Decades of efforts to end female genital cutting have resulted in some progress, but the ancient tradition stubbornly persists in many places.
The latest initiative to tackle the issue is an $11 million research project launched this month by a consortium comprising several African organizations and two U.S. researchers: Bettina Shell-Duncan, a University of Washington anthropology professor, and Gerry Mackie of the University of California, San Diego.
The five-year project, funded by the U.K. Department for International Development and led by the New York-based Population Council, has a goal of reducing female genital cutting by at least 30 percent in 10 target countries -- something no effort to date has managed to achieve.
"There have been a multitude of different strategies, but one of the frustrating things for those working on this issue is that there has been surprisingly little success in large-scale abandonment of the practice," said Shell-Duncan, who is also a UW adjunct professor of global health.
"In most countries, there's no decline in the prevalence of cutting, or only the slightest beginning of change among the youngest group of women."
More than 130 million girls and women worldwide have undergone female genital cutting and up to 30 million girls are currently at risk of it, according to UNICEF. More than 90 percent of women aged 15 to 49 have been cut in Somalia and Guinea, and percentages are also high in many of the 29 countries in Africa and the Middle East where the practice is concentrated.
Female genital cutting, also called female genital mutilation, includes a variety of procedures ranging from a small incision known as nicking to infibulation, which involves cutting the genitalia and repositioning it to form a seal with a small opening. The cutting is often done at home, traditionally without anesthesia. Though the practice is deeply ingrained and culturally valued in many places, it has no medical benefit and can cause severe physical problems and psychological trauma.
As varied as the practice are the motivations behind it. In some places, cutting is considered necessary for a girl to be pure for prayer or marriage; in others, it is seen as way to bring social respect and honor to the family. Women who aren't cut are often stigmatized.
Female genital cutting has declined in some countries, most notably Kenya. Twenty-two of the 29 countries where it is common now have some form of law prohibiting the procedure. The UN General Assembly and other groups have called for heightened global efforts to end it within a generation.
But as knowledge has increased about the risks involved, there has been a trend toward "medicalization" of the practice, with more than 18 percent of cases now being performed by health care providers.
Ian Askew, the Population Council's director of reproductive health services and research, said the new project is needed because despite more than 20 years of efforts to end female cutting, little is still known about which approach may be most effective.
"No one has really documented what works and what doesn't work," he said. "Bettina has been one of the few researchers trying to understand why the practice continues and looking at some examples of approaches to try to encourage its abandonment."
Shell-Duncan was doing research on maternal health and infant mortality rates in Kenya in the mid-1990s, around the time female genital cutting started getting media attention in the U.S. The topic came up during a conversation with a group of Kenyan women one day, and Shell-Duncan didn't understand what they were talking about.
The women were "kind of horrified when they realized that I -- a wife and mother -- had not been cut," she recalled.
Soon after, Shell-Duncan was invited to attend a female cutting ritual performed as part of a wedding ceremony. Witnessing the procedure, then the subsequent rejoicing outside by the community, Shell-Duncan was initially shocked and perplexed. How could such a painful procedure bring such joy, she wondered?
"That became a turning point in my research career," she said.
Shell-Duncan shifted her research to female genital cutting, doing fieldwork and studies in Kenya, Senegal and Gambia. For the new project, she will be working with the African consortium partners in six African countries to investigate where and why the practice exists, what role social norms play and the impact on the lives of girls and women.
Reducing cutting is not as simple as convincing individual women to change their behavior, Shell-Duncan said. In many countries, large numbers of women and men no longer favor the practice, but have their daughters cut regardless, she said.
"Nobody wants to be the first to change, because there is too much at stake. It's changing something that has significant cultural meaning and ramifications for people's lives in many, many ways," Shell-Duncan said.
"We also know that in a handful of places FGC has been abandoned, even in some communities that have not had intervention programs. What makes people ready to change a deeply held cultural practice? That is the puzzle we are trying to figure out."
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For more information, contact Shell-Duncan at bsd@u.washington.edu or 206-543-9607.