NATPAH Inc.

1. NATPAH Inc. PRESENTS HTP/FGM AFFECTING THE HEALTH

2. Introduction • Liberia is located on the West Coast of Africa currently with a population of about 3 million people. The country is divided into fifteen (15) Counties. The Counties are divided into Districts. The Districts are sub-divided into Clans, which in turn are composed of townships. There are 16 ethnic groups within the country. Research has shown that FGM/HTP is widely practiced by 12 out of the 16 ethnic groups in all 15 counties today. It is deeply rooted in the Liberian Traditional Society, which is the Sande Society for women. Map of Liberia

3. CONTINUED It was a taboo to speak about FGM/HTP before the establishment of NATPAH in March of 1985. Sometimes societies practice customs or hold beliefs that can be harmful to the health and well-being of an individual or a group of people. FGM is a harmful traditional practice that negatively affects a person’s, sociological and psychological well-being. It may also affect a society’s political and economic structure. A community may not know when and how the custom was initiated; however, the custom is valued and the community continues to practice it because their ancestors did. The community may never examine the effect of the custom on its members.

4. What is female genital mutilation • The World Health Organization (WHO) defines female genital mutilation (FGM) as practices involving partial or total removal of, injury to, the female external genitalia for cultural or any other non-therapeutic reasons.

5. WHO Categorized the Excision into Four Types of FGM • According to researched carried out in Liberia in 1990, the excision type is most commonly seen accounting for 84% of cases. The clitoris and all or parts of the labia minora are removed, leaving an anterior scar that often tears during childbirth. In 5% of cases, the clitoris was left intact while the labia minora were removed and <93%, the clitoris alone was removed. In 2% of cases infibulations (type III) the most extensive type was performed.

6. Cont. • In Liberia, FGM is usually performed on girls 14-20 years, but girls as five to six years are mutilated • Women and girls who have undergone FGM suffer from many physical, psychological and sexual complications. They suffer from immediate or long-term complications. The severity of the complications depends on who performs the operation, where and how it is done.

7. Where female genital mutilation is practiced • FGM is practiced by a number of ethnic groups in twenty-eight countries in Africa. It is also practiced in some parts of Asia, the Middle East and in Western Countries such as Europe, North America, and Australia where Africans live. With the increasing ease of migration and movement of refugees both regionally and globally, FGM is no longer a localized issue. It is now a matter of global concern. Even though it’s major impact is in Africa. It is estimated that three million women and girls are mutilated each year.

8. Reason FGM is practiced • There are many reasons for this practice, which fall into four general categories  • Religions: Female genital mutilation is practiced by animist, Christians and Moslems. Many Moslems believed it is a religious practice, but it is not. The Koran does not support the practice.  • Psychosexual: Many believe it is a way of ensuring sexual purity before marriage; it does not provide this guarantee. Some believe that it increases fertility and decreases problems with childbirth, it does not. It increases infertility and problems with childbirth.

9. CONT. • Socio-Cultural: Coming of age or “puberty rituals” are important in cultures. The event celebrating a girl becoming a woman is something to which the girl, her family and community look forward to. In some cultures female genital mutilation has become part of this right of passage, in other cultures, girls undergo the cutting or excision when they are 3or 4 years of age. In many societies FGM is a requirement for marriage and is considered a way for men to control female sexuality. • Hygiene and anesthetics: In many cultures female genital mutilations are considered dirty and ugly. Removing the genitals, leaving smooth skin is thought by some to improve their appearance and hygiene. However, as a result of female genital mutilation good hygiene often becomes more difficult and ugly scar tissue may develop.

10. Complications of female genital mutilation • In order to ensure all human beings enjoy a happy healthy life that is free from discrimination and violence, regardless of their Country, color, religion, race, gender or age, United Nations member States got together to agree on the international Bill of Rights in 1948;and the International Convention on Civil and Political Rights in 1976. • Furthermore, the African Countries met and agreed on the African Charter on Human and people’s Rights (1981). This charter promotes gender equality among children in Africa. • Because women and children needed special protection since they were not protected by many Countries ,the United Nations member states met again to improve the protection for children and women. The convention on elimination of all forms of discrimination against women (CEDAW) came into effect in 1981. The Convention on the Rights of the child (CRC) came into effect in November 1989. • FGM violates women’s sexual and reproductive health rights. • Even if the operation is done under hygienic conditions by a health care provider, the potential loss of sexual function violates the right to physical and mental health.

11. CONT. • Health rights are guaranteed under the Universal Declaration of Human Rights. CRC and the African Charter of Human and people’s rights. • When performed on infants and children (up-to age 18),FGM can be interpreted as a violation of the rights of the child that were guaranteed. These rights include • The right to gender equality(CRC) • The right to be free from all forms of mental and physical violence and maltreatment (CRC) • Right to the highest attainable standard of health CRC) • Right to be free from torture or cruel, inhuman and degrading treatment (CRC) • Requirement that member States take all effective and appropriate measures to abolish traditional practices prejudicial to the health of children(CRC) • FGM is recognized as a form of social violence against girls and women that violates their rights to their natural sexuality and physical integrity, and that has physical and psychosocial health consequences.  • FGM violates the fundamental rights of girls and women to achieve the highest attainable standard of physical and mental health.

12. Immediate health and physical complications include: • Pain: Severe pain due to lack of anesthesia and the many nerves in this area, making it a very sensitive area. • Bleeding: Mild to moderate or severe and fatal bleeding results when the clitoral artery is cut. • Shock: The victim may faint as a result of fear, pain, the bleeding or a combination of all three. • Infection: Usually unsterile instruments are used for the procedure (knives, blades, broken bottle, etc.). These introduce germs into the wound and if the germs enter the blood stream in a sufficient amount, then septicemia or thrush may develop.. • Septicemia: When the germs enter the blood stream the patient becomes very ill and may die if she is not rushed to a hospital. • Retention of urine: This may be due to the victim not being able to urinate (pee-pee) because of the sore or fear due to the painful swelling in the area. • Tetanus or Lock jaw may develop because of the dirty knife or blade used to carry out the operation. • Failure of the sore to get better or a sore that takes a long time to get better, may be due to infection

13. CONT. • Urethral or anal damage-the parts of the body through which one urinates (pee pee) and defecates (Anus) may be damaged. • Accidental cuts and injuries: Occasionally, there are other cuts that were not intended to be part of the operation as the girl does not lie supinely but forcibly resists by fighting and kicking. The knife or blade may accidentally cut her urethra (tube from bladder through urine passes) and her thigh. These cuts may be so deep that they cause damage to underlying tissue which will need suturing to stop bleeding.

14. Delay or Long- term health and Physical complications may include: • Demoid cyst formation in the scar • keloid formation or huge and extensive scaring mass can grow in the place of the clitoris which causes embarrassment during sexual intercourse • Infertility- the woman will be unable to conceive (inability to have a child). • Recurrent urinary tract infection • Pain during menstrual period (dysmenorrheal) • Stricture and difficulty passing urine. • Painful sexual intercourse (dyspareunia) • Problem with childbirth • Vulva stricture Blockage of menstrual flow (hematocoplus) • Excessive nerve damage that may lead to loss of sexual feelings in the area and muscular dysfunction in the area • Vesovagina and rectovaginal formed during deliveries.

15. Psychological Complications that mutilated women report include: • Depression • Anxiety • Shame and loss of love • Daily horror • Confusion • Low self – esteem • Fear of pain is overwhelming • Neurotic behavior

16. Social Implications: • Low self – esteem • Social misfit and outcast • May become barren and withdrawn from society and seeks anonymity

17. Sexual Complications: • Frigidity during sexual intercourse or fear of having intercourse. • When the clitoris (solely sexual organ) and other parts of the genitalia are excised, the woman‘s capacity for sexual stimulation and enjoyment are greatly affected. After various meetings of the World Health Assembly and International Human Rights agencies, a consensus has been reached categorizing FGM, as one of the most devastating HTPs. • The term female genital mutilation is now used to describe the practice termed female circumcision.

18. NATPAH ACTIVITIES TOWARDS ELIMINATION OF FGM NATPAH PROGRAM OFFICE WITH PARTNERS

19. CONT. • As mentioned above, that women and girls suffered serious health, sexual, social and psychosocial complications from the moment of FGM to their death. NATPAH in collaboration with partners, have come together to find best practices to fight against the practice of FGM/ HTP. These activities include:

20. NIMBA • MARGIBI • BONG • BOMI • GRAND CAPEMOUNT • GRAND BASSA • MONTSERRADO • LOFA COUNTIES • From 1985 to 2009 NATPAH Inc. has been raising awareness in eight (8) of the fifteen (15) counties where FGM/HTP is being practiced. EIGHT COUNTIES OF NATPAH ACTIVITIES

21. CONT. • About 1,500 youths and 1,200 women join the Awareness Action Group (AAG) and were trained in strategies of awareness raising. As a result of this work, 70,000 people were sensitized and about 385 girls resisted being excised (story). • In a focus group research done in December of 2007, NATPAH found out that awareness raising had turn 520 victims of FGM to anti FGM advocates based on their horrible experiences in the Sande bush. Work of this new group includes conducting campaigns in open markets, schools, churches, and mosques.

22. CONT. • They talk to young people, and parents, not to give in to FGM. Many girls were convinced and have rejected FGM. AWARENESS PROGRAMS

23. ZOES • From 2000 - 2009 Sixty ex-exercisers have abandoned the practice of FGM after undergoing intensive sensitization campaigns by the local NGO, the National Association on Traditional Practices Affecting the Health of Women and Children (NATPAH Inc., 2000). As change agents, they continue to mobilize communities against FGM/HTP. MOBILIZED, SENSITALIZED & TRAINED EX-CISERS OF FGM/HTP

24. SOCIAL NETWORK • One major breakthrough for NATPAH Inc. in 2008-2009 has been the establishment of a Social Network in three counties. • It provides a linkage between community members, women groups, health care provides, GOL, NGO and INGO. • Their main focus is to coordinate and collaborate their activities in transforming the public’s view of GBV.

25. SOCIAL NETWORK CONT. SOCIAL NETWORK MEETINGS WITH WOMEN, PRACTITIONERS, NGOs, MEN, COMMUNITY MEMBERS

26. ALTERNATIVE EMPOWERMENT OPPORTUNITY • For many of the practitioners, FGM have been the sole means of livelihood. NATPAH Inc. since 2002 has, introduced the Alternative Employment Opportunity (AEO) for ex-exercisers, which goes hand in hand with women economic activities. The funding has been provided by IAC. • (AEO) is considered a viable strategy to help eliminate FGM. It is a harmless way to generate income for family use. The program includes soap making, sewing, tie and dye, crocheting and fish drying (preservation). The ex-exercisers choose the trade they want and after training they are given seed grant to start off.

27. CONT. TIE DYING SEWING SOAP MAKING BAKING

28. BENIFICIARIES • This program has been introduced in eight (8) of the counties where FGM/HTP is being practiced. • To date 750 ex-exercisers have benefited. They have all abandoned the practice and are now advocating for the elimination of FGM.

29. BENIFICIARIES PARTIAL VIEW OF WOMEN & ZOES WHO HAVE BENEFITED

30. COUNSELING • Establish a unified way of sensitization by selecting 10 churches on any given Sunday that preaches on the harmful effects of FGM/HTP using text from the bible. • In 2009 training workshops are ongoing in recognizing the consequences of psychosocial effects and management.

31. COUNSELING CONT. PSYCHOSOCIAL COUNSELING

32. LATEST ACTIONS • On February 6, 2009 a Proclamation by Order of Madam Ellen Johnson Sirleaf, president of the Republic of Liberia, condemned the practice of FGM/HTP, and declared and proclaimed February 6 of each year as FGM Day. • It is designed to be a working holiday, calling upon all relevant institutions and the General Public to collaborate with the Ministries of Health & Social Welfare, Gender & Development, Education and NATPAH Inc. - Inter African Committee (IAC) in organizing meaningful and appropriate programs to commemorate the Day.

33. LATEST ACTIONS CONT. PRESIDENT SIRLEAF (L) VICE PRESIDENT JOSEPH BOKAI (R) / LIBERIA

34. CONCLUSION • We express thanks and appreciation to our partners and friends who have supported us in meeting our goals. Again, we want to solicit your support to enable us reach the rest of the country where NATPAH is not currently operating. FGM / HTP are a challenge, therefore, we need to galvanize our efforts to eliminate this practice. Thank You.