by Nadwa Mossaad

(February 2010) Female genital mutilation (FGM), also known as female genital cutting or female circumcision, is the cutting, altering, or injuring of any or all parts of the female genitalia for nonmedical purposes.¹ FGM's often catastrophic health effects and whom it affects are well known and well documented, but why FGM continues and how best to end this harmful practice are a matter of ongoing research and debate.

According to several studies, FGM continues because of cultural beliefs and tradition. The low prospect of marriage for uncut girls is often cited as the reason for the continuation of the practice. Interviews by Demographic and Health Surveys (DHS) of women who have been cut reveal that "a husband will prefer his wife to be circumcised" and "circumcision prevents adultery." Men who were interviewed listed the same reasons in higher proportions.²

Despite some successes in ending FGM—most notably in Egypt—the rate of abandonment has been slow.³ One approach used to combat the harmful practice has been direct message-based advocacy, but this approach is often judgmental and accusatory and seems to have very little effect on curbing the practice in the long term. Messaging that concentrates on FGM's medical and health risks can lead to an increase in alternative cutting carried out by professional health workers.⁴

The old approach also targets only those affected—particularly young women—by assuming that the practice is based on individual rather than collective decisions. This approach often excludes other members of the community, especially older women who are sometimes labeled as obstacles to positive change and even the driving force behind the tradition.

One new approach to the abandonment of FGM is the Grandmother Project (GMP). The GMP is a nongovernmental organization that promotes the health and development of poor communities in Africa, Asia, and Latin America. The GMP explicitly involves grandmothers as active assets in their communities to promote maternal and child nutrition, early childhood development, and education, and to eradicate female genital mutilation and HIV/AIDS.⁵ (The Grandmother Project is being implemented by World Vision, with technical assistance from GMP. The project is funded by World Vision Canada, GMP, and the U.S. Agency for International Development.)

Started in 1997 in Laos, and later in central Senegal, Mali, Uzbekistan, Albania, and southern Senegal, GMP's main goal was to overcome the negative biases against grandmothers and instead involve these elderly women in community efforts to improve the health and well-being of women and children. In a pilot study documenting Senegalese grandmothers' involvement in promoting improved maternal health and child nutrition practices, the findings were encouraging.⁶ The first stage of the study used an innovative method to inform grandmothers on the subject of nutrition practices through storytelling and songs. Data on women of reproductive age were collected in Senegalese villages before and after the education of grandmothers. In the intervention villages, women who had been pregnant recently reported, on average, a 92 percent improvement in pregnancy and nutrition practices compared with a 38 percent improvement in the control group where grandmothers were not involved. In addition to the health benefits to new mothers and their infants, the study documented increased self-esteem among the grandmothers.

Based on this pilot study, GMP was created in the context of FGM. The GMP aims to bring about positive changes by including grandmothers and elderly women, a once-marginalized group. The project encourages learning and communal decisionmaking through open discussions about problems facing the community. GMP hopes this will lead community members to identify their problems and reach consensus on possible solutions that best suit their needs, leading to long-term effective changes in harmful practices.

According to Judi Aubel, GMP founder and executive director, "Decreasing FGM is a major goal. But the strategy that [GMP] is using does not deal with FGM in a linear and reductionist way as many programs do." She adds that the main objective is to work on the holistic upbringing of girls' intellectual, spiritual, physical, moral, and psychological well-being as an alternative right of passage to FGM and an effort to strengthen positive cultural traditions and discard harmful ones.

Older women and grandmothers play a very important role in most traditional communities, holding matriarchal power and consulted on family affairs and conflict resolution. FGM and other harmful practices against girls are entrenched in cultural values, and grandmothers and elders are known to be the "guardians" of such traditions.

In October 2009, 13 months into the project, a mid-term review in the Velingara area in southern Senegal found several changes.⁷ Most notable were a greater appreciation for grandmothers' roles in disseminating positive cultural values and a positive change in communities' attitudes toward ending FGM as well as other harmful cultural practices, such as early marriage for girls and violence against women.

As for long-term results, project staff hope that GMP's intervention will increase communities' acknowledgment of the intellectual, psychological, and moral upbringing of girls and their importance to the well-being of the communities. Grandmothers can help lead a community to a collective decision to stop FGM.

Nadwa Mossaad is a research associate at the Population Reference Bureau.

References

1. The terminology for this harmful traditional practice varies greatly and many organizations use the combined female genital mutilation/cutting (FGM/C). Since the Grandmother Project prefers FGM, that is the term used in this article.
2. IFC Macro, 2008 Egypt Demographic and Health Survey (Calverton, MD: IFC Macro, 2009).
3. Charlotte Feldman-Jacobs and Donna Clifton, Female Genital Mutilation/Cutting: Data and Trends Update 2010 (Washington, DC: Population Reference Bureau, 2010), accessed at www.prb.org/pdf10/fgm-wallchart2010.pdf on Jan. 26, 2010.
4. World Health Organization, "Female Genital Mutilation and Other Harmful Practices," accessed at www.who.int/reproductivehealth/topics/fgm/fgm_trends/en/index.html on Jan. 26, 2010.
5. The Grandmother Project, www.grandmotherproject.org.
6. Judi Aubel, Ibrahima Toure, and Mamadou Diagne, "Senegalese Grandmothers Promote Improved Maternal and Child Nutrition Practices: The Guardians of Tradition Are not Averse to Change," Social Science and Medicine 59, no. 5 (2004): 945-59.
7. Judi Aubel, Dialogue to Promote Change From Within: A Grandmother-Inclusive and Intergenerational Approach to Promote Girls' Health and Well-Being and to Eliminate FGM, unpublished report (February 2010).