Today is the International Day of Zero Tolerance for Female Genital Mutilation (FGM). The United Nations website for the Day notes that globally, 200 million girls and women alive today have undergone some form of FGM, and 15 million more may be subjected to it by 2030 under current trends.

FGM, especially in its extreme forms, has serious health risks (World Health Organization 2016) and may even lead to death, apart from the psychological trauma it may cause. Infibulations are the most severe form of FGM and entail the removal of the clitoris and labia, and can include stitching together the edges of the vulva.

While low-income countries such as Somalia, Guinea, and Djibouti have high prevalence rates, FGM is also prevalent elsewhere including in Egypt.

Eliminating FGM is part of the SDGs

Target 5.3 of the Sustainable Development Goal 5 for gender equality calls for eliminating FGM. Achieving this target will not be easy. It will require concerted efforts. This is because many factors come into play for the perpetuation of FGM, including entrenched cultural and social norms.

As a result, to be successful, interventions towards ending FGM typically need to be driven by, or at least involve, the community. This requires gaining in-depth knowledge of local communities and paying careful attention to what works to successfully engage with leaders, including religious leaders (Johansen et al. 2013; UNFPA 2004; UNICEF 2010).

Interventions need to have a comprehensive approach, whereby prevention, protection, but also prosecution, when needed, and provision of services for those already excised, are to be included. Therefore, it is essential that different stakeholders such as policy makers, NGOs, religious leaders, as well as health professionals work together towards ending FGM.

How to reach those who practice FGM

In many settings, FGM continues to be perceived as a recommended practice under people’s faith. Yet actual support for the practice in religious texts—including in Islam—is very weak. More arguments based on faith can often be made against the practice as opposed to in its favor. Still, because the practice is entrenched, laws without appropriate community engagement have limited effects and may even in some cases lead to the practice being simply hidden, as opposed to suppressed.

This is why education has such an important role to play, both in a broad sense in order to support changes in traditional gender roles when those roles perpetuate gender discrimination, but also in a more targeted sense to reach those who actually practice FGM and explain the negative consequences of the practices.

Education of healthcare providers can help

In some countries such as Egypt, the practice is highly medicalized. As a result health personnel could play an important role in ending the practice. Medicalization is due in part to the perceived safety of health professionals in performing the procedure in comparison to traditional practitioners.

Yet a problematic structure of incentives is at fault when doctors performing a FGM may be earning more than what they would receive for a regular doctor’s visit. Medicalization also carries the risk of legitimizing the practice.

Proper training about FGM in the medical and nursing curricula can ensure that healthcare providers stop considering FGM as either harmless or medically indicated for women. Medical students need to know the risks associated with FGM and targeted information campaigns are vital.

Successful programs convey information about the potentially harmful effects of female genital cutting for health and rights by putting the community in the lead. These programs aim to change social norms at the community level instead of only individual attitudes, and empower women.

Overall, due to their sensitivity and complexity, practices like FGM must be countered with multi-sectoral engagements and the combined efforts not only from ministries (typically health, women’s affairs and education), but also civil society.

Pilot programs provide insights into what works

Ideally FGM should be treated as a human rights issue and not simply a health issue. Tostan and other non-governmental organizations have been leading the way in implementing programs to end FGM, but other organizations including national agencies are also active. In Egypt, an evaluation of the FGM-Free Village Model indicated that the program was successful in changing views and attitudes towards FGM.

The evaluation emphasized the role of mass media and the need to engage men and religious leaders. It cautioned against simply focusing on the physical consequences of the practice as this could lead to medicalization rather than eliminating the practice.

Beyond the issue of medicalization, FGM fundamentally remains prevalent in societies with often pronounced gender inequalities and power imbalances and cannot be ended without ensuring women’s empowerment. Again, education has a critical role to play in this respect.