All-Party Parliamentary Group on
POPULATION, DEVELOPMENT AND REPRODUCTIVE HEALTH
Hon Chair: Christine McCafferty MP
Hon Vice-Chair: Viscount Craigavon
Joint Hon Secretaries: Geoffrey Clifton-Brown MP, Martyn Jones MP
Joint Hon Treasurers: Baroness Flather, Tony Worthington MP
FEMALE GENITAL MUTILATION
SURVEY REPORT AND ANALYSIS
REPORT OF THE FINDINGS OF RESEARCH ABOUT THE WORK OF ORGANISATIONS IN THE UK AND OVERSEAS ON FEMALE GENITAL MUTILATION
Parliamentary Advisor: Ann Mette Kjaerby
All-Party Parliamentary Group on Population, Development and Reproductive Health
Room 563 Portcullis House, Westminster, London SW1A 2LW
Tel +44 (0) 20 7219 2492 Fax:+44 (0) 20 7219 2641
e-mail:
Website:
NOVEMBER 2000
TABLE OF CONTENTS
INTRODUCTION………………………………………………..p.1
KEY FINDINGS………………………………………………….p.2
SURVEY DETAILS……………………………………………...p.3
SURVEY ANALYSIS…………………………………………….p.5
1)BACKGROUND ………………………………………………p.5
a)Organisation contact details
- Geographic distribution of respondents
b)Type of respondent
c)Organisational objectives of respondents
d)Target group of respondent's services
2)ISSUES ………………………………………………………..p.8
a)Descriptive term used
b)Alternative practices
c)Health response
- Medicalisation of FGM
ii.Code of Conduct
d)Legislative response
- Role of Government
- Prosecutions
- Obstacles to prosecutions
e)Research
3. SERVICES ……………………………………………………….p.17
a)Organisation activities
- Services and support
- Cost and confidentiality of services
b)Community work
c)Problems and Achievements
d)Training
e)Origin of community
4) FUNDING ………………………………………………………. p.23
a)Budgeting
b)Fundraising
- Difficulties in obtaining funding
- Limitations on funding sources
- Funding sources
APPENDICIES ……………………………………………………p.29
Appendix I:Members of the FGM Steering Group - Questionnaire design
Survey analysis and report compilation
Appendix II: List of Organisations returning questionnaires
Appendix III:Questionnaire
INTRODUCTION
Female Genital Mutilation (FGM), also known as Female Genital Cutting (FGC) or Female Circumcision, involves procedures which include the partial or total removal of the external female genital organs for cultural or any other non-therapeutic reasons[1]. It is estimated that 130 million women and girls have undergone FGM and that 2 million girls are at risk of undergoing the procedure every year. The procedure is usually performed on girls between the ages of 4-13, but in some cases FGM is performed on new born infants or on young women prior to marriage or pregnancy. Most of the women and girls affected live in Africa, although some live in the Middle East and Asia. However, women and girls who have undergone, or are at risk of undergoing, FGM are increasingly found in Western Europe and other developed countries, primarily among immigrant and refugee communities.
To raise awareness of FGM in the UK and abroad and to generate support for FGM prevention and eradication programmes, the All-Party Parliamentary Group on Population, Development and Reproductive Health held two Parliamentary Hearings in May 2000.
The first Hearing was for witnesses from the UK and covered issues such as training, the effectiveness of the law against FGM, support services and care available and work with community based organisations. The second day of the Hearings was for witnesses from Europe and beyond covered overseas activities on FGM.
In preparation for these Hearings a questionnaire was circulated to organisations who were identified working in the field of FGM in the UK, Europe, Africa and the USA. To get a picture of the FGM policy and issues in UK, questionnaires were also sent to local health and education authorities, social service departments and refugee councils.
The responses to the questionnaire are analysed here and presented as an additional source of information and an accompaniment to the “Parliamentary Hearings on Female Genital Mutilation” Hearings Report, November 2000.
The All-Party Parliamentary Group would like to thank the UK Department for International Development for sponsoring the research analysis and production of this report.
Christine McCafferty MP
Chair
KEY FINDINGS
- BACKGROUND
- Responses to the FGM Questionnaire were received by 52 UK respondents and 45 overseas respondents. 45% of all respondents classified themselves as "Non-Governmental Organisations", among UK respondents another popular response was "Local Health Authority."
- "Advocacy and campaigns" and "Education and training" were the most popular FGM related activities cited by respondents.
- ISSUES
- FGM was the preferred terminology of respondents (85%).
- The vast majority of respondents were opposed to the medicalisation of FGM (94%) and expressed that there should be a general code of conduct for health professionals (91%).
- When asked what they thought should be the role of Government in addressing the eradication of FGM, a sizeable majority of respondents (75%) mentioned issues relating to the provision and implementation of a legal framework.
- Less than half (46%) of the UK respondents mentioned an awareness of the UK Prohibition of Female Circumcision Act 1985.
- The majority of the respondents cited pressure from the family or community, which is closely associated with a lack of evidence, as an obstacle for prosecution on FGM.
- 25% of UK respondents surveyed expressed a fear of being perceived as racist or culturally insensitive when dealing with FGM issues, in Europe 8% expressed a concern.
- SERVICES
- The most popular activities that the respondents were engaged with were activities to raise awareness of the issues of FGM, the provision of information about FGM and promoting understanding of FGM. Health and education service provision was popular in the UK, which reflected the composition of questionnaire respondent.
- Of the respondents that provided services, the vast majority (90%) answered that their services were provided free of charge.
- In the UK 77% of respondents said their services were confidential. In Europe 54% and in Africa 64% of respondents said their services were confidential.
- The most frequently mentioned problems encountered by respondents were the objections from religious and cultural groups and the barrier to discussing sexual taboo subjects. Other common issues cited included a lack of funding, particularly among African respondents, and the related obstacles of limited awareness and denial of the problems of FGM.
- A wide variety of "Countries of Origin" African community groups were represented in the survey. The most common group in the UK was the Somali community.
- FUNDING
- Most respondents currently spend less than 5% of their budgets on FGM.
- For all types of funding source, respondents had difficulties raising funds because they perceived that potential donors regarded FGM as less important than other priorities.
- In both UK and Europe the three most important sources of funding were seen as national Governments, the EU and trusts/foundations. However, in Africa, there was an increased emphasis on trusts and foundations relative to Government and EU sources.
SURVEY DETAILS
Sampling frame
Following a full review of NGO's and other contacts in the field, survey questionnaires were sent to organisations who were identified as playing a role in FGM policy and issues in the UK, Europe, Africa and the USA. In the UK, questionnaires were also sent to local health and education authorities, social service departments and refugee councils.
A total of 240 questionnaires were sent out to UK addresses, and a further 140 were sent to overseas addresses. Responses were received from 52 UK respondents and 45 overseas, although it should be noted that 23 (31%) of these were sent back by the original questionnaire recipient and in fact the questionnaires may have been passed on by the original recipients to a more appropriate respondent.
The low response rate from the UK can partly be explained by the number of organisations in the UK who probably do not address FGM as a primary area of concern, whereas the overseas recipients had already been identified as taking an interest in FGM activity.
UK / OVERSEAS / TOTALSent / 240 / 140 / 380
Received / 52 / 45 / 106
Response rate / 22% / 32% / 28%
Received from list / 39 / 35 / 74
Received from other / 13 / 10 / 23
Questionnaire design
The questionnaire was organised into 4 main sections, and this analysis has been prepared accordingly:
1)Background
a)organisation contact details
b)type
c)objectives
d)target group
2)Issues
a)descriptive term used
b)alternative practices
c)health response
d)legislative response
e)research
3)Services
a)activities
b)community work
c)problems and achievements
d)training
e)collaboration
4)Funding
a)budgeting
b)fundraising
The following report synthesises responses to all relevant questions in the survey, with the one exception of a question on human rights, that was later deemed ambiguous (question 3 in the section of Issues) - see Appendix III for the questionnaire that was received by all survey respondents. Unless otherwise stated, respondents were asked open-ended questions with the opportunity to provide a freely worded response. After the completion and collection of all survey entries, these answers were assessed and coding frames were developed. Every open-ended questionnaire response was assigned one or more codes according to pre-determined categories. Questionnaire responses were double entered and cross-checked using the QPS MR suite of programs and data analysis was carried out using SPSS v10 statistical software.
SURVEY ANALYSIS
1)BACKGROUND
a)Organisation contact details
i.Geographic distribution of respondents
97 valid questionnaire responses were received and subsequently analysed below. Of these, 52 responses (54%) were from organisations located within the UK, 18 (19%) were from other European countries, three (3%) were from the USA and 24 (25%) were from countries in Africa. The distribution of countries and regions of response is shown below:
Frequency / FrequencyEurope / Africa
Belgium / 1 / Côte d’Ivoire / 1
Denmark / 2 / Ghana / 2
France / 4 / Kenya / 3
Germany / 5 / Mauritania / 1
Greece / 2 / Nigeria / 1
Italy / 2 / Republic of Congo / 1
Netherlands / 1 / Senegal / 1
Portugal / 1 / Sierra Leone / 1
Spain / 2 / Sudan / 3
Sweden / 3 / Tanzania / 1
The Gambia / 2
Togo / 1
Uganda / 1
Subtotal / 75 / Subtotal / 19
b)Type of respondent
Organisations were offered a choice of 11 different responses from which to choose the best description of their type of organisation. The most popular response, given by 43 respondents (45%) was “Non-governmental Organisation”. Among UK organisations, other popular responses were “Local Health Authority” (11 responses) and “Health Facility, e.g. specialist care or antenatal care clinic” (11 responses). Responses classified as ”Other” included: Individual (4 responses, UK and Europe); Area Child Protection Committee (2 responses, UK) and Trade Union/Professional Association (4 responses, UK).
Organisation Type / UK / Europe / Africa / US / Total / % respondentsNGO / 13 / 14 / 14 / 2 / 43 / 45.3%
Research Institution / 1 / 2 / 3 / 3.2%
Local education authority / 3 / 1 / 4 / 4.2%
Church Group / 1 / 1 / 1.1%
Governmental Body / 1 / 4 / 5 / 5.3%
Academic Institution / 1 / 2 / 1 / 4 / 4.2%
Local Health Authority / 11 / 11 / 11.6%
Health Facility / 11 / 1 / 12 / 12.6%
International organisation / 3 / 2 / 2 / 7 / 7.4%
Advocacy group / 3 / 2 / 2 / 7 / 7.4%
Local authority / 7 / 1 / 8 / 8.4%
Other / 14 / 1 / 3 / 2 / 20 / 21.1%
Total responses / 68 / 26 / 25 / 6 / 125
Total cases / 52 / 23 / 17 / 3 / 95
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
c)Organisational objectives of respondents
Survey respondents were questioned about the general objectives of their organisation and how they relate to FGM in two separate open-ended questions. Responses from these questions were combined and categorised into 8 types of objectives relating to their work on FGM. The most popular responses given to these questions cited objectives relating to “Advocacy and campaigns” and “Education and training” (listed by 53 and 41 respondents respectively). Common responses among UK organisations, which were predominantly local health and social services authorities, were objectives relating to “Counselling and social support” and “Welfare and Child protection”; while African and European respondents, which were mainly NGOs, listed goals relating to “Research” and “Women’s empowerment”. This may reflect the continuing importance of community-based women’s empowerment groups as a priority in developing countries.
FGM Objectives / UK / Europe / Africa / USA / Total / % casesEducation and training / 14 / 12 / 12 / 3 / 41 / 43.6%
Advocacy and campaigns / 20 / 12 / 18 / 3 / 53 / 56.4%
Women s empowerment / 6 / 7 / 10 / 23 / 24.5%
Research / 3 / 10 / 5 / 18 / 19.1%
Medical Services / 19 / 1 / 6 / 26 / 27.7%
Counselling and social support / 17 / 4 / 1 / 22 / 23.4%
Welfare and Child protection / 12 / 3 / 3 / 18 / 19.1%
Legal enforcement / 2 / 4 / 2 / 8 / 8.5%
Other / 1 / 1 / 1.1%
Total responses / 93 / 54 / 57 / 6 / 210
Total cases / 49 / 23 / 19 / 3 / 94
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
d)Target group of respondent’s services
Survey respondents were offered a choice of 10 options to describe the target group of their services and activities. By far the most popular response across all regions was “Women”, to whom 73 respondents (81%) aimed their services. Migrant and Refugee work were more frequently mentioned in the UK and Europe which indicates that these are the communities where there is a prevalence of FGM, but could also indicate that refugee migrant communities moving to other African countries are not seen as a priority.
Target group / UK / Europe / Africa / USA / Total / % casesWomen / 36 / 19 / 18 / 73 / 81.1%
Children / 23 / 8 / 12 / 43 / 47.8%
Adolescents / 17 / 12 / 14 / 43 / 47.8%
Refugees / 21 / 10 / 4 / 35 / 38.9%
Migrants / 13 / 12 / 5 / 30 / 33.3%
Social Services / 13 / 14 / 4 / 31 / 34.4%
Local Education Authority / 9 / 8 / 4 / 21 / 23.3%
Local Authority / 10 / 6 / 5 / 21 / 23.3%
Local Health Authority / 14 / 10 / 3 / 27 / 30.0%
Professional Health Association / 16 / 11 / 4 / 1 / 32 / 35.6%
Other / 11 / 2 / 6 / 3 / 22 / 24.4%
Total responses / 183 / 112 / 79 / 4 / 378
Total cases / 47 / 21 / 19 / 3 / 90
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
2)ISSUES
a)Descriptive term used
Survey respondents were asked what name they use to refer to the cutting of female genitalia, and offered a choice of four commonly used terms, as well as traditional local names. The phrase “Female Genital Mutilation” has gained popular currency as both a descriptive term and a political lobbying tool among international organisations and is evidently the most popular term used (n=82, mentioned by 85% of respondents). However, use of the term “Female Circumcision” still remains common in the UK (mentioned by 15 out of 52 UK respondents: 29%), where even the relevant law is named The Female Circumcision Act. Traditional and “other” responses included two European organisations that used the term "Gudniin" (country of origin: Ethiopia, Somalia and unspecified), a Nigerian organisation using the term “Ibeugwu”, a Kenyan organisation using “Mutata Tipin” and a Tanzanian organisation using “Ukeketaji”. The use of different terminology in these answers reflected the overall need to be sensitive in addressing FGM at all levels.
Call the practice / UK / Europe / Africa / USA / Total / % casesFemale Genital Mutilation / 47 / 19 / 13 / 3 / 82 / 84.5%
Female Genital Cutting / 4 / 1 / 5 / 10 / 10.3%
Female Circumcision / 15 / 5 / 4 / 24 / 24.7%
Female Excision / 1 / 2 / 2 / 5 / 5.2%
Traditional name / 1 / 3 / 4 / 8 / 8.2%
Other / 2 / 2 / 2.1%
Total responses / 70 / 30 / 28 / 3 / 131
Total cases / 52 / 23 / 19 / 3 / 97
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
b)Alternative practices
A total of twenty-nine organisations (36% of respondents, of which 10 were from the UK, 8 European, 9 African, 2 USA) answered “Yes” to the question “Do you think there is a good alternative to the tradition of FGM?” Half of all 18 African organisations providing a response to this question answered “Yes”, compared to 25% and 40% in the UK (n=40) and Europe (n=20) respectively.
Is there an alternative to FGM?
UK / Europe / Africa / USA / Total / % respondentsYes / 10 / 8 / 9 / 2 / 29 / 35.8%
No / 30 / 12 / 9 / 1 / 52 / 64.2
Missing / 12 / 3 / 1 / 1 / 17
Alternative, non-mutilating rites of passage initiation ceremonies were identified as being a viable option in Kenya, Uganda, Ghana, The Gambia, and Senegal. Symbolic ritual celebrations suggested for such ceremonies included the giving of gifts (Uganda, Ghana), placing stones or seeds (Kenya), cutting a chicken (Côte d’Ivoire) and throwing a party (Ghana). “Ntanira na Mugambo” (Circumcision through words) was an example used in a Kenyan community group to mark a girls passage to womanhood. Other respondents identified other forms of circumcision (eg sunna) as a suitable alternatives to FGM (Somalia and Egypt) – whereas this is actually considered by the WHO to be a sub-classification of FGM (see footnote 1) so is not seen as an acceptable alternative. One UK recipient mentioned the practice of “pricking the clitoris” as a suitable alternative, but FGM remains illegal in the UK.[2]
c)Health Response
i.Medicalisation of FGM
The vast majority of respondents (93.5%, n=87) were opposed to any attempts by health professionals to engage in the cutting of female genitalia. A small minority of respondents (6.5%, n=6), were in favour of the medicalisation of FGM. Those who supported medical professionals carrying out the procedure cited hygiene and safety as the main reasons.
The most commonly given reason against health professionals carrying out FGM (used by 61% of medicalisation opponents, n=47) was that the practice could not be medically justified. Other popular responses were phrased in terms of a human rights argument (used by 27.3% of opponents to medicalisation, n=21). A further 28 responses (36.4% of medicalisation opponents) claimed that to allow medical professionals to carry out the practice of FGM even under hygienic conditions, would be equivalent to legitimising or sanctioning the practice: giving it credibility as a medical practice, whereas in fact FGM has no medical benefits.
Why health professionals should cut / Count / % CasesHygiene, safety / 3 / 75
Other / 3 / 75
Total responses / 6
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
Why health professionals should not cut / Count / % CasesMedical / 47 / 61
Legal / 2 / 2.6
Human Rights / 21 / 27.3
Psychological / 8 / 10.4
Legitimises practice / 28 / 36.4
Other / 4 / 5.2
Total responses / 110
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses
- Code of Conduct
82 respondents (91.1% of all who answered the question) were of the opinion
that there should be a general FGM Code of Conduct for health professionals. By far the most popular justification for this response (given by 79.2% of respondents, n=57) was that it would be advantageous to formulate practical guidelines for the provision of information and treatment in order to standardise practice among health professionals. Other reasons given in favour of a Code of Conduct included opening up the option of legal enforcement and the promotion of education that will encourage behaviour change eventually leading to the prevention of FGM.
8 respondents replied that there should not be a Code of Conduct specifically for FGM. These included two respondents citing inevitable practical difficulties in the implementation of such a Code, especially in the light of such a wide variety of practice and context. A further two respondents were opposed to singling out the practice of FGM for such special attention, which may stigmatise women who have undergone FGM. These respondents favoured FGM Guidance incorporated in a general Health Code of Conduct.
Why there should be a code / Count / % CasesGuidelines and standardisation of practice / 57 / 79.2
Legal enforcement / 13 / 18.1
Prevention of FGM / 16 / 22.2
Education and behaviour change / 11 / 15.3
Total responses / 97
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
Why there should not be a code / Count / % CasesPractical implementation difficulties / 2 / 40
Should integrate into general settings / 2 / 40
Other / 1 / 20
Total responses / 5
Note: percentage column totals may exceed 100% since respondents were permitted to give multiple responses.
d)Legislative response
i.Role of Government
When asked what they thought should be the role of Government in addressing the eradication of FGM, a sizeable majority of respondents (75%, n=64) mentioned issues relating to the provision and implementation of a legal framework. This may not be surprising considering that this question was headed “a legislative response to FGM”, already raising the issue in the minds of respondents. The second most popular response mentioned was domestic activities relating to education and awareness-raising (n=41, 48%). Both of these roles were mentioned by respondents from the UK, Europe and Africa. Proportionately more UK respondents than European groups answered that there was a role for the Government in the provision of social and health services, although this may reflect the organisational composition of the respondents. The provision of health and social services as a responsibility of the Government was barely mentioned by African respondents, perhaps reflecting the growing dependence on NGO activities and international aid. Few organisations from either the UK or Europe listed international campaigning among countries where FGM is commonly practised as a role for Government.