First Lady of Benin Claudine Talon. Credit: One CampaignCan These Three African First Ladies Can End Female Genital Mutilation? Alanna Shaikh, MPH April 13, 2017 By: Alanna Shaikh, MPH on April 13, 2017 This week, three African first ladies spoke out against female genital mutilation (FGM). Niger’s first lady, Lalla Malika, Claudine Talon, the first lady of Benin, and Sika Kabore, first lady of Burkina Faso called attention to the cruel persistence of female genital mutilation in their countries and others around the world. Perhaps most importantly, though, is that they called for a new strategy to stop this practice–one that brand new scientific research suggests has the best chances of success. FGM is defined by the World Health Organization (WHO) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” It may consist of anything from minor cosmetic scarring of the labia majora all the way to full removal of all external genitalia, including the clitoris. Even the least invasive forms can causes serious harm to the girls who undergo the procedure. It can causes hemorrhage, infection, severe scarring, lifelong chronic pain, urinary problems, and complications in childbirth. In addition to its physical impacts, FGM is a serious violation of the human rights of women and girls. WHO states that the practice, “It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children.” It’s also extremely difficult to eliminate. It’s performed by older women on young girls, and associated with ideas about femininity and modesty. Many parents worry that an uncut girl will be unmarriageable. Although no religious texts call for it, it is emotionally connected to religious practice in many communities. Cutting young girls is part of community tradition. There is no easy way to separate one harmful practice from that complex web of culture, history, and faith. Since 1985, the percentage of young girls undergoing FGM has decreased from 51% to 37%. That’s not an impressive decline. According to UNICEF, if trends continue, the absolute number of girls and women undergoing FGM will actually increase substantially in the next 15 years. Making FGM illegal doesn’t make it stop. Instead, criminalizing FGM seems to drive the practice into the hands of community circumcisers who often lack knowledge of hygiene and infection. Education about the health risks of the practice seems to make little difference; knowing the risks does not change the behavior. Opponents to the practice have tried everything from music videos to developing alternate rites to honor and ensure the purity of women. Ms. Malika, Ms. Talon, and Ms. Kabore call for community education to bring an end to FGM. This may be the approach with the best odds of success, especially in light of new research of FGM in West Africa. The study, “Cultural evolution: Evolution of female genital cutting ,” was published in February and finds that the babies of West African women who have undergone FGM actually have better odds of survival than the babies of women who have not been cut. Since the FGM itself is physically harmful, they conclude that there must be strong social and community benefits to being cut that compensate for and even outweigh the physical damage. The study’s authors suggest that the best approach to eliminating FGM is to take a community approach rather than an individual approach. They suggest that this community change approach be supported through both communal consensus approaches and by identifying individuals who could drive community change. This would eliminate the social hardship faced by women who have not been cut. The authors also recommend supporting programs to encourage social connections among cut and uncut women. Female genital mutilation is one of the wicked problems of global health. It doesn’t respond to the kind of behavior change programs that have increased vaccination rates or reduced the incidence of Guinea Worm. We can hope that this new community dynamics approach will have some effect, because no girl deserves to face mutilation and torture as the price of womanhood.