Professor Hazel Barrett West Midlands Strategic Partnership and Public Health England Female Genital Mutilation (FGM) Seminar 22nd April 2016 Understanding the cultural issues underpinning the continuation of FGM in the EU and challenges in supporting Asylum Seekers and Refugees Professor Hazel Barrett Executive Director of the Centre for Communities and Social Justice, Coventry University. h.barrett@coventry.ac.uk

Definitions FGM is defined by WHO as: ‘all procedures involving the partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.’ (WHO, 2008,4)

WHO Classification of Female Genital Mutilation Type I: Clitorectomy Partial or total removal of the clitoris and/or the prepuce . Type II: Excision Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora . Type III: Infibulation Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris . Type IV: Symbolic circumcision All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

Female Genital Mutilation Removal of clitoris and labia Scar tissue, cysts Damage to urethra, perineum, anal sphincter Fistula Inflexibility, tearing, inflammation on intercourse, difficulties in delivery Difficulty controlling urine Prolapse Post partum haemorrhage Greater susceptibility to infections Greater susceptibility to STI’s and HIV Painful sex Delivery problems Infertility Psychological problems, depression Foetal death Maternal mortality

Convention against torture and other inhuman or degrading treatment or punishment. Covenant on civil and political rights. Covenant on economic, social and cultural rights Convention on the elimination of all forms of discrimination against women Convention on the rights of the child African charter on human and peoples’ rights (the Banjul Charter) Protocol on the rights of women in Africa (Maputo Protocol) Africa charter on the rights and welfare of the child European convention for the protection of human rights and fundamental freedoms Charter of fundamental rights of the EU Beijing declaration and platform for action of the fourth world conference on women UN General assembly declaration on the elimination of violence against women

FGM: global situation Estimated that globally that 200m girls and women have been subjected to FGM. Practice is concentrated in 30 African, Middle Eastern and Asian countries. Half of the women who have been subjected to FGM live in three countries: Indonesia, Egypt and Ethiopia In 8 countries over 80% of women aged 15-49 have been subjected to FGM: Somalia, Guinea, Djibouti, Sierra Leone, Mali, Egypt, Sudan and Eritrea. Each year 3m girls are at risk globally. (unicef, 2016)

FGM in the EU FGM is a criminal offence in all EU countries. EU Parliament believe FGM is a serious issue in Member States, such as the UK, which are home to significant numbers of migrants from high FGM prevalence countries. In 2009 the EU Parliament estimated 0.5m women and girls in EU had been subjected to FGM. A further 180,000 girls are at risk.

FGM in the UK House of Commons Home Affairs Committee (July 2014): Estimated that 170,000 women and girls living in the UK are survivors of FGM 65,000 girls aged 13 living in the UK and under are at risk of FGM

UK Legal Situation concerning FGM In the UK FGM has been a criminal offence since 1985 (Female Circumcision Act). In 2003 legislation updated to address extraterritoriality(FGM Act). Serious Crime Act 2015 added a number extra additions, including anonymity for victims, parental responsibility, FGM POs and mandatory reporting. UK has no successful prosecutions.

Why is FGM still practised in the UK? Continuation of FGM is motivated by a complex mix of interlinked sociocultural factors. Beliefs associated with religion, hygiene and aesthetics and social acceptance combine to support decision-making in communities in favour of carrying out FGM. WHO FGM ‘Mental Map’ Source: WHO,1999, 7

Conceptual Model of Factors Promoting and Hindering FGM in Western Countries Source: Berg et al, 2010

FGM is a Social Norm FGM is a Social Norm Individual’s actions are interdependent on the actions of others including family and wider community. ‘Even when parents recognise that FGM/C can cause serious harm, the practice persists because they fear moral judgements and social sanctions should they decide to break with society’s expectations. Parents often believe that continuing FGM/C is a lesser harm than dealing with these negative repercussions.’ (Unicef, 2010,3)

Community enforcement of current Social Norm declines SUPPORTING FGM/C CHANGE AGENTS Resistant to change INDIVIDUALS Adopters of change INDIVIDUAL/ FAMILY AGENCY TIPPING POINT Resistant to change – INDIVIDUAL AGENCY – Adopters of change RESISTANT TO CHANGE NEW SOCIAL NORM AGAINST FGM/C Community enforcement of New Social Norm increases Source: H. Barrett

Time for a new approach Big question is how do we change deeply held community/social norms? How do we REPLACE social norms to end FGM? The REPLACE Cyclic Framework for Social Norm Transformation.

The REPLACE Approach The REPLACE Cyclic Framework for Social Norm Transformation in relation to FGM XX slides: 15-20 minutes (Hazel)

The REPLACE Cyclic Framework for Social Norm Transformation The REPLACE Cyclic Framework for Social Norm Transformation combines Community-based Participatory Action Research with behaviour change theories. REPLACE demonstrated that all intervention efforts should begin with a process of community based participatory research and/or exploration of the current belief systems and social norms relevant to any given community before conducting any behaviour change activity. The findings from the Community-based Participatory Research indicated that behaviour change needs to occur at both an individual and community level. Communities are at different stages of readiness of change/motivation to end FGM and this should inform the type of intervention implemented with the community The REPLACE Cyclic Framework recognises that a ‘one-size fits all’ approach is unlikely to succeed.

REPLACE COMMUNITY READINESS TO END FGM ASSESSMENT

REPLACE COMMUNITY READINESS TO END FGM ASSESSMENT Current Social Norm supporting FGM/C 1 NO COMMUNITY AWARNESS: FGM PRACTICE IS SOCIAL NORM 2 COMMUNITY DENIAL/RESISTANCE: SOME COMMUNITY MEMBERS RECOGNISE FGM IS AN ISSUE 3 VAGUE COMMUNITY AWARNESS: MANY HAVE CONCERNS ABOUT FGM BUT NO COMMUNITY MOTIVATION TO CHANGE 4 PREPLANNING: COMMUNITY RECOGNITION THAT SOMETHING MUST BE DONE ABOUT FGM, BUT EFFORTS LACK FOCUS 5 PREPARATION: COMMUNITY LEADERS BEGIN PLANNING IN EARNEST TO END FGM IN THE COMMUNITY 6 INITIATION: COMMUNITY ACTIVITIES & INTERVENTIONS UNDERWAY TO END FGM 7 STABILISATION:COMMUNITY LEADERS SUPPORT ENDING FGM IN THEIR COMMUNITY 8 EXPANSION: COMMUNITY MEMBERS FEEL COMFORTABLE WITH ENDING FGM COMMUNITY OWNERSHIP: HIGH LEVEL OF COMMUNITY BUY-IN TO END FGM WHICH BECOMES THE SOCIAL NORM CURRENT SOCIAL NORM SUPPORTING FGM Resistant to change – INDIVIDUAL AGENCY – Adopters of change NEW SOCIAL NORM AGAINST FGM NEW SOCIAL NORM AGAINST FGM/C 9 Source : H. Barrett

The REPLACE approach to measuring community change Can be used to evaluate communities readiness at one point in time. If used before and after an intervention can be used to see if change has taken place. Can be used to estimate the strength of the social norm perpetuating FGM

The REPLACE approach to measuring community based behaviour change. Easy and affordable Can inform intervention development Can measure intervention effectiveness Can indicate strength of social norm

Conclusions The REPLACE Cyclic Framework for Social Norm Transformation is culturally sensitive, puts the community at the centre of change, and takes into account various belief systems, barriers and motivations to change. It recognises the complex linkages between social norms and individual actions.

It is a flexible approach which can help communities end FGM as their readiness and motivation for change evolves, allowing communities to reach the ‘tipping point’ where performing FGM is no longer a social norm, and has been replaced by a new social norm of not performing FGM. The REPLACE Cyclic Framework provides the mechanism whereby social norms are REPLACED, with communities and individuals ending the practice of FGM.

Change must come from within communities. If we want to help communities abandon FGM we must understand the social norm supporting the practice and at what stage of readiness the community is to end FGM. The social norms concerning the continuation of FGM must be challenged and replaced. Coventry University’s REPLACE2 project is there to advise and help communities that want to end FGM. Let us work together to end FGM in the West Midlands.

The REPLACE Approach: Supporting communities to end FGM in the EU: Toolkit and Community Handbook www.replacefgm2.eu 5 slides: Hazel? About 15-20 minutes?