Mariam was just five years old when she was subjected to female genital mutilation.
“I can remember everything, every little detail about that day, those moments,” she says. “It’s all still in my head; where it happened, who held me down, the balcony above me, and how it was all masked by a party with gifts and music.”
Mariam’s clitoris, and inner and outer labia were removed with a razorblade, and then the two sides were stitched tightly closed. This is the most common of the three types of FGM practiced in Djibouti, known as the pharaonic type.
"I could see the regret in my mother's eyes. But it was too late."
Although the practice has been illegal in Djibouti since the 1980s, it was, and still is, a tradition of a majority of the ethnic groups in the country. The Afar, for example, practice FGM in the weeks after birth, and the Somalis mostly just before puberty, up to 15 years old.
The movement to abandon FGM started in the 1980s, and has slowly but steadily gathered momentum over the last 25 years – a generation’s worth of momentum. And Mariam is now part of that movement.
Over 10 years later, in 2005, Mariam joined a community empowerment program, where she learned about women's rights, democracy, health, environment, child protection and project management. She also learned about the dangers of FGM, and joined a movement to end the practice in her country.
So when Mariam married her now-husband Ali and became pregnant with a girl, she knew that she did not want her daughter to undergo FGM.
“My baby girl was perfect. And I looked at my mother, and I said she was not allowed to cut her."
"The tradition ends here.”
But Mariam’s mother was a staunch traditionalist. A week after giving birth, Mariam left the house to collect her training graduation certificate. Her mother saw the opportunity and called a traditional cutter from the neighbourhood. When Mariam and her husband returned, her newborn baby was bleeding and screaming.
"How could I have let this happen to my daughter, after I had promised she would be saved?"
Over the next 40 days, Mariam and Ali’s baby continued to bleed, and at six months, she had dropped to below her birth weight. Infection was shutting down her little body.
“I was ashamed and I was scared. How could I have let this happen to my daughter, after I had promised she would be saved?,” says Mariam. “If I went to the doctor, it would be like an admission of guilt, unless I told the truth and denounced my mother and my husband – which I could not do. I was paralysed. I could only answer the doctor’s questions with monosyllables.”
At six months old, Mariam’s daughter gave in to the infection and died.
“I could see the regret in my mother’s eyes. But it was too late.”
Intensifying efforts to abandon FGM is part of a Government strategy, together with the United Nations Population Fund (UNFPA) and UNICEF, that starts with educating the population. The organisations hold workshops throughout the country encouraging people to talk about FGM and refuting its connection to religion.
Mariam's training was developed by Tostan, an NGO with decades of experience leading similar program in Senegal. It works at many levels to end FGM – from community dialogues and care services for girls, to policy making and political commitment. UNICEF worked in partnership with Tostan, UNFPA and the Government to bring the program to Djibouti.
“For many young people this is the first time they may have spoken openly about the complications they have during their menstruation, for example, or that FGM is not a part of Isla,” says Fathia Omar Hassan, UNICEF Child Protection Officer.
Fathia says the biggest challenge is dissociating the practice of FGM from religion, and moving it to the category of a choice. “Once people have the choice, and can weigh it against the health risks, it starts to make sense to them. And through this, the idea that children, girl children, women, have the right to whole and complete bodies.”
The latest data from UNICEF and UNFPA indicate that FGM is still prevalent in Djibouti, with 78 per cent of girls and women subjected to the practice. While there is still a significant amount of work to be done, young women like Mariam represent a promising shift in group belief and behaviour. And public declarations against FGM in 2016 and 2017 helped save nearly 1,000 girls from cutting.
“I cannot bring my baby girl back, but I can keep it from happening to others," says Mariam. "I think now we can use the knowledge gained and stop these harmful traditions.”
"I cannot bring my baby girl back, but I can keep it from happening to others."
What you need to know about female genital mutilation
Female genital mutilation (FGM) is a procedure performed on a woman or girl to alter or injure her genitalia for non-medical reasons. It most often involves the partial or total removal of her external genitalia. In some communities, FGM may be commonly referred to as ‘female circumcision’. However this term has been criticised as it can normalise the practice by drawing parallels with male circumcision without distinguishing its serious physical and psychological harm.
In many of the countries where female genital mutilation is performed, it is a deeply entrenched social norm rooted in gender inequality. The reasons behind the practice vary. In some cases, it is seen as a rite of passage into womanhood, while others see it as a way to suppress a woman’s sexuality. Many communities practice genital mutilation in the belief that it will ensure a girl's proper upbringing, future marriage or family honour. Some also associate it with religious beliefs, although no religious scriptures require it.
FGM has no health benefits and often leads to long-term medical complications, including severe pain, prolonged bleeding, infection, infertility and even death. It can also lead to increased risk of HIV transmission. Women who have undergone genital mutilation can experience complications during childbirth, including postpartum haemorrhage, stillbirth and early neonatal death. In addition to its physical risks, FGM is a violation of girls’ and women’s fundamental human rights.
While the exact number of girls and women worldwide who have undergone genital mutilation remains unknown, at least 200 million girls and women aged 15–49 from 30 countries have been subjected to the practice. Of these 200 million, more than half live in just three countries: Egypt, Ethiopia and Indonesia. The practice is almost universal in Djibouti, Guinea and Somalia, where over 90 per cent of women and girls undergo some form of genital mutilation or cutting.
Unless action to end female genital mutilation is accelerated now, another 68 million girls will have been cut by 2030.
In several countries, qualified medical practitioners now play a significant role in performing FGM. More than 20 million women and girls in just seven countries (Egypt, Sudan, Guinea, Djibouti, Kenya, Yemen and Nigeria) have undergone female genital mutilation by a health care provider. Medicalizing the practice does not make it safer, as it still removes and damages healthy and normal tissue and interferes with the natural functions of girls’ and women’s bodies.
In many communities, the practice has been driven underground rather than ended, leading to girls being subjected to cutting at younger ages amidst greater secrecy.
Ending female genital mutilation takes work at many levels, including action by families and communities, protection and care services for girls and women, laws, and political commitment at the local, regional, national and international levels.
UNICEF and the United Nations Population Fund (UNFPA) jointly lead the largest global program to end FGM. The program supports zero tolerance laws and policies, while working with health workers to both eliminate genital mutilation and provide care to women and girls who have undergone the procedure. Recent data show that in countries where it is prevalent, the majority of men and women oppose the practice, but they often keep these beliefs hidden for fear of being rejected by their communities. To help reshape these perceptions, the UNICEF-UNFPA programme works with communities to openly discuss and voice support for ending FGM.
Since the UNICEF/UNFPA Joint Program was established in 2008, 13 countries have passed national legislation banning FGM. The program also provided access to prevention, protection and treatment services for more than 3.3 million girls and women. As a result of a community-led engagement, more than 34.6 million people in over 21,700 communities made public declarations against FGM.
Over the past three decades, there has been an overall decline in the prevalence in female genital mutilation – and momentum is growing. With our continued action, we can work together to end FGM by 2030.
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