Hello all,

I'm very late to this thread (new to the forums and site here) and realize this is from the last May28 day but want to chime in as I'm doing some FGM/C Menstruation surveying and work now. Currently doing key informant interviews and questionnaires on MHM practices and beliefs and Part 3 of our survey covers FGM in detail. I'm hoping to have this report wrapped up before this years May28 day. I'll be sure to post it here first. So far in the surveying we are hearing (and reading) several problems with menstruation due to FGM/C (including product use).

Hi everybody

Observing the stance of this forum on the subject of the relationship between FGM (Female Genital Mutilation) and Sanitation has been nothing but lukewarm and low key in interest just short of anathema. The scorecard to me is just pathetic.

While other discussions of less importance have taken space and time, the other world was in a convention and has captured the resolutions to protect of the rights girl child to live with dignity in her future womanhood (without FGM) especially in the developing countries full well aware that the developed share the forefont of the practice mostly mystic.

I couldn’t be more admiring to Honorable David Cameron of Britain as he remarked tonight in his speech at the Girl Summit 2014 that the practices were ‘standing rebukes to our world’.

That was a very resourceful speech. Google “FGM summit: Cameron calls for end 'in this generation' for details.

Cheers

Mwaniki

A pretty good map of FGM in the world - only Iran and the U.A.E. are missing.
orchidproject.org/fgc-map/

(on the website link above you can click on each symbol to get to the country file which gives you further detailed information about FGM in that country)

Our project "Stop FGM Middle East" works in Asia including a number of countries where FGM is prevalent such as the Gulf region (Oman, U.A.E.), Iraq, Iran, India, Malaysia, Indonesia. In fact, in Asia there are even more countries where no one is working yet, such as Singapore, South Thailand, Pakistan and the Maledives. So unfortunately, it is much more widespread than the UN implies by its last report and its map.

And there are also some differences concerning the practice in comparison with the situation in Africa: Sanitation is not so much a problem in these middle income countries, in some cases FGM is even performed in hospitals. And the religious arguments supporting it are more complex: It is true that the Quran doesn't mention female circumcision, but a few hadith (sayings about the life of the prophet) do and even though they are not clear some clerics interpret them in a way to support FGM. So, our local activists are sometimes involved in quite intellectual theological arguments.

Anyhow, I still see a connection to hygiene issues as all of this is a taboo. One experience we made was that talking about FGM is not only empowering women but also improving gender relationships, namely marital. We could win many men for our cause because they made the experience that after talking about it their marriage improved a lot.


Hannah Wettig
Program coordinator
Stop FGM Middle East
Frankfurt, Germany
www.stopfgmmideast.org

Hi, I appreciate this discussion on such a difficult topic. Recently several of us from PATH were in the Afar region of Ethiopia to gain a better understanding of the public health situation and needs. The population is largely pastoralist and follows many traditional practices, including historically, the extreme form of FGM. We showed a nurse in a health post examples of the hybrid sanitary pad concept we've been advancing
www.path.org/publications/files/TS_update_san_pad.pdf as well as a menstrual cup to get her feedback. She seemed quite intrigued by both, but said with sadness that the menstrual cup would never work with many of the women because of the very small opening left after the extreme form of FGM. I had not even considered the impact the small opening would have on the menstrual flow and the pain this could cause.

On a positive note, with UNFPA/UNICEF funding, a remarkable community-based process took place to review the Koran for examples of FGM. When none were found, and after lengthy discussions with the religious and community leaders, the leaders agreed to stop FGM. www.unfpa.org/public/news/pid/5141 It was a powerful example of respecting and working with community leadership and culture to end such a damaging practice.

Best wishes,
Nancy

Dear Carol,
Thanks for your post (Pakistan, Egpyt,... where else did you travel to "back then"? Impressive!! ).
I like your page with the Advocacy Days, maybe we should have a similar page on the SuSanA website somewhere. There could be a few more related days (e.g. on nutrition, soil, intestinal worms), but I don't know exactly when they are (need to search in Google for a list of all UN Days!).

About those doctors in Cairo who learnt in the 70s how to do "safe" surgical procedures to cut off parts of women's genitalia*: doing it safely with pain relief is better than those procedures with dirty, blunt knives and no pain relief at all (I shudder just thinking about it!). But maybe nowadays, doctors in Egypt and other countries should learn how to "reconstruct" female genitalia in order to give cut women back a sense of feeling, and thus dignity and womanhood (let alone improve their peeing experience!). Now that would be a worthwhile thing to learn for student doctors in such countries. Like those doctors in Berlin, Germany (which are mentioned in this article which I linked to earlier: www.welt.de/politik/deutschland/article1...zurueckerlangen.html).

Regards,
Elisabeth

* What was it like in the 70s at that mentioned grad school? Did anyone question the justifications for these cutting procedures? Did the students have any debates about it with their lecturers? Just wondering.

Re FGM in Egypt: In the mid 1970s when I was in Cairo during grad school, "safe" FGM surgical procedures were still part of the curriculum at Al-Azhar University medical school.

Do any of you know how med schools in Egypt and elsewhere are now dealing with FGM as a medical issue? Seems like by now medical training would be a good place for anti-FGM research and advocacy.

Re Advocacy Days. Agree Elisabeth, they seem to work - from editorials in the New York Times to activities in primary schools. For best results, we just need to get the commentaries and op-eds submitted on time to the media, including local media with which individuals and small groups have some influence. Research and advocacy organizations can do a service by making available the talking points well in advance to on-the-ground, citizens' and grassroots groups.

That said, I'll suggest to the PHLUSH editorial team that we include Feb 6 and May 28 on our International Advocacy Days page. www.phlush.org/public-restroom-advocacy/...ional-advocacy-days/

Carol

Yes, I've heard that too! For some girls the hole they're left with is so small that they can literally only urinate drip by drip. This is also where their menstrual blood leaves the body. So, it is unsurprising that these women suffer from infections.

It's so sad that they consider it 'normal' as it is common in their society.

Thanks for the link, Dani. The article makes it sound relatively easy and straight forward to change this and to end FGM (and gives hope). An "alternative" rite of passage sounds really good. I have heard of cases where the alternative ceremony involved just a little scratch on the skin, to draw a little bit of blood - just for the effect - but without really cutting anything.

One more thought I had about the link to sanitation: Some of the reports state that women who have been cut badly (so-called Type III according to WHO classification, see en.wikipedia.org/wiki/FGM) often have real problems empyting their bladder: It takes them a lot longer than normal, e.g. up to 15 minutes to empty the bladder (peeing)! And because it is the same for the other women, they even consider it "normal" (that's what the UNICEF report said).

In any case, the net effect would be that in areas where the majority of women are cut we would need to provide even more toilets at schools or public places for the girls/women - or more female urinals - to avoid long queues. And the girls would need longer toilet breaks at school (?).

Regards,
Elisabeth

A friend sent me this very interesting article this week, about an alternative to FGM being practiced by some women in Kenya:

An alternative to female genital mutilation that prevents girls sufferingCutting is embedded in Kenya's culture but there are more humane rites of passage that the entire community can embrace

Dear all,

Thanks to the two Danis who have raised this topic here! I support your view that the struggle to end female genital mutilation (FGM) has certain connections to our struggle to end the lack of sanitation, not only - but also - via that link of menstrual hygiene management.

I find further similarities in the fact that they are both massive taboos, that it affects women's lives more then men's lives, that girls suffer so much more from it than boys (at the time of cutting and the months afterwards), that prevalence levels are higher in poor families (eduation levels, rural living also show relationships, although not as clear - see UNICEF report mentioned below), that it is surrounded by all sorts of practices, beliefs, myths; that it can be very unhygenic, that you can die from it and that you can get sick from it - and that the health and dignity problems are entirely unnecessary (self-made so to speak) and solvable.

So I think we as SuSanA members can do no harm in - and in fact should be - supporting others who are struggeling to end this practice of FGM/C (the C standds for "cutting), which has already been banned in most countries, but where it's now a matter of enforcing the laws and changing the attitudes.

I also found it interesting that they use some similar methods to what we use: did you know that 6 February was the UN day for zero tolerance to FMG? For me, this became proof that such UN days actually do work (like "our" UN day for toilets on 19 November). In which way do they "work"? Well it gives an opportunity for mainstream newspapers to run articles on this topic to get people aware and concerned about this topic. This is what happened to me when on 6 February I happened to read an article in a German newspaper about a clinic in Berlin that helps women to be "reconstructed" (i.e. those that had been cut & mutilated as children or teenagers), and to drastically improve their quality of life (if you are interested, use Google Translate to translate this German article for you: www.welt.de/politik/deutschland/article1...zurueckerlangen.html). It certainly got me thinking!

So I think the key is to reach out across your own circles of people who are already working towards a common goal and to find new "activists" in other circles. And to reach the mainstream media of course. Maybe if we - the "sanitation community" - unite with those working on ending FGM (including e.g. tweeting about "their" Day on 6 Feb; discussing "their" topic on "our" forum) then maybe they will support our plight as well, e.g. on "our" UN day (19 Nov)?

For example this organisation listed "5 ways you can end FGM" (pretty similar to 5 ways to end lack of sanitation)
www.girleffect.org/news/2014/02/zero-tolerance-to-fgm-2014/

1. END THE FGM TABOO
2. HELP CHANGE THE LAW
3. SUPPORT COMMUNITY EDUCATION
4. FULLY UNDERSTAND FGM
5. USE THE POWER OF SOCIAL MEDIA

I will end my post with a report by UNICEF which can help you with Point 4 (to fully understand FGM):
www.unicef.org/media/files/FGCM_Lo_res.pdf

And a map of the prevalence of FGM from the same UNICEF report (Egypt and Kenya are for me the biggest surprises; Egypt even more of a surprise to me than Kenya):



What are your thoughts on this? Do you see links between FGM and sanitation issues? Have you come across it in your work? Do you see a potential for WASH practitioners to get involved?

Regards,
Elisabeth

Hi Dani,

I think you bring up a very important issue!! The impacts of female genital mutilation (FGM) on water, sanitation & hygiene (WASH) and menstrual hygiene management (MHM) are indeed, very compelling, and are areas that beg for more research & attention.

The most startling revelation I had that connects these acronyms is when I read the personal stories of Waris Dirie, the Somali women who was cut and left with such a small hole that every time she went to urinate, the fluid could only escape only one drop at a time, taking her ten minutes to pee. During her menses, she explained that she was not able excrete the menstrual blood at the rate required, a monthly process that, in addition to the internal, uncomfortable changes that come with menstruating, caused her excruciating pain. I wonder how many countless other FGM MHM-related stories have been silenced due to the taboo nature of it all....

I am quite fascinated in what the SuSanA community has to contribute with regards to this... so please, share your experiences or knowledge!

- Danielle, WASH United