Source: The New York Times
A comprehensive new assessment of the ancient practice of female genital cutting has found a gradual but significant decline in many countries, even in some where it remains deeply entrenched.

Teenage girls are now less likely to have been cut than older women in more than half of the 29 countries in Africa and the Middle East where the practice is concentrated, according to the assessment by the United Nations Children’s Fund. In Egypt, for example, where more women have been cut than in any other nation, survey data showed that 81 percent of 15- to 19-year-olds had undergone the practice, compared with 96 percent of women in their late 40s.

The report’s authors stress that the tradition still has a tenacious hold in many places, but they say the fledgling declines may foreshadow more generational change. In almost half of the 29 countries, young women were less likely to support the practice than older women. The difference in Egypt was especially stark: only a third of teenage girls who were surveyed thought it should continue, compared with almost two-thirds of older women.

“The fact that young women are against the practice in places like Egypt gives us hope that they will be able to stop the cutting of their daughters,” said Claudia Cappa, lead author of the Unicef report. “We need to create conditions so they can act on their beliefs.”

Over all, Unicef estimates that more than 125 million girls and women have undergone the practice and that 30 million girls are at risk of it over the coming decade. The report, released Monday, is the first in which Unicef assessed the practice among all age groups based on household survey data from all of the 29 countries. Its last report, issued eight years ago, was based on 30 surveys in 20 of the countries; the new study includes 74 surveys done in 29 countries over two decades.

The report depicts progress against female genital cutting as halting and uneven. It also offers a portrait of nations where its prevalence is still stunningly high. In addition to Egypt, where 91 percent of women 15 to 49 have undergone the practice, countries with the highest percentages of women who have been cut include Somalia, at 98 percent; Guinea, at 96 percent; Djibouti, at 93 percent; Eritrea and Mali, at 89 percent; and Sierra Leone and Sudan, at 88 percent.

Unicef found that the steepest declines in the prevalence of the practice, also known as female genital mutilation, have occurred in Kenya, one of Africa’s most dynamic and developed nations, and — most surprisingly — in the Central African Republic, one of its poorest and least developed.

Researchers now say the prevalence of the practice in these two countries began to fall four or five decades ago. They said the progress made sense in Kenya, where efforts to stop female genital cutting stretch to the early 1900s, but they were at a loss to explain why it had plunged in the Central African Republic, to 24 percent in 2010 from 43 percent in the mid-1990s.

“We have no idea, not even a guess,” said Bettina Shell-Duncan, an anthropology professor at the University of Washington who was a consultant on the report. Professor Shell-Duncan said researchers needed to get to the Central African Republic soon to figure out what was happening there.

The country has received no significant foreign aid to combat the practice that Unicef researchers knew of, and it has been the subject of no scholarly study that they could find.

While experts were amazed about the Central African Republic, they were disappointed that no significant decline had been detected in Senegal between the surveys done in 2005 and 2010-11. Tostan, a human rights group whose name means “breakthrough,” has led a much-hailed and growing social movement there to stop the practice, with support from Unicef and other donors. Thousands of villages working with the group have declared their intent to abandon genital cutting.

Molly Melching, Tostan’s executive director, said in an e-mail that the momentum in Senegal had accelerated in the past five years and that changes would probably become visible only in 2020, as girls who would otherwise have been cut grow old enough to be interviewed in household surveys. She also noted that the national surveys had not specifically sampled the villages where Tostan worked or evaluated the group’s impact.

Mrs. Cappa, of Unicef, acknowledged Ms. Melching’s points but said “the real surprise for Senegal” was that support for the practice among women and girls had not noticeably declined.

The new report is based on data from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys; women ages 15 to 49 were questioned about their own status and that of their daughters.

 This self-reported data should be treated with caution because women may be unwilling to disclose having undergone the procedure because of the sensitivity of the topic or the illegality of the practice. And some women may be unaware that they had been cut or the extent of the cutting, especially if the procedure was done at an early age.

Nonetheless, it identifies intriguing trends in who is performing the cutting, its severity and people’s attitudes toward it.

In most countries, traditional circumcisers still do the cutting. But in Egypt, a troubling shift has occurred as people have become more aware that girls can die from the procedure: the number of girls and young women cut by medical professionals, mostly doctors, has risen to three out of four from just over half in 1995.

“Women know more about the harms, but there is still social pressure to conform, and so they medicalize the procedure,” said Francesca Moneti, a senior child protection specialist at Unicef.

Across all countries, one in five of the women and girls genitally cut has undergone the most severe form, known as infibulation. It usually involves cutting and stitching together the vaginal labia, nearly covering the urethra and the vaginal opening, which must be open later for intercourse and childbirth.

But a trend toward less radical forms of genital cutting has taken hold in some countries, including Djibouti, where 83 percent of women in their late 40s report being infibulated — sewn closed — compared with 42 percent of 15- to 19-year-olds.

Female genital cutting includes a range of practices from pricking or piercing female genitals to amputating some or all of the external genitalia, including the clitoris. The practice can diminish women’s sexual pleasure and increase the risk that they and their babies will die in childbirth.

The Unicef report also found that while the practice is sometimes seen as a patriarchal effort to control women’s sexuality, it is often women who carry it out, and in a few countries, including Guinea, Sierra Leone and Chad, more men than women support its abandonment. Significant numbers of women also do not know what men think about the practice and often underestimate the proportion of them who want it to end, survey data show.

“In the United States, how many husbands and wives talk about sex?” asked Stanley Yoder, a researcher with ICF International, a consulting firm, who has been involved in surveys in Africa for 15 years. “Some do, but many don’t. There are things people don’t talk about.”

The most common reason women give for continuing genital cutting is to gain social acceptance. United Nations researchers for the first time cross-tabulated data on women’s views and learned that many mothers opposed to the practice reported having had their daughters cut.

“This shows the gap between attitudes and behavior,” Mrs. Cappa said. “What you think as an individual is not enough to put an end to the practice because of social pressures and obligations.”

 

The Fight Against Female Genital Cutting: New York Times reporter Celia Dugger reports from West Africa on progress in community-based efforts to eradicate female genital cutting.