A circumcisor from the Afar community who has given up the practice after working with CARE's health extension agents (Amy Mehringer, ©CARE)

AWASH, Ethiopia (April 2002) - As the elder, Nana speaks for the women in the hut. She squats on a colorful plastic mat, wearing a blue headscarf and skirt, and many necklaces. Behind her stands the circumcisor.

"Circumcision has been handed down from generation to generation," Nana says through a translator. "Our grandmothers and mothers were circumcised. We were circumcised, and our daughters are circumcised."

Nana is of the Afar people – a nomadic group that follows the rainfall through northeastern Ethiopia. The type of circumcision (commonly referred to as Female Genital Cutting, or FGC, in the West) practiced by the Afar people is the most severe kind, called infibulation and often referred to as salot. It involves the removal of the clitoris, the labia majora and part of the labia minora. The results include innumerable health problems, such as gangrene, hemorrhaging, chronic bladder and urinary tract infections, tetanus and retained menses. The average age for undergoing circumcision is 12 years old.

Because these health issues seriously affect the lives and well-being of women, children and families, CARE began partnering with interested Afar women to raise awareness among the rest of the community of the dangers of FGC. With their health and the health of their daughters at stake, the Afar women know that stopping this practice is a necessity.

Added to the numerous health risks, childbirth for circumcised women also can be a nightmare. A circumcised woman often cannot be dilated beyond four centimeters (ten are needed to birth a baby). Therefore, she must be cut, and afterwards, in a practice called reinfibulation, she is re-stitched and the process of painful urination, sexual intercourse and childbirth begins again.

In addition to these severe health problems, there is also the added risk of HIV/AIDS infection. The knife used during circumcision is the same knife used on all the girls, and boys as well, as they undergo circumcision, and it is not sterilized between uses.

A Tradition from Time Immemorial

In Ethiopia, approximately 90 percent of girls are circumcised, according to UNICEF. Even in the capital city of Addis Ababa, where women enjoy relative freedom, close to 70 percent are circumcised. Ethiopia is not the only country that practices FGC . The practice is widespread throughout Africa, and in some Middle Eastern and Asian countries. It is a practice born from the belief that, unless they are circumcised, women will be sexually promiscuous.

Some say FGC began 4,000 years ago, though there is no definitive documentation for this. It has been practiced in ancient Egypt, ancient Greece and ancient Rome. Although now it is often perceived in a religious context, Muslims, Christians and indigenous religions alike practice FGC to mark the passage between girlhood and womanhood.

Examining FGC Benefits

Through conversations with CARE-trained extension agents (liaisons between the community and the health clinics), Nana and the other Afar women now spread the news of the harms FGC can cause. However, the women frequently encounter arguments that FGC has useful purposes as well, and combating this belief is a great challenge to the women and to CARE staff.

"The Afar believe that FGC keeps the virginity of the girls; girls are often alone, herding animals and doing chores. FGC makes it difficult for men to sexually assault them," says Asmelash Wolde Mariam, CARE FGC Project Coordinator. "FGC also marks the passage into womanhood. After a girl has been circumcised, she can be married. However, it also makes sex and childbirth very difficult. Even urinating can be painful."

CARE began working with Afar communities on basic health issues, such as malaria prevention and child immunization, in 1996. This work put CARE in the right place at the right time when the Afar women decided they were ready to tackle the issue of FGC. In September 1999, CARE began a project to work with FGC-practicing communities to eradicate the practice. Currently, the project in Ethiopia works with 29 villages, reaching approximately 15,000 to 20,000 people. CARE has similar projects in Sudan, Kenya and Somalia.

The project’s three strategies include:

1. Advocating with civil society and training key people like religious leaders, community elders and circumcisors to turn them against FGC;
2. Training Ministry of Health staff to manage and treat complications of FGC; and
3. Developing a behavior change and communication strategy to augment the advocacy and health training.

"We had many challenges when this project began," Mariam says. "No one in

the community talked about FGC. Now, it is an open issue."

One reason for this success is the four-day discussion CARE held with religious leaders, people from the local government and the community. There were many debates about the merits of FGC, but in the end, the religious leaders concluded that their religion did not advocate or promote FGC. Since then, they have been against the practice.

"Had they not been convinced," says Mariam, "We could not have progressed."

The conviction helped Nana and other Afar women to advocate for their own rights.

"Now that we know more about the harmful side effects, we are trying to stop it," says Nana.

"This year, we didn’t cut," chimes in the circumcisor standing behind her.

Obstacles Yet to Overcome

Despite these advances, FGC is not yet a thing of the past. Although many men support abandoning salot, they do not support abandoning circumcision altogether. Instead, they advocate for a lesser form, which involves the excision of the clitoris. And because men are the decision-makers in Afar communities, the lesser form of FGC is widely practiced even when the severe form has been abandoned.

"It is like a dream to think of completely abandoning it," says Mariam. "It is a great achievement to talk with the Afar about FGC. We are very fortunate to have come this far."

To make further progress, the Afar communities – with CARE – are contemplating taking on FGC as a national advocacy issue. While the Ethiopian government has written a new code outlining criminal penalties for those caught performing FGC, the practice is not yet formally outlawed. Few African countries, in fact, have actually outlawed FGC. Among them are Senegal, Burkino Faso, Central African Republic, Djibouti, Ghana, Guinea and Togo.

Many Western countries have had to address the issue of FGC as people from Africa, the Middle East and Asia immigrate and continue the tradition. Consequently, there has been pressure from the international community to eradicate FGC. The World Health Organization came out against the practice in 1979; the United Nations banned it during the Decade of the Woman (1975-1985). The United States formally banned it in 1995. Currently, FGC also is illegal in Sweden, Norway, Australia and the United Kingdom.

International pressure and local awareness indicate that the support and the desire to eliminate FGC exist, both in and out of Ethiopia. But the real test will come in time, when the Afar girls who went uncut this year are old enough to marry. The only way to ensure that FGC becomes history is if men want to marry an uncircumcised woman. If not, the rights of women will continue to be violated, and girls will surely go under the knife again.

Nana and the other women are not worried about this prospect.

"If our men won’t marry an uncircumcised woman, she will seek out another," says Nana. "And there are always men of different ethnic groups who will marry our women."