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GAGE Ethiopia’s qualitative research team on FGM/C

An adolescent girl attends a girls’ club meeting in Afar, Ethiopia. Photo: UNICEF Ethiopia

FGM/C is believed to be widespread in Ethiopia. The 2016 Demographic and Health Survey found that over 65% of women aged 15–49 were circumcised, including 47% of girls aged 15–19 and 59% of young women aged 20–24. The Government of Ethiopia has committed, however, to end female genital mutilation/cutting (FGM/C) by 2025 in collaboration with development partners and NGOs.

As part of the GAGE Ethiopia qualitative research team’s debriefing for the baseline research, GAGE Director Nicola Jones recently talked to Abreham Iyasu, Meti Kebede, Kassahun Tilahun, Fitsum Workneh and Workneh Yadete about their reflections on girls’ circumcision, the effects it is having on adolescent girls’ lives in Ethiopia, and forces for change over time. They highlight that the process of change is likely to be complex due to deep-seated cultural and religious norms and practices.

Having just been to multiple sites across Ethiopia, can you please start by describing the range of circumcision practices you have encountered?

Meti: The thing that stood out for me was the fact that the age when girls are circumcised and the type of circumcision they undergo differs widely. In Afar for example we found that girls of very different ages may all be circumcised at the same time. One family I interviewed explained that the aunt (aged 12 years), the oldest daughter (10 years) and her infant sister (1 year) had all been circumcised a month ago together at home. Other girls however are getting circumcised in a group – recently 20 girls in one of the villages we were researching were circumcised together by a traditional birth attendant.

Fitsum: In Amhara some girls avoid circumcision because they are perceived to be ‘naturally circumcised at birth’ while others are circumcised at 7 days. By contrast, in Harar, we found that there is very limited awareness raising about the risks of circumcision and that girls are asking their mothers to be circumcised before they start participating in the Shagoyeh cultural dance in which young people participate to find a marriage partner.

Are you seeing change in attitudes and practices vis-à-vis female circumcision practices and if so in what ways?

Fitsum: I’m a bit sceptical. In the case of Afar, people have been telling us there is a change from very invasive practices to the milder so-called ‘sunna’ type that Islamic religious leaders are promoting. But at the same time we are hearing that when adolescent girls and young women give birth that they need to be incised suggesting more invasive practices are still common…. We also hear that girls have their legs bound together by rope when the practice is carried out, and they remain like that for at least a week in order for the wound to heal. And then in Oromia, when we asked about what the community was doing to tackle harmful traditional practices, the response was ‘we will tell them not to use the same sharp object from one girl to another’ rather than thinking about eradication…

Workneh: Yes it’s true but in the past in Harar there was complete removal – it was totally brutal and afterwards girls would be stitched up with thorns – can you imagine?! – but after Menschen fuer Menschen came in the late 1990s, there has been dramatic change. They worked with community leaders to change people’s attitudes about circumcision and now very few girls undergo the severe practice – almost all are now opting for the much milder type which religious leaders argue is more in keeping with Koranic scriptures.

In Afar though change is slower. One father I talked to explained that the girls are often circumcisedin a group –the others stay nearby and sometimes when the girl under the blade is screaming, other girls become upset and run away. The men will stand far away – and catch them – and bring them back. But look at the psychological trauma when it is mass circumcision. You can understand if there are 20 girls what suffering the 20thgirl must face. It is terrible!

Meti: Traditional perceptions are still widespread. In some sites we heard people saying that unless a girl’s clitoris is removed through circumcision it will continue to grow and she will become like a man!

Abreham: NGOs are calling for the complete avoidance of circumcision – but still religious leaders are promoting slight removal as the tip of the clitoris is assumed to be ‘haram’ (forbidden by the Koran). In fact there is no clear statement in the Koran – but woreda (district) level religious leaders enforce messages like this – and those on the ground comply with these.

Kassahun: Yes, and there is still this idea that without circumcision a girl will have strong sexual feelings, break things in the house, become clumsy and hard to control.

Abreham: And we can’t forget one important thing – there is also a perception that if girls are not circumcised that it will be hard for the boy to take her virginity at marriage.

Where there is change, what factors are driving this?

Workneh: When we talk to the Bureau of Women and Children’s Affairs they take a strong stand but it is challenging for this sentiment to translate down at community level. And it is difficult as the women in these positions themselves are often subject to gender discrimination and violence themselves.

Meti: Yes one official I talked to complained that her husband is beating her almost every day – three times she was admitted to hospital.  And although she asked for divorce – he repeatedly refused – and so she has no option but to stay with him.

Workneh: Religious leaders play a key role in agitating for change – against the kind of brutal and harsh circumcision. They explain that it is not in the Koran – and this is helpful as when NGOs start to educate people and religious leaders confirm that there is nothing about sewing or re-stitching after circumcision, then the practice was very quick to change.

Fitsum: Health extension workers are also really trying – their intervention is recent but they are trying.

Meti: Girls clubs or anti HTP (harmful traditional practice) clubs in schools can be effective in raising awareness but the problem is that in the places where it may be most needed, there are no active clubs.

Abreham:  The solution is to convince religious leaders. In the case of the cultural dance that Workneh mentioned before – Shagoyeh – in which we found that many young adolescents in Haraghe are regularly engaged and dropping out of school, when community officials tried to change things no one listened. But in locales where religious education is strong, the practice has greatly declined highlighting the huge acceptance of the teachings of religious leaders. Even so in that case it requires that the leaders at the big city level buy into the change first, so that they can convince the leaders underneath them and they in turn the communities.

Having encountered this diversity of attitudes and practices, what steps do you think need to be taken from a policy and programming perspective? Which champions of change might we be able to learn lessons from for the future?

Workneh: The mothers want their daughters to be circumcised – internally I believe that it is part and parcel of our culture – it is perceived as a respect for the mother, beauty for the daughter. It is not just about religion – but about deep-rooted culture. It doesn’t mean you can’t bring changes – but religious understandings of these practices is more superficial. In Harar people are seeing that  –the changes from this old kinds of circumcision is now contributing to early sexual relations and so they are starting to resist and moving the practice underground. So unless we work on the elders we may not see sustainable change.

We also need to work on the mothers – in many places mothers are happy if their daughters are circumcised.

And we also have to consider the young generation – in order to improve their agency – at school and at the community level – in some locales circumcision has almost stopped as girls now start to resist against the mothers. And boys are supportive. However, if the boys are not supportive and insult her as ‘lumbut’ / ‘unclean’, then you may find as we saw in Ziway that girls are then compelled to be circumcised after marriage.

Abreham: In Amhara the Orthodox Christian leaders are quite dominant and they are helping to bring change. And we saw during our research that the contribution of Care Ethiopia is huge in kebeles (communities) close to the woreda (district) town – religious leaders have attending trainings on HTPs and the risks to health – they could discuss lots of details – and they are promoting this in church – not only on Sundays after prayer but also during house to house visits to their ‘spiritual children’.

Meti: It is good to strengthen these school clubs and provide girls with confidence – I was really struck by one ten year old girl that we talked to saying she would rather be a boy as they have so many advantages.

Workneh: NGOs can play key roles. Menschen fuer Menschen’s contribution is so huge in Haraghe – they constructed a school as a mechanism to enter the community – and to reduce this culture of circumcision, they made a huge campaign with health extension workers, teachers, community members. And we saw in Fedis district that there is no intention to go back to the old tradition. But elsewhere because the agitation is stopped it is changing back now in some locales.

Kassahun: And in Afar we saw that Save the Children is providing different kinds of incentives and awards to encourage girls in the towns to remain uncircumcised. But this may not be sustainable.

Abreham: And health extension workers at kebele level are helping to change perceptions. School clubs are very influential and for some, radio dramas.

Workneh: Elimination of circumcision is the most important – we need to stick to the law – agitate and campaign on that.

Messaging around health risks appear to have been quite effective in helping to shift practices from the more severe type of circumcision to less invasive forms. But the messaging is likely to be more complex in the case of working towards complete eradication. Based on the conversations you have had with communities during the baseline data collection, what sort of framing might work?

Kassahun: We could start with sexual health – and that avoiding circumcision is key to girls’ rights to sexual health.

This is clearly important but do you think that framing will be convincing in conservative rural areas?!

Abreham: The channel matters – it really depends on whether we are talking about broadcast media or policy implementers or community leaders. ‘Girls have rights’ could be persuasive at Addis level but we will need to have a different approach in rural areas for sure.

Fitsum: ‘Girls and women have the right to freedom from physical harm – plus circumcision has no benefit – just negative impacts’. I think this has to be the messaging.

Workneh: ‘Girls and boys have the freedom not to be physically harmed – in any part of their body’. We need to see it as a child protection issue.

And in cases where religious ideas have strong resonance, would this work?

Abreham and Workneh: Perhaps the message should be something like ‘Allah is complete and so human beings are already created perfect’. This might be a good way forward especially in countering the idea in Muslim areas that the tip of the clitoris is ‘haram’. This idea definitely needs to be changed.