An estimated 140 million women and girls alive today have suffered female genital mutilation (FGM). About two million girls every year - or 5,500 a day - are put through this excruciating and dangerous procedure.

Wednesday, February 6 marks the tenth International Day of Zero Tolerance to Female Genital Mutilation.

According to global children's charity Plan International, and its Irish branch Plan Ireland, who are working with governments and community leaders in West Africa to eliminate FGM, many girls bleed to death or die of infections from being cut with dirty utensils in the performance of this controversial procedure.

FGM is carried out for various religious and cultural reasons

By circumcising their daughters, parents are felt to be showing respect for their culture and to their ancestors.

The pressure to undergo excision in order to conform to social norms can be immense - those who disrespect the norm are likely to be stigmatised, treated as non-adults, or even ostracized from society.

In a number of African societies, the practice of excision is an important part of an initiation ritual that marks the transition into adulthood.

Some African Muslims believe that excision is recommended, or even required, by Islam, when it is not. They hold on to the practice of female genital cutting to fulfil a perceived religious obligation.

Also in many societies in West Africa, FGM is part of an attempt to control female sexuality.

Female genital mutilation can be carried out in sterile, surgical conditions, but the reality is that the procedure is frequently carried out using unsterile equipment, blunt cutting instruments and without any real anaesthetic.

Plan says those who survive the the FGM procedure face severe and lasting effects such as painful sexual intercourse, menstrual problems, infertility, HIV/AIDS and birth complications. FGM doubles the risk of a mother dying during childbirth, and makes it three or four times more likely that her child will be stillborn.

The FGM world awareness day this week underlines a strong commitment of member states of the United Nations to ending the practice, Plan points out.

However, there is continued adherence to the practice of FGM in some societies, mainly in Africa but also in Asia and some Arab countries.

For example in Mali, the rate is estimated at 86% while in Guinea Bissau over 90% of girls have undergone some form of FGM.

To a lesser extent, female genital cutting is also practised in some countries in the Middle East and parts of Asia and the Pacific. There is also evidence of it being practised among immigrant communities in Europe, including Ireland, North America, and Australia.

The collaborative effort by Plan and other groups to eliminate FGM is aimed at eliminating this harmful practice, which can be performed on girls as young as six.

The collaborative approach includes outreach to religious leaders, community leaders, youth and parents. Crucially, it also focuses on the FGM practitioners who actually wield the knife.

Plan's advocacy programmes call for the protection and respect for the freedom and the dignity of children and girls, while its global 'Because I am a Girl' campaign specifically focuses on helping girls achieve their basic human rights.

"FGC (Female Genital Cutting) is a cultural rather than a religious practice which predates both Islam and Christianity. Reasons for it include control of female sexuality, a perception that female genitalia are unhygienic and unsightly and that uncut woman are impure, according to CEO of Plan Ireland, David Dalton.

"Plan Ireland is actively lobbying government and working alongside local grassroots organisations in West Africa and elsewhere to change public attitudes to FGM by advocating, raising awareness and educating government and local communities."

There have been some successes, says David Dalton.

"Since the introduction of this approach, Guinea Bissau has recently introduced a law to criminalise FGC and many communities and villages in West Africa have abandoned the practice and are proclaim themselves to be FGC free. There is still much work to be done given the scale of this problem in the developing world."

Types of Female Genital Cutting

* Removal of the clitoral hood only (female circumcision), or together with partial ortotal removal of the clitoris (clitoridectomy).
* Removal of the clitoris together with part or all of the inner vaginal lips (excision).
* Removal of part or all of the external genitalia and stitching or narrowing the
vaginal opening leaving only a small hole (infibulation).
* A variety of unclassified traumatic procedures of cutting, stretching, or piercing performed on the external genitalia such as cauterization by burning of the clitoris and surrounding tissue or scraping of tissue surrounding the opening of the vagina.

Health effects include the trauma and pain of excision, with deaths of girls during FGM ceremonies being quite common.

Other likely health effects include HIV infection. If the excision is performed in a group ceremony without proper attention to clean instruments, HIV may be transmitted through blood contamination.

FGM can also have after-effects on sexuality and reproduction. Women can suffer from gynaecological complications related to excision and are likely to develop difficulties during sexual intercourse.

In addition, the obstetric complications of female genital cutting can be serious. These include obstruction of labour, tearing of tissues during delivery, the formation of vaginal fistulae (openings between the vagina and the urinary tract or the bowels) leading to lifelong incontinence of stool or urine and finally maternal and child death during delivery.

And there are also effects on mental health: Female genital cutting can cause long-lasting psychological harm, with excised women often experience feelings of incompleteness, humiliation, betrayal, and anxiety.

Case study: Stopping 'the knife'

Bobo Seide is a widow and worked as an FGM practitioner for over 20 years. Now she works with Plan International and its partners to raise community awareness and advocate against FGM practices in Bafatá region of Guinea Bissau.

"I started practising FGM just after my elder sister passed away; she had also taken the knife after my mother died many years ago, and I was very proud to become a practitioner. It was very prestigious and had great social status to become an FGM practitioner in those days, as people used to view our family as one who had honour and privilege. I felt well respected in the community and people invited me everywhere to attend ceremonies. But now I believe it was purely traditional beliefs and nothing more.

"I abandoned the practice six years ago, but I was confidentially practising it on children from the neighborhood and on my close family until I was sensitised enough to be involved in Plan's activities against female genital mutilation."

"Now I am a 100% activist against FGM. I attended many training sessions and meetings organised by Plan and I am working in my community to tell people everything l know about the practice. I know that FGM can lead to women having complications during birth and you can easily catch infections such as HIV/AIDS. I feel regretful now about practising FGM for 20 years, as l wish l had known what I know now."

"Most of the people remain in the practice because it's lucrative and at a community level practitioners are considered having spiritual power that makes them strong in the community and they are respected by both men and women. Due to this power they are often part of the decision making processes."

"Since I left the knife, I have been selling fruits and vegetables to make a small income. Many people are afraid to do this, but I am working to convince as many as I can to give up the knife."

Testimonies from Mali

Fatoumata, 43, member of CBO Sabougnouman 'women grouping'" in Kela (Kangaba):

"We women have experienced difficulties related to female genital cutting. Recently with the reduction of the practice, fewer girls die of haemorrhage than before."

Daouda, 75, religious leader:

"I have gone to Mecca three times and I am a reference in Islam, which means I should not tell lies. From now on, during my preaching sessions, I will preach that female genital cutting is not at all an obligation in Muslim. As a practitioner, our duty is to inform people about the true content of the Koran, not to invent things."

Fanta, 15, student:

"I have learned a lot about child rights and complications related to female genital cutting. Right now, I know that female genital cutting is a bad thing. I have undergone female genital cutting, and don't want my sisters to experience it. What is done is done. Female genital cutting is not a good thing. I will protect my daughters from experiencing it."

Sabou, 53, FGC practitioner:

"We get given many animals, and a lot of poultry and money when we practise female genital cutting. But I was shocked by what I saw and heard during sessions of sensitisation, for the life of human being is more important than everything. From now on I have decided to stop doing this activity."

Kankou, 23, a young mother and housewife in Kela:

"I have two children, a girl and a boy. The girl had not yet undergone female genital cutting and I will do everything possible to protect her from it. Before, when I heard educators addressing this issue, I got angry. Right now I have understood how harmful it is and I will do everything possible to save as many children as possible in our family and in other families."



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