Female genital mutilation (FGM) is a procedure that involves altering or injuring female genitalia for non-medical reasons.   It is estimated that almost 200 million women and girls worldwide have undergone some form of FGM. FGM has been recorded in 30 countries with Somaliland having one of the highest prevalence rates in the world at 98% for women and girls aged between 15 - 49 years old. Hope on the horizon documents the hard work IPPF member association SOFHA (Somaliland Family Health Association) is doing within the local community to help change minds and eventually bring an end to female genital mutilation (FGM). Slowly, but surely, attitudes are changing.

I left Somaliland when I was 9 years old with my mother, brother, uncles, aunts and cousins. It was the civil war and we were lucky enough to reach Canada as refugees. I remember that time as a pleasant, warm, loving time where my cousins and I had a lot of freedom to play, walk to school and daydream. I am from Somaliland so of course I am part of the 97-98% or so of girls who undergo the female genital cut. I think it happened when I was around seven years old. I remember being restrained. I remember strangers being around and I remember peeing standing up and it burning. These memories don’t come up often and they don’t cause me pain. It’s a distant, childhood event. A cousin and a niece my age were there and we went through it together and afterwards our mothers and aunts took care of us. I grew up, went to school, questioned the world and my role in it for a time, got married, had kids and eventually went back to Somaliland. There I met Edna Adan Ismail and asked to volunteer with her. She opened her office, hospital and life to me and I became immersed in the maternal health issues of the women in my home country. The effort to end FGM Most were not as lucky as I had been. Because of FGM/C (female genital mutilation/circumcision), most had experienced recurring infections and difficulties in child birth. Some had formed cysts, some became infertile, and some had obstetric fistula. But few linked these problem to the cutting. At SOFHA (Somaliland Family Health Association) we’ve been working to help women (and men) understand these links and get the help they need. That’s only a part of the work. The effort to end FGM/C in Somaliland goes back almost 40 years. FGM/C programs and projects have been happening for at least the last 25 years. We’re now at the point where it’s recognized as a legitimate, critical, health and social issue. We’re on the cusp of a law against the practice and I have personally witnessed a transformation among the individuals who engage in this work. NGO and government staff tasked with working on FGM/C used to go into communities apologetically, “Sorry but we have to talk to you about this ‘issue’, we know it’s unpleasant but bear with us” to “I have 2 daughters and I have not cut them. This is a terrible practice and we must stop it now”. It fills me with great joy to see young women and men taking this personal stance and doing it confidently and proudly. But it’s not easy for most people to do this. It certainly wasn’t for me. This is personal. This is private. Before I got into the work I might have said, “What business is it of yours anyway? Do you really want me digging into your private life? Into your past and history? I am not a victim. I may be a survivor but not in the way you think and not for the reasons you imagine. I am bigger than this. This doesn’t define me.” Dignity, bravery, respect And it may not define most Somali women. I think that’s what confuses many people. Maybe it’s because it happens in childhood and those memories are lost or hidden or maybe because mothers and grandmothers have such good intentions or maybe because it’s so universal within the community? That’s why it’s a completely different experience for a young Somali girl born and brought up somewhere else. The experience is very personal and it varies from person to person. Dignity, respect and bravery are guiding principles for our work on female genital mutilation. In Somaliland, a dynamic young generation connected to the world through the internet, and integrated multi-pronged FGM/C programming, is helping us to influence a generation of Somalis to abandon the cut and break the cycle. It’s still some distance away but we see the end in sight. Words Amal Ahmed, the executive director of our Member Association in Somaliland (SOFHA) 

Eliminating Female genital mutilation (FGM) is finally in the spotlight of the international policy agenda. It is part of the United Nations sustainable development goal 5 – to achieve gender equality and empower all women and girls, with a target to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation”. The World Health Organization estimates that more than 200 million girls and women worldwide have been subjected to FGM, with approximately three million girls at risk each year. The majority of girls are cut before they turn 15 years old. Female genital mutilation (FGM) comprises of all procedures that involve altering or injuring the female genitalia for non-medical reasons and is recognized internationally as a violation of the human rights of girls and women. FGM is a human rights violation, a form of torture and an extreme form of violence and discrimination against girls and women, rooted in harmful gender norms. The continuation of FGM sustains massive gender inequalities in practising societies, as it limits opportunities for women and girls to realize their full rights and potential. In areas where FGM is prevalent, IPPF clinics are often the first point of contact for affected women. To date, IPPF has put in place various efforts to advance this work, including; the launch and dissemination of a Statement by the International Medical Advisory Panel (IMAP), offering programmatic recommendations to MAs on how to address FGM; provision of technical and financial support to implement FGM-related initiatives in key countries; partnership building. IPPF Member Associations (MAs) play a pivotal role in tackling social norms that hinder meaningful and equal participation in society including, FGM. MAs promote enabling legal environments and facilitate access to services and reparation, provide comprehensive care to women affected by FGM and generate evidence on best practice. "I cannot talk about the bedroom when all I experience is pain and recurrent infection. My husband knows this. We both agree that our daughter will never be cut' and growing understanding from young male peer educators, 'we do not need to cut our daughters at all, not even the 'sunna'. I will marry whoever I marry but she does not need to be cut. If I have daughters, they will not be cut, not at all." Somaliland Family Health Association (SOFHA) and the diaspora women at the frontline of change At a prevalence rate of 98.9% Somaliland has one of the highest rates of FGM in the world. With evidence showing that about 1 in 5 girls who have been subjected to FGM, had the procedure performed by a trained medical professional (in some countries it is as high as 3 in 4 girls). Somaliland Family Health Association (SOFHA), the IPPF MA in Somaliland is at the forefront of advocacy to end FGM. A baseline research carried out by SOFHA and partners showed that FGM is widespread and cuts across all ages and locations, including in urban and rural communities. Implemented with funding support from the Norwegian Development Agency (NORAD), “Empowering a first generation of Somalis to Abandon FGM”, is a flagship initiative that has gained momentum and is catalysing change from the grassroots upwards. Inspired by their belief in social norm change that is from their own experience and that of their peers, many Somali women from the diaspora are returning home to lead the struggle to end FGM. Amal Ahmed and Edna Adan Ismail, SOFHA executive director and president, are some of those leading the struggle by building partnerships with government ministries and civil society organisations (some of whose leaders are also returnees from the Diaspora), in schools and communities and reaching out to young women of the Somali diaspora - to build a movement for social change; "We recognise that to succeed in ending FGM - we must work at all levels and with all players, including religious leaders, young people, mothers and grandmothers; focusing on human rights and gender equality and to speak in a language that is understood". Yet the practice is far from over. Much more needs to be done, to anchor policy into practice. IPPF and Member Associations will continue to fight for change to ensure women and girls can live free from sexual and reproductive coercion and all forms of gender based violence.

Today the world celebrates the International Day of Zero Tolerance for Female Genital Mutilation (FGM), a tradition that still puts at risk the life and health of millions of women and girls. FGM refers to different types of cutting and the removal of external female genitalia, and in its most extreme forms in the partial stitching together of the vulva (infibulation). All of these practices can lead to recurring infections, fistula, infertility, HIV and even death. FGM often leads to pain during menstruation and sex and difficulties during childbirth are very likely, resulting in a lifelong threat to women's health and well-being. The practice persists even in countries, like Kenya, where it has been officially outlawed, because it's strictly bonded to religious beliefs and traditional rites of passage. What can be done to eradicate female genital mutilation?  We asked the advice of Dr Edna Adan, founder of IPPF Somaliland Family Health Association (SOFHA) and the first person to start the fight against FGM in her country, and of Amal Ahmed, SOFHA's Executive Director. SOFHA's staff deals with FGM complications on a daily basis and is actively working to lead a cultural change in Somaliland where 98% of women are FGM survivors and a vast majority of them has undergone infibulation.  Here is their key strategy to try tackle FGM. 1- Go down to the community and talk about things people understand and care about. "You need to get trusted people to go to the community, to the villages. Don’t talk about human rights or girl’s integrity and don’t directly talk about FGM. Talk about health, they want their girls to be healthy. Tell them about the risk of infertility and HIV, about the pain and recurring infections." -Edna   "We approach mothers from the maternal ward, we discuss with them and try to earn their trust. We explain them the health risks and invite them to keep coming to our clinics." - Amal   2- Engage religious leaders. "FGM is not an Islam requirement, it's a traditional mutilation. Religious leaders are trusted in the community and can help fight this misconception, affirming that FGM has no place in any religion, that God created the girls and forbids FGM."  - Edna   "When we tell mothers that FGM is against Islam, then we get their attention." - Amal   3- Collaborate with educators to inform and engage young people. "Go to the elite of educators. IPPF since last year is funding a 3-years project to institutionalise FGM campaigns by involving the Minister of Education, to bring FGM to high-schools and universities, to form the next generation of educators and medical professionals to become change-leaders." - Edna   "First years of school are crucial to engage parents, because girls are cut during those years. "In high schools and universities, we also invite young people to think about what they will do as parents, and to intervene at home for their younger siblings." - Amal   4- Engage men, especially fathers. "I knew that what was done to me was wrong because my father was against it, but most men don't know what happens, they think that FGM is like male circumcision. Let it become a male issue, men doctors talking to men.  Engaging fathers is the best strategy. Tell them they could never be grandfathers if they let their daughter be cut." - Edna "Men consider reproductive health a woman issue. We brought them to a maternal hospital, they've never been there before. We also invite young men to become activists." - Amal   5- Don't rush to legislation, invest in cultural shift. "Resolutions are easy, but their implementation is difficult, unless you want to convict every mother and look after all children. You need to convince the majority, then convict the minority." -Edna "I'm from the diaspora community, when the practice has been abandoned. When my aunt visited us from Somaliland, and saw how horrified we were about her idea to cut her daughter, she changed her mind." - Amal   6- Invest in relationships. "Trust and personal relationships are extremely important, both with the community, the government and the civil society. We've created a national taskforce to learn from each other and collaborate across the country.  We're also collaborating with four ministries, Education, Health, Social Affairs and Religious Affairs. Through IPPF's project, we want to mainstream FGM campaigns to build the capacity of these institutions so they can keep intervening after the end of the project. It's important to remember that the focus is not on you, but on the elimination of this dangerous practice." - Amal