Forced Gential Mutilation of 120 Women and Girls in Uganda Sparks Public Debate

Jodi Jacobson

Forced mutilation of some 120 young women and girls in Uganda last week has sparked a public debate inside the country about the limitations of a new law and the politics behind the practice.

Late last week, an estimated 120 young women of the Sabiny ethnic group in Uganda were forced to undergo severe forms of genital mutilation despite a new law banning the practice.  The mass “circumcision” involving the removal of the clitoris and other parts of their genitalia took place in public with crowds looking on. The fact that leaders of the Sabiny carried out the genital mutilation despite the new law–in fact in open defiance of it–has sparked public debate about the limitations of legal strategies operating in a vacuum.

In theory, the law poses strict penalties against those who perform or facilitate FGM.

According to the law, “aggravated FGM”–when death occurs or where the victim is disabled or is infected with HIV–results in life in prison. Parents, guardians, health workers, or “persons with control over the victim,” can be charged with aggravated FGM. The law also states that “others who engage in FGM shall be imprisoned for a period not exceeding 10 years.”

In practice, the law is being openly flouted.

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FGM is one of those “cultural” practices the sole purpose of which is to control women.  According to the Sabiny, reports New Vision, “a girl is circumcised to initiate her into adulthood. The clitoris is cut out to interfere with a woman’s arousal process.”

It also interferes with her life and health.  Where FGM does not lead to immediate death due to infection caused by the use of dirty instruments, it is associated with higher rates of pain during sex, sexually transmitted infections and HIV, problems urinating, and complications in labor and delivery leading to higher rates of maternal mortality and morbidity.  Not surprisingly, and complicating the overall picture, is the fact that FGM is practiced in cultures that also promote high fertility, measuring the value of women by the number of children they bear.  More pregnancies lead to higher risks of complications.

Reports from the site of the mass circumcision of Sabiny girls and women are gut-wrenching.  A New Vision reporter writes:

Some cried. Some were confused. Others still traumatised, while many were left speechless.  They looked on in disbelief as a local female surgeon tried in vain thrice, probably using a very blunt knife, to cut off a girl’s clitoris.

She then asked for another, similarly blunt knife and to make it work, applied extra force, going back and forth, the way a saw cuts into timber. The girl struggled not to show fear and to contain her trembling, which is culturally unacceptable and would have attracted scorn and ridicule from the attentive crowd.

As blood gushed from her private parts, the crowd urged the girls: “Be strong! You are almost done! Remain calm!”

Once cut, the girl was pushed aside, like a slaughtered chicken, her legs put together as if to stifle the pain and another descended upon.

Two knives were used to operate on 8 young women (whom the reports characterize as “girls.”)

The girls “wrapped in dirty blankets and strewn all over a compound hosting two huts,” were circumcised by a local female “surgeon.”

The circumciser would first throw fine millet flour into their private parts to reduce friction and wetness. 

She used the same knife to cut each of them. The knife was not sterilized, exposing all of them to the risk of the deadly HIV.

The cuts lasted close to 50 seconds. As the mutilated girls lay helpless, an old woman, threw millet flour over them to appease the spirits and ordered them to kneel so that the blood could pour out.

Most of the girls were barely in their early twenties but someone in the crowd said they were all married. “Girls here marry by their 15th birthdays,” he said.

“A few minutes later, the girls were told to march into a hut where they would spend the next three weeks healing from the mutilation. But they did not march; they staggered.”

These eight are among more than 120 girls who have been mutilated in Sebei region since the “FGM season” kicked off in Sebei in eastern Uganda.

As reported by New Vision, according to Alfred Ayebwa, the LC1 chairman for Kapkorosia village, over 50 girls were mutilated in Kabei and Kortuk sub-counties, 20 in Chesower sub-county, and 34 in Chekwasta sub-county. Another 16 were mutilated in Suam sub-county.

Bukwo vice-chairman John Chelangat said the mutilation was done between midnight and two in the morning, behind closed doors.

“This is due to fear of the new law that calls for the ban on FGM and gives harsh penalties to anybody participating in FGM or withholds any information about it,” he said

Critics blame what they contend have been failures to build support for the new law, to conduct effective public education campaigns on the consequences of female genital mutilation, and to enlist support for social change within the communities in question.  And while FGM persists in part because women are effectively seen as property, the women who do the cutting also depend on it for income, further increasing resistance to ending the practice.

A New Vision editorial, for example, argued that “FGM is still treasured by the Sabiny as a cultural practice [and] [n]o one should think that enacting a law against FGM would be enough to stamp it out. A lot more is required, mostly in sensitising the masses about the evils of circumcising girls.”

“[P]rotracted sensitisation, backed by supportive social structures like easy accessibility to schools, mass media and factors of production, is needed in Bukwo, Kween and Kapchorwa urgently. UNFPA accessed funding for this but has concentrated most of its work outside the region.”

New Vision reports on the limited reach of international funding and support for campaigns to eradicate FGM:

The United Nations allocated about $300,000 (about sh600m) for FGM activities but, to-date, people on the ground report no sensitisation activities.

The national gender officer for the UN Fund for Population Activities, Brenda Malinga, said some of the money has been used at the national level to get the law working and the rest was supposed to be disbursed to the districts in November for sensitisation about the law.

She says last year, focus was mainly on enactment and enforcement of legislation against FGM.

“We have been supporting training on community dialogue for FGM abandonment in Amudat, Bukwo and Kapchorwa. We also simplified the new law for them.”

But when Saturday Vision visited FGM districts, no impact was seen. And the FGM season started in July 2010.

Women who make their living by circumcising girls complained that “FGM activists promised them compensation for income lost but up to now, nothing has been done.”

“We shall continue cutting girls because this is where we get our income. They have also not sensitized us and we do not know what is in the law,” said Sunday Kokop, the surgeon in Suam-sub-county. 

Changing deeply ingrained cultural practices like FGM is not easy, though it has been successfully tackled in other places.

In Uganda, rural poverty is a barrier to change.

The lack of sensitisation about the law can be blamed on factors like lack of a radio especially in Bukwo district to carry the message, low levels of education and high levels of poverty.

Alex Cherop, 34, of Chesimat village in Kortek sub-county, said nobody has ever told them to abandon FGM. They hear about a campaign in Kapchorwa but do not know how it fits in their culture and customs.

The police are also unable to enforce the law because they do not have vehicles or other resources needed to patrol rural areas.

“We lack transport and most of the places are vast and hilly for us to reach,” said Bukwo district Police chief, James Wamwenyerere.

Moreover, it is difficult to get victims to help proscecute cases.  Becasue of fear of social censure or violence against them, women and girls who have been mutilated often will not speak out in identifying those involved.

And then there is the curious approach of arresting the victims themselves.  Police told New Vision about a case in which they arrested four girls who had undergone FGM and five of their parents. But, according to the district police chief, “they refused to name the people who mutilated them. They told the magistrate that they mutilated themselves.”

But this is also an issue of pure discrimination of women exacerbated by politics.  District leaders have expressed concerns about campaigning against FGM because they are afraid they may lose their personal political power.

“Local leaders are reluctant to swing into action because… they may lose votes,” reports New Vision.

Still, there is hope that this episode will catalyze more concrete action.  In response to the mass mutilation event among the Sabiny, and perhaps due to international publicity, Ugandan President Yoweri Museveni earlier this week promised to build boarding schools in the region to act as safe havens for girls seeking refuge from being mutilated.

“We are going to build boarding schools so that we protect our children from these local surgeons,” Museveni told the cheering crowds at Kween district headquarters.

He described the practice as backward and ungodly.

“How can you oppose God? God wired human beings the way he wanted them to be. You cannot be more clever than God to change his creation,” he said.

The President also urged the surgeons to form an association so that he could help them find an alternative source of income.  These suggestions have been on the boards for some time.  Last year, the equal opportunities committee of Uganda’s Parliament asked the Government to build model schools, where vulnerable girls will be kept during school days and holidays, until they are of age to resist the practice. 

Commentary Health Systems

How We Are Failing Women and Girls in Humanitarian Emergencies

Jamie J. Hagen

“Protecting the sexual and reproductive rights of women and girls in crisis settings is essential and a matter of human rights, but it is also complicated and unsustainable without a change in the way humanitarian assistance is provided and funded,” states a recently published report from the UN Population Fund.

Every day, 507 women and adolescent girls die due to a lack of reproductive health services in humanitarian emergencies. There are now 13 million displaced refugees globally. This number will only continue to grow as more people seek refuge from war and violence.

In addition to this growing refugee population, there is an ever-increasing population of internally displaced people: about 38 million in 2014, equaling 30,000 per day. These individuals fleeing conflict within their own country spend an average of 17 years displaced from their home relying on international humanitarian assistance. Although the international community first recognized providing reproductive health services as a human right with widespread economic and social benefits 20 years ago, barriers remain to meeting these needs for the 25 million women and girls living in emergency settings.

A report from the UN Population Fund (UNFPA), titled Shelter From the Storm: A Transformative Agenda for Women and Girls in a Crisis-Prone World, urges new directions in financing for sexual and reproductive health to address this problem.

“Protecting the sexual and reproductive rights of women and girls in crisis settings is essential and a matter of human rights, but it is also complicated and unsustainable without a change in the way humanitarian assistance is provided and funded,” states the report.

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Two critical ways for the global community to begin making progress include, as the report notes, increasing the international community’s focus on the availability and accessibility of safe abortion and post-abortion care, and cultivating a culture of preparedness and prevention when it comes to providing a full range of such services in communities prior to any crisis. 

Access to Safe Abortion as a Human Right

An oft-cited 1999 UNFPA report estimates that 25 to 50 percent of maternal deaths in refugee settings are due to complications of unsafe abortions. (Little research has been done in the past two decades to learn more about this crisis.) This is a startling statistic, yet abortion remains politicized and difficult for non-governmental organizations and leaders to talk about in the international arena, let alone fund.

Few displaced women are in a position to demand access to abortion or organize to advocate for these services. Societal forces are a large part of this disenfranchisement, including pressure from family and the broader community to bring a pregnancy to term to replace lost family or to hide a pregnancy that is a result of rape, which can increase the stigma they are facing. In addition, clinics in most crisis settings are not outfitted with the necessary medical equipment to provide safe abortion care or even to address complications of abortion. Also, many organizations receiving international funding to provide relief to refugees are religiously affiliated and do not offer reproductive health care, including abortion, according to a report about safe abortion for refugees.

As a result, research specifically addressing the state of abortion and post-abortion care in conflict zones often is neglected, creating a gap in information around this specific program area.

Sandra Krause, director of Reproductive Health at the Women’s Refugee Commission, explained to Rewire that, according to a 2012-2014 Global Evaluation from the Inter-Agency Working Group on Reproductive Health in Crises (IAWG), access to post-abortion care in crisis settings has expanded since 2004 but “comprehensive abortion care—in particular, safe abortion care,” is still lacking. The IAWG has since formed a working group to address this gap.

However, the results of that working group are unknown, and much of this work remains unfunded. On a hopeful note, Krause said that she believes the working group will create a sea change in the conversation around funding safe abortion access in humanitarian emergencies. “We did just receive some funding to update the global guidelines for reproductive health and humanitarian settings to better integrate safe abortion care,” she added.

Economic Case for Funding Reproductive Care Services

In addition to recognizing these services as a human right, the UNFPA report points to obstetric care, safe abortion and post-abortion care, and services for those who experience gender-based violence as keys to achieving sustainable development. There are measurable economic impacts from denying these services to women and girls.

“It prevents girls from being able to go to school, it prevents girls and women from accessing education more generally, and seeking higher education. It pulls women out of the workforce and makes them unable to provide for their families and for themselves,” Katherine Mayall, a global advocacy adviser at the Center for Reproductive Rights, told Rewire.

“There is a strong economic case to be made for meeting the reproductive health needs of a country’s population in humanitarian emergencies,” added Kade Finnoff, an economics professor at the University of Massachusetts. “In lower-income countries where many humanitarian emergencies occur, we now have empirical studies that document the economic impact to individuals and local economies.”

One study of Ghana and Bangladesh about the impact of increased access to reproductive health services found that improved access to family planning services led to “improved birth spacing” and an increase in women’s earnings and participation in paid employment. Further, children of women with access to family planning were better educated than those without these services. Another study of Nigeria found, “reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development.”

A long-term strategic focus on providing sexual and reproductive health services could also allow non-governmental organizations to increase their support for prevention and preparedness before a humanitarian emergency.

As the UNFPA report notes, “Humanitarian funding is mainly directed towards the response to crisis, with relatively little directed to prevention and preparedness.” This lack of preparation often exacerbates already devastating situations, as we’re seeing now in countries affected by the Zika virus. Some government leaders in these affected nations are advising their citizens not to get pregnant for fear that their fetuses will develop a life-threatening anomaly. But many of these same countries don’t have the health-care systems in place to assist the women in need of contraception or abortion care, because of restrictive anti-choice laws.

Ultimately, meeting the needs of every community requires a holistic approach that includes support for prevention and preparedness as well as emergency services.

Cultivating a Local Response

IAWG encourages all communities to implement the Minimum Initial Service Package (MISP) for reproductive health, which is a “life-saving” set of guidelines “to be implemented at the onset of every humanitarian crisis,” the website reads. “It forms the starting point for reproductive health programming and should be sustained and built upon with comprehensive reproductive health services throughout protracted crises and recovery.” For example, a MISP checklist includes a form with sections on how to gather information about the demographics of a humanitarian setting, how to prevent sexual violence and respond to the need of survivors, how to reduce the transmission of HIV, and how to prevent excess maternal and newborn morbidity and mortality. And a yes/no checklist fosters the development of a weekly monitoring initiative at the onset of a response and then tapers down to a monthly review of the status of reproductive health-care services in the humanitarian setting.

“We know in every crisis women and girls are going to have these priority needs, even if it’s in New York City,” said Krause. “Pregnant women are going to need emergency obstetric care because of the breakdown in civil society in cities. There is always an increase in risk for sexual violence and so women are going to need access to care. A certain percentage of women who are pregnant are going to have emergency complications. Newborn care is essential.”

Some local communities are already focusing on prevention and preparedness. “There are some wonderful efforts—led by displaced communities themselves—to address these issues, such as the Adolescent Reproductive Health Network (ARHN) on the Thai-Burma border and Association for Refugees with Disabilities in Uganda,” noted IAWG researcher Sarah Chynoweth. Both organizations work on issues often overlooked in emergency situations.

Rewire reported on the work of ARHN to meet the needs of adolescent refugees, such as providing condoms, peer sex education, and birth control pills. The UN Human Rights Council has recognized the Association for Refugees with Disabilities in Uganda as an example of good practices for allowing refugees living with disabilities to advocate on their own behalf.

Chynoweth emphasized the importance of focusing on those who are particularly marginalized when preparing for emergency response and outreach. “Displaced adolescents, people with disabilities, LGBTQ individuals, and sex workers are particularly vulnerable to sexual violence and exploitation, and they also have specific [sexual and reproductive health] needs. We can’t just keep ‘doing business as usual’—targeted outreach must be conducted to engage these groups, something which humanitarian agencies often neglect.”

As the UNFPA report and other researchers have shown, the best way to provide for immediate and long-term support for sexual and reproductive health services is to fund both global and local initiatives aimed at spurring sweeping improvements in the lives of women and girls.

Commentary Race

Advancing Reproductive Justice for Black Women and Women of Color in Cleveland

Jasmine Burnett

Recent efforts by reproductive justice organizations in Cleveland, including New Voices Cleveland, show that women will not stand idly by and watch their rights be taken away or have others—be it mainstream media outlets, anti-choice organizations, or anti-woman politicians—dictate their health and safety needs through racist billboard campaigns.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

A politically hostile and anti-woman sentiment is playing out in Ohio, where local and state legislators are using women’s access to reproductive health care as a tool to jockey for power. We are seeing varying degrees of this in states across the country, but the anti-choice movement’s “war on women” most recently came to a head in Ohio following the tragic death of Lakisha Wilson, a 22-year-old mother who had sought an abortion during her second trimester at Preterm, which provides abortions through 22 weeks’ gestation.

After Wilson’s death, the media and anti-choice organizations began stirring the anti-abortion discussion at the local and state level, but it was the response from women of color and allied organizations that is setting a precedent. Their work fighting back against these attacks shows that women will not stand idly by and watch their rights be taken away or have others—be it mainstream media outlets, anti-choice organizations, or anti-woman politicians—dictate their health and safety needs. It’s a model that other groups around the country should follow, especially in the coming year, when newly elected GOP lawmakers will be fighting hard against them.

On March 21, a Preterm clinic employee dialed 9-1-1 and reported to the dispatcher that Lakisha Wilson, who had been 19 weeks pregnant, was not breathing. The medical staff at Preterm immediately performed CPR. The ambulance arrived three minutes later and transported her to University Hospital, where she died on March 28, a week later, of “cardiopulmonary arrest immediately following elective abortion of intrauterine pregnancy.” The Cuyahoga County medical examiner determined there was no medical error in her procedure at Preterm. (According to a study published in Obstetrics and Gynecology, abortion is 14 times safer than childbirth.)

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When Lakisha Wilson entered Preterm in March, she had made the same choice that one in three women will make over the course of her lifetime. (Six out of ten of those women, like Wilson, are already mothers.) Four months after her death, however, Ohio Right to Life erected billboards aimed at spreading “awareness about the racial crisis of abortion” through racist campaign ads—not the first time anti-choice organizations erected billboards aimed at shaming and stigmatizing Black women seeking abortion.

The ads said things like “Stand by me,” and “Fatherhood starts in the womb,” presuming that abortion is the result of male irresponsibility. Additionally, the messages reinforced negative tropes about Black fatherhood, such as that Black fathers are conditioned to be absent, and that Black fathers are the only men impregnating women outside of marriage. These are extensions of anti-choice myths about Black women and Black motherhood.

In response to the ads, New Voices Cleveland, a grassroots organization working as part of New Voices Pittsburgh to advance reproductive justice for women and girls of color in the Rust Belt region through education, training, and advocacy, wrote an open letter calling on the groups responsible for the billboards to stand down. But Clear Channel, the media company that hosted the billboards, completely ignored its call for justice, as did Ohio Right to Life.

“The fact that they did not respond, reach out, or attempt to have a conversation with us, shows how much they do not value Black women,” said Maria Miranda, a member of New Voices. (Miranda is also director of development at Rewire.) “Black women said these billboards were offensive and [the groups] ignored it. This speaks volumes to their abilities to engage Black women on this topic. They say they care about Black communities but don’t want to talk to Black women who disagree with them.”

Because of my experience battling the racist anti-abortion billboard campaigns in 2011, through the Trust Black Women partnership, I know that developing a strategy in which allies stand with, but not in front of, women of color is integral to this work. The reproductive justice framework, specifically, centers the voices and experiences of women, girls, and the people who are most affected by white supremacy in the United States.

It is with this in mind that New Voices Cleveland was joined by NARAL Pro-Choice Ohio, Planned Parenthood Advocates of Ohio, and Preterm Clinic to retaliate against these anti-woman, racist attacks. They began working together to engage community members in a more positive way around reproductive health care, by launching efforts to de-stigmatize abortion and address health disparities by race and class that affect whether or not a family will receive quality care, if any at all. I assisted in this work, serving as a consultant organizer for New Voices Cleveland.

The themes they are adhering to as part of this collaborative work include: creating an ethos of collective work, responsibility, accountability, and trust among partner organizations; building a shared voice on reproductive justice issues in Greater Cleveland and in the State of Ohio; coordinating “first-response” work to political and legislative fires; and supporting collaborative efforts over the long-term for advocacy, organizing, and communication strategies. Our pro-active position is crucial because for too long the human rights and progressive movements have only been able to respond defensively to attacks from anti-choice extremists and political conservatives. We are clear that our values have always been rooted in true liberation and in acknowledgement of the difficult decisions that families have to make. These themes are placing the state’s leading reproductive health, rights, and justice organizations in a position to lead and bring in more allies and partners that share these values for Ohio women and families.

The context for these circumstances is informed by the politics of the state government: under Gov. John Kasich’s leadership, the legislature is now a conservative super majority in an otherwise purple state. Further, “Gov. Kasich has politicized the Department of Health by appointing Mike Gondiakis, president of Ohio Right to Life (an attorney, not a health-care provider), as a member of the state medical board,” explained Kellie Copeland, executive director of NARAL Pro-Choice Ohio, in a phone interview.

The political relationships that are brokered on the bodies of women and their families situates reproductive health needs in a conservatively biased, ethically challenged position. “[The right has] looked for opportunities to exploit and abuse their power to close clinics, not for medical reasons, but simply to placate their political base, like the anti-choice movement,” Copeland added.

Overall abortion is a safe medical procedure that has been legal since Roe v. Wade 41 years ago. However, even after the Cuyahoga County medical examiner determined that there was no medical error when Lakisha Wilson took her final breath, mainstream media outlets published articles that attempted to position abortion as an unsafe procedure.

Celeste Ribbins of Planned Parenthood Advocates of Ohio explained to Rewire that it was “really unfortunate how the media coverage [about Lakisha Wilson] has shamed [women] and their decisions. Abortion and women’s health care are complex issues, so I think that it has been oversimplified in some of the coverage.” Ribbins added that “the information has been presented in a way that does not help women who may be contemplating what to do about their pregnancy make a truly informed decision about their health” and that her group will help a woman “no matter what, based on all of her options, and she will be educated on those options, whether that be to parent, adopt, or end the pregnancy.”

Nancy Pitts, director of development and communications at the Preterm Clinic, emphasized the safety of abortion procedures and the supportive environment her clinic offers to clients, despite what anti-choicers have instilled in their followers. She said Preterm is “a place of complete human dignity and complete human respect.”

“It’s a process coming into the heart of Preterm,” she explained, “Everyone has to go through a metal detector and we have a security guard on duty, but once you get inside, we create a welcoming, nurturing space … in a way that honors people, their experiences, values, feelings, and needs.”

Pitts added that because of the state’s 24-hour waiting period law, “we have two waiting rooms …. We know that people spend a lot of time here so we try to create a space where they can be comfortable.”

For now, Preterm continues to meet the needs of the community’s most vulnerable. But as the results of this year’s elections show, the fight to protect women’s reproductive rights, health, and safety in the state is far from over. That’s the bad news. The good news is that, as this reproductive justice work in 2014 is demonstrating, women of color leadership and allied organizations in Ohio will not stand by while the rights of Ohio women and families are dialed back to the 1950s and 1960s when birth control was not readily available or affordable and when the only abortions women had access to were those that were unsafe. We will mobilize our allies and convene our partners that are invested in advancing the human rights of Ohio women and families.

The collaboration with NARAL Pro Choice Ohio, New Voices Cleveland, Planned Parenthood Advocates of Ohio, and Preterm Clinic is only the beginning of our strategy to attain reproductive justice for women and girls of color and our families in Ohio, which includes fighting for access to quality care for women even before they become pregnant. While we don’t know more about the events leading up to Lakisha Wilson’s death, we do know Black women are less likely to have access to preventive care services, which is literally killing them.

“I never met Lakisha, I only know her through the circumstances of her death, but boy did she spark something from the anti-choice folks,” said Maria Miranda. “At the same time, she sparked the voices of Black women to say, ‘Wait a minute, not in her name will you shame the choices that we have to make for our families.'”

“A woman I will never know is part of this history-making moment in Cleveland around getting Black women’s voices amplified, and there’s something very powerful about that,” she added.

There’s also something very powerful about the ways in which Cleveland groups have collaborated around making change in the state. The response from a coalition of women’s health organizations was a vital step in advancing reproductive justice for Black women and women of color in the state. Now, advocates must continue to fight back against these racist, anti-choice attacks. As my experience in Cleveland has demonstrated, the way to do this, and ultimately achieve human rights for all, is to put the needs of the people most affected at the center of this work.