection work. I want to present some key
issues relating to prevention, protection and treatment, and particularly emphasise the crucial role of area
child protection committees in protecting children around the issue of FGM.

The most recent Government guidance for statutory agencies is contained in Working Together to
Safeguard Children. That is a fairly recent document, published late last year. It states that local
authorities may exercise their powers under Section 47 of the Children Act 1989. This states the duty of
local authorities when they have reasonable cause to suspect that a child is suffering, or likely to suffer,
significant harm to make such inquiries as they consider necessary to enable them to decide whether they
should take action to safeguard or promote the child‟s welfare. I would suggest an allegation relating to
actual likely FGM of a child must trigger a multi-agency response.

Initial inquiries should follow a multi-agency strategy discussion and a decision be made as to whether a
Section 47 investigation is required. The new Working Together states that local authorities may exercise
their powers. I would suggest that it should be “all agencies must implement child protection procedures
and act to protect”. It should be a lot stronger than is stated in this document.

Perhaps I may give an example of a midwife or health visitor who refers a family to social services where
they know the mother has suffered FGM and her daughters are at risk. The first thing would be that a
multi-agency strategy discussion would be convened and a risk assessment completed with the assistance
of specialist advisers. Probably health and education staff working with the advisers would re-educate the
family and the children would gain protection. But if this was not sufficiently protective, a Section 47
would be commenced to consider what child protection planning and/or legal safeguards were required.
If, however, a child disclosed in school that she was to be taken abroad for FGM, that would lead to an
immediate Section 47 joint investigation with speedy action to protect.

In both cases, a decision would be made about whether a child protection case conference was required.
But unfortunately Working Together does not specify FGM as a category of physical abuse, providing no
guidance for professionals about registration in these cases. I find it astonishing that FGM, which
involves a serious level of injury inflicted upon children resulting in long-term damage is not specified.
Neither does Working Together specify the absolute importance of involving specialist advisers in the
child protection processes. In Harrow we are fortunate to be able to seek advice at the African Well
Women Clinic at Northwick Park but I realise that that facility is not available nation-wide.

Another new document is Framework for the Assessment of Children in Need and Their Families which
came out earlier this year. There is no reference at all to FGM in that document. Neither of these
documents specify any requirement on ACPCs to include FGM within their local child protection
guidance policies and procedures. There is no Government requirement for setting standards or auditing
implementation. I consider both these documents lost opportunities within this very important area of
work.

To move on to prevention, in Harrow ACPC we consider child protection to be everyone‟s businesses.
We have concentrated on creating a local network of protective adults to encourage early recognition and
early reporting of abuse. FGM as a subject is integrated into this process. We have a comprehensive
programme of professional training at all levels to raise awareness and ensure appropriate intervention.
We also train primary health workers, nursery staff and reception class teachers specifically in recognising
the indicators of FGM as part of the Knowing the Basics training initiative. We have also organised



                                                    25
public meetings, exhibitions and information distribution to encourage reporting by the general public.
We use the video, “Another Form of Abuse” as a basis for much of our training.

As regards treatment, ACPCs should also be concerned with the right of child victims of FGM to
appropriate remedial medical treatment. There should be no difference between such children and any
other child who has suffered non-accidental injuries. If, because of parental refusal, a child is denied
treatment, surely the statutory agency should inform the young person of the treatment options available,
seek and assess their wishes and feelings in the light of their age and understanding and then seek legal
advice about considering the pursuit of legal proceedings under the Children Act to obtain for the child
the required treatment. The court would need to hear the evidence of professional witnesses to state that
the child had indeed suffered significant harm in respect of ill-treatment and the impairment of health.

The Government should not delay in providing guidance to ACPCs about the crucial important role they
must play to promote children‟s health and well-being in this area of child protection.

                                                Chairman

Thank you very much. There clearly are very frightening gaps in the legislation and, indeed, the
implementation of what legislation there already is. Can you tell us what kind of training you offer for
your child protection officers and would you regard that as an example of best practice that could be
replicated elsewhere, or do you think that the Government really need to move on this and produce
guidelines for training in the area of FGM?

(Liz Davies) We did provide training. Mr Gordon came and spoke in Harrow and trained all our senior
managers in all agencies and the members of the area child protection committee. That then triggered a
raising of awareness at that level, but we integrate a more general awareness of FGM within all our child
protection training. It has to be integrated.

                                             Baroness Gould

Obviously things seem to be happening in Harrow. Have you any idea what is happening in other local
authorities? If not, do you think that this is an exercise that the Government should undertake, to find out
what is happening in other local authorities? That is my first question. Secondly, you highlighted some of
the deficiencies in the government documents. How do you think we can go about trying to redress that
and ensure that those deficiencies are put right?

(Liz Davies) I think with regard to the deficiencies there should be Section 7 guidance under the Local
Authorities Social Service Act 1970. This would be a statutory basis for local authorities. These two key
documents have both very recently been produced. They are not likely to be rewritten in the near future
so I think there needs to be some specific guidance on this subject.

I do not know about other authorities. We have been quite innovative in Harrow with our public
awareness programmes around child protection in general.

                                             Baroness Gould

Do you think that the Government should undertake to do an assessment of what is happening in other
local authorities?

(Liz Davies) An assessment and some national guidance around child protection training in general to
include this subject.

                                               Alice Mahon




                                                    26
There is a law in this country and a Human Rights Act, of course, that protects children. You seem to
indicate that there is a reluctance to carry out the law. Could you give us a specific example of something
you have come across where the authorities or the various agencies have stood back and not been as
forceful as they might be?

(Liz Davies) There is the criminal law but there is also the Children Act around child protection
proceedings. Within the area we are working, in particular there is the use of the Children Act to protect
children. I think that civil proceedings could be considered more, but through all the usual child
protection processes. From the point of getting the referrals to come in, that should trigger a multi-agency
child protection strategy discussion to decide whether it then moves into an investigation or not. It is just
getting that process to happen. It is a well-recognised process, so it is getting it to apply in this area of
work.

                                                Alice Mahon

Are professionals reluctant to trigger that?

(Liz Davies) I think there is a reluctance and a lack of awareness. It is more lack of awareness, I think.

                                                  Dr Brand

Would you take proceedings to take a child into care if you genuinely thought that they were at risk of
female circumcision?

(Liz Davies) It depends. Every case would be different.

                                                  Dr Brand

Have you done so?

(Liz Davies) No, we have not.

                                                  Dr Brand

 I am slightly worried about the tone of the questioning and the presentation. Clearly, one can use the law
and the courts to impose something, that is if one can. But that may drive the problem back underground.

(Liz Davies) That would be an absolute last resort.

                                                  Dr Brand

You are suggesting that we treat female circumcision as any other non-accidental child injury. That really
does not allow for the cultural side of things. I do not personally think that the solution lies with using the
power of the courts to deal with this. The courts should be used for the perpetrators, the people who do
the surgery. Dr Faith Mwangi-Powell talked about this as being a holistic issue. I hate to say this as a
man, but this is a feminist issue, is it not? It is about empowering women to say "no” on their behalf and
on behalf of their children. I do not think that having a social services child protection department taking
over that role is helpful. You may be there to help those who present themselves and to help mothers
protect their daughters. I have been involved in lots of child abuse case conferences and that sort of thing.
It is a very non-empowering experience. The state takes over. I am not sure that that is the right
direction. I would like some feedback.

(Liz Davies) It is my view that child protection work should view the child holistically, to work in
partnership with families and to consider the cultural issues.



                                                      27
Dr Brand

But that is not how the families would see it. The families would see it as social workers taking over their
family, going to a court saying, “You can‟t do this, you can‟t do that, and if you do we‟ll put you in prison
and take your child away”. Are you right in taking the child out of its cultural setting if you have not
persuaded the people within that cultrual setting that what they are proposing to do is wrong?

(Liz Davies) 96 per cent of all multi-agency investigations result in children remaining within their
families. To remove a child is an exceptional situation. With FGM it would be even more exceptional.

                                                 Dr Brand

Do you have statistics on what you have done in female mutilation cases?

(Liz Davies) It has always been addressed through preventative work and the education process.

                                                 Dr Brand

How many cases do you deal with per year?

(Liz Davies) I could not say. Not very many.

                                                 Dr Brand

Half a dozen?

(Liz Davies) Half a dozen at the most.



                                                 Dr Brand

So we are really not talking about a body of practice or work?

(Liz Davies) No, we are not in relation to child protection investigation.

                                                 Dr Brand

So it would be premature to suggest a code of practice if we have not worked out where we are trying to
go?

(Liz Davies) But our emphasis through the ACPC is on prevention and raising awareness through
educational programmes and training. That is our key emphasis for multi-agency work.

                                                 Dr Brand

I am sure that is how it looks from your perspective but that is not how it looks from the community
perspective.

Chairman

Perhaps we could confine the questioning.

                                                 Dr Brand


                                                     28
I think that it is right to test this out. This is really what this whole issue should be about. It is the rights
of the cultural communities and the rights of individuals to be protected and we have not explored that in
significant depth.

                                                  Chairman

One of the weaknesses of a hearing of this nature is that there will never be enough time in the public
arena to debate the questions that will arise from the statements that the witnesses make. It will take quite
a long time to digest what we are being told and to make sense of it. Unfortunately, we do not have the
time this morning to debate these matters in depth. But you are absolutely right. These are serious,
important, moral questions. However, in terms of our witness, Liz Davies, she is presenting us with what
happens in Harrow, and posing questions about the limitation of the law as it stands.

What you are suggesting is that we should be using child protection procedures in cases of FGM and we
are failing to do that. You are not suggesting that we should be taking children away from their parents?

(Liz Davies) No.

Chairman

We shall now have a break for 10 minutes, rather than 15 and that will hopefully put us back on track.

(Short adjournment)

                                                  Chairman

Our next presentation is a joint one from two representatives of trade unions which have an interest in the
issue of FGM: Angie Marriott and Hilary Pollard. Angie Marriott completed her Enrolled Nurse training
at Withington Hospital in South Manchester in 1984. She spent the following 14 years specialising in
women‟s health issues such as gynaecology and breast surgery. She currently holds the post of Clinical
Research Nurse in Radiology, monitoring the complication rate of endoscopic and arterial surgery.

She was first alerted to the problems associated with FGM when a 14 year-old patient was admitted for
corrective surgery following infibulation. She is an active trade unionist in UNISON. Over the past two
years, UNISON has played a proactive role in raising the profile of FGM, including sponsoring
FORWARD‟s one-day conference on the issue. I understand that Angie is currently formulating a leaflet
on FGM which will be integrated into UNISON‟s health pack in the near future.

Hilary Pollard‟s career has been in inner city schools since the 60s working in mixed comprehensives.
She became the branch secretary for the Association of Teachers and Lecturers in her local authority in
1986. She has been a member of the Executive Committee since 1990. She is now Chair of ATL
National Equal Opportunities Committee and representative on the Women‟s National Commission.

She was alerted to FGM through a seminar that the Women‟s National Commission had on this issue and
she realised that many teachers were probably as ignorant as she felt herself to be at the time. She felt that
there was a need to develop materials that would educate teachers about FGM, so she subsequently joined
FORWARD. She will tell us about the things that she feels teachers need to know. This is a joint
presentation.

(Angie Marriott) Good morning, everybody. I should like to thank you for this opportunity to speak on
behalf of Unison. I have spent 14 years working in women‟s sexual health. My first encounter with FGM
was when I looked after a 14 year-old patient. I had absolutely no idea how to treat this patient. I had no
training whatsoever on female genital mutilation and it was a shock to me.




                                                      29
I am an activist in UNISON. UNISON is one of the largest trade unions in Europe, having 1.3 million
members. Ten per cent of our members are from black and ethnic minority populations. I am on the
National Black Members Committee, the National Women‟s Committee, Vice-Chair of the Black
Women‟s Committee, Women‟s Officer for the North West Regional Black Members Group and Equality
Officer at South Manchester Hospital where I strongly believe in promoting equality.

I first became interested in female genital mutilation when I attended FORWARD‟s conference last year,
which was sponsored by UNISON. Myself and Pearline Parker, our national women‟s officer for the
black women‟s community are co-opted on to the National Women‟s Committee. We felt that it was our
job to raise the profile of FGM, to educate all the women on the National Women‟s Committee and
throughout UNISON.

We also highlighted FGM as a form of abuse as 1999 was a year of Action Against Domestic Abuse to
Women. We decided to raise that as a way to promote FGM. We were working with the National
Women‟s Committee and decided to produce a leaflet to go into our women‟s health pack. This will be
distributed throughout the union to all members and hopefully raise awareness and provide education to
our members.

In November 1999 we held a seminar on FGM at our Annual National Black Members Conference. We
also held a workshop at Unisons National Women‟s Conference to raise awareness to our Women
members. We also held one in February this year to raise awareness in all our members on FGM. It was
very successful. A lot of people attended and were astounded to hear that it was still being carried out.
Very few people had knowledge about female genital mutilation.

Dave Prentice, Unisons General Secretary and Bob Abberley, head of health have supported issues of
FGM throughout Unison; John Nobleman, Regional Officer; Coral Jenkins, Chair of National Black
Members Committee; Pearline Parker, Women‟s Officer, and Reginald Hamilton, Vice-Chair of National
Black Member‟s Committee, have spent the past 12 months working collectively on issues of female
genital mutilation. We feel it is an important role for Unison as a trade union to raise awareness, offer
education and training wherever possible. We should like to see the Government provide training for any
workers who come into contact with FGM associated problems.




(Hilary Pollard) I have been in teaching for 40 years. Teaching has changed completely. The schools I
taught in originally were totally white. Now they are racially mixed. I am aware that many teachers like
me just do not know anything about female genital mutilation yet we might have children sitting in our
classrooms who have been subjected to it or are in danger of being subjected to it.

At the WNC Seminar I learned of the work of FORWARD. I asked permission from my own union to be
able to go to FORWARD‟s meetings which were developing materials. It is important that teachers are
trained. We do not know the indicators to look for. We do not understand what we are supposed to do.
We need a great deal of training and need to work much more closely with the area child protection
committees. I know that my own area child protection committee does not even mention female genital
mutilation. We are right next door to Leeds where there is a large Somali community. It is quite possible
that because of dispersion amongst immigrant communities, those people will come to Kirklees where I
teach, yet none of us know anything about female genital mutilation.

It is absolutely essential that there are materials for training teachers so that they understand what is
involved, how to deal with families and children and to work with the area child protection committees. It
is essential, too, that we have materials for children. That will be really difficult. I have just been saying
during the recess that I would not wish to teach about this in the mixed groups which I currently teach. I



                                                     30
quite happily teach sex education in mixed groups but I would not want to teach about female genital
mutilation. So, it is far reaching. It brings problems for schools. If you are in a mixed school which
normally teaches everything mixed, there will be timetabling problems. I cannot imagine anybody wishing
to tackle this in a mixed group. However, it is just as important to have boys know about female genital
mutilation so that they are encouraged to say, “When we grow up we will not inflict this on our women”.

                                                  Chairman

Thank you very much. You seem very clear that we need to be tackling what is essentially a health
promotion issue within schools. Would you agree with that? Do you think that the school is the primary
place to start with the little ones? How would you include the parents in that?

(Hilary Pollard) I am not sure how we include the parents, except that when we do sex education, we
always let the parents know what is being taught. So, they would be included if they chose to come along.
Yes, I do think it is a health issue. I also think that it is a human rights issue. It really does have its place
within PSE. Now that PSE has become PSHE it has its place there and that will strengthen it. Of course,
we can use religious education, which is really my specialism, to underline strongly that this is not a
religious thing; it is purely cultural.

                                                  Chairman

Given that parents can opt out of their children receiving sex education if they so wish, would you choose
to include this within sex education or would you put it in religious education, or what?

(Hilary Pollard) They can opt out of that as well.

                                                  Chairman

That poses a difficult question.

(Hilary Pollard) If I had my way, there would be no opting out, particularly of sex education.

                                                  Chairman

I totally agree.

(Hilary Pollard) They cannot out of sex education –

                                                   Dr Brand

Unless they opt out of sex.

(Hilary Pollard) – when it is taught within science, so it could be that this is where we have to approach it,
and put it within the science curriculum because you cannot withdraw your child from the biology element
of it. We have to find ways to get round it.

                                               Baroness Gould

I was going to ask about the relationship with the parents. It seems to me to be important that there is
discussion with the parents before there is any training, teaching or discussion with the children. I do not
know how one gets round that if the parents say that they do not want their children to have this
discussion. You made the point, and it worries me very much, that you do not know what the indicators
are. It is important because, again, if it is a health question, it is a rock and a hard place, is it not? How
do you solve the health problem at the same time as satisfying the cultural needs and the needs of the



                                                      31
parents? I do not know whether you have thought about that.

Perhaps I may ask a question of both of you. You are both parts of big networks: a trade union and the
Women‟s National Commission, which is large and is a women‟s network. How do you think we could
extend this message out into both those networks?

(Hilary Pollard) The Women‟s National Commission is trying very hard. It has had two meetings: a
brief one and then the UNISON-sponsored meeting which attracted a tremendous number of women.
Materials went out to those who wished to have them. We need to have a great many more attractively-
presented materials which can be given to people through places such as public libraries, doctors surgeries
and so on. That is where people will pick them up.

(Angie Marriott) We need to be able to run more workshops up and down the country to raise awareness
and involve and educate men. We felt it was an important role to begin by educating our men on the
National Black Members Committee. All our men on the committee are very committed and interested in
educating themselves so that they have an understanding of what takes place. Most men would say, “It‟s a
woman‟s thing. We don‟t really know what happens”. From UNISON‟s point of view, I would like lots
of workshops up and down the country and lots of literature that people can get their hands on, which is
readily available.

                                              Baroness Rendell

You said that you would not be willing to teach or explain female genital mutilation to a mixed class but
at the same time you say that you think it is important that men should be aware. Why would you not
teach it to a mixed class?

(Hilary Pollard) Prurience. It is as simple as that. Young teenage boys become very prurient and I do
not want it treated as something that is “dirty”. It would not be done in the same way if it were single sex.
It would make it much easier to be open. It would enable a man to teach them which, again, would be
important. I think that is something which would concern, in particular, Muslim families. I do not think
that they would want their girls to be taught in a mixed group.

                                              Baroness Rendell

But you could separate the children?

(Hilary Pollard) Yes. That is why I say that it will cause timetabling problems. Girls would have to be
timetabled in one place and boys in another.

                                                Lord Ahmed

In Muslim categories there could be Asians, Indians and Pakistanis. There are lots more of those in
Kirklees and West Yorkshire than there are Somali or Sudanese people. You could offend those
communities by raising this issue because it does not exist in those communities, to the best of my
knowledge, so you need to be sensitive.

                                                  Chairman

I accept that it is an educational matter in general terms.

                                                Alice Mahon

Angie, I am pleased that UNISON is taking a radical, progressive approach. UNISON can get at the grass
roots because it is a grass roots organisation, so congratulations. I wondered if you were going to



                                                      32
distribute your findings? You have had 12 months working on the issue with workshops, etc. Do you
intend to draw up a report?

(Angie Marriott) Yes.

                                            Alice Mahon

(Angie Marriott) At the moment we are doing quite a lot of work with FORWARD so I think if we do, it
will go to FORWARD.

                                            Alice Mahon

Will we get the results?

(Angie Marriott) Absolutely.

                                              Dr Brand

Is any academic work being done on the effects of having it on the curriculum or the effects on general
education? I personally think that it is a question of empowering women. That is part of education,
giving them job opportunities and making decisions themselves. But the intervention that we are talking
about, having groups either through trades unions or discussion groups within a school, is anybody
looking at the outcomes?

(Hilary Polard) Not that I am aware of.

                                              Dr Brand

Is UNISON looking at it?

(Angie Marriott) Towards the end of this year when we do our annual report from the National Black
Members Committee to conference, I think we are looking overall to evaluate what information has gone
out, what people are doing and how knowledgeable people are. We are hoping to audit that probably by
October before our national conference.

                                              Dr Brand

Your approach is very much about empowering the individual with knowledge and working with
communities to allow people to make their own choice?

(Angie Marriott) Yes. We are hoping that by November we will have carried out an audit, which will be
ready.

                                              Dr Brand

Is there any international work which is being drawn on? Are you aware that other trades unions have
done a similar job?

(Angie Marriott) UNISON has an international committee. We are in the process of taking that forward.
We are just at the stage where we have drawn up a policy but it has not yet been finalised, but we have
links with our international committee.




                                                  33
                                                Dr Brand

Madam Chairman, I know that there are some very expert people in the room today. I think that written
submissions would be extremely helpful where people have taken this work that we have been talking
about now a step forward to see what effect it has.

                                                Chairman

You are quite right. A steering group operated prior to today‟s hearing. A very wide range of groups
have been contacted and filled out comprehensive questionnaires. We hope that subsequent to the
publishing of the hearings, we will be able to have an analysis done of all the responses. There were quite
a large number. Trudy, do you know how many responses we have had?

(Trudy Davies) 350 went out and I think that 80 came back.

                                                Chairman

So, we have a lot of information. We shall have a professional analysis done of that work. Hopefully, that
will inform our debate. Thank you very much indeed.

Our next witness is Ekhlas Ahmed from the Midlands Refugee Council. Ekhlas Ahmed is a qualified
Social Worker with particular interest of Community Development and Community Action. Mrs Ahmed
worked for the Sudan Ministry of Education as an adult education instructor during the time she was
working for her degree in sociology. She has worked, and still does, as a community development worker
at the Midlands Refugee Council. She is also now the FGM project worker for the Midlands Refugee
Council. She is a member of Sudanese Human Rights in UK and a member of the National Strategy
Group for FGM. She is also the founder and fundraiser for the Midland Refugee Council FGM project.
Clearly, her heart is in her work.

(Ekhlas Ahmed) I started work with the Midlands Refugee Council as a community worker in
Birmingham in 1996 to provide support and advice for refugee women. In our work, we realised that
refugee women, especially Somali and Sudanese women, face difficulties in childbirth. They have
difficulties because health professionals are not prepared and they perform unnecessary caesarean
sections. That was a very bad experience for them.

Talking to them one-to-one, we decided to initiate the FGM project. We submitted a bid to the Lottery
Commission and it was successful in 1997. The project started in 1997 to provide advice for health
professionals as well as advice to women. We have two focus groups, one for women and one for men.
We have regular meetings. Because we are a community organisation, we also provide advice for
refugees. We provide advice on housing, education and employment.

The Midlands Refugee Council, as a community organisation, provides community-based advice for
refugees. It is a grass roots organisation. Because this is a very sensitive issue, especially for women‟s
groups, we realise that if we want to talk about FGM, or female circumcision, it is difficult. We tend to
use indirect or less direct methods. For example, we provide sexual awareness, health awareness, family
planning for the group. That has been successful.

We also tend to use activities organised within the community to help them to break the communication
barrier. The project mainly provides advice for communities as well as health professionals. We did a
survey at the end of March. In our findings we discovered that about 31 per cent of 70 women would still
consider circumcising their daughters; 9 per cent had not made up their mind; and 60 per cent said that
they will not circumcise their daughter. 31 per cent is alarming. Work still has to continue.

In our experience with women‟s groups we discovered that because this is a community issue, we have to



                                                   34
involve the community and bring them together. We want to change the mindset of the people. That
cannot be done from the top. It has to be done from the grass roots. We have been successful in getting
members of the community from our focus group to join our campaign, especially the women. That was
very helpful. We realised that there is a need for a Somali link worker for the project to be easily
accessible. That was very positive.

We also realised that it is very difficult, especially with the Somalis, to get the men to talk. If we have the
resources in future, we would like to involve them more and to involve them in the work. We also
discovered that the approach involving community and religious leaders is useful. They are the ones who
are accepted by the community. They have their ways of talking to the community and the community
will listen to them.

Also in our findings we discovered that some of the community are aware that it is illegal but some are not
aware. They have never questioned something which happened to their mothers, grandmothers and
daughters. They do not question whether it is right or wrong to continue. There is a need for the
community to keep them aware that it is bad for their daughter‟s health. There are positive traditions
which we have to promote. The Sudanese community have produced a documentary film about the
positive image of the culture. That is a way to promote positive culture to help them to feel that they are
proud of their culture.

All refugees are newcomers to the system so they are not aware of how to access the service. Here in
England they are sometimes subject to harassment from the host country because of the issues and
problems. Some tend to keep their traditions even if they believe they are wrong because they are scared
that they will lose them. They do not want their daughters to be English. There is a fear that if they leave
the girls uncircumcised, they will lose their tradition. That is one of the issues.

Some of the men seem to have a dilemma. They believe that there is something wrong but they have a
dilemma with their wives who strongly believe in the practice. They feel sorry for their daughters but at
the same time they are under pressure from their wives. They say that they do not know whether it is right
or wrong. By involving them in the project, at least they can manage to help us to prevent some cases.

When I was community development officer in 1996, there was a young Yemeni girl who was to be
subject to circumcision. With the help of the social services, the Yemeni community social worker, we
managed to stop the girl from being circumcised. We used a Section 47 emergency order. The Yemeni
community did not do anything. They do not want to get into trouble. That worked. So I believe we can
use the law to stop girls from being circumcised. I am a social worker and I strongly believe that if it
comes to using child protection, I really feel that we have to use it. The social services think that it is a
tradition and they do not want to get involved. I do believe that is wrong. It is a harmful tradition for the
girls. We should come forward to stop it. Whatever the reaction, we have to be sensitive but we have to
stop the practice. In the case of this Yemeni girl, it helped to stop the circumcision. That was an
achievement.

                                                 Chairman

Thank you very much.

                                             Baroness Rendell

When I visited the African Clinic at the Central Middlesex Hospital, Harry Gordon, the surgeon there,
told me that there was no longer any FGM carried out in the Sudanese community in London; that they
had ceased the practice and they looked upon it as an ancient tradition; they no longer did it. Can you tell
me if that is true? If it is, how did they do it?

(Ekhlas Ahmed) That is not true. I remember that one of my colleagues working for a human rights



                                                     35
organisation in London was informed by two women that they had taken their children to Egypt to
circumcise them.

                                             Baroness Rendell

Were they Sudanese women?

(Ekhlas Ahmed) The numbers for Sudanese is less than for Somalis; that is a fact, but we still have
Sudanese women. The numbers are not as high as before but we still have Sudanese women in the
community practising circumcision.

                                              Baroness Gould

I was very interested in the point you made about the men. You said that the men receive pressure from
their wives. I had always thought that maybe it was men themselves who felt that this was a practice
which should continue. You are saying that they do not think it is a practice which should continue, but
that they get pressure from their wives. Can you elaborate a little on that and on the role of men in the
whole process?

(Ekhlas Ahmed) The tradition and the culture involves the whole society and the family. Because she is
part of a family and of society, a mother does not want her daughter to be stigmatised and isolated. She
wants her daughter to have status and a good life. There is an assumption that if the girl is not
circumcised, some of the community will not marry an uncircumcised girl. So the mothers do it on the
grounds that they love their children, not because they think it is child abuse. That is the issue. It is part
of the culture. That is why they need to be educated to inform them that it is not, that they cannot
continue with the culture if it is harmful to the girls. A father may say that his wife strongly believes in it
and he has difficulty, he is in a dilemma as a father. He has two daughters and does not know what to do.

                                              Baroness Gould

But does it not reflect on the fact that the mother thinks that the daughter will not be able to get a
husband? This is a problem that men must face up to.

(Ekhlas Ahmed) Somehow, yes. It is not only to get a husband. It is to reduce the sexual activities of the
girl. They believe that if a girl is circumcised, she will not have the same pleasure as an uncircumcised
girl. So, it is for the men to have a faithful wife when the husband is not around. They think that if they
circumcise, they are secure that their daughter or their wife will be faithful and will have no sexual
relationships.

                                                  Dr Brand

Perhaps I may say what a positive contribution I thought that was. You have obviously done fine work
within your community. You have arrived at a majority community view against female circumcision. I
think that that is perhaps something we could draw lessons from, if there are other areas where the same
proportion of people still believe in female circumcision.

You have also highlighted the uncertainty within families where mothers want to be protective of their
daughters; men are not quite sure whether it is the wife that is pressing for it and 60 per cent of the
community at large want to abandon or leave this practice behind. Is that why you think under those
circumstances the area child protection team can be of help; because it clearly means that nobody loses
face?

(Ekhlas Ahmed) Definitely. I strongly believe in that. With the help of the social services, we can inform
the community that it is illegal. Although we will not proceed, at least we can follow the procedure as



                                                     36
happened for the Yemeni girl. There are other issues which depend on education. It does not mean that
some men do not agree with circumcision. I remember when I was a student at university, there was a
Sudanese girl whose father separated from her mother. All her friends were going to be circumcised. The
girl was given pressure from her mother and her father, who said, “You are not the same. You don‟t care”
so the father managed, with the help of a medical doctor, to perform an official circumcision – it was like
a wedding. Although it is illegal, it happened in public. That is a dilemma because the tradition is
stronger than the law.




                                                  Dr Brand

You feel that where a community has accepted that they have to let this practice go, as Miss Davies said,
there is a role, once you have the community on your side?

(Ekhlas Ahmed) Yes.

                                                  Dr Brand

When there has been such a change in opinion within the British Sudanese community, does that feed
back into the home country in the fullness of time?

(Ekhlas Ahmed) From my observation, I believe that the Sudanese in Sudan are more flexible than the
Sudanese in the UK. It is part of the culture and they accept it. The problem that the Sudanese here face
is that of insecurity. They feel as if they are losing their culture so they stick to it more than the Sudanese
in Sudan.

(Baroness Gould took the Chair)

                                                 Chairman

Thank you very much indeed. I apologise for Chris‟s sudden departure and the fact that I have moved
over. She has to take part in a House of Commons Committee which is taking place upstairs. We hope
that she will be back with us very shortly, but in the meantime you will have to put up with me.

We move on to our last witness, Shamis Dirir, whom many of us have known for some time. Shamis is
the Development Director of the London Black Women‟s Health Action Project. She is Somali born,
born in Aden, South Yemen. She has been active in setting up various voluntary agencies in Tower
Hamlets. The first association she set up was the Somali Women‟s Association in 1979, so she has been
doing this work for a long time.

She then went on to set up the Maternity Services Liaison Scheme in 1980 which deals with ante-natal and
post-natal care of pregnant women, specifically from the Somali, Bengali, Chinese and African
communities. In 1982 she founded the Black Women‟s Health Action Project, a registered charity
organisation that campaigns against the practice of FGM based on the fullest involvement of the women
concerned.

 (Shamis Dirir) First, we have had much debate today, but let us hear from the grass roots level
organisations working with the communities. I should like first to tell you what we do as an organisation.
We are an 18 year old organisation, we were involved in the passing the Female Circumcision (FC) Bill
which was passed at the House of Commons in 1985. We currently have 7 projects within our
organisation. Our work is to educate on the harmful effects of FGM. We intend to eradicate FGM from



                                                     37
the grassroots level by talking to women, young and old people to see what lessons that be can learnt from
our work, and encourage them to come out and discuss their problems and understand the harmfulness of
the practise.

Imagine that you have been carrying out a practice which had been in existence for several years and then
you migrant to another country and are told, “You must stop the practise”. It is rather a shock. How
would you explain this to the community? “We are harming our children and is there is a way we can
stop”?

First we look at the law in this country and say: “A law has been passed in this country and that you
cannot continue with the practise.” Secondly, we can look at the religious aspect and say, “It is not
religious. Why are we then practising it? Why are we harming our children?”. Those whom we see in
this country do not come only from cities, some also come from the rural areas and that they do not know
anything about the religious interpretation of the FGM, as FGM has never been talked about in
community due sensitivity. A lot of women have recently learnt that FGM is not a religion practise.
Some are asking that if it is not religious then why are we practising it? “Some women say that it is our
culture practised for thousands of years. Why should we stop now?” We then bring in the prohibition
law.

In 1991 we inquired from the child protection team to find out if female circumcision was being branded
as child abuse? They said „yes‟ and whenever we say to the community “You are abusing your children”,
many women get very angry. They always say, “We are not abusing our children. We love our children.
We perform this traditional practise for our daughters‟ interests, to have a husband and to become the best
girls in the world. This is why we are practising it.” We say “If FGM is not child abuse, what are you
doing to your child?” The community considers child abuse as sexual abuse and other intentional harms
that can be done to children. The community believes that they are not sexually abusing their children.
We are helping our children to get married, and to find husbands”.

We have been working over the past 18 years and we have had a lot of women who listen to us, many of
which do not want to continue the practise. But there is another dilemma. Some of the women would like
to practice sunna. I do not know whether people know that there are two types of Sunna. One is to cut
the hood off the clitoris and the other is to prick the clitoris and shed blood. We ask the women which of
the two they would like to practise? If they say, “We would like to cut the hood off the clitoris”, we say,
“That is wrong”.

In our organisation we see 1,767 people in a year, most of which are the young people and their families.
We have different projects such as: young boys‟ project, young girls' project, education and training
project. The education and training projects works with the community, parents, social services and
schools to remove barriers in education and assist young Somalis to achieve their maximum potential by
making their learning experience more enjoyable. We cannot say that we work all over the country and
all over the world because we do not have the capacity to do so. We are a small organisation but we think
that our work has prevented thousands of girls from being circumcised.

Although, we are eradicating the practice, some parents take their children to Somalia and other parts of
the world when schools are on break to have them circumcised. Some parents also take their children
abroad not to be circumcised but to show the community that it has been done so the community would
accept them. From this we can see that some parents do not want to circumcise their daughters, but they
only want to be accepted by the community.”

Our work with the community is unique, we have reached a target and we can say that we have helped the
young and older people to understand different aspects of our work. Our aim is to educate women,
children and their families. Every week we educate up to 44 women in basic English. This is designed to
help women who are not very educated. Just like any normal group of people when they come together
they get the opportunity to discuss all issues.



                                                   38
In 1994 some women said, “If we go back tomorrow or if we stop FGM in this country, what would
happen to us?” With this in mind we organised an international conference "Change without
Denigration" in that year more than 400 people from all over the world attended the conference and the
black communities we serve, fully participated. It is therefore very necessary to eradicate FGM in other
countries as well.

We are linking our work to Africa where we came from. I am a Somali woman and work for the Somali
community, but I help other communities that practice FGM. We also have two research projects in East
Africa, on the attitudes and experiences of Somali young people on female circumcision and the attitudes
of the older generation (45-60 year olds). We had 2 young people a man and woman to carry out the
research and the research was very successful, and some people admitted that they had had enough of the
practice and they did not want to continue. There are a lot of young men and women who are not going
to circumcise their children in this country. But they are concerned about going back to Somalia in future
as the practise still goes on there. We need help as an organisation. Our Management Committee has been
very supportive in organising events.

We need the Government to help us with funding, not just here but with the work we are linked with in
Somalia. Unless we link the two works together the practise will not stop in Europe. These women would
go back in future and they would still practise it. I went to Somalia on 3 occasions. I established an
organisation called the Somali Rehabilitation Development Agency the first time. I re-visited the Somalia
in July 1991 during which I visited 15 villages where I saw 10 young girls been circumcised in front of
me. I could not say a word because it was not my place. They said, “You come from England and you are
westernised. Your mind is gone. I went back again to Somalia in December 1999, I had the chance of
meeting 33 women from a different NGOs who understood me, and said, “Why can‟t we work on female
circumcision and talk to other women?” A five day research was successfully carried out

There are many women who would like to stop the practise but have no means of stopping. The Bill in
this country is working as far as the communities are aware of the penalty. But at the same time we need
the Bill to be translated in different languages and monitored. FGM should be debated and discussed on
the television by the communities, religious leaders. FGM issues are very sensitive and should not be
horrifically publicised by the media.

I am also planning to have a law passed in our country Somalia. There are many strong women in
Somalia who said that they will help. We have about 17 people who said “We will help you to formulate
it”. We work with schools, social services and the police. We are doing a lot of tremendous work. We
do an inter-agency work. We have produced an FGM strategy policy which was produced in
collaboration with the social services psychology team, hospitals and universities which could be used by
other organisations. Several researches have been carried by us. At the same time, we have all kinds of
information for the community and the professionals. However, we cannot reach everybody. We need the
help of the Government and other organisations. To eradicate this we would all have to work together.
But we must be sensitive to the community. We are winning the trust of the women, and once we win
their trust, the trust of the men will come. We are also winning the trust of the young and the older
people. However, some people are stubborn too.

I worked with a family for six months to educate them not to circumsise their daughters. Once she agrees
to stop, she would stop other women from practising. The community is word of mouth. They go around
and talk to each other. We are doing wonderful work with the community, linking our work back home,
many muslim men try to talk about the religion mentioning what has not been said before in mosques,
everywhere, and even in our country, “It is not Islamic and it has stop. Other Islamic countries do not
practise it. What is the reason why we are practising it?” But, I am sorry to say that at the same time
many men said, “Well, how would we trust girls if we were not circumcised? Many men think that girls‟
virginity is the stitched bit. We all know it is not – so they need a lot of convincing – we have to convince
men.




                                                    39
I saw a Senegalese Imam yesterday who went to villages to educate the people on issue of FGM. I would
like to have that kind of man to go to every village and come out and talk about it. I also met one of the
researchers who seemed very confident about the research. Sometimes people say, “No, I am not going
to stop female genital mutilation. What is the problem? Why should we stop?” The researchers explained
to the community and referred them to us for further information.
Chairman

Thank you very much. You have outlined a whole range of things that have to be done: training,
education, research and so on. You have also said that you want more resources. If the Government have
limited resources but are prepared to put more resources into this whole project, where do you think they
should go? Should they go to organisations like you that are doing all this community work or should
there be a concentration in the health service? Where do you think the resources should go?

(Shamis Dirir) First of all, the health services need the resources. All these women are going back to the
health service for infibulation, to have their babies and with health problems. But the community also
needs the support to eradicate and stop. There is no unity in the work of FGM. If it is not there,
everybody will take the law in their hands and we will not know who is doing what. We need unity. We
could save a lot of resources by working together.

Recently we have been trying to organise an international conference either in Somali or elsewhere in
Africa. We shall be preparing for this until 2001. We would like to collaborate with other organisations.
We need to work together. As a civil health authority, we work together but we need unity. If we had that
we could spend some of the money on the health authority, some for the health service and some for the
other work. We need major research to see what we are doing and how we can work together. That might
come from the Department of Health. Our two research projects are from the Department of Health but
we need a larger research. We are the only organisation which is researching. We need co-ordinated
research.

                                              Alice Mahon

I was interested in what you had to say about going back to the home country, to Somalia. You mentioned
the work of the NGOs there. What are they doing to help promote this? Is there any truth in the reports
we read about Mèdecin san Frontière advocating that for this to be done medically and in clinical,
controlled conditions, would be better than it being done in unhygienic conditions?

(Shamis Dirir) The people I met with from 33 NGOs were mainly Somalian. They were concerned with
disability, women‟s health, child orphans, war, and such issues. None of them were working on FGM.
We have opened a health centre there. Within that centre we said we could do two things. The first is to
detect all the children who are taken from here and safeguard them. The second is to help the women
advocate for themselves to stop female genital mutilation. You can imagine a country recovering from
war. Everybody is taking the law into their hands and doing all kinds of things. There are international
organisations which are going there but not doing much.

                                              Lord Ahmed

I found your talk very interesting too. You mentioned that some people argue for sunna. I am a Muslim.
I am not aware of any Hadith saying that in relation to female circumcision. Which sunna are they
referring to?

(Shamis Dirir) I have not read of it either but I was shown in a Hadith someone said that a woman was
circumcising her daughter and he said, “Why are the daughters crying? Why are you doing that?” She
said, “I have to have something to eat for my children, for money”. He said, “Don‟t go deep. It‟s
enjoyable for men and bad for a girl”. This is what I heard. It is not what I know. This is what all the
religious people are telling us. So maybe you could go back and look at it in another Hadith, but this is



                                                   40
what I heard. At the same time I am saying that with female circumcision or female genital mutilation,
whatever we call it, it is no good either to break it or to cut it. I think a girl has to be tight as they come
out of their mother. That is what I believe.

                                                Lord Ahmed

Perhaps I can make one point. I know that of a total of about 8,000 to 10,000 Hadith, only about 4,000
are authentic, where there is adjudication, in other words, there is evidence to back it up. I have heard of
the same one, but there is no evidence to back it. That is the first point. Secondly, as a practice, he never
approved of it anywhere in Islam. He never approved it.

(Shamis Dirir) He never approved it. I agree absolutely.

                                                Lord Ahmed

Although he never approved of alcohol, it took 12 years before he actually banned alcohol from the
introduction of Islam. So this was one of those things that he never approved. Maybe in time he would
have banned it if this practice had continued.

(Shamis Dirir) It is a horrible practice and it should stop.

                                             Baroness Rendell

In the debate in the House of Lords, or perhaps it was a Question – I cannot remember – I advocated
encouraging young Somali graduates to enter social services so that they could go into the homes of
members of the community who belong to their own ethnic group and dissuade them from female
circumcision. That would be on the grounds that people would listen to their own ethnic group with more
faith than they would perhaps to other people. What do you think of that?

(Shamis Dirir) it is a wonderful idea. The Somalis are a deprived community. Now we have another six
social workers coming into Tower Hamlets, so that is a wonderful thing.

                                             Baroness Rendell

So it is happening?

(Shamis Dirir) It is happening. We have about six social workers in Tower Hamlets who are going to be
trained. It is better nowadays than it was before. People are listening.

                                                 Chairman

Thank you very much indeed. Now is your opportunity to participate. We have three quarters of an hour
for discussion on any points that you would like to make and that you would like us to take on board as
part of this report.

(Dr Nahid Toubia) My name is Nahid Toubia. I am the founder and President of RAINBO. We are an
international organisation with several offices, mainly in Europe. I am not going to talk very much about
our work. I want to take the opportunity that I have now to address the issue of information and data.
First, I congratulate you on a wonderful hearing. I have learnt a lot today, even though I have followed
the issue closely and been involved in it for the past 20 to 25 years.

I am from Sudan. I am a physician and a member of the Royal College of Surgeons in England. Also, for
the past 10 years I have been an activist globally for women‟s health rights and sexual and reproductive
health rights in particular.



                                                     41
Britian has had activities. FORWARD is 15 years old – congratulations. Shamis‟ organisation is 17 years
old. Many things have been happening for 17 years. Social services have been involved, more or less, on
and off; health services more or less, on and off. You have reached a point where you have to gather
appropriate information. If you are going to put more investment in and the Government are going to be
involved more heavily, you have to start from an objective more studied point.

At the end of the day, it is all about data. I do not want to lose sight of that. What data? You cannot just
gather data. You have to know why you are gathering it. We have talked about health services, social
services, education, teachers, schools and communities. I am sorry that the Chairperson is not here with
us because I really would like to address an important issue we have heard this morning; that is, that this is
a health issue. If we do not stop and realise that basic fundamental principle, we are in trouble.

It is also fundamentally a human rights issue and a social issue. If we deal with it only as a health issue
we will gather the wrong data from the wrong places and devise programmes that are not well informed.
If you think about it more as: “Yes, it does have health consequences; absolutely, but it is a social issue
and gender dynamics issue”, you are starting from a different point. Your data will be different and your
programmes will be different.

Let us go back and say, “Ok, this is a social issue. Therefore, it is about social change.” The approach is
about social change where everybody becomes an agent of change: the health care providers, the social
work providers, teachers, the community and teachers. Everybody becomes an agent. Our approaches
will then work towards that.

Let us return to the data issue. There has been much concentration on infibulation which is a particular
service need. I shall not go into the details. This concerns the Somalis and the Sudanese. It is not that
difficult in this country. This is a very small country compared to the United States. You can go to the
clinics, as Momoh said, but you can also go to the refugee services, the centres and the educational
services and collect a lot of data about where the congregations of Sudanese and Somalis are so that you
know where to put services. That is not difficult.

If you want to know about risks, who do you approach? That is a different kind of gathering of data. I do
not want to go into details but I did speak to a chairperson who said that the follow-up to this should be a
little more nuance than thought. There is a lot of information which can be gathered. Who is the
population? Who are the women? What services do they need? What approaches do we need to bring
about social change and who can be the most beneficial activists towards that social change? That is the
sort of point at which I would start if I were gathering data.

(Speaker) I work here for an international NGO. The point I want to make is that circumcision really
started here in 1983. By the time we came here In 1989 and 1990 there was a lot of change. In 1991
there was a programme on Channel 4 which delayed years of work, just by reinforcing two or three
assumptions about people who advocate circumcision.

They interviewed quite a large number of Somali women who did not even know that there was a law at
the time. They found themselves harassed by the social services and everyone else. That was one of the
things which closed down a large number of women from coming and talking about it. Secondly, there
was a girl whose circumcision had been reversed because her boyfriend wanted to have sex with her. That
was even worse. There are a lot of other issues, such as child abuse and people are saying, “Why are you
talking about us?” A third matter which came out was that a lot of girls in schools and even in the street
were saying that Somali women when they are circumcised do not have any sexual desire. That is
rubbish, and we know it, all of us. So, there was really a pre-conception in the community. It took us two
or three years to take up the subject again. We have to get round the issue of health and other problems. I
urge you, whatever you do, to be very sensitive on this very delicate subject.

(Pearline Parker) I am women‟s officer for the National Black Women‟s Committee for UNISON. As



                                                     42
Angie said in her report to you, we have 1.3 million members. Those members are representative of local
government, health and the voluntary sector. We believe in using our structures to try to get the message
across. We have representatives on the TUC Race Relations Committee and on the TUC Women‟s
Committee. This is about trying to be empathetic to the issue and to try to advise, guide and support. It is
not our role, as members of our union, to take over work that is being done in the community. That is an
important message.

The second point I wish to make is that we are trying to educate the men on our committee. We believe
we have done that successfully, and they have taken that message back into the community. We have
worked with FORWARD. We are going to work within organisations but it should be said that there are
so many organisations involved in this, perhaps it would be best if we do something collectively, where all
the organisers work together. We, as a union, could affiliate and work with you and adopt a multi-agency
approach. As we realise, resources are scarce. Rather than trying to help one organisation, if you could
all perhaps think about working collectively together, we can try to help all women, the whole community
and adopt a holistic approach.

(Joan Davies) I am chairman of an advisory group on children rights to the Commonwealth Secretariat.
Looking round the audience, it is a fairly typical one on this subject. There are three men in the audience
and we actually have two on the platform. That is better than usual. These affairs are entirely women‟s. I
think this is a great mistake. I should like to take up the theme introduced by the lady behind about how
we can be most effective in getting our message through and getting action.

Men tend to be rather devious over this whole subject. You will find Muslim men will say, “I don‟t
require it. I don‟t understand it”, but yet deep down many of them, in fact, will refuse to marry a girl who
has not been genitally mutilated. I met a Sudanese doctor trained in this country, full of modern ideas
who went back to the Sudan. Within 10 years he was having his own daughters circumcised.

Many men believe that it ensures chastity and faithfulness, despite the fact that almost all prostitutes in
Cairo have been circumcised. Again, I should like to talk about tradition. We talk about tradition as if the
whole practice is thousands of years old. It is hundreds of years old in some places but in fact it was
spreading in the Sudan in the 20th century. If you read the memoirs of a colonial official like Hickes,
talking about the western Sudan, he will describe how a nomadic tribe arrived who practised female
genital mutilation and spoke to the local people. They said to the male leaders, “female genital mutilation
will enhance your sexual pleasure” whereupon it was promptly adopted in that area of western Sudan. So,
there is an element of sexual pervasion in this which was never challenged. Here is where the role of
western men comes in. We have two male parliamentarians here.

We are dealing with societies where women are under-valued and their voice is not listened to. Men‟s
voices will be listened to more readily. Why does not every male parliamentarian flex himself to tackle
every man they will meet from any of the practising countries and say, “Most of your beliefs are invalid
and untenable. You are being cruel to your women and daughters for no good reason at all. You are
endangering their life and health”?” Can we get the men to speak up? I think that is vital.

(Christine McCafferty took the Chair)

                                                Chairman

Thank you for that. Perhaps I may just say that it was not easy, apart from the two members of the panel
here who readily volunteered themselves to be on the panel today, to get male participants for these
hearings. So all the more credit to Dr Brand and Lord Ahmed for being present.

                                               Lord Ahmed

Perhaps I may say, not for credit, but even as a Muslim male, I feel proud to be on the panel. I spoke in



                                                    43
the House of Lords debate also, and I have very good relations with the Sudan Government. Whenever I
go, I promise that I am prepared to raise it as well. As long as I have full brief on Sudan available, I am
quite happy to speak with their government and other officials and even the religious leaders. I travel
quite often in the middle east and north African countries as a Muslim member of the House of Lords.
What we are talking about here is compatible with Islam and compatible with human rights, which is most
important. That is also part of Islam. I am very proud to be here.

(Dorothy Stuart) I am a midwife and also representing here today one of the women‟s groups in the
Church of England. I should like to pick up one of the points made by a member of the panel. We should
be careful of the idea that this is something that is only to be found somewhere in Somali communities and
in the Sudan. It is a fact that it can be found all around the world. So the idea that it is only Muslims
from those areas is not really a safe idea to carry through. Perhaps we could bear that in mind when we
are talking about being sensitive to communities.

                                                 Chairman

That is a very good point.

(Toby Levin) Toby Levin from FORWARD, Germany. I should simply like to second what our delegate
said about the importance of men in this movement, and to mention what is a highly successful project on
education for the German population at present. It came from Nigeria. We are working with Women‟s
Issues Communication Services Agency which is a women‟s and men‟s group in Nigeria. It is composed
mainly of people in advertising who felt that if they took their own craft and put it to the services of
improving women‟s lives they might really be able to accomplish something.

They put out a call for paintings and sculpture among Nigerian artists and received 80 contributions for an
exhibition which was shown with great success to a varied population which included government,
business and a number of leading opinion-makers. The exhibition has now come to Germany where it will
be shown in major cities in at least two dozen places with the aid of the Ministries for Health and
Refugees. I have a full colour catalogue of the paintings if anyone is interested in seeing that. Most of the
artists are men.

                                                 Chairman

Thank you for that. Perhaps after the hearing you could communicate that to the administrator of the All
Party Group. It may be that we could arrange to have that exhibition here in Britain which would be
excellent. Perhaps we could tie it in with the launch. We hope to launch the report of these hearings in
November here in Parliament. We are hoping to have a play about FGM, with actors and players from the
African Continent. We hope that that will be part of the launch. If it was possible to have an exhibition at
the same time, that would enhance what we are hoping to do.

(Evelyn Martin) My name is Evelyn Martin from the GMU trade union. We are not as active as
UNISON in this field but we do give our support in every possible way we can. We carry an article in our
quarterly magazine to promote and educate people in this worthy cause. I understand that this is not an
easy issue to address, but my specific reason for being here today is to represent my union and to report
back. I must thank you for your support in tackling this issue. I should like to say to those at the forefront
that you are not alone. We have various groups all over the place who are bringing your cause to the
forefront and we support you. I hope that this will not be a dying cause. I hope that it will be followed up
and that before long we shall see this on the statute book and it will become an issue which we can all
support equally.

We are now living in a multicultural society. This has been taken seriously by some people as a religious
or cultural issue. With inter-marriage, there is a serious issue as to which culture will be maintained in the
family. What if a Somali or person from another culture decides, “My children of this mixed marriage



                                                     44
will have to be circumcised”? That is a problem we have to foresee and tackle along the way. That is why
it is everybody‟s problem. We are all involved in it. Although many of us do not see it as a health
problem, it becomes a health problem. Thank you very much for your support and help. You are doing
wonderful work and we are all here to support each other.

(Ekhlas Ahmed) I should like to take this opportunity to thank the parliamentary group. They are doing a
great job. With their support, our organisations are able to help families.

(Amal Sayed Arbab) My name is Amal Arbab. I am from the Sudan. I have been working in this country
since 1973. I am now living in Sweden and working with an organisation called RIFFI, which is a union
for immigrant women. I was shocked when I came to Sweden 10 years ago and found that this practice
has been going on in Sweden. When I left Sudan, a national committee was doing research. They said,
“We are approaching it. Yes, it is changing the whole attitude of the society, but it will take a very long
time”.

Doctors in the Sudan were very much involved in it, although they were not medical doctors. It started
with the family planning organisation. The doctors had confidential meetings because we could not bear
to speak about it. They all confessed that they knew about it. Their daughters are circumcised. They
would not listen because this is done by the older women in the family, the elders. The role of the
grandmother is very important in carrying on this tradition. We had to tackle it as a multi-holistic
approach, which we did. I was responsible, over three or four years, for approaching them. Unfortunately
I could not get any information because a lot of the Somali community, in particular, are newcomers to
Sweden and face a lot of problems. First, there is unemployment. Many of them were not thinking of
female genital mutilation in their country. They are thinking of it now and they are taking a very negative
approach about the people who are working in this subject. They say, “We are facing a lot of problems.
Why are they only concerned with this?”

I am a lawyer and social worker. The law existed in Sudan since 1984 but people refused to comply with
it. Now there are new laws in Sweden. There was a law passed in 1982 and another in July 1999, so all
the people who are living in Sweden do know about the law. They take their children to other countries to
perform female genital mutilation. But now the law is that when they come back, if they have been living
in Sweden, they will be prosecuted. The people are thinking, what about their families? Will they be
prosecuted? What about the children? It is a very sensitive subject and we have to tackle it.

The law would be a tool to help people who come in. It would help people who go out to be criminalised.
So, we cannot approach this subject unless we look at all the roles: the men and also the elderly women.
The role they play is very important. We cannot tackle it alone for economic reasons. If we are going to
compile statistics or data, especially in Europe and if we are dealing with immigrants, we have to deal
with all the problems they face. We should not ignore female genital mutilation because it is very
important. We have to include it. We are talking about laws but also about abusing women, equality of
women, and children‟s rights. We have to involve men within the family problems. We cannot talk only
about one single thing. I am happy and honoured to be here today. We have always had to talk about it in
a confidential, secretive way and now we are talking about it openly.

                                            Baroness Gould

Was the law passed in Sweden in 1984 originally?

(Armal Sayed Arbab) No, in 1982, and in 1999 there was a new law.

                                            Baroness Gould

Have there been any prosecutions?




                                                   45
(Armal Sayed Arbab) There were cases of what was happening, so there are some figures but the police
could not follow up because they did not have evidence. Now they are investigating new cases. I think
there are two cases

                                             Baroness Rendell

Perhaps I may ask one question before you sit down. You said that the Swedish law of 1999 sets out to
prevent people taking their children back to –

(Armal Sayed Arbab) Not preventing. If it happens that they know when they come back because there is
a follow up from awareness in school or health clinics, that the girls have been circumcised after they
come back, then they would follow up, question the fathers and introduce them to the court, because they
know about the law. The law has been translated. We have been working with organisations to raise
awareness of these laws so they cannot say that they did not know or that it was done because it was best
for the children.

(Shamis Darir) Perhaps I can add to that. In Sweden the law is that before the children are taken, they
are searched to find out if the girls are in tact. When they come back they are looked at. So, it is a strong
law.

                                                Chairman

That is very good. We are not enforcing our law in that way. That is probably where we are going wrong.

(Dr Faith Mwangi-Powell) I should like to make two comments. I shall not introduce myself again. I
wanted to make a comment about data. While it is very important to have data, it is also important to
make use of the data. We talked about the documents which came from child protection. One lady said
that FGM was not even mentioned. That was a surprise because in 1998 we were asked to prepare a
document of policies and procedures, which I have here. We came up with this document with all our
recommendations and findings. It is very thorough. It covered England and Wales. Out of 83 local
health authorities which were surveyed, 65 per cent responded, so it is the most thorough research you
could ever have. But it has not even been mentioned that we have been commissioned to do that. While
data collecting is very useful, we also ask the Government or the people involved to make use of our
recommendations.

My second point is that European Union has funded a European network. We talk about unity and people
getting together. In the past two weeks I was involved in a meeting in Sweden where about 23
organisations from Europe met discussing gateways in working with communities. We also have another
meeting on 22 June for health professionals. They are trying to develop national gateways which are
applicable not only in the UK but in Europe dealing with FGM. I think it is useful for those of us who are
here working in the organisations to get involved. If anyone would like details of that, I would be willing
to provide them. I am working in FORWARD. If you get in touch with FORWARD, I will provide you
with that information.

(Sarah McCulloch) My name is Sarah McCulloch and I am currently the programmes co-ordinator for
Agency for Culture and Change Management in Sheffield. Just over a year ago we set up a project to
work on female circumcision. We found that the issue relates to social issues and also touches on
immigration issues. The people involved are all refugees. It is a very serious issue. In the project that we
set up, we have only two workers: myself and an admin worker. We are finding it difficult to establish the
project and get the work going. We would like more support from the authorities and from the
communities themselves. Either they are ignorant of what they have been through or ignorant of the
legislation. What I am really saying is that we need support and ongoing long-term policy to support
small projects and individuals working on the issues.




                                                    46
(Speaker) I am a non-executive director for a health authority in North London. I want to talk about
those who have already been circumcised and their ability to have access to services. We are moving into
primary care teams and moving on into primary care trusts and touching on the business of training. I
wondered whether there was any move towards engaging the RCGPs in our training programme so as to
enlighten them on the issues pertaining to female genital mutilation. In future, they will be the keyholders
to access to services.

(Sarah Butterfield) My name is Sarah Butterfield. I used to be the focal point for FGM at the
International Parenthood Federation. I now stand as one of the Directors on the management committee
of London Black Women‟s Health Action Project.

Essentially I wanted to make three pleas. The first plea I emphasise strongly. It is for there to be greater
honesty in this area and for us to open up a climate of trust around being honest about the results of the
work we have done so far. I was very disappointed at the last hearing I came to in this House. It was the
hearing where WHO came to present their results on FGM. I sat here and listened to a catalogue of
achievements. The point I want to emphasise is that because a lot of agencies are dependent on results for
their funding, they are very fearful in speaking out about the fact, both internationally and in this country,
that there has not been a significant decrease in the practice. Before we can be honest about that and say
if we really care about making a difference, we have to ask why. We have to be honest about the fact that
there has not been a serious decline in the practice. I would absolutely reiterate the words of Nahid
Toubia. We need to ask the right questions. We need to recognise that a vertical approach does not work.
This is an intersectoral issue.

My second plea regards investment in the community. This is another area where there is a lack of
honesty. I was at the Swedish conference in Gothenburg recently looking at this issue in Europe. There
were recommendations at the end and much of the talk was about investing in health professionals, legal
professionals and educational professionals. It took right to the end of that meeting for someone to say,
“What about investment in the community?” If we just invest in the professionals, our work can only be
curative. If we want to get to the route of it we have to ask the right questions among the community. We
have to be honest about the fact that at the moment, especially in this country, we are relying on two very
small NGOs with minimal funding to try to tackle Goliath. London Black Women, which I know
initimately, are doing phenomenal work but on an absolute shoestring. In terms of staff and human
resources it is a few people working themselves into the ground to try to make an impact on this
widespread problem.

My third plea is in terms of procrastination. I was sitting in the middle of Task Force for UNICEF on
their communicaton project when our multicultural meeting was interrupted. A draft of Germaine Greer‟s
new book had been brought out and they wanted us to quickly proof read one of the chapters. The chair
of that group was a Nigerian lady, very well known to FGM activists, who had been circumcised. I have
never seen such a calm, composed lady become so outraged by what she read in front of us. She said,
“This is an insult to thousands of women‟s dignity.” We all have our own views about Germaine Greer. I
mention this because in her new book she has a chapter on female genital mutilation. My personal belief
is that that book has done a lot of damage. The chapter is very uninformed. It has not gone into the issue
far enough. She has not read enough of RAINBO‟s publications. She is influential. She is speaking on
female genital mutilation at a festival in which I am involved. I shall be there to challenge her. That
chapter is deeply insulting. To give one illustration, she compares female genital mutilation to US
females electing to have cosmetic surgery in American hospitals. She forgets the issue of informed
consent and many other issues.

On that point, as I round off, I just want to emphasise that this is a highly sensitive issue and highly
complex, more than most of us realise. A lot of people like yourselves find it very hard to know where to
start with it. But just because an issue is culturally sensitive, is not a reason in itself not to move forward.

(Baroness Gould took the Chair)



                                                      47
                                               Chairman

Perhaps we may have two brief contributions.

(Amina Gorani) My name is Amina Gorani. I represent Kensington and West Chelsea Health Authority.
We have been putting some resources towards conducting research to see how many women have
undergone circumcision in the area of Kensington and West Chelsea so that we can provide better services
for women. There are scarce resources and we have to face up to differences in equality and health. We
would welcome the back-up of the Government. We have also produced a film about female genital
mutilation in Africa. It is called, “It is for us to Decide”. We work with communities. We have a steering
group and we would welcome any input from the Department of Health. At present, we are looking at
whether there is a need to provide specialised services but it is very hard without data.

(Jo Bryant) I am chair of the London Black Women‟s Health Action Project that we have heard so much
about today. I also run an organisation with a friend on awareness raising on this subject in Kent. My
point is that because of certain colonial undertones that surround the subject where cultural issues are
involved, my feeling is that our job in the British Government should be to support the work which is
being done by the black women in the field.

It seems to me that we have wonderful examples of good practice in FORWARD and the London Black
Women‟s groups. They are both London based. They both have skills and techniques to form very good
community based and multi-agency thinking around this subject. If they were given the kind of support
by the Government to help them go out and do it throughout the country, we would have the change of
feeling that we are beginning to detect in our awareness group.

Only four years ago we would talk about this subject and receive a blank look, a look of scared
blankness. That is not the case any more. People are becoming aware. If we could take the example of
FORWARD and London Black Women and put forward really strong groupings, it could spread
throughout the country.

                                               Chairman

Thank you very much. That point reminds me to stress what I said earlier. In reply to a question in the
House of Lords, the Health Minister said that our hearings would help to shape the future policy of the
Government. Having heard what has been said today, we can hope and certainly put pressure on for much
more in the way of resources. Certainly, we will have discussions with him about the report when it
comes out. Maybe we will have some good news for you next time.

Perhaps I may also apologise for the fact that Chris is not here to close the proceedings. She received a
message and dashed off to vote. I know that she would want me to say thank you very much to everybody
for coming. It has been a tremendous morning. We have all learnt a great deal. We have another hearing
tomorrow. For people who are intending to come tomorrow, perhaps I may remind you that the meeting is
at 9.15 at 1 Abbey Gardens which is across the road from the House of Lords. I look forward to seeing
some of you again tomorrow morning. Thank you to everybody for coming. Thank you to the witnesses
for their contribution and everybody else who contributed. I also thank members of the Panel.




                                                   48
49
PROCEEDINGS OF THE ALL-PARTY PARLIAMENTARY GROUP ON POPULATION,
DEVELOPMENT AND
                           REPRODUCTIVE HEALTH
                 HEARING ON FEMALE GENITAl MUTILATION

                                        Wednesday 24 May 2000

                                            Members present

                                  Christine McCafferty, MP, in the Chair
                                    Baroness Gould of Potternewton
                                           Dr Jenny Tonge, MP
                                                Lord Rea

                                                Chairman

Good morning, everybody. First, I welcome everyone here this morning. I would like to mention one or
two house notes before we start. If you have not already done so, could I please ask you all to sign our
little black book before you leave. That will help us to know who was here and ensure that you receive a
report of the hearing when it is published.

I should like to introduce our panel. On my far right is Lord Rea. On my near right is Baroness Gould.
On my left is Dr Jenny Tonge and the lady who you see writing furiously at the end is the Hansard
reporter. I am Chris McCafferty, Chair of the All-Party Parliamentary Group on Population Development
and Reproductive Health. All the panellists here are members of that group.

I shall now call our first witness who will speak for five minutes and then receive questions from the panel
for a further 10 minutes. Our first witness is Mrs Virginia Osofu-Amaah, Director of the Africa Division
at UNFPA. She began her career in Ghana in 1965 with the Ministry of Finance and Economic Planning.
She joined UNFPA in 1988 as a technical officer in the Special Unit for Women, Population and
Development. She subsequently assumed the functions of Chief of the West and Central Africa Branch
and Chief, Gender, Population and Development Branch. She organised a technical consultation on FGM
to develop a programming framework for use by UNFPA for the eradication of FGM in Africa. She is
currently the director of the Africa division and has responsibility to co-ordinate all UNFPA-supported
population programme activities in sub-Saharan Africa.

(Virginia Osofu-Amaah) Good morning, everybody. I would like to thank the Population Development
and Reproductive Health Group for inviting UNFPA to be a witness at these hearings. I work with the
UN Population Fund. I am based in New York and I am the Director of the Africa Division. The United
Nations Population Fund (UNFPA) is the UN organisation with a specific mandate for population
activities. It helps developing countries to find solutions to their population problems. UNFPA started
operations in 1969 and is today the largest international source of population assistance to developing
countries. UNFPA‟s mandate, at least 30 years of operations in population and family activities, has
placed it in a unique position to have policy dialogue with governments and to work with non-
governmental organisations at regional, national and international level. We therefore are in a unique
position to address difficult population and family planning issues. You will recall that two decades or
more ago, family planning was taboo in most African countries. Many Francophone countries still had the


                                                    50
1921 French law which forbade the distribution of contraceptives. Today, all countries in sub-Saharan
Africa have family planning programmes which are being expanded to include components of
reproductive health. The 1921 French law has been abrogated as a result of our advocacy work.

The programme of action of the International Conference on Population and Development and the
platform for action for the 4th world conference on women and many other international agreements
provide us with powerful frameworks to address issues such as FGM. These frameworks have also helped
UNFPA to intensify its activities at all levels: country, regional and global.

Our commitment to addressing this issue derives from our special role and comparative advantage in
supporting activities in three main areas: reproductive and sexual health and rights; population and
development, and advocacy. Gender, equality and women‟s empowerment are cross-cutting issues in all
three areas. We therefore address the problem of FGM, not only because it is harmful to women‟s
reproductive and sexual health; we consider it as a violation of women‟s fundamental human rights. It
perpetuates gender inequality and women‟s lack of decision-making power.

At the country level we support activities which are integrated into the three areas I have mentioned. We
support activities in the area of information, education and communication, targeting parents, teachers,
adolescents and community. We support advocacy for policy and legal reforms and gender equality. We
also support the provision of reproductive health information services and the training of healthcare
providers in reproductive health. We also support family life education programmes in and out of school,
in which we try to integrate reproductive health education, human rights education and gender equality
issues.

In addition, we work with national, international and regional NGOs such as the IAC and its national
committees at country level that advocate the elimination of FGM. At the regional level we have been
working with parliamentarians. There are two networks with which we have been working. One is the
Forum for African and Arab Parliamentarians on Population and Development. We supported that group
recently with two workshops to develop a legislative framework on reproductive health care rights. As
you can imagine, FGM was one of the issues discussed in these workshops.

The other is the Network of African Women Ministers and Parliamentarians to sensitise them to some of
these issues so that they can become advocates on gender equality issues, reproductive health and rights,
adolescent health issues and FGM. There will be a meeting of this group in July in Namibia where we
will focus on adolescent reproductive health issues, which will definitely include female genital
mutilation.

As I have said, we have also been working with the Inter Africa Committee at the regional level. We have
recently supported an East African Task Force network on FGM. That covers the three east African
countries: Kenya, Uganda and Tanzania. This is to address FGM, to sensitise on FGM, to promote gender
equality and women‟s empowerment and encourage men‟s involvement through building the capacity of
their field workers.

What have we been doing at the global level? We organised a technical consultation on FGM. We were
able to bring together representatives of all the NGOs in the 26 countries where FGM is practised to
discuss how we can support them and what activities we should be supporting at the country level to
address the issue of FGM.

We have also appointed a goodwill ambassador; a Somalian model who has undergone FGM and who we
are using as an advocate. She has been travelling to many countries advocating the need to stop the
practice of FGM. We have worked very closely with UNICEF and WHO to issue a joint statement on
FGM expressing a common concern to protect women‟s health and development.

What has been the outcome of these activities, not only by UNFPA but by the NGOs and others working
at the country level? One important breakthrough is that FGM is now being discussed openly. In the past


                                                   51
that was not possible. That is a major breakthrough. The harmful effects of FGM are being recognised
gradually by many communities. Some countries are adopting legislation to ban the practice: Burkina
Faso, Central African Republic, Ghana, Togo, Cote d‟Ivoire and Senegal. Recently, I realised that this
issue is being discussed at the House of Representatives in Nigeria. They have condemned the practice as
being dehumanising to women. They also blame it for the high level of divorce in Nigeria and hope that a
Bill will soon be passed on this issue.

What are the lessons learnt? First, the adoption of legislation alone to ban FGM is not enough. It will not
stop the practice. Sometimes it will be done secretly and it will be difficult for people to know that it is
going on. It has to be accompanied by sensitisation. The legislation will have to be translated into many
local languages and widely disseminated. We cannot stop there. We must continue with advocacy,
training, research and data collection to be able to develop culturally sensitive materials on FGM that can
be used. We need to collaborate more and co-ordinate our activities in countries, both UN agencies and
NGOs working in this area. We need to be sensitive to the issue of FGM and need to persist. We cannot
stop this in a couple of years. It will take a long time.

We need to exchange experiences and work through NGOs that are active in this area. We need to
address the issue of FGM within the larger context of reproductive health and rights and community
development.

I would like to mention a few projects that have been successful. They are limited to communities and are
not nation-wide. The Reproductive Education and Community Health Project (REACH) in Uganda, in
one province where FGM is practised, has been extremely successful. The community leaders decided to
preserve the positive aspects of their culture and to replace what they call “female genital cutting” with
gift giving. They go through the initiation rites. When it comes to the time when FGM would have been
performed, it is replaced with gift giving.

Recently in Guinea, we realised that after 14 years of education by the IAC National Committee, last
November the women decided to return the implements that they use on FGM. Those are some of the
interesting developments in this area. I have pictures here, which you can see later, of the women in
Guinea who have decided to return their knives. They show an interesting story of what happened.

                                                 Chairman

Thank you, Virginia. That was very revealing. Would you agree that it is important to change the
thinking or mindset of leaders of the community and that without that we will not get far in changing the
attitude of ordinary men and women? I would like to know how you feel that can be done and what can
be done to encourage leaders in communities to set an example to change their attitudes.
(Virginia Osofu-Amaah) It is absolutely important to change the attitudes of leaders in communities.
With the REACH project, for example, initially a top down approach was adopted to try to stop FGM.
That backfired, so a different approach was adopted with a focus on constant dialog and discussion with
the elders and community leaders. That took some time, through constant discussion and dialogues until
the elders and community leaders understood the health implications. They were encouraged and decided
themselves to replace FGM with other practices. That is what happened in the case of Uganda. It is
absolutely necessary to work through community and religious leaders and to get them to support the
activities in the community.

                                                 Dr Tonge

I have travelled in Africa for the Select Committee on International Development and have found this a
difficult subject to broach. If it is mentioned at all when there are men present, there is a total denial. I
found that there was no response at all. Some of the women, even the doctors and nurses, were reluctant
to admit that it still goes on. There is a feeling that it should not happen and therefore it does not happen.

I feel that we have to be a little devious about this. I wondered how important you think it is to link it


                                                     52
with other messages. It must be a significant factor in the spread of AIDS because of the amount of
genital damage, bleeding and exchange of body fluids. I wondered how much it is being linked with the
prevention of AIDS message. How helpful would it be if it could be seen as something which is
endangering the men and the community as a whole and not just as a women‟s issue?

(Virginia Osofu-Amaah) There are communities which are in denial. That is why we have to work with
NGOs, and grass roots organisations which are very well known to these communities and which have the
confidence of the communities. That is how one should approach it.

As regards HIV AIDS, there is a need for empirical evidence to establish a linkage between FGM and
HIV AIDS. We do not have any such evidence. This is an important area for research. But, as I
mentioned earlier, one has to look at FGM in a larger context. In providing reproductive health, as we
have done in Uganda, we have used the issue of reproductive health in addressing the needs of the
community as a basis for doing this. We cannot take FGM out of context. One must also bear in mind
that FGM is part of an initiation rite. One cannot go to a community and condemn everything that they
do. There are positive aspects which the communities must be told to strengthen and maintain. Then, in
discussion, we can encourage the communities to do away with the negative practices.

                                                  Dr Tonge

With many of these practices, it is certainly thought by the medical profession that way back in the mists
of time were started for some good medical reason; for instance male circumcision started in the desert
because the sand was such a nuisance. It seems very difficult to understand the origin of this. It is
important to link it with another health message. I hope that we can somehow set the ball rolling to do
that, and convince people that it is bad for other reasons, not just for women.

                                                  Chairman

Virginia, are you aware of any research that is being done that is looking for the empirical evidence that
you said is needed? Is any research being done regarding FGM and AIDS?

(Virginia Osofu-Amaah) Not to my knowledge. I do not think there is any research being done. As I
have said, we need funding for such research. There is a lot of work being done on HIV AIDS in sub-
Saharan Africa. A lot of resources are being mobilised. All UN agencies are very much involved.
Countries are very concerned about the issue of HIV AIDS. We have to do the research to be able to link
this up. We would then have a powerful entry point for addressing this issue.

                                                  Chairman

Yes, I agree. That would be a very strong tool.

                                             Baroness Gould

We talked about health aspects but of course there is a human rights aspect. To me, this is not only a
health issue; it is a human rights issue and rights of the child issue. I wonder how much emphasise you
put on that aspect.

I also want to make two other points. First, you said that legislation alone will not stop the practice. That
is absolutely right. As we have found in the UK, it has had no effect whatever on stopping the practice.
But what it must do, in the African countries in particular, is to send out a message. Therefore, it is
important, it seems to me – I do not how you feel – to ensure that we try to continue to get governments to
legislate.

My second point concerns initiation rites. I read an article about a community in Kenya where they
accepted initiation rites and at the behest of the men, which is terribly important, they performed another


                                                    53
form of ceremony, rather than a physical one. I wondered how much influence the men were exerting in
order to change the method even if they wanted to keep some form of initiation.

(Virginia Osofu-Amaah) I totally agree that there is a need for legislation but I was making the point that
legislation alone is not enough. It sends a powerful message. We have to sensitise communities to the
provisions of the legislation. They have to understand that if they violate the provisions of the legislation,
they have to know the consequences.

I know about the Kenya project. It was not funded by us, which is why I did not mention it. It was funded
by PATH, a US NGO. Men should be very much involved in this; both men and women. In the case of
Guinea, for example, it was the women who decided that they would not subject their daughters to FGM.
It depends on the community. In Kenya it was the men. Both men and women will have to come together
and decide that they will not want to subject their daughters to FGM.

                                                 Lord Rea

It has been held, particularly by Germaine Greer, the feminist writer, that this practice is a traditional one
and that to tell women not to continue with it is really a continuation of imperalism and cultural
domination from the west. I do not agree with that but I wonder if you could say how we counter that
argument.

(Virginia Osofu-Amaah) I totally disagree with that argument. The same argument has been used for
family planning, being a western idea that is meant to reduce the black population in Africa. I totally
disagree. This argument has no basis and one should not even take it into consideration as regards FGM.
The ending of the practice is a decision of the communities where we have had success. It is not an
imposition from outside. When they decide to stop the practice, it comes from within the communities,
which is important. We can support, but we work through grass roots and national NGOs who are already
working to stop this practice.

                                                 Lord Rea

Could it not be said that Germaine Greer, who is a very intelligent women, is being a devil‟s advocate on
this? It is being suggested through her that we must be careful because this is a very culturally sensitive
area. Perhaps she is saying it in a way which is “over the top” but making us sensitised to that point?

(Virginia Osofu-Amaah) I do not think she is playing devil‟s advocate. I think it is just ignorance. That
is the way I see it. I agree that it is culturally sensitive. That is why activities also will have to be
culturally sensitive so that the interventions succeed. It is important, when we are doing activities in this
area, to ensure that we well understand the communities, their culture and their sensitivities, otherwise we
shall not make an impact.

                                                 Chairman

Thank you very much, Virginia. That was very revealing. I entirely agree with the comments about
Germaine Greer. (Applause)

Our next witness is Susan Rich who is the Senior Programme Officer for Population at the Wallace Global
Fund. Susan has worked for many years on developing and raising funds for population and women‟s
health projects. Her special areas of interest are abortion, adolescent health and the eradication of harmful
traditional practices such as FGM.

Susan was first trained as an anthropologist and has an extensive background in African area studies.
Because of her background in the cultural aspects of women‟s reproductive health, particularly in Africa,
Susan has been advising CNN and the ABC network when they have produced shows on population and
reproductive health matters. CNN is recording at least part of this hearing this morning for a programme


                                                     54
that is being made. I understand that Jane Fonda is doing the voiceover, so all smile!

(Susan Rich) I am honoured to be here today to speak on the topic of strategic funding opportunities in
the area of FGM eradication.

First, I can see from the grants that the British Government have made in the past several years that you
consider FGM to be a serious issue. I commend you for that. You may wonder how I, an American
woman, became interested in this issue that was totally unknown to us Americans in 1980. As you have
heard, I am a student of Africa. Twenty years ago I was assisting a Sierra Leonian woman anthropologist
and the topic of female circumcision came up. She warned me not to, in her words, “Poke nose into this
cultural matter”. She said it was none of my American business; it was an African matter. That attitude
paralysed governments and multi-lateral donors until the mid-1990s when they began to make significant
grants in this area. What a shame. In that time period alone, from 1980 to about the mid 90s, probably 30
million more girls were mutilated until Governments realised that this practice had ramifications for all of
development. They could not ignore it any more.

But I have to come clean here. Back in 1984, when interviewing for a job with the late Dr Gordon
Wallace, she asked me if I would work on female circumcision and I said, “No, it‟s an African matter”.
She hired me anyway and took me to Sudan where there was a meeting of 45 African leaders who were
very angry about female genital mutilation and wanted to end it. Gordie said that we must work with them
to develop and raise funds for programs but African women must take the lead and define the approach.
After all, FGM was part of their culture.

Let me share a bit of history. It was private donors who originally funded work in this area. They funded
the research and the initial innovative programmes. When the sky did not fall in and the issue of FGM
had been detoxified, it was ready for greater public pick up and funding. We know from other issues that
the public sector donors with significant funds and political clout can have a huge and meaningful impact,
but where should they use their influence?

I am going to be technical for a moment and suggest that there are three areas where public support is
needed: replication, integration and stopping the process of medicalisation. Let us begin with replication
or the scaling up of successful programmes such as the one mentioned this morning in Kenya. It has been
conducted by the largest grass roots women‟s organisation, Maendeleo Ya Wanawake. They have
introduced alternative rites of passage to encourage communities to give up FGM. So far 2,000 girls have
passed through the ceremony without the cutting. The rituals honour the girl and fulfil society‟s desire to
recognise her maturation but she is not maimed for life.

There is a long list of communities in Kenya who would like to perform these alternative rituals. They
need financial support and technical assistance to take these programmes to scale.

The second area of strategic investment is integration. In the last decade, FGM has been moved from a
private issue to one that has broad social and economic implications for development. Therefore, public
sector donors should encourage the integration of education about FGM into every programme they
support, whether it be literacy, agriculture, micro-enterprise or governance and democracy.

For example, in Ethiopia the National Committee on Traditional Practices has added eradication of FGM
to the activities of rural agents of the Ministry of Agriculture. They have also added FGM to the
curriculum of schools through the Ministry of Education. Integrated programmes have more impact at
lower cost than free-standing ones. They require some creativity and some negotiation, but it can be worth
it.

Finally, the challenge for the future is to stop the so-called “medicalisation” of FGM. What do I mean by
that? I mean when trained health professionals, like doctors and nurses, begin to carry out FGM in their
clinics and hospitals. The first law of medicine is to do no harm. Although these health professionals
may think that they are improving the practice by doing it in an hygienic setting, the side effects can be


                                                    55
just as devastating as the traditional form. There can still be excessive bleeding, infection, scarring and
psychological trauma that stays with girls for the rest of their lives.

In 1982 the World Health Organisation made a statement about this saying that they consistently and
unequivocally advised that FGM should not be practised by any health professional in any setting
including hospitals or other health establishments. But we know it is happening. In Kenya, a senior health
official stated in 1993 that FGM was being carried out in Kenya‟s health institutions. In Nigeria,
midwives admitted that they had moved the practice to their clinics and later learned that it was still
harmful.

The so-called medicalisation of FGM is the final abuse: a damaging practice is translated into healthcare
and it is insidious. It legitimises the harmful practice as a procedure. It is not done with razor blades. It is
done with scalpels and anaesthesia. The operators wear white surgical gowns, not traditional cloth but the
clinical outcomes are similar.

What can public sector donors do? Through Ministries of Health you can influence medical and
midwifery training curricula in order to discourage the practice of FGM in clinics. Midwives are probably
the best because they are in the front line delivering the babies. Of course, those institutions, the schools
of midwifery are the least funded. They see the complications caused by FGM and some of them have
turned to performing it in the clinic.

Public sector donors can cut funding to African hospitals and clinics where FGM is being carried out.
Governments can support WHO, UNFPA and UNICEF to conduct training for both traditional and
licensed midwives on this topic. If they make it a priority, governments can stop the so-called
medicalisation of FGM.

I would like to share a story. Whenever I wonder why I should work on this topic I recall a visit I made to
a programme in a village in Nigeria. After the nurse midwives graphically explained the harmful side-
effects of FGM a village woman asked them, “Why didn‟t you people of science come sooner?” Why
didn‟t we? That serves as a poignant reminder to me that because I am aware of the harmful effects of
FGM, I must advocate for its eradication.

I am encouraged by the progress that has been made on raising awareness on FGM in the past decade. I
congratulate the British Government on the support they have given to grass roots groups who are making
a difference. These programmes work and matter and make a big impact on health and development. But
many more groups are asking for support. I hope that the Government can amplify its support, fund
strategically, and thereby give African girls their rights and health for the future.

                                                  Chairman

Thank you, Susan. That was very enlightening and interesting. You made the point about donors which I
think was very well taken. What do you think about the really big players, let us say the World Bank,
using issues such as FGM or education on reproductive health matters as leverage for lending to countries
where the practice is still fairly dominant? Do you think there is a reasoned argument for using this issue
as leverage for lending in other areas or do you think that is an unacceptable practice?

(Susan Rich) You would have to do some major education work within a bank to ever have a loan that
was tied to FGM. It does not even happen on family planning. I am not even sure how I feel about that. I
think that since countries are borrowing money, education has to be done at the Ministry of Finance. So,
then we are starting with the health education of a financial minister, but then also within the World Bank
itself. I think there are lower hanging fruit in the donor community.

                                                  Dr Tonge

I would love to see a surgeon or a doctor taken to the European Court of Human Rights to challenge this


                                                      56
practice. I wondered if there was any chance of doing that. We know that this is happening in Europe.

(Susan Rich) Can I defer this question to Linda? I know very little about the legal aspects.

(Linda Weil-Curiel) I share your wish but I could never nail any doctor anywhere in France, because my
field of work is France. We have had investigations in 1983 in all the main hospitals in France but there
was no trace of any doctor doing this in any public hospital.

                                                 Dr Tonge

There must be young women somewhere in the world who are now horrified that this was done to them
and would be able to find out who did it and, with support, could take a case to the court.

(Linda Weil-Curiel) Usually it is the traditional practitioners who do it.

                                                 Chairman

Linda, you are a witness later on, so perhaps we could follow up that line of questioning then.

                                              Baroness Gould

I was very interested in this “medicalisation”. It seems to me that it creates conflict between those people
who are wanting to make the change and those who are being told, “Well, it‟s all right now because it is
being done safely.” I wonder how you are coping with that conflict.

(Susan Rich) In the late 1980s, the National Association of Nigerian Nurses and Midwives who have
60,000 members approached us and said that they were having problems with deliveries because of FGM
and asked why we did not start a project to educate people about it. We had no idea that they were doing
it at the time. In the course of the workshops, which had a three-dimensional anatomical model showing
the effects, it became clear that they were engaged in doing it. Some of them began sobbing and rocking
in the foetal position upon the realisation that they were causing harm by performing FGM in clinics.

We saw two levels of change, or perhaps there were three. They had to change from being operators
doing it, having it done to their own daughters and also deal with their own circumcision. There was a
psychologist engaged with the project who helped the nurse midwives work through their feelings. Then
they became the major leaders against the practice within their own professional association.

                                                 Lord Rea

Speaking as a member of one of the public organisations which provides support for the campaign against
this activity, can you say whether your organisation or any other funding organisation has given grants
towards the eradication of FGM to any government body in the developing world or is it all going to
NGOs? Is there any government department of health that you know of in any country in the developing
world that is devoting funds to further the aims in which we are interested?

(Susan Rich) I am not aware of any but I see Nahid nodding over there. We all try to keep track of this.

(Dr Nahid Toubia) The work in Egypt is quite advanced. There are a lot of NGOs working there and a lot
of technical material that has been developed in Arabic. As a result of that, the Ministry of Health and the
Ministry of Social Welfare are now launching major projects to train the health care providers, both
doctors and community health workers. I understand that it is mainly funded by UNFPA Egypt and
UNICEF Egypt.

                                                 Chairman



                                                     57
Thank you very much. That was very useful. Our third witness is Dr Nahid Toubia, who has just been
speaking to us. Dr Toubia was born in Khartoum and became a fellow of the Royal College of Surgeons
in England. She was the first woman surgeon in Sudan. Recently, she worked for four years as an
associate for Women‟s Reproductive Health at the Population Council in New York City. She is a
member of several scientific and technical advisory committees at the World Health Organisation,
UNICEF and UNDP and Vice-Chair of the Advisory Committee of the Women‟s Rights Watch Project of
Human Rights Watch, where she serves on the Board of Directors. She publishes widely on issues of
reproductive health, women‟s rights and gender inequality, particularly in Africa and the Middle East.

(Dr Nahid Toubia) Good morning, and thank you for inviting me. I am familiar to many faces in this
room. A lot of you work together with us. I am glad to see you all and glad to make new acquaintances
who I hope may be new partners in the future.

Briefly, I want to use my five minutes to give an exposé of some of the work we have done and lay it out
for the Committee to make use of. RAINBO is an international not-for-profit organisation. We are very
careful about how we define ourselves. We are multi-cultural so we welcome working with everybody,
north-south, white-black. However, we are also very clear that it is an organisation led and directed by
African women. Our board of directors is mixed but also has a major African presence. These are
important issues, not things to be taken lightly. Yet, we are an international organisation. That is unique,
to have an international organisation led by African women.

RAINBO started in 1994. Briefly, we have three major programmes. I shall go through them quickly and
focus on certain aspects that will be useful to the Committee. We have an international programme which
interacts with UN agencies, World Bank, USAID, European bi-laterals, Australians, Canadians and so
forth. We have given technical assistance to all these governments and the Danish, who are here with us.
We have worked with the World Bank and others. We have worked with UNFPA in the past. We have
ongoing work with UNICEF with whom we have worked for several years. We are reaching a stage of
evaluation of programmes. We are developing tools for understanding what works and what does not
work. That project is a joint one with the UK Department for International Development (DFID). I shall
talk about some of the projects we have with them.

We have worked extensively with the World Health Organisation (WHO) in the past. We have produced
a review of all the scientific data and information regarding FGM, both from the medical and scientific
point of view, cleaning off the cobweb from the information. I shall flag some of this literature that will
be outside for people to look at.

Our international programme is to help other major agencies on the issue of integration of FGM into
existing programmes that Susan has been talking about and how to think through this issue in their
policies and, more importantly, in frameworking and articulating their programmes. How will a
programme officer of UNICEF, sitting in Bamato for example, suddenly receiving a directive from New
York saying, “Do work on FGM”, actually do it? We have done some of that technical work with them.

After three years UNICEF staff complete questionnaires. We carry out evaluations with them: what they
did, what they funded, what works and what does not. That is the international programme.

The next programme I shall return to shortly. It was mentioned yesterday and I think it is one of the most
important programme. The African immigrant programme in the US, which has been in existence for four
years. I shall return to that in depth. There is a lot of material here that can be shared with your workers
here in the UK.

The last programme is the Africa programme. Here, we have several compnents: a small grants
programme with major funding from the World Bank and other US foundations. We give small grants
and technical assistance to organisations on writing a proposal to the Ford Foundation or the World Bank.
They can get money through us. We have technical assistance to screen them, give them advice and work
with them on how to do that.


                                                    58
We have an adolescent programme in west Africa. We focused on French-speaking west Africa because
we think that there is less and less funding and support for west Africa. We have an adolescent
programme on sexual and reproductive health and rights, but FGM is part of that, particularly the right
component for adolescents. We are working in Senegal and Mali. We have a representative based in
Senegal who is from Mali. We work in Egypt extensively to develop technical material for community
workers, the people who work with mothers, fathers and communities.

In the Africa programme we have just launched a major initiative. I will not have time
to talk about it today. It is an initiative that brings together African women leaders and
feminist organisations. It is called African Partnership for the Sexual and Reproductive
Health and Rights of Women. Unfortunately, I find what Germaine Greer says
extremely insulting, not just ignorant. A lot of African women leaders call themselves
feminists. Africa is not made up of one woman or one type of woman. There are
people like Germaine Greer who want to see us only as ignorant village women who
want to stay traditional. She never talks to African women leaders. That attitude is
arrogant, imperialist and derogatory. She never spoke to Nahid Toubia or to any of the
people here. We have materials. She ignores all that and says, “I know what Africans
should think”. That is the ultimate of arrogance.

Let us move on. Our African partnership is called Amanitari. Amanitari was one of the first ever group
of ruling Nubian Queens in the world, before Britain. They became suppressed by western history and
western documentation. We want to revive that. Amanitari is the name of this partnership initiative which
I shall talk about on another occasion.

As Virginia from UNFPA said, the issue for us is sexual and reproductive health and rights of women
across the board from family planning to safe abortion, violence against women, the lot. FGM is part of
that.

Let us return to the technical side because we advocate through technical work. We do not advocate
through political demonstrations, although that is important. As I mentioned yesterday, in the immigrant
programme we started by gathering the right data. I think that Britain can gather even better data than the
US. I trained in Britain so I know the systems well. In this book we have a map of where Africans live in
the United States. That was not an easy task. In Britain it could be done easier and quicker. To this day,
when we tried to review the statistics in Europe, there was nothing. Australians produce very good
statistics. We worked with the Centre for Disease Control in the US under the direction of Congress.
They produced the best statistics that we could get as to who was living where. I think it could be done
even better in Europe. The information is not with the health sector; it is not in clinics. It is with
immigration, refugee services, and education. It is very easy to get.

We started with conducting a needs assessment, which was done statistically but only for New York State.
As you know, America is larger than the whole of Europe put together in terms of volume of people – at
least western Europe. In New York we conducted a survey among doctors, nurses and community
members, both women and men. We looked at their needs. We started scientifically and asked, “Who are
these people?” Before we start talking about “them”, who are they? Are they Sudanese or Somalis? Are
they inflibulating or practicing minor circumcision procedures? Are they Senegalese or Egyptian? Let us
start with understanding what is at stake. We identified that.

We had directions from Congress. By that time we ensured that the Congressional Bill did not pass
without provisions for community outreach, education and involvement of the community. We did not
educate them by saying, “You ignorant people; stop”, but involved them. Based on that we developed a
lot of materials. One of them is this technical manual which was partially funded by the US Government.



                                                   59
That is why we have an introduction by Donna Shelala who is the equivalent of the Minister of Health
here. There was also collaboration with Columbia University, to which we are affiliated. This technical
manual was reviewed by a whole team of gynaecologists, obstetricians, nurses and midwives. It was taken
up by the Government and is now the reference for every medical school, midwifery school and
homeopathic school in America. It has become the reference guide. They bought up thousands of copies
and sent them everywhere.

In conjunction with that we developed this quick reference, a pictorial guide so that doctors diagnose the
type of circumcision. There is reference to emergency procedures, etc. The American College of
Obstetrics and Gynaecology paid for 39,000 copies of this and gave one to every gynaecologist in the
United States. The Department of Health in New York State also has these. There are brief summaries
of these everywhere in the United States, with every general practitioner and well woman clinic. They
have extracts of this on how to do the basics from a physical point of view, but also the basics of
counselling, handling families, cultural sensitivity issues and so forth. This material is available and we
can talk about them later.

We also developed three community brochures. Unfortunately, my boxes have not arrived and I do not
have them. They have just come off the press. They are entitled “Talking to the Community”. That
means talking to the community as “us”, not “us and you”. We are the African community immigrant
voice saying, “People, guys, let‟s sit down together and think”. Here we have one on health issues,
psychological as well as physical, for us African women. There is one on cultural and religious issues and
one on legal issues, at least for New York State. These are the kind of materials we have developed
locally. We do training for doctors. We have just piloted that in New York and are starting in California
next month with collaboration from a Sudanese American doctor in Harvard. We have training for the
community – both men and women – on reproductive health generally, including FGM, violence issues
and so forth. The community is becoming receptive to that.

That is all inside the US. As you can tell, I can go on for days and I do not want to do that. Briefly,
internationally, I want to flag a couple of matters. Again, I shall send a complimentary copy of this to
Germaine Greer. If she has any sense she will read some of the basics where we talk about the cultural
dialogue from our point of view. I know that this is available everywhere. This is the first book I
produced which changed a lot of the dialogue. We started working together. We have always worked
together with western women everywhere as partners, but not as subservient receivers of gratuities given
to us by whoever, in knowledge or money.

I want to flag this document which is extremely important in changing the course of international dialogue
about FGM, from bleeding, AIDS and infection to fundamental issues about social change, behavioural
change and moving the whole world, including Africa which is not just this dark continent that dies of
bleeding and infection, to saying that women have to be respected. Fundamentally, that is important for
us. If we stop all the bleeding and circumcision, but women still do not have rights and are being beaten
up, we have failed. It is not about stopping the bleeding; it is about getting respect for women and
children.

This was developed by us through our technical consultation with African researchers all across Africa
such as Pamela Green who was with us yesterday. We took the word of the researchers and we developed
this technical manual. It is a research and evaluation guidebook used in FGM but it could be used in other
respects, for example, on how we look into social change.

Social change is a process which does not happen overnight. That process has to be understood, studied
and worked on. I do not want to talk much more because I know that the chairperson is becoming irritated
with me. However, I want to flag this for you. We talk about what promotes change and what hinders
change. As I said, this is funded by UNICEF which is now developing a whole programme of evaluation
on how people do the work based on some of these models. It is also supported and funded by UK DfID.
I shall stop there and put all the material outside for people to pick up.



                                                   60
                                                Chairman

I must say that I am not agitated with you. I am frustrated that there is not the time to listen more fully.
For the record, Germaine Greer is an Australian.

(Dr Nahid Toubia) I know that!

                                                Chairman

Today we are focusing on the international aspect. However, I should like to know your views on how we
can stop young girls from being taken abroad in order to have this practice done to them while they are
perhaps in the home country of their parents and, indeed, what you think can be done in the home
countries of the parents to prevent children from Britain being taken there.

(Dr Nahid Toubia) First, I to say that it breaks my heart, and genuinely I am sure that everybody here
thinks that one single child circumcised each day hurts. However, in the process of change we know that
many things will happen regardless of what we do. Let us start with that fine balance. The DfID and
others are supporting programmes in the home countries. That is one thing we are doing anyway,
including passing legislation in the home countries: Senegal, Burkina, and so forth, and doing educational
programmes. That is something that is done to stop it from happening.

You are also passing legislation here which is fine, and we are also educating the community here, which
is much more important, and empowering the women to protect their daughters rather than have the police
protect their daughters. Those are two very different approaches. However, having said that, there is the
carrot as well as the whip. The whip is important. It is important to say to that I do not disagree with
women who say, “If you circumcise your daughter somewhere else and come back you will be punished”.
People are very worried about their immigration and employment status. It is just pushing them that bit
further not to do it.

                                             Baroness Gould

Is not part of the problem – I do not know how we cope with this in Sweden – of identifying that this is
happening: if a girl goes home for a holiday, how are they going about identifying that that practice has
taken place? Also, how does that cross-refer to the question of human rights?

(Dr Nahid Toubia) The question of reporting is a very difficult issue. Even for doctors, sometimes it is
difficult to find someone to report them. I do not have a solution for that. We just have to live with it.
That is what I meant, whether she is a girl living in Britain who goes to get circumcised or whether there
are hundreds and millions living in Africa who are being circumcised. We just have to be realistic about
that. Reporting is a big issue. I personally know of a case that was reported to us in the US where the
day-care nursery noticed the child coming back after a holiday subservient and subdued. They checked
and found out. They spoke to one of the community outreach people, who happens to be from the
community. She called us, but under no condition was she going to reveal where this happened, who did
it or whatever. She knew that it would alienate her from her community and she would be ostracised.
There are issues like that that we cannot overcome.

                                             Baroness Gould

Perhaps I can add to that. We had a case, and I cannot remember in which year – somebody will remind
me, I am sure – where the General Medical Council struck off a doctor in Manchester but then the police
refused to prosecute. So, I accept all the points you say about how difficult it is.

                                                Chairman

Thank you very much indeed. We were supposed to have a 15 minute break. I was going to put it out


                                                    61
altogether but I decided you need a break. We will have a five-minute break.

                                           (Short adjournment)

                                                Chairman

I shall call our next witness, who is Dr Olayinka Koso-Thomas who is a medical consultant by profession
and public health consultant to international and national NGOs. She is currently the Anglophone
International Vice-President of the Inter-African Committee. She has a number of publications to her
credit on cultural practices affecting reproductive rights and health of the female population in Sierra
Leone and other African countries. She has published a book entitled, Female Circumcision, a Strategy
for Eradication.

(Dr Koso-Thomas) Good morning, ladies and gentlemen. I should like to thank the British Government
on behalf of the Inter-African Committee and on my own behalf to invite me to come here and be a
witness to this hearing on FGM. I have been listening to the speakers this morning. I should like to point
out that FGM has been going on in Africa for many decades. In Sierra Leone it has been going for about
500 years. It is so endemic that we have to realise that it is very difficult to eradicate it in such a short
time. I should also like to inform the Committee that FGM is money-making for the people who are
practising it. They believe they are doing what is good for their daughters. In our society, to be married
you have to be circumcised. Every mother wants to see her grandchildren. African women do not like
children born out of wedlock; they like their children to be married. As your children must be
circumcised to be married, although you do not like the practice, you just have to agree with everybody
else. Once we know the concept and the recent taboo surrounding the practice, in our dealings with this
practice, we should take all this into consideration.

First, I should like to read about our organisation. The Inter-African Committee was inaugurated in 1984
after a seminar held in Dakar, Senegal to address the issues of harmful traditional practices. It is a non-
governmental and voluntary organisation comprising concerned health activists and professionals.

It has 26 national committees in 26 African countries where these practices are endemic. This makes IAC
the biggest regional NGO in Africa. Besides FGM, other harmful traditional practices are: childhood
marriage and pregnancy and practices related to childbirth. The 26 national committees have been
working with grass root communities for the past 15 years. Our objectives are: to reduce the morbidity
and mortality rates of women and children by identifying harmful traditional practices (FGM) and
eradicating them; to promote the beneficial ones such as prolonged breast-feeding, baby massage and
care of the elderly. We do not put our elderly people in homes.

These objectives we have achieved through sensitisation seminar/workshops in local languages using
culturally sensitive educational materials in the form of posters, pamphlets, plays, songs, video films, etc.
Our target groups are grass root communities, their leaders, traditional healers and youth organisations.

To realise our aims and objectives, we work in collaboration, co-operation and partnership with others in
the fields of health promotion. The people we work with are the government of the day, especially the
Minister of Health so that they can include our objectives in their primary, secondary and tertiary health
policy. We also work with the Ministry of Education to include our programmes in school curricula and
also allow us to give sensitisation lectures to all schoolchildren.

We also work with the Ministry of Information which allows us to use its electronic media for
dissemination of information. The third ministry is social welfare, which allows us access to our target
groups of rural youths and adolescents living under the yoke of traditionalist parents.

We also now work with international organisations such as WHO, UNICEF, UNFPA, UNDP and
UNHCR. These UN agencies deal with governments in a decision-making position. Within our
organisation, the local and national committees can make an impact during decision time as we work and


                                                    62
know these grass roots communities better than people from outside.

We also work with non-UN agencies such as Plan International, Marie Stopes International, Planned
Parenthood Association of Sierra Leone (PPASL), Zonta International, and Medical Women‟s
International Association (MWIA) and Sierra Leone Association of NGOs (SLANGO). SLANGO is the
umbrella NGO organisation in Sierra Leone with 800 members, which are local NGOs. We also work
with religious Christian organisations such as World Council of Churches; Methodist Ministers Wives‟
Association; YMCA, YWCA and the Christian Health Association of Sierra Leone (CHASL).

Apart from the Christian organisations we also work with Islamic Women and Youth Organisation and the
Organisation of Islamic Leaders and Imams. Most of our target groups in African communities are
Muslims which constitute over 80 per cent of the population. In some countries, over 90 per cent are
Muslim, especially in Senegal, Gambia, Sudan, Somalia, Mauritania, Mali, Burkina Faso, Djibouti, and so
on. Without these partnerships our objectives of health promotion to eradicate FGM and other harmful
traditional practices can never be realised.

What do we use? We use our vertical and horizontal approaches in health promotion. Using such
approaches we have achieved a reduction in the practice of FGM in many communities, with baby girls no
longer being circumcised. This has happened in Nigeria and also in Sierra Leone and other countries.
Since our sensitisation, there is open discussion on FGM without fear of being attacked. There have been
attitudinal and behavioural changes in many circumcisers who have given up the practice. They are now
in alternative employment with higher financial remuneration than before. They are earning more now
than when they were circumcising periodically. There has been the passing of legislation banning the
practice of FGM by some enlightened heads of states in their countries; for example, Burkina Faso,
Ghana, Sudan, Senegal, Guinea-Conakry. Also, we have achieved recognition in some countries as
experts in IEC production and in income-generating activities. Many governments of the day invite us
and use us as advisers and resource persons on their health promotion initiatives. At this point in time
Sierra Leone is having a problem with civil war, but the situation is slowly returning to normal.

                                                Lord Rea

In your talk you mentioned that marriage depends on the bride-to-be having been circumcised, in having
had FGM, in certain traditional societies. That brings in the role of the men in the perpetuation of this
practice. It is done to young women mostly or entirely, I believe, by women traditionally. But for men it
is often a practice which is taboo to speak about. Nevertheless, they play quite a major part in its
perpetuation. Could you say how to get through to men that this is an unacceptable practice and to get
them on the side of those who want to eradicate it?

(Dr Koso-Thomas) In communities which practice FGM, men have been conditioned to believe that
circumcised women are docile, not promiscuous and if the cutting is not done, it will make them want sex.
I went to a chief in Sierra Leone who had about 22 wives. I said “Chief, let me talk to them. I would like
to stop this practice”. He said, “Dr Koso-Thomas, we know that this practice is not good but I have all
these women. If you don‟t do the cutting, they will all come to my door knocking. Everybody will want
sex from me”, and he is the only man! He discovered that he cannot satisfy them all. It is a terrible thing
to say but you have to tell them about the practice of circumcision. They also genuinely believe that they
will enjoy sex more with circumcised women. They have to be told that what they are enjoying is pain. If
a man is having sex with a woman and she is not enjoying it, and is crying with pain, that is not sex, it
shows lack of care and love for the wife.

I have interviewed many women. When you asked them, “Do you enjoy sex?”, they say, “Is it to be
enjoyed?” It is not to be enjoyed. Sex to an African woman in a rural area in the community is to have
children. Her children are her joy. If you live in a community and you do not have children, they say a lot
of bad things about you. They call you a “cock”, a male hen. Women are supposed to have children.
Therefore, with that in mind, we have to counsel the men also. We have sensitisation programmes for
them. We try to convince them about this practice. If you use the human rights aspect they tend to get


                                                   63
annoyed. I try to tell them that the part that is removed is genetically programmed; it has to be there. We
show them the functions of the part that they removed. Then they are able to see what we are trying to
say. In Sierra Leone, when I did the research I found that this has been in practice for about 500 years, so
how are we going to change things in 10 or 15 years? It is difficult but we are getting there.

                                                 Dr Tonge

Perhaps we should remind ourselves that it is only a couple of generations ago that English women were
supposed to lie on their backs and think of England. Nice girls did not enjoy sex. I always hate this view
that is from another country. It was not so long ago when you could not talk about this at all in this
country, if you were a nice girl.

What is the connection in the initiation ceremonies between the boys and the girls? Is it done at the same
time? What actually happens? The boys are also circumcised and we never talk about that, but there is an
awful lot of little boys who are terribly damaged by male circumcision. It is nowhere near the scale of
female circumcision, I know, but it is also a problem. I just wondered if these things are done at the same
time and if there was any value in trying to connect the two.

(Dr Koso-Thomas) Female circumcision is done by women only in a secret place by a secret society.

                                                 Dr Tonge

But at the same age as the boys are done?

(Dr Koso-Thomas) No, in towns and cities when a boy is born he is circumcised within 24 hours. Most
boys in Sierra Leone are not circumcised as an adult.

                                                 Dr Tonge

But not in South Africa. There is a very vivid description in Nelson Madela‟s book of his initiation
circumcision.

(Dr Koso-Thomas) In some communities it is done, even in Australia. I have read about the marking of
the body. They do that also in Sierra Leone. Boys go into a society in Sierra Leone. It is a very secret
society. They are taught many things about manhood before they get married. But some of them are
circumcised already. If they are not, at the age of 18 they are then circumcised. The women and girls in
Sierra Leone have a range for circumcision from 8 days to 18. It depends on the tribe they come from.
Some do it at eight days and some 40 days, so the babies do not know anything. The children go to
school, so it is done in the long holidays. In some places, parents who have been pressurised to
circumcise their daughters, will say, “Ok, when she has taken her GCEs”. Can you imagine that at 16 they
are taken out to be circumcised because it is the tradition? The whole of the tradition is extremely strong
and people support it. In Sierra Leone it is a political issue.

It is also a financial issue. As Nahid and the UNFPA representative said, when you talk to the
circumcisers and say, “You stop”, they say, “How can I eat? This is what I am using to feed myself”. In
Sierra Leona, the way it is done – I am not talking about the way the girls are held down – is that for each
child they are paid the equivalent of $10. You take a bag of rice, corned beef, tinned sardines and all sorts
of food. So, when the session is over, that lady, the circumciser, will give a few things to her assistant.
Then she will have a mini-market and the food that is left she starts to sell. This is what she uses. So, if
we really want to get rid of FGM, we have to address the issue of the circumcisers and give them
alternative employment.

We did that in Sierra Leone. It was very helpful. We gathered together about 40 circumcisers, sensitised
them and taught them alternative jobs. The circumcisers do not know anything else. They are not trained
in anything. The only thing to do is to deliver babies, look after them and circumcise girls. We want them


                                                    64
to stop circumcision. We were given some money to help them have alternative employment opportunities
and we found somebody to train them. They were taught how to bake bread, and make soap. They made
their own outfits. In the end they realised that they were getting more money, and that the money was
coming in every day. That is why some stopped in Sierra Leone. The circumcision session was three or
four times a year. The money they collected had to last them until the next session, but the alternative
employment supported by DANIDA makes them earn money every day. They looked well. We taught
them nutrition. The condition we insisted on was that all of them must make their female children go to
school, because they do not send girls to school. As a result of that, the girls went to school. That is a
success story in Sierra Leone. If we get a lot of funding, we will probably attack other problems of the
circumcisers. If they decide to give it up and do something more financially rewarding, the whole
problem will be reduced.

                                              Baroness Gould

It is very much that last point that I wanted to ask about. We have had lots of examples of where the
practice has been eradicated. Because of your experience in the Africa-wide field, I wondered whether
you could give any indication of what sort of proportion of eradication there has been. We have
individual examples but we need to put all those together to see how widespread eradication is. This is
particularly important, of course, in the UK, as we discussed yesterday. A lot of girls are taken back to
the home countries. It is important for them culturally, whereas if in their own country it has been
eradicated, it will have an effect here where it is a growing practice. It is the level of eradication that I am
after.

(Dr Koso-Thomas) I did some research for IAC before we started. I found that in Sierra Leone 90 per
cent of the women were circumcised, had been genitally mutilated. But now that has gone down to about
60 per cent. We have been allowed to sensitise and we have understood the community. When I talk
about the horizontal and vertical approach, as one of the previous speakers said, the decision to stop must
come from the people themselves. We go into the community and stay there for one or two weeks and
then we go. They are left by themselves so they can always go back to what they were doing. If they are
told, “A law is being passed”, they do not regard that as anything but they themselves must want to stop.
The Minister of Education was very enlightened when I was campaigning before the rebel war. They
allowed us to go to all the schools in the western area, both male and female. We showed films and
discussed it. There are those who refuse to go to school in the provinces. The Ministry backed us up.
When they come to Freetown they tell you that they have not gone. In the olden days I used to examine
girls. If we examined 10 girls, we would find that at least nine of them had been through the society and
were circumcised. But now, even with children from the provinces find that some of them have not been.
If we examine 10, we will maybe find that four have been circumcised. As regards those who have not
been, I used to argue and say, “What happens when you are 18?” They would say, “Oh, no, I refuse to go.
Sometimes they would say, “Remember you came and gave us a lecture”. There are other NGOs such as
Plan International and Marie Stopes. They say, “I told my mother, „Look, mother you are suffering. If
you love me, don‟t send me‟.” They put their foot down. That is where our success has been, among the
people, especially the young girls. The boys also complained that the girls tend to be promiscuous, as
they felt that they had been deprived of orgasm, so they tend to go from one man to another believing that
their lack of orgasm was due to the fact that their partners do not know how to make love or satisfy them,
not realising that the organ responsible for orgasm (the clitoris) has been removed.

Somebody said, in discussing the high rate of divorce in Nigeria, that she sees women who have been
circumcised who are going from one man to another. I said to one woman “Why?” The reply was, “I
don‟t have orgasms”. I said, “Well, you cannot have orgasms because what gives you the orgasm has been
removed. It is your clitoris”. She said, “Help me.” There is a very good gynaecologist called Dr Fraser.
She said, “Can you send me to Dr Fraser?” I said, “Well, whose clitoris will I give you?” That causes a
lot of problems. Women now know that they must feel something and they are not feeling it. They
presume they are not feeling it because the husband does not know how to make love to them. But that is
not the case. It is because they have been genitally mutilated. When we tell them, they feel very sad and
depressed. It is not a nice thing to tell another woman that this is what she will be like until she dies.


                                                      65
Mostly these women are 22, 23 or 24 and at university. It is a big problem.

                                                Chairman

Thank you very much indeed. It is difficult to know how to follow what you have just said. Our next
presentation is a joint one. Molly Melching first went to Senegal in 1974 as an exchange student at the
University of Dakar. After finishing her Masters Degree Molly remained in Senegal and began a village-
based education programme in 1982 and in 1991 created Tostan, a non-governmental organisation.
Although founded by Molly, Tostan is, in reality, a grass roots organisation. It provides participants with
skills and concepts of practical use but leaves the application of the lessons up to the participants. For
example, it was village women educated by Tostan who decided to combine their lessons in human rights
with information they had learned about health and hygiene to start a grass roots movement against FGM.
Tostan was a finalist for the Conrad N. Hilton Prize in 1999 and was chosen by UNESCO in 1995 as one
of the most innovative non-formal education programmes in the world.

Her co-presenter, Demba Diawara, is a farmer and Imam of the Muslim religion from the village of Keur
Simbara in Senegal. Demba had always supported the practice of cutting until he participated in the
Tostan basic education programme in his village. Not only did Demba learn to read and write at the age
of 65, he also learned of the health dangers and the human rights violations related to FGM. Demba has
become a leading spokesperson for the movement to end FGM in Senegal and has travelled to Egypt,
Malaysia and New York to explain how his approach has led to thousands of people ending this very
ancient and deeply rooted practice.

Molly is going to translate Demba‟s words for us.

(Molly Melching) We have decided this morning, if it is all right with you, to let Demba speak first for a
while but since there is not enough time to go through the whole presentation if we do the translation, he
and I spent last night working on what he would like to say to you and I will translate it for you into
English. He will begin first so that you can hear him speak first. At one point we will stop and I will
translate for you what he has said. As I talk and tell you what he has said, I may add some things to the
translation if they are not clear and you need background.

(Demba Diawara – interpreted by Molly Melching) He begins with a prayer. He knows that we are all
here in peace, that there are many ethnic groups in this room, many nationalities and many religions. But
he knows that we are all gathered here for one goal; that is, to bring peace to other people in this world.
Therefore, he blesses this meeting. He says that you may be surprised to see an older man – the only man,
I add – to give testimony so far. He said, “I am an older man. I am an Imam who is a religious leader in
my village. I am someone who is highly respectful of my religion and of all the traditions in our village.
But also, I am a person who has never been to formal school. However, I have always believed that
someone who has read 100 books or travelled through 100 countries or talked with 100 old people or who
is almost 100 years old can sit down with others and talk and generally come to a consensus around that
issue.

You see that I am an Imam. I am an older man and I feel very strongly about this issue. It is unusual to see
a man talking about this issue in front of all these women. It is because it is very important. It is an
extremely important issue, especially since we are dealing with health issues and health is the one thing
that is important to all of us. I participated in the Tostan programme where I learned to read, write and to
do maths at an advanced age. But I also learned about human rights and social responsibility. I learned
also how to solve problems in our village. I learned about hygiene and health, particularly women‟s and
young girls‟ health. We also learned how to manage projects and do feasibility studies to increase our
income in the village.

Then, after we did the programme and after other villages did the programme, one of the other villages in
Senegal stood up and decided to end the practice of female genital cutting. That village was Mulikunda
Banbra. On 31st July 1997, once the women, with the community, had convinced the religious leaders and


                                                    66
the traditional leaders, the other women in the neighbourhoods together declared an end to female genital
cutting. That surprised me very much. I did not understand it. I had always supported the practice of
female genital cutting because it was so deeply rooted in our traditions.

I went to talk to the women in that village because I am a person who likes to do research and likes to look
into what is going on and to understand why people do what they do. The women came to our village.
We are the same ethnic group. They explained to us why they had ended the practice. When they came,
we listened to them politely but we all said, “In order to make a decision of this magnitude, we need to
first do some research ourselves”. I took it upon myself to go then and do this research. I went first to the
religious leaders that I knew and respected. I asked them about this question. I knew that for myself, I
did not feel like it was a village‟s obligation but I wanted to be sure so I talked to many people about this
and found that they all agreed with me”.

He said last night that someone asked him, “Are all the religious leaders in agreement with this?” and he
said, “No, some think that it is a religious obligation. There may be 10 per cent. but out of 100, if there
are 90 that think it is not, I will go with the 90”.

He said, “I was also able to speak with the women in my village”. When he first came to me he was so
shocked about this that I said, “Demba, you are so intelligent; you are so bright. You will know how to
get the women to speak” and he did. He went back and he said, “Ok, I will try to get the women to
speak.” There are superstitions in Senegal about talking about the practice, as you all know. He was able
to get them, somehow – these are his secrets – to talk about it. He came back to me and said, “I‟m
shocked. If I had known 10 years ago what I know now, I would have started 10 years ago. I did not
know the amount of suffering that our women have gone through. I did not know that the women in the
village who were sterile had infections after their operation. I did not know that the girls who had died had
died because of this practice. I did not know that haemorrhaging was caused by the operation. We men
never talked about it. We never asked and we just never knew”.

After talking to the women, he also worked with the women and discussed human rights. For him, the
most important human right which they discussed which related to this issue was first of all the most basic
human right to life. We all know in Senegal and he knows also in his ethnic group that many girls have
died. In the programme we discuss a lot about our responsibilities. We not only have rights, we also have
responsibilities. We have a responsibility to ensure that we are not the cause of a young girl‟s death.

He knows also, and the women discussed this a lot, that everyone has the right to health, girls and women
– men also of course, but this particularly relates to girls and women. Also, they learned about bodily
integrity. There was a great amount of discussion. For him he said one of the rights that was most
applicable to his case was that his village was next door to a village where people did not practice female
genital cutting. He said that some of the girls in his village and the boys in the village fell in love because
they grew up together, which is a natural thing to do, but they were not able to intermarry because the girls
in that village did not do female genital cutting. He said that leads to discrimination. They have learned
in their programme to try to end all forms of discrimination, whether it be around issues of ethnic groups,
female genital cutting or the caste system. There was no marrying between different castes also, and they
are trying to work on all these issues, not just the one of female genital cutting. That is important.

Demba also said that when he looked at all these issues, he realised, however, that he could not stand up
and say, “I end the practice in my family”, or “I end the practice in my village”, or “We end the practice in
our village”. Why? Because he intermarried. His own wife comes from a village that is far away. There
are 10 villages with which the people in his village intermarry, which are near Joal, which is about an hour
and a half away. He said “In order to stop this, we must discuss this with the whole family, the whole
inter-marrying group.” He said to me, “I would like to go there and talk to them.” I said, “Well, fine.” We
gave Demba transportation money to go to those 10 villages and he walked from village to village and
talked to each of the villagers about why they had been discussing ending the practice and why Mulikunda
had ended the practice.



                                                     67
Together, they met on February 14 1998 and made a communal declaration to end the practice together;
that is, of that date, they no longer would practice female genital cutting which would then make it safe for
them to end knowing that their children could inter-marry later on. They could find husbands and be
successful. At that point we also met up with Jerry Mackie from Oxford University who had written an
article about the similarities between foot binding and female genital cutting, and comparing them. Foot
binding in China ended through public declarations. It was a social convention and people could not stop
unless everyone stopped together because they would not have a husband if they did not do that. It was a
question of inter-marriage. They had to do it as a public declaration so that they could safely end it. As I
have already said, Demba has a doctorate in wisdom and social transformation and a doctorate from
Oxford. I think they met Jerry earlier but Demba certainly realised this. He pretty much led the way for
Tostan and told us what he thought should be done, in discussion with the women, of course.

We had many women leaders and other leaders who were involved in this. I wish I could have brought
them all today. We were able to bring Demba who is a great example. He not only stopped those 10
villages with a declaration on February 14 1998; he went to many other villages. Other villages in the
southern and northern regions of Senegal saw what was going on in the movement, that the people
themselves were standing up and deciding to end the practice, and we have had, to date, 174 villages,
representing about 140,000 people who have decided to end the practice of FGC.

We have organisations contacting us now asking to do the programme and to use people like Demba and
these other village leaders who have gone around and worked among themselves. Obviously whenever
Tostan goes around, it is they, the people, who are doing this work with the help of organisations.
UNICEF studied Tostan for quite a while, and other organisations such as Wallace, which recently helped
us to spread the programme to Sudan and Mali.

In Senegal he went to the Parliament. Demba told you that he went to the National Assembly when they
were voting in a law. It was voted in on 13th January. On 12th January he went with a whole group of
other Imams and women leaders from the village who had been working on this. They told the parliament
that it is important to have a law and that they understand this. It is a deterrent. They themselves do not
mind the law because they have already decided to end the practice. However, the important thing was
that they said to the Parliament, “Give us two years. We don‟t want to see our villagers in gaol.” He gave
an example of a parent who can use a whip on a child but when the child is not near the parent it will do
what it wants. It is much better to discuss it and ensure that people understand. He believes that people
do not know the human rights issues involved nor the health issues. He says that other men have not have
got involved because they just do not know. They just have not heard the stories from the women.

Therefore, during the parliamentary debates, they often referred to these people who had done all this
work. The parliament got in touch with Tostan afterwards and asked us to do our programme – which is a
six month programme and includes human rights, problem solving, hygiene and women‟s health – in 900
villages throughout Senegal. They have started participating in all the public declarations. The Network
of Population Development came to the last two declarations and have been very involved in coming to
the villages and congratulating. They do not ever tell people to stop but congratulate the people who are
already working on this. They meet with them, encourage them to continue their work and ask for their
help, getting ideas from people at grass roots. They ask what they can do in parliament to better help the
people to go out and work with others.

Demba says, “Force is not the best way. It is not the best method”. He recommends the following, and I
agree: a basic education programme is essential; a participatory programme that allows people to dialogue
and that has a strong human rights component where other issues related to women‟s rights are discussed;
that women understand this and have a chance to understand how to apply these rights; to do role play; to
practice and work with others who have gone through this and have made important social change in their
villages. In many of our villages the women and the whole communities – men belong to this too – have
formed human rights communities throughout Senegal. The people have done human rights work and
pronounced a human rights city in Senegal. They are ending early marriages. They have stopped sending
their girls off at 10 and 12 years old as maids. They have stopped forced marriages, for example. They


                                                    68
have done many things. They have led a massive campaign to register children in schools, particularly
girls.

Children were not registered at birth. They realised that this was a human rights violation and decided this
on their own. We did not realise that this was such a big problem. They are the ones who did this. It is a
holistic approach to this issue which has brought about great social transformation within the communities
where the programme has been carried out.

In particular, working with respected leaders is important; not just traditional leaders but leaders which
people really respect. The religious leaders, the Imams, village chiefs, the youth and the women, in other
words the whole community, is involved in the decision that is made, not just one segment of the
population. We all believe that public declarations are important. They allow people to say, “From this
day on we will no longer do this practice”. I notice in our last declaration on 7th April 2000 that we had
to postpone a declaration that the women had decided to call. We said, “We cannot do this in January
because of the elections”. We had recently had elections in Senegal. They said, “Please, don‟t wait too
long because we cannot stop until we do the declaration”.

It is also important is to have media coverage in local languages so that when these declarations are held,
people hear about it in their own languages. I know that people in other countries, such as Mali, Guinea
and other African countries have heard about what is going on in Senegal. They have written to us. We
have sent them much material. We have sent them the declarations and they have used those in their
villages and a lot of discussion has been held because of that exchange of information. That was thanks to
the media.

Thank you very much for inviting us both here. We shall be pleased to answer any questions which you
might have.

                                                Chairman

Thank you, Molly. Perhaps you could briefly say to Demba that we are very grateful to him for making
the journey to come to talk to us today. I certainly would like to congratulate him. He is clearly a very
good manager of change, and that is not always an easy task, nor one which is well received or gets much
thanks. But he has clearly done a wonderful job in Senegal.

I would like to ask a question of you both. Clearly, the programme has been a great success. You
mentioned other countries to which the programme has been expanded, but the country you have not
mentioned is Gambia. I know that Gambia is wholly surrounded to north and south by Senegal and that
many of the tribes do not see the country barriers, and move around between Gambia and Senegal. I
wondered whether the programme was being developed there. If not, is that a problem?

(Molly Melching) We have received requests from the Gambia to do the programme there and asked if
we are able to do it. I have said that it is really a question of funding. Currently we have funding with
UNICEF for 60 villages where we are doing the programme and 83 other villages in Senegal. We were
hoping to get other villages in southern Senegal which is near the Gambia. Unfortunately, we do not have
funding to go to the Gambia at this time. I have had to say “no” but I have told the women that I am
looking for the funding. We would like to start it. They have requested it in 30 villages in the Gambia. It
would be with a local organisation. Tostan always works with local organisations. We do the training for
them. We train their supervisors and their facilitators. We do not actually go ourselves. We help them
with the management of the programme and training. We give them the materials and work with them to
adapt to the localities. But because of lack of funding, we have not been able to do that.

We have had requests from many African countries to do the programme training. With the Wallace
Global Fund we are starting a small regional centre so that people can come and visit these villages and go
where they make the declaration and speak to Demba for hours if they want. This is what we did in Sudan
and Mali, and it was so motivating. The Malis, the Sudanese and the Senegalese got together. They


                                                    69
shared positive traditions and talked about how they could learn from what they had done and from
experiences in Sudan and Mali and how together they could try to find a solution to these problems.

                                             Baroness Gould

The story that we have just heard is wonderful. All congratulations must go to Demba and Molly for what
has been happening. Could you tell us whether there has been resistance? It seemed as though one
moved fairly easily through these stages. I just wondered what level of resistance you had met and where
it had come from.

(Molly Melching) Demba says that all of you sitting here know that that there was lots of resistance
otherwise he would not be here today! He tells the story about the first village he went to. The village
president was angry and said that they had never discussed this issue publicly. He had to run after her and
say, “Listen, if I‟m an Imam, I‟m in the same ethnic group as you. I have practised this religion for more
years than you have. You can at least sit down and listen to what I have to say”. He said that it was only
through talking, dialogue and going back and having other traditional religious leaders and people that the
villagers respected come and talk about why they had decided to end this practice that he had success.

But he literally walked from village to village. Gordie Wallace bought Demba a pair of shoes, which was
an appropriate gift. People were angry with Tostan saying, “Why did you become involved in this?” We
said, “We didn‟t. It was the women who made this decision. In the programme, we never asked people to
stop. We gave them their human rights information and health information. We were probably more
shocked than anyone when the women made this decision in Mula Kunda. We found that many other
women were encouraged by the fact that the women from Mula Kunda got up and nothing happened to
them. That was surprising to everyone. Then, the women‟s stories came out. That was one of the things
that has been most powerful in Senegal. I was talking to a journalist the other day who was promoting
female genital cutting and saying that this was a village practice. However, when I finished telling him the
list of 10 stories – there are many now because the women have started talking – he said, “Please stop. I
am convinced. Do not go on. I just didn‟t know.” As Demba said, we just did not know. We have heard
the whole consequences. The women never talked about it before. They are very courageous and have
spoken on TV, which is very unusual. They were a little afraid but they were criticised. The TV did a lot.
UNICEF chose people who were very respected in the community and had them talk. Leading religious
figures spoke on TV about this.

                                                Lord Rea

Are you getting moral support, if not financial support, from the Senegalese Government?

(Molly Melching) Yes. Tostan has always worked with UNICEF, the Ministry of Education, the Ministry
for Family and Social Action. They have just passed a national plan for ending female genital mutilation.
You say “mutilation”; we say “cutting” so as not to be judgmental. As many people have said, people do
this because they love their daughters. These are good people. By saying that to people in Senegal, it
offends them. We talk about abandoning female genital cutting, not eliminating or eradicating. We want
it to come from the people themselves.

The Government have been highly supportive. They have come up with a national plan. They are looking
for funding for that national plan. Public declarations are a big part of that now that they have seen the
success. The Government, through parliament – mostly the Women‟s Congress and Population and
Development Network – has become involved and goes to all of these meetings. On 24th May there is a
meeting in the northern region of Senegal with many villages. They have decided to end and they are
going towards a declaration. The parliamentarians are coming to congratulate them and tell them how
happy they are.


                                                Lord Rea


                                                    70
How important do you think it is that there is official recognition of the good work that you are doing?

(Molly Melching) It is very important. It helps because they are also having seminars for the media and
journalists. In the beginning the journalists had a difficult time covering these public declarations. They
did not really know what to say about it and sometimes did more harm than good. They were not aware of
all the dangers involved and some were seeing this as a western imposition on other countries. It is
interesting that at our last public declaration, it was almost like, “Oh, well, so what? That is nothing new”.
The first time was shocking. The second and third time it was astounding to everybody. Now it seems
that people are saying, “Yes, we are abandoning it.” We all believe that the people in Senegal will
abandon FGC rapidly because the convention is changing and shifting. When that happens it does so
quickly. People will start to realise that there is a whole movement.

Demba is going to Mali. We are working with the Institute for Popular Education in Mali. They are
doing a programme now with a local organisation. He will be going there with other women not to tell
them to stop but to explain to them why they stopped and to have discussion with them. There are these
type of exchanges. He went to Egypt and met all the religious leaders. When he came back, he was so
excited. He said, “They all support what we are doing”. That was important to him. I heard him go with
a religious leader, telling him exactly what those religious leaders should say; where he went, the Mosque
he went to. Exchange between people at the local level, meeting other people who can reinforce the work
they are doing is important.

                                                 Chairman

I thank you both for a very good presentation. Our next witness was going to be Professor Dr Marleen
Temmerman, but I understand that she is not here and that her deputy will speak instead.

(Els Leye) I apologise for Professor Temmerman. She is the promoter of the project that we are running
at our centre, but I am the co-ordinator, so she thought it would be better for me to come.

I work in the International Centre for Reproductive Health, which is a research centre based at Ghent
University in Belgium. The centre focuses on various issues of reproductive health: family planning and
contraception HIV/AIDS and STI‟s, cervical cancer, mother-child health, safe motherhood and violence
against women, including female genital mutilation. Projects are running in several countries in Africa,
Latin-America and Europe.

Within the International Centre for Reproductive Health (ICHR), I am the coordinator of several projects
tacking the issue of violence against women. One of these projects tackled the issue of female genital
mutilation among African Communities in Europe and was carried out in 1998. The overall goal of the
study was to gather available resources, with the intention to examine problems surrounding FGM in the
EU and to formulate recommendations on several aspects of FGM, in order to prepare a European
Strategy for combating FGM. These recommendations have been discussed on a meeting in Ghent,
Belgium in November 1998, with experts from Africa, the USA and Europe. A report of this study has
been submitted to the EU, containing all recommendations. I shall not go into detail, as the report and its
recommendations are extensive.

One of the recommendations was that at community level there was a great need to network within NGOs
and community-based organisations within Europe. That is why the International Centre for Reproductive
Health applied for funding to establish such a network. The network was approved in 1999, and is now
running until the end of 2000. The activities of the network focus on three levels: research level, health
care level and community level. At research level we shall organise a workshop with European research
institutes to set an agenda with research priorities on FGM in Europe. We shall have a workshop for
health care professionals to discuss guidelines on how to take care of women who have been circumcised;
how we can include training on the issue within the curricular for students and to discuss the issue of
refibulation, that is when a woman comes to the gynaecologist and asked to be closed again.


                                                     71
There is much discussion on whether that can be done, whether it is allowed, and so forth. Thirdly, we are
working at NGO level. We have had a workshop in Sweden with NGOs and community-based
organisations from 10 European member states. We are gathering together to discuss their field work,
problems and solutions. It has been a fruitful workshop. We joined with NGOs with much experience in
Europe, such as FORWARD in England, the project from Sweden and the project from FRANCE. There
are other projects from Spain and Austria where the organisations do not have much experience but have
gained a lot of information on how they should work in future.

At the workshop the NGOs asked for the European network to be further established. I am writing a
proposal for the network to be continued for the next three years. We shall mainly focus on capacity
building for NGOs, dissemination of information within Europe and shall try to link it with the African
NGOs. Briefly, that is what we are doing.

                                                Chairman

I have been looking at the recommendations made from that meeting. One was for a European framework
for developing training and management guidelines. How do you see that being taken forward? Would it
be through the European Parliament or through the Council of Europe which exists for human rights issue
or by getting individual governments to sign up to it on an individual basis? Which way forward?

(Els Leye) This might be a problem. We have submitted recommendations to the European Commission,
and it is difficult to detect how far they have got with them. It is very difficult to know who to contact. I
know that the Council of Ministers now has a group of specialists working on draft recommendations for
the member states on the protection of women and young girls against viokence. There might be a good
chance – that is how it was stated in a letter – that the draft recommendations will include FGM. The
work of the group of specialists will not be ready before the beginning of 2001.

                                                Chairman

Can you tell us which commissioner has this responsibility?

(Els Leye) Do you want his name?

                                                Chairman

Not immediately, but it would be useful to know. If it is Chris Patten, that would be very useful.

(Els Leye) The name is Olof Olafsdottir. It is a Finnish name.

(Linda Weil-Curiel) At the end of this year, a report of The Parliamentary Assembly of the Council of
Europe will be adopted.
                                              Chairman

Yes, I know of that because I am a British delegate to the Council of Europe. That is why I asked the
question about the platform for feeding this in. It has been the subject of a report. I am the rapporteur for
Social Health and Family. Just as a point of interest, there is a report to be made from the Equal
Opportunities Committee of the Council of Europe on this issue. I am the rapporteur to that report from
the Social Health and Family Committee. We feel that this is an issue for families, not just important as a
human rights issue.

(Els Leye) I shall discuss the management guidelines for health professionals in a workshop but I am
thinking of distributing it to key persons in all European member states such as the British Medical
Association, so that it can be further distributed.



                                                    72
                                                  Dr Tonge

There is still a huge amount of ignorance on this issue, certainly in the UK, amongst medical professionals
and nursing staff. Some of them are still coming across it for the first time. There is now a European
Accreditation Scheme, an agreed course of training for specialists in various fields of medicine. Is that
part of that accreditation now? There should be something about FGC in that accreditation before a
person can be said to be a qualified gynaecologist, for example.

I wonder if anyone has done anything like that yet. I also want to return to one of my earlier points
concerning bringing a case to the Court of Human Rights. I still think that must be possible. We know
that it is going on in Europe. There must somehow be a way of doing that.

(Els Leye) As regards your first question: not that I know of but we could certainly take that up in our
workshop in June where we will discuss training modalities for health professionals.

                                              Baroness Gould

I should like to ask a question about funding. We have heard much during the course of two days about
the lack of funds to promote this work. I wonder whether you are adding the funding, costs and
expectations from Europe to your project? Is that part of the project? Are you looking at how much it
will all cost and how that money can be used by NGOs in the different European countries?

(Els Leye) I am currently writing a proposal for the next three years for networking. One of the
workshops in the future network will be on how NGOs can write project proposals and on fundraising.
We shall organise a workshop to empower them on where to look for funding, how to write project
proposals, and so forth. The project I am running is funded by a European Commission project Line
(Daphne Line) which as been specifically designed for the prevention of rights against women, young
persons and children. They do not fund a lot of projects. Last year, out of 356 projects, only 56 had been
approved. I know that many other organisations in Europe are applying for funding to work on the topic
of FGM. So there is a competition between all of us. That is why I am trying to network to empower the
NGOs and to pass on knowledge so that in future they can apply for funding themselves.

                                                 Chairman

Thank you very much indeed. Our last presenter has been very patient. She is Linda Weil-Curiel. She
has been a member of the Paris Bar since 1973. In her professional career as an attorney, Linda has been
in the forefront of the fight against the sexual mutilation of girls in France by enforcing the penal code that
punishes physical harm. She has participated in each of the 25 trials in Paris and surrounding cities since
1982. It is now indisputable in France that foreign customs are no excuse to mutilate, though the
background of families is considered as extenuating circumstances.

To date, 90 people have been sentenced, out of which 2 performers, that is cutters, have been given prison
sentences (5 and 8 years respectively), with mostly suspended prison sentences for the parents, but not all.

(Linda Weil-Curiel) I, too, come from a country where FGM is practised but in a different way. Since
1982, when the first baby died in France, the public authorities took the matter very seriously. The
Minister of Women‟s Affairs immediately called for a working group with African women‟s
organisations, African male workers and doctors. I also belonged to that group. The discussion was on
how we could prevent such events occurring in France.

At first, word was given to the doctors in the family and child centres, which are free. The families
usually go to be clearly informed of the harm being done to the child, that it is forbidden by the law in
France and should the families still cut their children, they will be reported to the legal authorities and
prosecution will ensue.



                                                     73
Male workers were also asked to spread the word in the workers‟ foyer. Women‟s organisations were
funded to speak to the families. We hoped that that would be enough to stop the practice but
unfortunately, people do not want to listen to things they do not like to hear. When doctors saw that
children were still being cut, they had to report it to the police or the prosecutor. It is now their legal duty.
Doctors are not subjected to the professional code of secrecy when it comes to child abuse. They have to
report any kind of child abuse, among which, of course, is the cutting of the genitalia.

Doctors now speak more openly to the families. Because of the trials, the taboo has been lifted. The
families did not want to speak to the doctors at first. But when they saw that their practice was known to
everybody, they could not hide any more. In the end, there were many young mothers who came to see
the doctors and said, “I should respect my tradition or the law of our group and cut my daughter but in my
heart I don‟t wish to do that and I am glad that it is forbidden. I can say to my family back in our country,
„I won‟t do it because I don‟t want to go to prison‟. That allows us time to explain to the families back
there what we have learnt today. We want you to know that”.

The subject was also being discussed in Africa. So, families had a good excuse not to cut their children.
But if they do, they find me. I step in court and I accuse them. I am not a prosecutor; I am a defence
lawyer for the children but on behalf of an organisation. Our processing code allows groups to be joint
parties to the prosecution in favour of the victims. In this case, the victim cannot defend itself. It is the
parents who are accused who should protect the child. I am a lawyer, in court I am adamant. I say, “These
families have been informed. They know about it. They may say that they have not met anybody who
said that excision is forbidden in France but the doctors are here to testify that the families were
informed.”

Some doctors when in court burst into tears because they had not informed the authorities soon enough
because they doubted that the family had been informed that it is forbidden. One doctor said, “If I had
immediately reported this woman, I would have saved three other little children. I spoke to the woman
and she did it three times after I told her not to.” She was very heavily punished by the court.

In the beginning the doctors would hesitate to inform the authorities. I must say that it is thanks to Dr
Piett who is here and has been doing the job in France. They would say, “I didn‟t feel like informing the
authorities. I believe I would betray the families‟ interest. We have talked to each other and now I have
to report them to the police”. I say, “But whose interests are you in charge of: these adults who you have
informed that it would be harmful for the child and that it is against the law, or is it the child? In not
reporting, you are betraying the child‟s interest. In a few years‟ time, how will you be able to face the girl
when she comes to you and says, „You could have avoided this for me and you did not‟?”

Some people are very angry with the French for enforcing their law. They say, “You do not have the right
to judge our culture”. As has been said, “Torture is not culture”. I say, “Yes, of course I am entitled to
bring you to the courts because if a white child is cut in France, it would cause a scandal. Why should we
be quiet when it is a black child? She does not suffer less. She is not less entitled to her physical
integrity. When she grows up she will not have less need to enjoy the pleasures of life and love. What
hurts a black child hurts a white child.”

Should we not prosecute and punish, we would introduce discrimination between children and not give the
same protection of the law to all children. That is the meaning of my fight in court. I want society to
understand that all of these children are entitled to the same protection.

Young girls do not accept that they have been cut. They are angry with their parents. They say, “This
tradition is not ours any more. We are born in France in Europe. We want to be like the others. Our
future is different from that which our parents imagined. We want to be free to make choices and we need
to be recognised as members of society like the others and not be put aside because we come from a
different culture.”

There was a large trial last year. For the first time it was not a doctor who reported the facts but Marietta.


                                                      74
The day she was 18 she left home for good and went straight to the juvenile judge and complained. She
said, “Now my father wants me to be married by force. He has chosen someone I didn‟t want. Moreover,
me and all my little sisters have been cut by Mrs Greou. She is a good friend of my mother. Mrs Greou
came into my home to excise other children”. The judge opened an investigation and you know what
happened.

In court it was very painful to see Marietta facing her mother who said, “You are lying, Marietta. You
don‟t know what you say, and why do you judges believe my daughter instead of believing what I say? I
never saw Mrs Greou.” Nevertheless, Mrs Greou admitted she had cut that girl. The judge said, “Now,
Marietta, what do you expect of the trial?” Marietta said, “I want justice to be done”.

A month later there was another trial. I was very surprised to see her step into the court one of the women
who was also tried with Marietta‟s mother and the performer. During the recess I went to speak to her. I
said, “Why have you come?” She said, “I wanted to see how the other families got along”. I said, “But
what did you think of your trial?” It lasted 15 whole days. She said, “We have heard so many
testimonies: the doctors, the African activists, the experts and everyone. We have learned a lot. We and
all the other mothers”, there were 24, “have discussed a lot among us and we have understood the harm
we have done to our children”. That woman is from Senegal. She said, “Next time I go back to Senegal I
will tell the women in my village not to excise their girls any more.” Maybe that is thanks to the law.

                                                     Chairman

We, too, have a law here in Britain: the Prohibition of Female Circumcision Act passed on 16 July 1985.
A couple of weeks ago I asked the Home Office in a Written Question how many prosecutions there had
been under that Act in the past 15 years. The answer is that there have been no prosecutions under this
Act since it came into force. The Minister says that the lack of prosecutions for this offence is only
because of the small number of complaints made to the police and the difficulty of obtaining evidence
where a complaint is made. She goes on to say that encouraging the education of professionals and
practising communities is a more effective tool for eradicating FGM. That may well be true. However, I
wonder if you have any views on why we have had no prosecutions in Britain?

(Linda Weil-Curiel) Shall I dare?

                                                     Chairman
Please do.

(Linda Weil-Curiel) It is because they are “chicken”.

                                                     Chairman

I think that our doctors do not have to report it.

(Linda Weil-Curiel) They are afraid of being called racist.

                                                     Chairman

Yes, that it is against the culture.

(Linda Weil-Curiel) But it is the opposite. It means that you do not make any discrimination between
children. What hurts a white child hurts a black child. Sometimes the families know that small children
from one to six are under the surveillance of the family and child care centres. Sometimes they say to the
doctors, “We are going back on holiday to our country” and the doctor is very alert. Sometimes when
there is a real risk of excision back in the country, they will inform the juvenile judge who will summon
the family and explain that if the child returns excised there will be a prosecution against them. But very
often the doctors understand that when the mother expresses her fears, it is because she has does not have


                                                       75
the guts to say “no” to the family. She wants help and calls for help and is very glad when the doctor or
the judge says “no”.

                                                 Dr Tonge

I think that there is an issue here. First, perhaps I may say thank you very much, France. I now know
there is another reason why I love France so much. This makes me weep. I think you have done a very
courageous thing. I feel very ashamed of Britain. I saw in one of the Answers that Chris received to a
Question from the Secretary of State for Health that the Prohibition of Female Circumcision Act 1985
makes female circumcision, excision, infibulation, an offence except as a specific physical and mental
health ground. Nick, you are a doctor like me. What on earth does that mean?
                                                 Lord Rea

We had problems with that.

                                             Baroness Gould

There were lots of problems when that legislation was being passed.

                                                 Dr Tonge

The other problem, of course, is trying to convince doctors that sometimes they should not protect
confidentiality. In this case it is not the patient but the child who has no voice and the doctor should be
able to speak up.

                                                 Lord Rea

When the legislation was going through Parliament, the gynaecologists wanted to have this little possible
exception included for one or two cases that were so rare that they hardly ever happened. This was put
into the Bill rather against the promoters of the Bill.

                                             Baroness Gould

There was also a long discussion on this particular clause, having read it through, about the mental health
of patients. The reason that that was put in was to counter any cultural problems and difficulties that there
might be within the communities. My understanding is that there were days and days of discussion about
that one particular point about mental health and whether it should be in or not. It was really put in almost
as a compromise in order to get the Bill through. I think that was a great shame. To me, the crunch is that
doctors have no obligation to do anything in this country. It is interesting to know that they have to do
that in France. We should think about changing this law.

(Linda Weil-Curiel) They are not subject to professional secrecy on child abuse. You have the 1999 Act
on child abuse which is very good. In France we do not have a special law against FGM. I am against a
special law. We have discussed it. I said that we did not need a special law because the penal code
punishes people who inflict harm and violence. The law should be the same for everyone. Moreover, I
thought that if we had a special law, what would it mean? It would be like pointing an accusing finger
towards a population. When we say excision is forbidden, we do not mean to address people from
Strasbourg. It means, “It is you Africans”. This is why I do not want a special law in my country.

Lord Rea
When the legislation was going through Parliament, the Lord Chancellor of the time, Lord Hailsham, put
that exact point and said that our existing legislation should be sufficient to prosecute.

                                                Chairman


                                                    76
I have just been looking again at a further Written Answer that I had from the Minister of Health
regarding disclosure. The Children Act certainly requires that if a local authority has reason to believe a
child is likely to suffer harm it is obliged to make inquiries to see if it considers it necessary to make a
prosecution or take action to safeguard or promote the child‟s welfare.

Another point I should like to raise with Linda is the issue of parents taking daughters abroad. The
Minister‟s reply on that issue was that if parents take their daughters abroad to have them cut, it would be
an offence in Britain if FGM is also an offence in the country to which they are travelling. That is a
nonsense. It means that it is not an offence here if they have gone to a country where it is not legally an
offence. That may well be a lot of the countries about which we have been talking. We need to look at
that area closely. I should like to know if that is applicable in France? I would imagine it is not, that
there is no differentiation.

(Linda Weil-Curiel) Our law is quite similar, but if the excision has been performed on a French national
abroad, there is no need for a condition that it is illegal in the country. All the children born before 1994
are presumed French. Now it is more difficult, since 1994.

                                                 Chairman

Are there any more questions of Linda?

(Dr Abiola Tilley-Gyado) I have a question about the law. I am not a lawyer; I am a doctor. I wonder if
the fact that the British Government recognise dual nationality could be a point in question, that if you
hold dual nationality, British law does not protect you as regards things that take place in your country of
second nationality? That might be a point worth looking into. It may not be the same in French law.

(Linda Weil-Curiel) France is not perfect. What happened in Seine Saint-Denise, which is a French
suburb is thanks to Dr Piett. A few years ago, 500 mutilations were executed. Thanks to her work and
thanks to the trials, there has not been one single excision since 1997.


                                                 Chairman

I know that people were hoping for and expecting wider discussion as, indeed, we had time for yesterday.
Unfortunately, it was taken out of our hands and this has been a shorter hearing. I think you will agree
that the presentations we have had this morning have been illuminating. I wish we could stay here all day
to discuss this subject but that is not possible.

I knew that this issue was important. We all know in our hearts as well as our heads that it is a difficult,
sensitive issue but it has to be tackled, certainly in Britain. It is clear to me that our law needs tightening
up and strengthening. We have to bite that bullet. We must also look at how we fund organisations which
work in this area, both in Britain and abroad. There are a number of objectives: primarily, to raise the
awareness of our Government here in Britain and that of European governments and governments
throughout the world. We need a strong level of support for national and international activities on this
issue. We need governments to invest in programmes for prevention of FGM at home and abroad.

We have heard enough in the past two days to provide all the justification that is needed to release more
money for key agencies, both non-governmental and other organisations working in this area. I believe
that all the evidence is there.

We shall analyse carefully the report of these hearings. We also have the questionnaires that were
responded to by a wide range of national and international organisations, some of which have been
represented in the audience, if not as witnesses. Those questionnaires will be looked at carefully and
analysed professionally. When we launch the report of the hearings in November, I hope that that analysis


                                                     77
will be available.
Yesterday, we were told about an exhibition currently being held in Germany. It is mainly paintings and
exhibits to do with this issue. We shall look into the possibility of having that exhibition in Parliament
during the week of the launch and the play. That might well be possible.

I shall conclude by thanking all our witnesses today and those who were here yesterday. I believe it has
been a very important issue to raise awareness. I am pleased that people were willing to come and talk
about it. It is still a sensitive issue here in Britain, not just in communities in Africa and Asia. But for
Jenny here, most people find it difficult to talk about reproductive health and rights. Some people would
say it is mission impossible, but I think we have had a very good two days. I thank you all for being here.
I also thank the members of the panel and, not least, Trudy Davies, Vanessa Haines and Flo Harding for
all the hard work they have done.




                                                    78
GLOSSARY


ACPC……………            Area Child Protection Committees (UK)
APPG ……………           All-Party Parliamentary Group
CEDAW….………           Convention on the Elimination of all forms of Discrimination
                     Against Women
DFID …………….          Department for International Development (UK)
FGC ……………...         Female Genital Cutting
FGM.……………..          Female Genital Mutilation
FORWARD ..……         Foundation for Women‟s, Health, Research and Development
LBWHAP ……….          London Black Women‟s Health Action Project
NGO ………….…           Non-Governmental Organisation
RAINBO ………..         Research, Action and Information Network for the Bodily
                     Integrity of Women
RCOG …………..          Royal College of Obstetricians and Gynecologists (UK)
TOSTAN ……….           “Breakthrough” – Senegalese non-governmental organisation
UN ……………...          United Nations
UNFPA …………           United Nations Population Fund
UNICEF ………..         United Nations Children‟s Fund
WHO ……………            World Health Organisation



APPENDICIES



Appendix I:

Members of the Female Genital Mutilation Hearings Steering Group:

Christine McCafferty MP, Chair All-Party Parliamentary Group on Population,
Development and Reproductive Health
Dilys Cossey OBE, International Planned Parenthood federation (IPPF)
Trudy Davies, Research and Liaison Officer, APPG (until May 2000)
Shamis Dirir, Director of the London Black Women‟s Health Action Project
Vanessa Haines, Parliamentary Advisor, APPG (From May 2000)
Florence Harding, Commonwealth Secretariat (until May 2000)
                        Naana Otoo-Oyortey, Chair FORWARD

Report compiled by Vanessa Haines


Appendix II:




                                        79
Prohibition of Female Circumcision Act 1985



                                                    1985 CHAPTER 38

                                         An Act to prohibit female circumcision.


                                                                                            [16th July 1985]
   BE IT ENACTED by the Queen's most Excellent Majesty I by and with the advice and consent of the
   Lords Spiritual and Temporal, and Commons, In this present Parliament assembled, and by the
   authority of the same, as follows:

   1 Prohibition of female circumcision

   (1) Subject to sect/on 2 below, It shall be an offence for any person


                               (a) to excise, infibulate or otherwise mutilate the
                               whole or any part of the labia majora or labia
                               minora or clitoris of another person; or

                               (b) to aid, abet, counsel or procure the
                               performance by another person of any of those
                               acts on that other person's own body.

  (2) A person guilty of an offence under this section shall be liable


                              (a) on conviction on indictment, to a fine or to
                                  Imprisonment for a term not exceeding five years
                                  or to both; or

                              (b) on summary conviction, to a fine not exceeding
                              the statutory maximum < ...> or to Imprisonment
                              for a term not exceeding six months, or to both.

 NOTES

Amendment

                   Sub-s (2): words omitted repealed by the Statute Law (Repeals)
                   Act 1993.

2 Saving for necessary surgical operations

(1) Subsection (1 )(a) of sect/on 1 shall not render unlawful the performance of a surgical operation If
that operation


                            (a) Is necessary for the physical or mental health of
                            the person on whom It Is performed and Is
                            performed by a registered medical practitioner; or

                            (b) is performed on a person who 18 In any stage of
                            labour or has just given birth and Is so performed
                            for purposes connected with that labour or birth
                            by                       80


                                                                                                           1
                                                     (i) a registered medical practitioner
                                                     or a registered midwife; or

                                                     (II) a person undergoing a course
                                                     of training with a view to becoming
                                                     a registered medical practitioner or
                                                     a registered midwife.

            (2) In determining for the purposes of this section whether an operation Is necessary for the mental
            health of a person, no account shall be taken of the effect on that person of any belief on the part of
            that or any other person that the operation Is required as a matter of custom or ritual.


Extent
            NOTES
                 This Act extends to Northern Ireland.




           3 Extradition etc
           (1 ), (2) < ...>




          NOTES

          Amendment

                              Sub-s (1): repealed by the Extradition Act 1989, s 37(1), Sch 2.

                              Sub-s (2): amends the visiting Forces Act 1952, Schedule.

          Extent

                              This Act extends to Northern Ireland.




         4 Short title. commencement and extent

         ( 1) This Act may be cited as the Prohibition of Female Circumcision Act 1985.

         (2) This Act shall come into force at the end of the period of two months beginning with the day on
         which It is passed.

         (3) This Act extends to Northern Ireland.              81

								
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