Circumcisers in the Gambia publicly declaring that they have abandoned the practice of FGM. Credit: Saikou Jammeh/IPS

By Saikou Jammeh
BANJUL, Jul 13 2014 (IPS)

Women’s rights activists in the Gambia are insisting that more than 30 years of campaigning to raise awareness should be sufficient to move the government to outlaw female genital mutilation (FMG).

The practice remains widespread in this tiny West African country of 1.8 million people, but rights activists believe that their campaign has now reached the tipping point.

Two years ago, GAMCOTRAP, an apolitical non-governmental organisation (NGO) committed to the promotion and protection of women and girl children’s political, social, sexual, reproductive health and educational rights in The Gambia, and one of the groups behind the anti-FGM campaign, sponsored a draft bill which has been subjected to wide stakeholder consultations.

Several previous attempts to legislate against FGM have failed, with no fewer than three pro-women laws having had clauses on FGM removed from draft bills. But activists now appear determined to make the final push and hope that when introduced this time round, the bill will go through.“We’ve caused lots of suffering to our women ... if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem” – former circumciser Babung Sidibeh

The time has now come for final action, says Amie Bensouda, legal consultant for the draft bill. “There can be no half measures. The law has to be clear. It’s proposed by the law that FGM in all its forms is prohibited. This discussion cannot go on forever. The government should do what is right.”

“The campaign has reached its climax,” Dr Isatou Touray, executive director of GAMCOTRAP, told IPS. “A lot of work has been done. I am hopeful of having a law because women are calling for it, men are calling for it. I know there are pockets of resistance but that’s always the case when it comes to women’s issues.”

“In 2010, we organised a workshop for the National Assembly,” she continued. “They made a declaration, pledging to support any bill that criminalises FGM. I am happy to report that, since 2007, more than 128 circumcisers and 900 communities have abandoned the practice. This trend will continue to grow.”

Seventy-eight percent of Gambian women undergo FGM as a ‘rite of passage’. However, after more than three decades of the anti-FGM campaign in Gambia, a wind of change is blowing, sweeping even conservative rural communities.

Sustained awareness-raising programmes have resulted in public declarations of abandonment of FGM by hundreds of circumcisers. Babung Sidibeh, custodian of the tradition in her native Janjanbureh, the provincial capital of Central River Region, 196 kilometres from Banjul, was one of them. The old woman assumed the role after the death of her parents, but she has since “dropped the knife”, as no longer practising FGM is known here.

Sidibeh did so after receiving training in reproductive health and women’s rights. “Soon after we circumcised our children in 2011,” she told IPS, “Gamcotrap invited me for training. I was exposed to the harm we’ve been doing to our fellow women. If I had known that before what I know today, I would never have circumcised anyone.”

With a tinge of remorse, she added: “We’ve caused lots of suffering to our women. That’s why I told you that if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem.”

Mrs Camara-Touray, a senior public health worker at the country’s heath ministry confirmed to IPS that her ministry has since taken a more proactive role on FGM.

She explained: “The ministry has created an FGM complication register. We’ve also trained nurses on FGM. Until recently, when you asked most health workers about the complications that can arise with FMG, they would say it has no complications. That’s because they were not trained. Since 2011, we’ve changed our curriculum to include these complications. After we put the register in place, within three months, we’d go to a region and see that hundreds of complications due to FGM had been recorded.”

In March, Gamcotrap organised a regional religious dialogue that sought to de-link FGM from Islam. Touray said that the workshop was a prelude to the introduction of the proposed law in parliament.

“Islamic scholars were brought together from Mali, Guinea, Mauritania and Gambia,” she told IPS. “We had a constructive debate and it was overwhelmingly accepted that FGM is not an Islamic injunction, it’s a cultural practice. It was recommended that a specific law should be passed and a declaration was made to that effect.”

However, there is resistance in some quarters. An influential group of Islamic scholars, backed by the leadership of the Supreme Islamic Council, continue to maintain that FGM is a religious injunction.

With a large following and having the ears of the politicians, these clerics have in recent times also intensified their pro-FGM campaign.

“It will be a big mistake if they legislate against FGM,” Ebrima Jarjue, an executive member of the Supreme Islamic Council, told IPS.

“Our religion says we cut just small. We should be allowed to practise our religion. If some people are doing it and doing it bad, let them stop it. Let them go and learn how to do it. If circumcising the girl child when she’s young is causing problems, then let’s wait until she grows up. That’s what used to happen.”

Meanwhile, the Women’s Bureau, the implementing arm of the Ministry of Women’s Affairs, is hesitant about legislating against FGM.

“As far FGM is concerned, the position of the Women’s Bureau is that there’s need for more sensitisation and dialogue to push the course forward,” Neneh Touray, information and communication officer of the Women’s Bureau, told IPS. She declined to comment on whether the bureau thought that the bill was premature.

Chiang Both from Gambella, a remote and a traditionally non-circumcising province in Ethiopia that borders Sudan, volunteered to undergo the procedure despite his community’s initial mistrust.  

Ethiopia has one of the highest circumcised male populations in Africa – 93 percent, according to a 2005 survey by the Ethiopia Demographic and Health Survey. But the dominant ethnic groups of the Nuer and the Anuak in Gambella have until recently regarded the procedure with suspicion and as an instrument of “imperious foreigners”, disliked because of their historic attempts to change the Nuer culture. They also feared that it could cause impotency.

“The people in our culture are in doubt and believe that others want to change our culture. But those of us who have thought about the benefits, see it as only positive,” Both told IPS, explaining that hygiene and HIV prevention were two important benefits of circumcision.

Kelly Curran, director of HIV/AIDS and Infectious Diseases at international health non-profit, Jhpiego, told IPS: “The vast majority of men in Ethiopia are circumcised for religious or cultural reasons, usually in infancy. Gambella region is the exception.”

However, attitudes in the region are changing. It started in 2009 with a voluntary medical male circumcision (VMMC) campaign, which set out to increase circumcision prevalence to 80 percent by circumcising more than 40,000 men.

“When the VMMC programme started, Gambella was the only region in Ethiopia where less than half the men were circumcised, and it had an HIV prevalence three times the national average,” Curran said. Gambella has an HIV prevalence rate of 6.5 percent and a male circumcision rate of only 46.8 percent.

Randomised controlled medical trials in Kenya, Uganda and South Africa carried out by the French National Agency for AIDS Research and the United States National Institutes of Health successfully demonstrated that VMMC reduces the risk of female-to-male sexual HIV transmission by roughly 60 percent.

Based on the success of the trials, in 2007 the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation identified 13 countries with high HIV prevalence and low circumcision rates, all of which were in East and Southern Africa.

There are now 14 countries implementing VMMC programmes, in which males receive a package of HIV prevention services including education and risk-reduction counselling, HIV testing, screening for sexually transmitted infections and condoms.

HIV transmission in Gambella is high due to a low level of awareness, a high influx of itinerant farm workers, and a high number of refugees from neighbouring South Sudan said Ajim Othow, the Gambella regional HIV/AIDS prevention and control officer.

“HIV awareness is low especially among the local population. Many still believe that condoms carry viruses. They understand that HIV exists, but do not take it seriously,” Ajim told IPS.

In 2009, Jhpiego, with support from the U.S. Centres for Disease Control and Prevention, partnered with the Gambella regional health bureau to target adult males here. Gambella had only one surgeon prior to the medical alliance.

To date, the programme has circumcised over 32,000 males, trained 71 healthcare providers as male circumcision surgeons, and trained 26 educators and counsellors as well as 129 health extension workers.

“This programme is really trying to create a new norm in Gambella, it also has worked hard to respect the diverse ethnic groups living in Gambella,” said Curran.

VMMC is cost effective as it saves on antiretroviral therapy costs, which are expected to exceed 5.8 million dollars between 2009 and 2025 in Ethiopia. Modelling shows that every five to 15 circumcisions avert one HIV infection in a high HIV-prevalence environment.

In Gambella town, outreach campaigns have targeted at-risk populations such as high school students and the city’s prison population. The programme has also sponsored educational broadcasts in the local ethnic language on local radio. All of which have helped to raise awareness of the benefits of male circumcision.

Bang Chut, a 32-year-old water supply worker, attended the programme’s Lare health centre in Gambella with his wife. On the basis of an educational campaign, they both decided he should take advantage of the free surgery and be circumcised.

“We read the leaflet together. It was written in our language and easy to understand. We both see the obvious benefits. Now that it’s free, there’s no reason not to do it,” he told IPS.