Female genital cutting and the international response surrounding the practice represent incompatible cultures coming together in a shrinking world. According to UNICEF, in 2016, an estimated 200 million girls and women have been cut in 30 different countries.
Though an incomprehensible practice to some, cutting makes sense to people socialised in practising cultures. Whatever one's cultural background, however, cutting arguably represents a violation of universal human rights that supersedes culture.
These alternate views place international agencies promoting the abandonment of cutting in a dilemma, trapped between conflicting commitments to cultural tolerance and universal human rights.
This dilemma is exacerbated by the common view that cutting is a locally pervasive practice based on a deeply entrenched social norm. An influential version of this view suggests that, where cutting is practised, families must match the local norm to ensure good marriage prospects for their daughters. When most families cut, under this view, incentives favour cutting. When most families do not cut, incentives favour not cutting. Incentives like this could be present because, for example, a family that deviates from the local norm is ostracised and hence their daughters cannot grow up to marry good husbands.
If correct, this view implies that abandoning cutting requires efforts that introduce or even impose foreign values onto a cutting society.
But a successful programme can change incentives in the marriage market by shifting a sufficiently large number of families away from cutting. Such a shift means that the incentives for families to coordinate with each other can switch from favouring cutting to favouring abandonment. Once this happens, the need for families to coordinate takes over and accelerates the process of abandonment.
My colleagues and I have been examining these ideas in Sudan, a country known for both a high overall cutting rate and extreme forms of the practice that bring risks of infection, haemorrhaging, and obstetric complications.
Much of Sudan is estimated to have a cutting rate above 80% for women and girls aged 15-49. Infibulation, which involves removing large amounts of tissue and sewing the edges of the vulva and the wound closed so they heal to leave only a small opening, is also believed to be common.
What we have found may come as a surprise to some. Cutting is not always a deeply rooted norm, and it is possible to change attitudes towards the practice through the surprising medium of entertainment.
In direct contrast to the prevailing view of cutting, we have found that attitudes and practices vary tremendously over small areas. We have worked in dozens of farming communities along the Blue Nile in the state of Gezira, south of Khartoum.
We have found that communities consist of a thorough mix of cutting and non-cutting families, and a mix of people who are relatively positive and relatively negative about uncut girls. This finding has broad implications for both our understanding of why parents cut and how to promote the abandonment of cutting.
We developed a number of methods for measuring attitudes and practices related to female genital cutting. One method was based on the fact that girls have henna applied to their feet the day they are cut, and this is the only circumstance in which a young girl would have henna on her feet. For the several weeks that henna remains on the toenails, it thus provides a reliable and easily observed indication that a girl has been recently cut.
We essentially counted girls with henna on their feet and combined these figures with other sources of data to estimate the prevalence of cutting in each community.
With respect to both behaviour and attitudes, we developed our methods to minimise the risk that participants would simply tell us what they thought we wanted to hear. Henna on a girl's foot, for example, provides a ready indication that a girl has recently been cut without a data collector having to ask the girl's parents how they feel about cutting.
We also used implicit association tests: psychological measures that rely on reaction times and have been specifically designed to minimise the potential for respondents to misrepresent their attitudes.
Our results show that a diversity of views on genital cutting is not only present, but typical, in the area we studied. This is in direct contrast to the working assumption of international agencies that promote the abandonment of cutting. Put simply, cutting is not locally pervasive. Those who cut and those who do not are often neighbours.
We did find that in most communities, many people claim it is important for men and women who marry to come from families with the same cutting practices. Such a commitment to coordinated cutting practices in the marriage market could promote locally homogeneous attitudes and practices.
But this is reliably true only if families are similar in terms of the intrinsic value they place on cutting. Families might be similar in this way, for example, because they all have the same opinion about whether Islam requires cutting. Or perhaps all families have similar views about the health risks of cutting.
Families could be dissimilar because one family believes Islam requires cutting, while another does not. Or maybe one family is preoccupied with the health risks of cutting, and another family is not.
Policy-wise, this means that international agencies cannot initiate a process of behaviour change and then expect social pressure among families in the target population force to accelerate the process of giving up the practice.
Changing attitudes with movies
Local diversity came as a surprise to us, but it can be used to design a different kind of intervention. Accordingly, we produced four fiction feature-length movies that show an extended family in Sudan as family members arguing about whether to continue cutting.
In our films, some family members favour continuing the practice; others favour abandonment. Because the debate about cutting is strictly within an extended family, the films situate the antagonism between cutting and abandonment as locally as possible.
The four movies differ in terms of the types of arguments family members bring for and against cutting. One movie was a "control". The control movie consists entirely of an entertaining main plot that does not address cutting in any way. The other three movies include 27-minute sub-plots that dramatise the family's internal conflict about cutting.
One movie emphasises values. Some family members worry that cutting is necessary for the moral development of girls, for example, while others are preoccupied with the health risks.
Another emphasises the effect of cutting on the future marriage prospects of girls. Some family members speculate that their daughters will not grow up to find good husbands if they are not cut. Others argue that times are changing fast, and their daughters will not grow up to find good husbands if they are cut.
The third movie has a combined plot. It includes arguments based on values related to health, religion, and moral development, along with arguments based on how cutting affects marriage prospects. We used the four movies as treatments in two separate experiments.
In one experiment, we randomly assigned individuals within communities to watch one of the four movies, while in the other we randomly assigned entire groups of communities in a given area to watch one of the four movies.
We worked with around 8,000 randomly selected adults in 127 communities. We found that all three movies about cutting improved attitudes toward uncut girls, but one movie in particular produced relatively persistent changes.
The movie with the relatively persistent effect was the combined movie, that dramatises the full suite of arguments for and against cutting. In addition to the basic effects of the three movies about cutting, we also found that families with a history of nomadism and animal herding were more negative about uncut girls. Although somewhat speculative, this correlation could follow from the fact that families with a highly nomadic past place more value on cutting because it potentially increases certainty about the paternity of children.
Our research in Sudan has shown that cutting is not necessarily a pervasive and deeply entrenched norm. In our case, we produced movies that dramatise a Sudanese family grappling with its own internal conflict about whether to continue cutting.
Using a measure of implicit attitudes, we found that these movies significantly improved people's view of uncut girls. Like other recent studies showing that entertainment can change attitudes and specifically reduce gender bias, our results show that entertainment can lay the groundwork for socially beneficial behaviour change.