• Above all, their smiles.

Opening the dialogue on FGM/C in The Gambia

The I International Forum on Harmful Traditional Practices becomes a milestone in the fight against FGM/C in The Gambia. In front of over 200 participants from Africa and Europe, the Vice President of The Gambia, the spokesman of the Congress and the Grand Imam of the Mosque in Banjul chaired the opening of the meeting, making public their commitment to this fight.

For the first time, experts, governmental and non-governmental actors gathered to dialogue about the issue and explore strategies for its prevention. NGOs from The Gambia, Senegal, Burkina Faso, Kenya, Tanzania, Nigeria and Ethiopia shared their experiences with international agencies such as UNFPA, WHO and UNICEF, as well as a delegation of Inter-African Committee Against Traditional Practices Affecting the Health of Women and Children. Decided to build synergies, participants signed the Brufut Declaration.

This conference was held at Brufut, in May 2009, and organised by initiative of the Interdisciplinary Research Group for the Prevention and Study of Harmful Traditional Practices and Wassu Gambia Kafo, with the support of the Universitat Autònoma de Barcelona, Ministry of Health and Social Welfare of The Gambia, University of The Gambia and UN Agencies (WHO, UNFPA and UNICEF).

Brufut Declaration - video-documentary

Initiation without Mutilation: a welcomed approach

In 2004, Prof. Adriana Kaplan developed the video-documentary "Initiation without Mutilation" directed by Sebastián Risler. It is a proposal for an alternative rite of passage that excludes the first stage of the rite (physical stage), where mutilation is practiced, and keeps later stages of cultural transmission and social belonging. In a country where all preventive actions against FGM/C have been prohibited, the documentary receives a surprising warm welcoming. The Vice-President of The Gambia recognizes it as culturally respectful and, in 2006, demands its translation to the main five local languages (Mandinga, Fula, Sarahole, Djola & Wolof), apart from the already existing versions in Spanish, English and Catalan.

Initiation without Mutilation - video-documentary

The Gambia becomes the first African country having FGM/C integrated in the Academic Curriculum

Sustainability and ownership are at the core of our intervention. To ensure that health students initiate their professional practice with all the necessary skills to identify and manage FGM/C health consequences, and are aware of the role they can play in the prevention of the practice, we have developed an Academic Curriculum where FGM/C is integrated as a cross-curricular subject.

Throughout four years, we have worked with the University of The Gambia and the Cuban Medical Mission, which was the instigator of the establishment of the School of Medicine and Allied Health Sciences (SMAHS) in The Gambia. The result is an Academic Curriculum in which the issue is approached during 30 hours distributed by 6 signatures (anatomy, physiology, gynecology-obstetrician, pediatrics, psychology and community medicine). The Academic Curriculum was approved by the Ethical Committee and the Senate of the University of The Gambia, being now implemented not only in the SMAHS but also in the School of Public Health and all Nursing and Midwifery Schools throughout the country.

The first clinical evidence of FGM/C health consequences for Gambian girls and women

In 2008, WGK conducted the first clinical study ever developed in The Gambia on the consequences of FGM/C for women's and girls' health. Results revealed that FGM/C was still practiced in all the six regions of the country and resulted in injuries for 1 out of 3 girls and women. In 2010, a second clinical study was done in order to gain precise information on long-term health consequences of FGM/C in The Gambia, including the outcome of deliveries and the health of the newborn. The study shows that women with FGM/C are four times more likely to suffer complications during delivery and for the newborn than women without FGM/C.

Empowering people through knowledge transfer

In The Gambia, 3 out of 4 girls and women have been subjected to FGM/C, which indicates that health care will be needed for decades to come. Health care professionals are in the frontline to assist FGM/C related complications and in a privileged position to promote the abandonment of the practice, but our studies have revealed that they share widespread misconceptions and are highly unaware of its consequences. There was an evident need to build their capacities on FGM/C identification, management and prevention – and with that purpose we have developed a culturally adapted training programme.

The success of our commitment and advocacy efforts became evident in 2011, when a Memorandum of Understanding was signed between the Ministry of Health and Social Welfare, United Nations Agencies (UNICEF and WHO), Universitat Autònoma de Barcelona and Wassu Gambia Kafo to conduct the National Training Programme for Health Professionals on FGM/C. This programme targeted 1,500 health professionals (doctors, nurses and midwives) and is being implemented by Wassu Gambia Kafo throughout the country, with a positive impact in the health and well-being of many girls and women.

We have also extended our training to Traditional Birth Attendants (TBA), who due to the insufficient numbers of qualified professionals and health services centralization, assist almost half of deliveries in The Gambia. TBAs live within the communities by whom they were selected and some of them are themselves circumcisers. Through our training, they learn how to identify and anticipate the wounds of the practice during the childbirth, understanding its negative impact and how they can play a role for its prevention.

Mapping of FGM/C in Spain: a unique tool for planning

The first step for designing policies and actions to prevent FGM/C and respond appropriately to the needs of affected populations requires knowing their characteristics and geographical distribution. Based on census data, the mapping of FGM/C in Spain allows quantifying and localizing in the Spanish territory the migrant female population coming from a country where FGM/C is performed, being a unique tool to guide policies and actions for the prevention of FGM, available to all who wish to convert intercultural challenges into growth opportunities and contribute to the realization of the rights of girls and women.

First published in 2002, this map is already on its fourth update (2006, 2010, 2013).

FGM/C and the Islam: breaking new grounds

In a respectful way, we have presented the results of our clinical studies on FGM/C health consequences to the Supreme Islamic Council in The Gambia and to the Imams and Oulemas of West Africa in an International Conference in Nouakchott (Mauritania), "Islam and FGM/C", organised by United Nations Agencies and the German Society for International Cooperation (GIZ), achieving the promulgation of a Fatwa (resolution) that recognizes that FGM/C is a Harmful traditional Practice and the commitment of Muslim authorities to avoid it.

Fatwa (French, English and Arabic).