PROJECT INTACT: FGM SUPPORT AND EDUCATION

Project Intact:

A Plan for Education, Support, Empowerment and Initiating Conversations About

Female Genital Mutilation

University of California, Santa Cruz

A Project By:

Megan Joyce, Alisha Tahir-Kheli, Megan Schnabel, and Maria Vega

Project Intact: A plan for education, support, empowerment and initiating conversations
about female genital mutilation from a local community and culturally sensitive standpoint.
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Executive Summary:
Female Genital Mutilation is an extremely prevalent practice women and girls in Sub-

Saharan Africa are subjected to. The practice, as well as the many physical and psychological

issues that arise from it, often goes on without much conversation or awareness. Our proposed

NGO, Project Intact, hopes to change that, and as a result reduce the rate of complications and

traumas related to FGM. The purpose of Project Intact is to educate the public, specifically

communities within Sub-Saharan Africa, about the practice of FGM and its psychological and

physical complications while providing alternative views such as sex positivity and women

empowerment. By connecting with local communities, we will provide African women with the

tools to make educated and autonomous choices about their bodies and FGM. As for the women

already affected, our team will help provide local and adequate medical and psychological

services to meet their specific needs. We will also work to create safe spaces to have discussions

about their experiences and traumas, what FGM means to them, and how this tradition of cutting

will affect future generations.

Literature Review:
An estimate of 100 to 140 million girls and women in the world today have undergone

forms of female genital mutilation (FGM). Around two million girls are at risk for FGM each

year (World Health Organization, 2001). The greatest percentage of affected women live in Sub -

Saharan Africa but it is also practiced in other regions in the world. This review plans on

discussing FGM in Sub - Saharan Africa since it is more prevalent in this region. In a study by

Yoder, Wang, and Johansen (2013) they studied the number of females in Sub - Saharan Africa
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who have been involved in FGM through using the national population based survey and census

data. The researchers found that 85.8 million women aged 15 and older have undergone FGM in

Sub - Saharan Africa. Also, it was found how 13.8 million girls aged from 10 - 14 years were

also involved in FGM. This totals to 99.6 million females who have undergone FGM just in Sub

- Saharan Africa which is an alarming number, because many of the procedures are done without

consent and cause a multitude of health problems. Next, we will discuss the reasons for FGM

from a cultural context and how it is performed.

Some people believe that FGM began in Sub - Saharan Africa with the arrival of Islam

but the research is still not clear since others believe it started independently in this region.

People in Africa perform FGM as rituals such as coming of age ceremonies and gender - identity

ceremonies which involved genital alterations (Shweder, 2000). Some other communities

perform FGM because they believe that the clitoris must be removed from a girl such that they

can associate with others in the community and be considered a mature women. Another reason

is that FGM is believed to ensure a girls virginity which is a prerequisite for marriage tying into

the patriarchal views of the society. In other communities, FGM is performed because it is

believe that a womans external genitalia have the power to blind anyone attending to her

childbirth to cause the death of her infant or a physical deformity or to cause the death of her

husband. Usually, the communities in Sub - Saharan Africa who practice FGM, girls are usually

pressured socially from their peers and family members to undergo the procedure or else they

will be threatened with rejection by the community. Another reason for FGM is hygienic and

aesthetic because when removing it, some believe it the genitalia is ugly and dirty so it must be

removed while others think it makes a girl beautiful to remove it. In relation to spiritual reasons,

some communities believe that removing the external genitalia will make a girl spiritually clean
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and it might be required by their religion. Lastly, some believe that a girl with external genitalia

has an overactive sex drive so she is likely to lose her virginity prematurely and to cut it will

lessen the likelihood of having sexual pleasure. Also, some believe it is related to infertility so

cutting it will make a women fertile. Basically there are many reasons for FGM in Sub -Saharan

Africa since there are multiple cultures in this area (World Health Organization, 2001).

In Sub - Saharan Africa, the regions where FGM is a custom usually the operation is

performed by traditional excisors such as elderly women in the community who are designated

for this task. Sometimes FGM is performed by traditional birth attendants and village barbers

(World Health Organization, 2001). For example in Faranah District, Guinea girls aged 6 - 14

are being cut with a traditional knife and FGM involved the religious leader removing the total or

partial removal of the clitoris in conjunction with instructions on how to behave when they are

married ( Keita & Blankhart, 2001).

There are four sub types of FGM. The first is the partial or total removal of the clitoris

which can involve removing the clitoral hood or prepuc or both (World Health Organization,

2017). The second type is the partial or total removal of the clitoris and the labia minora which

involved removal of the labia minora only or the partial or total removal or the clitoris or both

(World Health Organization, 2017). The third type is the narrowing of the vaginal orifice with

creation of a covering seal by cutting and repositioning the labia minora and//or the labia majora

(World Health Organization, 2017). The fourth type encompasses all other harmful procedures to

the female genitalia for nonmedical purposes such as pricking, scraping, incising, and etc (World

Health Organization, 2017).

Although there is variation between types and procedures of FGM, there is a large,

general pool of physical complications that occur both immediately and long after a woman
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undergoes FGM, and can be either short or long term issues. Aside from the pain of the

procedure itself, women can suffer injuries during the process including tearing of adjacent

tissues, hemorrhages, and fractures or dislocation of bones and joints from restraints. Various

infections, including pelvic and urinary tract infections, frequently occur soon after the procedure

and can become reoccurring issues. Sexual dysfunctions, difficulties with menstruation, cysts,

keloids, and abscesses are frequent, long term complications. Women who undergo FGM are

also at higher risk of HIV transmission from unsanitary tools used during procedures and

reopened wounds. (World Health Organization, 2001).

Women often face the most complications throughout pregnancy and childbirth. A study

conducted by members of the World Health Organization found the most common obstetric

complications included caesarean sections, extended hospital stays and recovery, postpartum

haemorrhages, infant resuscitation, premature births, stillbirths, and early neonatal deaths.

(Banks, et al. 2006).

The studies mentioned above, as well as much of the other research, show that regardless

of the type, cultural significance, or procedure of FGM there are many physical complications

that are prevalent and damaging to the women involved.

Mission Statement:
Educating and empowering local women in Sub-Saharan Africa through supportive

community outreach programs to promote choice and autonomy while providing adequate, FGM

specialized medical care.

Goals and Objectives:

Main Goal:
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- Reduce the rates of FGM and related medical issues in Africa by 2025

Objectives:

- Educate the public on FGM, its practices, and the effects on mental/physical health.

- Promote sex positive views of the female body and women empowerment.

- Provide services for women who have undergone FGM such as therapy, safe spaces,

reconstructive surgery, and adequate and continuous medical care.

Action Plan Introduction:

Our group will be taking the initiative on educating ourselves and fellow peers about

Female Genital Mutilation and its medical complications through an initial university project and

kickstarting our proposed NGO: Project Intact. In order to succeed we will be working towards

short and long term goals and objectives while attending to the ideals, mechanics, cultural

relevance, and continuous accounts of young females living in the circumstances of FGM.

Action Plan:
Within this section we will outline the methods and procedures in which we will work

towards our goal of reducing rates of FGM and its related medical complications in Sub-Saharan

Africa by 2025. This includes general plans to educate and empower, who our target

population(s) will be, and timely goals for our team to meet. This section will further describe

how we will meet our goals and objectives, including details that may have not yet been

addressed.

University Project
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First, we will propose and kickstart our NGO through a educational project and event at

UCSC called the CEC Awareness Evening at the Namaste Lounge. This project will take

approximately ten weeks, and include a project proposal, literature review, presentation, website,

educational pamphlet, and slam poetry performance. Our four person team will distribute the

work amongst each other over the course of ten weeks, while checking in with the supervising

professor and teaching assistant. We will use this project as an opportunity to further educate and

challenge ourselves and our understandings about FGM, while educating local peers and

promoting our NGO in the hopes of finding more sponsors. Once all parts of the project are

completed and we present at the CEC event, we will move forward with our long term goals for

Project Intact.

Target Population(s) and Expanding Our Team

As stated before, Sub-Saharan Africa is our general target region, with Guinea and

Somalia having the largest prevalence of FGM. As an NGO based in the United States, our

biggest concern is maintaining a culturally sensitive standpoint towards such a controversial

issue, with the focus being not whether the practice itself is right or wrong, but preventing human

rights violations and medical issues from occurring. We also need to expand our team and

collaborate within the local communities in order to reach our goals and make an impact

successfully. In order to do this, we will spend one year living in, working in, and making

stronger connections to the local communities. This will make it easier to collaborate with

already existing medical professionals and advocates, as well as schools and local businesses,

who have similar goals to our project. Hiring staff and working within the community -- which

we will later elaborate on -- will make the most direct and positive impact we hope to achieve

while reducing the risk of cultural blindspots hindering our efforts to help.
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This year of immersion in our target location will also allow us to foster a better

understanding of the culture and beliefs of the community, and what role FGM plays in the lives

of locals, and what role the locals play in the cycle of FGM. Although our main concern is the

young girls and women who will be and have already been affected by FGM, we realize there are

more parties involved in the cycle than the individual girl being cut. Mothers, female elders,

husbands and fathers, healthcare programs, and the community mindset all contribute to the

cycle of FGM. Becoming directly involved in the community will help create connections with

everyone that can make a difference in the health and wellbeing in these young girls.

Providing Services: The Long Term Effort

After becoming more settled in the community, our team will turn our attention to the

long term goal of reducing rates of FGM and pool together our acquired resources. This includes

our new connections with advocates and organizations, already existing medical facilities and

their working professionals, local schools, and other businesses that may be able to help our

efforts in meeting the various needs of these women and girls, educating the community and

ending the cycle. These efforts will be explained in the following sections, organized by the

different needs and services we hope to meet and provide through our organization, as well as

how we can make collaborative efforts with existing organizations to continue making a

difference. This part of our project is not as time sensitive, but more of a long term movement

over seven years of troubleshooting and improving. However, some aspects have a more

immediate need than others, so we will push to act quickly on those who have been affected and

are in immediate medical need. After our team has created a stable way to meet those needs, we

can move forward in expanding our services.

Those Who Have Been Affected

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We will dedicate the following year or two (after settling in the community) to work with

existing medical facilities and professionals to ensure the right medical care is being provided to

the women who have undergone FGM. This part of our project is of the utmost importance, and

requires a quicker and harder push to help the women in immediate distress. This may require

fundraising, further educating local medical clinics, and working with department heads and

supervisors to get approval for these services. Emergency services, ongoing health check ups,

and FGM specialized obstetric care will be put on the forefront of services needing

improvement. Other services include access to free feminine hygiene products, antibiotics and

vitamins, and options for reconstructive surgery if the woman wishes to have for physical or

mental health reasons.

It would be more beneficial to work with and expand already established hospitals and

clinics that are well known and already treating clients with FGM related issues. But if medical

facilities are not already in place, we will rent or build spaces needed and hire local professionals

to work in the clinics. Our team will also work towards acquiring transportation services, like

free clinic shuttles and emergency vehicles, for the women and girls in need who may otherwise

have difficulty traveling to a clinic.

We also recognize that those who have been affected by FGM often face difficulties that

are not just medical. The mental health of these young women and girls is also in need of

support, and we will provide that through trauma therapy, workshops on coping skills, a support

hotline, and access to additional resources. This can be done through an existing clinic with local

therapists, or a clinic created by us with local community mentors we have trained ourselves.

This will give these women and girls options for safe spaces to share their traumas, express any

emotional struggles they may be having, and seeking comfort without judgement.
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Those Who Still Have a Choice

We hope to ensure that the girls who have not yet been affected by FGM will be able to

maintain an awareness that can improve their well being and make educated choices about their

bodies. This will be done through educational seminars and workshops in local medical facilities

and school. Information on all of the physical and mental health effects of FGM will be easily

accessible to the public in every medical facility, and educational seminars on important issues

like HIV transmission will be held within the clinics. With approval from the schools -- which

may be a long and difficult process -- sex education workshops will be provided by local

advocates to promote sexual health and body positivity, while educating children on health risks

related to sexual behavior and FGM. Our team also recognizes that not everyone will have access

to these clinic and school programs, and using the rising use of technology to our advantage we

will work with local phone companies and service providers to allow people to subscribe to

PSAs about FGM, health advice, and sex and body positive information. The support hotline

described in the previous section can also serve as an information database for any women who

have specific questions but may not be able or comfortable attending a workshop. All of these

options focus on promoting educated choices and autonomy, advocates and speakers will remain

impartial, recognizing that cultural and beliefs play a big role in FGM. These programs are not

about whats right or wrong, but the importance of being aware of the facts and the choices these

girls make about their own bodies.

Those Who Can Help End the Cycle

As stated before our teams main focus is helping the women and girls that will of have

been directly affected by FGM, but we are aware that they are not the only ones involved in the

cycle of practicing FGM. After introducing and successfully executing the medical and
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education aspects of our plan, we will work towards initiating conversations about FGM. This

will be done by create additional safe spaces and seminars for different groups of people --

mothers and elder women, fathers and husbands, young girls and women -- who take part in the

pressures maintaining the cycle so that they can discuss -- amongst themselves and with each

other -- the practice, its issues and benefits, and what can be changed. These seminars will be

help within the clinics and schools if permitted, led and overseen by advocates from our team

who will be trained with communication and conflict resolution skills. While these seminars will

rely on the public's contributions to the conversations, our advocates will guide the discussions

and maintain the safe space.

General Timeline:
Spring 2017 (April-June) University Project
- June 1st - CEC Awareness Night presentation

July 2017 - August 2018 Move team to Guinea and Somalia: live,
work, make connections in local communities

September 2018 - 2020 Establishing clinics and physical/mental

health services within communities

2020 - 2022 Expanding our services to promoting

awareness and education through clinic and
school workshops and PSAs

2022 - 2024 Encouraging more involvement from the

community by starting safe space seminars to
discuss how everyone contributes to the cycle

2024-2025 Running all of three aspects and making a

difference

Budget:
Item Time/Financial Cost*
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Information Pamphlets 1 hour/$2

Action Plan Proposal ~10 weeks

Slam Poem < 2 hours

Website ~6 hours

Namaste Lounge Event 15-20 mins

Personal travel fees ~2days/ $1,000/person

Renting facilities (medical, safe space etc.) ~$1,000/month

Hiring medical and therapy staff ~$5,000/month/person

Travel fees (for women to/from facilities) ~$500/month

Feminine products, medicines etc. ~$300/month

Advertising ~$1,000

*Highest average listed to maintain successful budget, does not account for possible donations.

But we have a generous sponsor, Tony Hoffman, who has offered us an unlimited budget to

fund our entire endeavor.

Deliverables:
Ultimately, by 2025 our team will be working to ensure that women and girls do not

experience the health problems caused by FGM, and feel empowered enough to make educated

choices about their bodies.

We expect every clinic in Guinea and Somalia to have accessible professionals and

services specializing in FGM related issues. Monthly educational workshops within each clinic,

and annual sex education in every school. Weekly seminars for community discussions, with
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both separate and commingled groups. And a constant community mindset that the health and

wellbeing of these girls matters.

References:
Banks, E., Meirik, O., et al. (2006). Female genital mutilation and obstetric outcome:

WHO collaborative prospective study in six African countries. The Lancet,367. Retrieved from

http://search.proquest.com/openview/67a8574a76f616a3fef747d079798168/1?pq-

origsite=gscholar&cbl=40246

Keita, D., & Blankhart, D. (2001). Community-Based Survey on Female Genital

Excision in Faranah District, Guinea. Reproductive Health Matters, 9(18), 135-142. Retrieved

from http://www.jstor.org/stable/3776160

Shweder, R. (2000). What about "Female Genital Mutilation"? And Why Understanding

Culture Matters in the First Place. Daedalus, 129(4), 209-232. Retrieved from

http://www.jstor.org/stable/20027671

World Health Organization (WHO). (2001). Female Genital Mutilation: A Students

Manual. Retrieved from

http://www.who.int/reproductivehealth/publications/fgm/RHR_01_17/en/

World Health Organization (WHO). (2017) Classification of female genital mutilation.

Retrieved from http://www.who.int/reproductivehealth/topics/fgm/overview/en/

Yoder, P., Wang, S., & Johansen, E. (2013). Estimates of Female Genital

Mutilation/Cutting in 27 African Countries and Yemen. Studies in Family Planning, 44(2), 189-

204. Retrieved from http://www.jstor.org/stable/23408619