Is Zero Tolerance the right approach for ‘FGM’?

The impending US trial of Dr Nagarwala accused of carrying out ‘FGM’ on young girls in Detroit, has ironically helped trigger more reasoned discussions about the practice in general and how it could be addressed, than has been possible for some time.

Is Zero Tolerance the Right Approach for FGM? was the question posed in The Inquiry, a recent BBC radio programme. It also asked a number of other important questions and illustrated concerns and problems through interviews with four experts.

The first part usefully went back to basics on the issue.

Sara Johnsdotter, Professor of Medical Anthropology at Malmö University, Sweden demonstrated her knowledge and understanding in regard to its origins, reasons for the practice, and in particular how it became politicised following the 1970 Hosken Report “Genital and sexual mutilation of females”. In relabelling cutting as ‘mutilation’ Hosken had ostracised many African activists whilst pleasing westerners. Her report helped create an unprecedented focus on genital cutting in girls. But male genital cutting was ignored.

The UN officially began to use the term ‘mutilation’ in 1994 and that further problematised the practice. The WHO’s umbrella classification of all types of the practice, from clitoral pricking to infibulation, as ‘FGM’ and violence against women, helped compound the problem. And resulted in far-reaching policy changes. Consequently, an increasingly well funded, high profile ‘industry’ has developed with ‘Zero Tolerance’ its motto.

The second part, ‘Chasing Presidents’, looked at work undertaken by Gambia born US activist, Jaha Dukureh. Jaha underwent genital cutting as a baby in Gambia and is the subject of an award winning film, Jaha’s Promise. It describes her work in the Gambia where she realised her ambition of getting the former President, Yahya Jammeh, to suddenly and unexpectedly declare a total ban on ‘FGM’ there.

She recognises that although ‘FGM’ has been banned in many other African countries, the law is rarely enforced, and the practice has gone underground. She attributes the tendency to ban the practice as a response to western, not African pressure. But the African women who want ‘FGM’ banned on the continent by 2030 are now ‘going after African leaders’ to help ensure a successful ban there, by then.

Part three looked at the implication of the legalisation of FGM: unintended consequences. Academic, Naisula Lapario has been exploring the problems wrought by zero tolerance campaigns, and discusses specifically what has happened among Kenya’s Samburu people.

Because of western refusal to recognise ‘FGM’ as an important rite of passage, imbued with social and cultural meaning, it has been driven underground. But all girls continue to be cut in secret, when younger, at night, but without the important accompanying celebrations. Not only has this had social consequences, negative health implications have also been reported because fewer competent circumcisers practice. And when problems arise, people fear taking girls to hospital for treatment. She describes a disconnect between what happens on the ground and what policy makers think and want. Nor does she see how blanket solutions to what is not a homogenous practice could ever work.

She thinks people might be willing to consider alternatives to female circumcision, but because of the zero tolerance approach, this is not allowed.

In part four ‘Zero Tolerance has widened the knowledge gap’, an ‘honest conversation’ was held with Dr Jasmine Abdulkadir, a Somali/Italian gynaecologist working with migrants in Geneva. She acknowledged that genital cutting is a complex issue and, while ‘zero tolerance’ may be a catchy slogan, she finds explaining it difficult in clinical practice. While most of the people she encounters have abandoned the practice, she describes dilemmas that occur when patients ask about genital pricking as an alternative form. She has to tell them that because the WHO considers it harmful, it is not allowed. But she cannot back up the harm argument with evidence because none exists.

Officials also believe that the practice would be perpetuated were pricking allowed. But there is not research, evidence or studies to explain why this might occur. Neither is future research likely. While she believes eradication to be the ultimate aim, the freedom that is necessary to enable a more honest, constructive debate about how this could be achieved is needed, now.

She also observed that male circumcision is viewed differently to female, despite that some forms of the latter are comparable to the first. She believes an objective, scientific approach to the practice is necessary.

Conclusion. The issue remains controversial and opinion is polarised. But a new discussion that happens on the ground is needed.

The Inquiry was broadcast by the BBC in Jan 2018