There's no question that female genital cutting is difficult to talk about. This is true not just in the United States, but even in the communities where it is practiced, in countries throughout Africa and parts of the Middle East and Asia. So when CARE began to work with communities in Ethiopia, Kenya and Sudan to try to stop the practice, just opening the discussion was the hardest step — and the most important.

A Complex Issue

Female genital cutting,  also called female circumcision, has affected more than 135 million women and girls worldwide. FGC includes to several different forms of cutting practiced for hundreds of years. Infibulation, the most severe, involves cutting some or all of the external genitalia, leaving only a very small opening for urination and menstruation.

Each ethnic group and community that practices FGC is unique, but some details are common across different cultures. In the communities where CARE works, girls are usually cut between the ages of 4 and 12. The cutting is performed by a circumciser, a woman who often is also a traditional birth attendant. The event is a rite of passage, celebrated by women in the community. Many communities see FGC as an important part of their heritage and cultural identity, and often believe it to be a religious obligation under Islam or Christianity. It also plays an important role in a girl's social standing: FGC is seen as ensuring her virginity until marriage, and thus her value as a bride.

But FGC can also cause serious health and social problems that follow a woman her whole life. The health complications from infibulation can include chronic and severe pain, infection, prolonged and difficult labor and difficulties with menstruation. Psychologically, cutting can cause tension between couples due to painful or difficult sexual relations. Socially, cutting makes it harder for girls to go to school or earn income by making them more likely to marry early.

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Starting the Discussion

Many health programs in a variety of countries have tried to eliminate FGC by educating people about the health problems the practice causes. But usually these projects didn't take into account the social support that the practice received, and most were only marginally successful. We know from past experience that in order to motivate a village to consider giving up a deeply-ingrained practice like FGC, our work has to address the social norms, beliefs and attitudes of the entire community. The trust that CARE has built through our long-term work with communities is crucial to our success.

When we began to work in communities in Ethiopia, Kenya and Sudan, the first step was to talk to a range of people in each village and find out what they felt about FGC. There were some people who wanted the practice to end or change, but most people felt it was important.

Many said FGC was required for religious reasons. "A woman who is not circumcised is not a Muslim," said one man in Kenya, while one woman in Sudan suggested that food prepared by an uncircumcised girl was haraam (unclean under Islamic law). FGC was also seen as an ancestral practice, passed down through generations; women in particular saw themselves as custodians of this cultural tradition. Many people spoke of sexuality, saying that FGC ensured the girl would remain a virgin until marriage, and that after marriage, the practice would ensure she remained faithful to her husband. Many believed that no one would marry an uncircumcised girl, and that such girls would be subjected to abuse and insults. Very few people, especially among the men, knew about the health consequences of FGC. What they did know was often limited to immediate problems after the procedure, rather than long-term effects like difficulty in childbirth or pain during sex.

CARE's Approach

Listening to the communities and understanding how they valued FGC made it clear that any effective program would need to change deep-seated attitudes and assumptions. CARE decided to work with key members of the community, such as religious leaders, elders and traditional birth attendants. These leaders are highly respected and play an important role in upholding social customs. Working closely with these key people, CARE provided training and educational sessions to talk about the health problems caused by FGC and discuss some of the justifications for the practice.

It was especially important to convince community leaders that there was no religious obligation to perform FGC. In Ethiopia, CARE organized a four-day seminar for 12 religious leaders to study the Quran and other Islamic scripture for references to female circumcision. At the end of the meeting, the leaders agreed that Islam did not require communities to perform FGC. Their outreach following the seminar led to more than 50 other imams speaking out in favor of abandoning FGC.

CARE worked with these community leaders to start a community dialogue about FGC, in some cases organizing large public discussions where community members could talk about the issue in a safe environment. Just getting communities to talk about the practice at all was a huge first step, giving people a chance to learn about the consequences of FGC and voice their opinions and concerns. The discussions also helped people to consider how the practice affected the rights and social status of women and girls in the community. More and more people learned about the harmful effects of the practice and began to question its value.

Changing from Within

Slowly but surely, progress is being made. We have already seen changes that would have seemed impossible a few years ago. Communities are now having public debates about alternatives to FGC. Women are taking active roles in the discussions. Families are starting to state publicly that they do not want their girls to be cut. In Ethiopia, clan leaders from 70 communities have united to declare an end to the practice of FGC in their villages.

Change has not been easy. As one CARE staff member recalled: "At the beginning, it was difficult, even risky to talk about FGC. One Ethiopian man was so fearful that CARE staff were coming to prevent him from circumcising his daughter that he pointed a gun at two field workers and held them hostage inside their car. The CARE staff rolled down their window and talked to the man for an hour. They then got out of the car and talked for another two to three hours. Finally, the man gave them afu, a ceremony asking for forgiveness."

Despite the difficulties, however, CARE's work has shown that, with a respectful approach, it is possible to break the silence and start an effective community dialogue about abandoning female genital cutting. For the thousands of girls who risk undergoing the painful procedure every day, it's a discussion that can make a world of difference.

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