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A gender-transformative approach to female genital mutilation in Guinea

A gender-transformative approach to female genital mutilation in Guinea

With 94.5% of girls and women affected, Guinea has the world’s second-highest rate of female genital mutilation (FGM) after Somalia (UNICEF 2023). The ACT! approach is tackling this tough challenge.

This article is also available in French.

The ACT! approach and the three R’s of Feminist Development Policy
By leading women and men to reflect profoundly on their respective social roles and interactions and how these came about, the gender-transformative ACT! approach is designed and structured to challenge entrenched gender norms. By promoting equality between men and women, it encourages women to access resources and share in financial responsibility for their families, helps them to realise their sexual and reproductive rights as well as those of their daughters, and strengthens women’s representation both in the community and as resource persons.

In the rural municipality of Samoé, prefecture of N’Zérékoré, a group of eight married women have been discussing the vital topic of marital harmony. They are participants in an action-research cycle of community-based dialogues entitled ‘Women’s submissiveness, female genital mutilation and sexual fulfilment of the couple: Findings, analysis and perspectives for less gender-based violence in Guinea’. After working through dialogues on ‘Sex and Gender’ and ‘How we are socialised’, the participants feel at ease to look critically at their experiences of married life and share their feelings about how relations with their husbands could be improved: ‘I wish my husband would wash before he comes to bed.’ ‘If my husband doesn’t like my cooking, he yells at me, and sometimes even hits me – and that’s not fair!’ ‘My husband says having our daughter “taken to the river” [i.e. operated on] is women’s business and he doesn’t want to get involved!’

In the West African nation of Guinea the traditional practice of modifying the female genitals has barely decreased over the past 30 years – from 99% (DHS 1999) to 94.5% of girls and women aged 15 to 49 (Figures, when not otherwise specified, are from Guinea’s most recent Demographic and Health Survey of 2018). Despite intensive efforts by NGOs, development partners and legislators, the practice, commonly known as ‘excision’, continues almost unabated. Even families who have emigrated to other countries send their daughters back to Guinea during school holidays to undergo this operation. Treated as a prerequisite for marriage and a matter of family honour, FGM is a firmly anchored social institution, believed to promote girls’ chastity before marriage and fidelity thereafter. Along with other persistent practices such as child marriage, arranged marriage, polygamy, conjugal violence, unpunished rape, virginity tests and surgical reconstruction of the hymen, FGM is a manifestation of women’s and girls’ subordinate position in Guinea’s male-dominated social order (see White-Kaba for Health Focus, 2024).

FGM in Guinea: a never-ending story?

Since 1965 Guinea’s legal system has condemned FGM, periodically introducing new laws to punish families and those performing the operation. These efforts have been accompanied by massive information campaigns on the harmful consequences of the practice – but with little impact. 

Since its independence in 1958, Guinea has experienced long periods of social and political instability, which have taken a toll on the country’s infrastructures and organisation of services. In such situations, communities and individuals tend to cling all the more strongly to religion and tradition as sources of structure and stability. Despite the multiplication of laws against FGM, in reality very few families or practitioners have been accused or punished with fines or imprisonment. In a situation where FGM is nearly universal, it is very difficult for police, prosecutors or superiors to sanction someone for doing what they themselves are ‘guilty’ of. 

Though Guinea’s succeeding governments have positioned themselves against FGM, their voices have been largely drowned out by the multiple community-based institutions – traditional marriage, religion, clan structures – that maintain girls and women in a dependent position in the name of social stability. Respected community leaders, including many religious authorities, are in favour of FGM, while traditional exciseuses – and increasingly, health personnel – have economic interests in continuing the practice. By 2018, 35% of operations on girls under 14 had been performed by a medical professional.

A fresh approach to tackling FGM?

Yet participants in the Action Research programme – a gender-transformative approach crafted in collaboration with community members – have been striking a new and different note. Reflecting on their experience, participants – male and female, married and unmarried – share some of the ‘aha!’ moments which have led them to see relations between men and women in a very different light – and change some hitherto unquestioned behavioural patterns, especially on the part of men:

Women’s voices:

  • ‘I have learned that I am in control of my body, I have the right to decide freely about my own body.’
  • ‘I am now aware of the dangers of excision and will not have my daughters excised.’ 
  • ‘I asked my husband for understanding and respect between him and me.’

Men’s voices:

  • ‘A woman’s life should not be worse simply because she is of the female sex.’
  • ‘I now ask my wife’s consent before having sex.’ 
  • ‘I no longer hit or yell at my wife if she doesn’t want to have sex.’
  • ‘I have learned that the organs removed during excision play a role in sexual satisfaction.’

Such unexpected utterances give the impression that these men are seeing women through new eyes and would be willing to relinquish some of their male privileges in favour of a more equitable balance of power with their female partners.

Focus group married men, Samoé
Focus group married men, Samoé

The community-based approach which has brought about such individual transformations is called ACT! (Approche Communautaire Transformatrice du genre). It has been introduced since 2022 by the Guinean NGO AFASCO, the Belgian NGO GAMS  and the international consulting firm Health Focus GmbH in the form of an Action-Research in the prefectures of Mamou and N’Zérékoré with support of the Programme de Santé Reproductive et Familiale (PSRF), implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ) on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ). ACT! is inspired by the gender-transformative concept of UNICEF, UNFPA, UN Women 2020 and the GIZ-supported hallmark Generation Dialogue, which was itself developed and implemented in Guinea 20 years earlier in collaboration with the predecessor organisation of AFASCO.  

‘What is a man? What is a woman?’

It is with this soul-searching question that participants in the ACT! approach embark on their voyage of discovery. To reduce shyness, discussion is held in the local language and in groups of eight that are homogeneous for age, sex and marital status – including the facilitators. In the course of seven half-day encounters, spread over a five-month period, participants in each group drill down to unravel their own beliefs, habits, attitudes and social conditioning, gaining insights into the arbitrary nature of many assumptions that they have taken for granted.

We wanted to get to the root of the problem: gender inequalities, the way we are socialised; whether in the south or the north, we are in a very patriarchal society.

Dr Fabienne Richard, Director GAMS

The ACT! implementation guide provides clear and detailed instructions that enable even less experienced facilitators to cover each topic, including lively games and exercises that permit participants to share and confront their perceptions. Adapted with inputs from community members, the seven sessions are presented in a sequence that is stimulating to participants, each new session being based on the discoveries made at the preceding encounter.

Half ‘sex education for adults’ and half rights-based reflection and introspection, the curriculum challenges each individual to review who they are and how they interact with others – particularly others of the opposite sex. In the two weeks between sessions, each participant is required to gather five community members of their own sex and marital status and share with them what they have just learned. Teaching others reinforces participants’ mastery of the course content, and in this way the learnings of the 32 participants are progressively disseminated within the community, reaching over 150 of their neighbours.

Sharing learnings with neighbours, Samoé
Sharing learnings with neighbours, Samoé

After the seventh session, the participants in the four homogeneous focus groups (married men, married women, young unwed men and young unwed women) finally come together in a day-long meeting to blend their experiences. They share their impressions and insights and negotiate recommendations that they would like to propose to their communities and decision-makers.

In a public meeting, participants, using their local language, share their eye-opening experiences and resolutely present their recommendations, e.g. supporting a girls’ school, protecting unoperated girls from denigration, abuse, and the operation itself, or sharing the information about the law against FGM with nearby communities. Dialogue participants have become community resource persons, and their sincerity convinces local, regional and even national decision-makers and partners that finally an effective approach has been found that could change mind-sets on the thorny topic of FGM.

ACT! addresses FGM as a form of gender-based violence

Harmonising with the government’s official Platform for National Coordination of the Combat against FGM, the ACT! approach is one of the first to specifically present abandonment of FGM as part of a package of reproductive health measures to reduce gender-based violence (GBV). 

The greater social acceptability of ‘diluting’ FGM within the broader problem of GBV was confirmed by AFASCO’s experience in the village of Samoé in Guinea’s Forest Region. When years before, for another programme, the NGO approached the village with a proposal to work with them specifically on FGM, they were met with steadfast refusal, but with ACT! the community was open to the topic of working together to better understand issues around reproductive health. All the more so since the intervention focusses also on ‘sexual fulfilment of the couple’ and men were to participate as well as women.

In a patriarchal society such as those of Guinea’s different ethnic groups, men are the ultimate family and community decision-makers. No deep-going social reform can succeed without their cooperation. Since FGM is mainly organised and carried out by women, men tend to distance themselves from the practice as being ‘women’s business’, though they are officially the beneficiaries of thus obtaining a ‘pure and faithful’ wife.

Getting men – and women – to see things in a different light is an intricate process of deconstructing the stereotypes that lie at the heart of gender inequality and GBV. An example is ‘bride price’: If you ‘buy’ your wife, she becomes your possession, to do with as you like, including hitting her if she displeases you. Another is the humiliating – and highly stressful – ‘verification’ of the bride’s virginity during the wedding night.

Use of local language (rather than a ‘school language’ like French) and being in a homogeneous peer group remove barriers of shame and poor comprehension, to foster honest self-discovery about subjects that are often considered taboo, and gender-transformative learnings that ‘hit home’.

Where other approaches focus just on FGM – a subject that makes people uncomfortable, and that they have already heard so much about – the ACT! pedagogical guide efficiently touches upon several vital and fascinating themes, and shows how they are all connected: sex, gender, becoming an adult, FGM and its consequences, family planning, managing your emotions….

Mr Fara Djiba Kamano, Executive Director, AFASCO

An overview of the ACT! approach can be found here.

A way forward for ACT!?

Training of male facilitators in Mamou
Training of male facilitators in Mamou

The ACT! approach was developed on the basis of a critical review of past and present strategies against FGM applied in Guinea and elsewhere.

After piloting a first ACT! cycle in the prefecture of Mamou, where FGM prevalence stands at 95.2%, the ACT! team moved to N’Zérékoré, which with 84% has the country’s lowest prevalence. Here they found greater openness on the part of the population and community leaders to reexamine existing ways of being.

To defuse potential opposition from ‘guardians of tradition’ such as religious leaders and exciseuses, the team was careful to include representatives of these groups among participants, all of whom were influential community members selected with the local authorities.

When the results of the group’s reflection were presented to regional and national authorities and development partners, these decision-makers unanimously applauded the initiative and recommended adopting and scaling up the approach.

I am enchanted by this action-research approach! It is not scientists coming from outside and ‘doing something for the community’, but the community members themselves, who know their own problems the best. They themselves have done the research and the analysis, and proposed their own very practical solutions.

Mme Fatoumata Barry, Assistant for youth implication and campaign ‘Equity for Girls’, Plan Guinée

Effective as it appears to be to change individual perceptions, ACT! is not a stand-alone approach. The many layers that make up a human society need to function together to deconstruct the sex-based inequities that condition gender-based violence including FGM. The ACT! team’s hope is that Government and development partners will be willing to invest in scaling up and sustainable follow-up of the approach in order to have a broad impact on reducing gender-based violence including FGM in Guinea.

Dr Mary White-Kaba
March 2024

© Health Focus GmbH/Marine Kololo
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