2002 EGY: Protection of the Girl Child and Eradication of Malpractices
Author: Helmy, M.
UNICEF's belief in the dangers of Female Genital Mutilation (FGM), its high prevalence in Egypt, and the role that governmental and non-governmental organizations can play in this issue -- through training of trainers, awareness-raising campaigns, production and dissemination of educational materials -- led the Women's Program in UNICEF Egypt to fund some projects aimed at the eradication of FGM among which is the project implemented by the Ministry of Health & Population and the Ministry of Social Affairs in four governorates in Upper Egypt: Giza, Minya, Assiut and Sohag. This project's goal is to create a cadre of medical doctors, nurses and health home visitors who are aware of the danger of FGM and are able to advocate, through their activities, the need to stop the practice.
Purpose / Objective
- Review actual project outcomes vis-à-vis the goals and suggested plan
- Evaluate the quality of performance and accomplished activities
- Measure changes in trends among the project's target categories
- Suggest recommendations to develop the performance and activities, and to outline a system for monitoring and following up for similar future projects
Structured individual interviews were held with officials in charge of the project at UNICEF, the Ministry of Health and Population in Cairo and health directorates in the four governorates. A review of project documents was also conducted.
A total of 31 focus groups were organized in the four governorates (Giza, Minya, Assiut and Sohag), comprising a total of 364 individuals. Discussions were held with: officials and trainers (36 individuals), eight groups of physicians (82 doctors), eight groups of nurses (91 nurses), eight groups of health workers or Raedat Rifiyat (93 Raeda), one group of traditional birth attendants or dayas (ten dayas), and three groups of mothers in villages (52 women).
Key Findings and Conclusions
Physicians, nurses, health workers and officials affirmed that some doctors still practice circumcision, particularly ob/gyn specialists and physicians who have private clinics. These conclusions were also confirmed by the Egypt Demographic and Health Survey (2000). A large number of dayas still practice circumcision.
Doctors, nurses, health workers and officials affirmed that one of the main obstacles facing anti-circumcision efforts is the continuous practice of circumcision by some doctors. Some participants favored the gradual elimination of circumcision by allowing doctors only to practice it as a minor plastic surgery that does not pose any harm to girls.
A limited number of participants had read or seen the Ministry of Health publication entitled "No to Circumcision." All doctors and nurses said they learned about the Ministry of Health decree of 1996 from the training session only. They had no previous knowledge about it. The ministerial decree has a loophole since it allows circumcision when it is a necessary procedure. Sometimes, girls suffer a congenital enlargement of the external genital organs and require plastic surgery. The majority of physicians and health workers, and two thirds of the nurses chose the phrase "circumcision is necessary for a small percentage of girls." Although doctors affirmed that congenital deformities are very rare and that they personally have not seen any, the majority of medical professionals reiterate that circumcision is necessary for some girls. Stressing the need for doctors to decide whether or not circumcision is required, gives a general feeling that cases of congenital deformities are widely prevalent. As a result, many mothers are left to believe that their uncircumcised daughters are not normal and require circumcision.
Awareness raising messages still focus on the health ramifications of circumcision such as severe pain, hemorrhage, infections and psychological shock, as well as extreme complications such as sterility, infant deformity and death. It is true that circumcision has health ramifications, yet focusing on them leads to more practice by doctors in order to avoid complications [as opposed to a reduction in the practice]. Those undertaking awareness-raising efforts tend to lose credibility among women who did not experience these complications.
Some physicians, nurses and health workers stated that the training duration (two days) was not sufficient to address all aspects related to circumcision. Some physicians, nurses and health workers did not receive the training manual. Physicians asserted that they did not study circumcision as a topic in medical school.
Participants in the concluding workshops generated many good ideas for posters, pamphlets and poetry. Some doctors, nurses and health workers complained about the absence of simple illustrative or audio visual materials in large numbers to help them raise public consciousness.
Participants expressed regret that the mass media, particularly TV, does not adopt this issue and raise it for public debate.
The majority of participants had no knowledge about the position of international organizations and conventions towards circumcision. Despite cooperation and coordination between the Ministries of Health and Social Affairs on this project, participants did not refer to any kind of coordination with NGOs or community development associations.
Making available the full media publication of the Ministry of Health (Advocacy Component Project) entitled "No to Circumcision", since this is one of the most comprehensive references available on the subject. The publication is divided into six pamphlets addressing: the medical perspective; the cultural and social perspective; the religious (Moslem and Christian) perspective; the legal perspective; the media perspective; and previous studies and research. The publication should be disseminated to health units and directorates and medical centers.
Dispatching a circular letter to all health units, hospitals and private clinics, including the decree of the Minister of Health forbidding the practice of circumcision, as well as the verdict of the Supreme Administrative Court supporting the decree and the perspective of the religious, medical and legal establishments on this issue. Requiring hospitals, health units and private clinics to hang an enlarged copy of the Minister's decree forbidding the practice on their walls. This should be in the form of a poster designed specifically for this purpose. The poster should be placed in a prominent place so that all visitors and clients can read it. The Physicians' Association must issue an explicit declaration forbidding the practice, follow up its implementation and impose penalties on doctors who practice it. The Nurses' Association should undertake similar measures.
Raising the awareness of girls and women through women's health clubs, family planning and reproductive health sessions, vaccination sessions and ante-natal clinics. All occasions should be seized to integrate the subject of circumcision within the health awareness campaigns.
Newly developed media messages should explicitly reject all kinds and forms of circumcision. They should indicate that it is harmful even if performed by physicians, and is absolutely unnecessary. Activating the role of the media, particularly the television, because of its influence on public opinion, and encouraging central and regional channels to raise the issue for discussion through drama and programs. Such measures would help raise awareness and create an anti-circumcision social climate and public opinion.
There is a need to address female circumcision from a wide perspective. It should not be examined simply as a harmful practice, but within the overall context of reproductive health, women's rights and violence against women. Female circumcision is a main component of reproductive and public health, and should be discussed within this framework. The health hazards of circumcision are not the central focus and should not be exaggerated, since this will encourage physicians to perform the operation. The social, cultural and psychological motives and beliefs that encourage the perpetuation of the practice should be studied, and correct scientific and medical information simplified to analyze these beliefs and undermine them.
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