February 6 is the International Day of Zero Tolerance to Female Genital Mutilation (FGM). The day is a rallying cry to call attention to what the World Health Organization describes as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons." This can include cutting away all or part of a girl's clitoris and sometimes the labia as well, depending on the range of cutting completed. This procedure, sometimes called Female Genital Cutting, has been performed on 140 million girls in the world today, and often results in devastating health implications from bladder and urinary tract infections to infertility, or even death by hemorrhage.
The procedure is performed on girls between infancy and age 15, usually without pain medication or proper surgical tools. If a needle and thread are available to stitch the girl back together after the cutting, fine; if not, thorns plucked from nearby bushes are used to set the wound until it seals. With the more severe forms of FGM, after the wound heals, only a very tiny hole remains, through which no more than urine or menses can pass.
FGM is not mandated by law or by religion; it is a cultural practice that has been handed down for generations because of the belief that it will result in chaste and marriageable daughters. The procedure is carried out by traditional circumcisers, sometimes referred to as "cutters," and, alarmingly, increasingly by health care providers, because they are asked to do so. As New York Times columnist Nicholas Kristof so astutely observed, "People usually torture those whom they fear or despise. But one of the most common forms of torture in the modern world... is inflicted by mothers on daughters they love."
Stopping this practice is no easy task. Culture and beliefs are two of the most difficult things to change.
I know how difficult this can be from my own line of work at The Fistula Foundation, where we support the treatment of obstetric fistula, an injury caused by prolonged obstructed labor. Without emergency intervention, like a C-section, a woman will remain in labor sometimes for days, until her baby is dislodged. The constant pressure from the baby causes tissue to die, which creates a tiny hole -- a fistula -- through which a woman will leak urine or feces or both. Her incontinence often prompts her husband and community to abandon her because they cannot stand her smell, often because they believe the woman is cursed. These beliefs and the stigma around obstetric fistula are the focus of the work of a number of our partners, because in order to provide surgical treatment, a woman and her community first need to understand that what she's suffering from is an injury, not a curse.
While FGM does not cause fistula, the scar tissue that develops when the cuts have healed can complicate fistula repair surgery for a woman who develops obstetric fistula, requiring perhaps several invasive surgeries in order to attempt a repair. The Fistula Foundation is fortunate to be funding two pioneering partners working to treat obstetric fistula, run by strong leaders who are working to end FGM -- and are seeing some great success.
One of these partners is Edna Adan. As a young girl growing up in what is today the breakaway Republic of Somaliland, Edna was unsuspecting victim of FGM. When her father was out of town, Edna's mother allowed a traditional cutter to undertake the practice on her daughter. Seeing her father so outraged at her mother for allowing this to happen, Edna knew that cutting was not right. She carried this with her for years, and today, as founder of the Edna Adan University Hospital, Edna trains midwives to respond to and overcome cultural and traditional beliefs regarding FGM. When training is complete, these midwives return to their communities and teach that FGM should be abolished. As Edna said recently during a Google+ Hangout on maternal mortality: FGM has no place in medicine because it is harmful and damaging; no place in religion, because Islam does not encourage it, and no place to prevent promiscuity or preserve virginity -- it is a girl's upbringing that protects her morals and her virginity.
In Senegal, I'm deeply inspired by our partner Molly Melching, who moved to the country as a Peace Corps volunteer three decades ago and never left. She realized early on that the way to help communities prosper was to start by listening, without judgment, to understand the hopes and aspirations of the community. Within the boundaries of these trusting relationships, she started to understand more sensitive topics, like FGM. By focusing on communities' beliefs and understanding from where these beliefs were derived, Molly found she could overcome cultural barriers without demonizing those who promoted FGM's continuation.
One of my favorite examples of Molly's approach is her use of the western practice of breast implants. In the communities where she works, community leaders listen with shock and surprise that women in the western world would go so far as to cut open their breasts and insert implants inside, all for sake of making their breasts larger. Eventually, communities were able to make the connection themselves and saw that FGM was just as unnecessary. The organization Molly founded, Tostan, has used these wise and respectful approaches to successfully encourage more than 6,000 communities in eight different countries to declare an end to the practice of FGM.
So, what can people like you and I do to join the Edna Adans and Molly Melchings of the world? The first step is just being aware that there's a problem. The next step is spreading that awareness so it can translate to action.
An old African proverb states, "If you want to go fast, go alone; if you want to go far, go with others." FGM is not going to disappear overnight, but by continuing to work within the framework of existing cultural beliefs to change behavior, ending this practice is possible.
So, I hope you will stand with me, with the United Nations, WHO and countless other organizations and individuals who are lending their voices and energy to end FGM and help girls grow into women with their bodies intact.