The One Community Project FGC prevention strategies within impacted communities in the Twin Cities, MN and Erie, PA Micaela Schuneman, REFUGEE SERVICES DIRECTOR, International institute of Minnesota

Focus on women's care Outreach staff from the community Curriculum empowers women to prioritize their health and make informed decisions Convening in a ‘safe space’ Integrating FGC discussion into other health topics Same-sex groups for productive discussions Address pressing issues/needs Outreach staff: (Health Educators, CHWs, & other community workers) Addressing pressing issues: (preventative care, social services, domestic violence, etc.)

Women’s Workshop Topics include Introduction to OCP Preventative Health Care I Preventative Health Care II Introduction to FGC FGC and Health FGC and the Law Embracing Change The sessions included guest speakers, breathing and stress techniques, story telling, and sharing.

Women’s Workshop Other women’s workshop participants are women who attended the workshop but were not necessarily from impacted communities: Iran, Japan Healthcare referrals include: Primary care, OB/GYN, Mental Health services

Challenges and Lessons Generational divide. Mixed generation groups sometimes hindered the younger women from being open and honest in fear of disrespecting their elders. Enrollment forms were taxing; “overwhelming” and “uncomfortable.” Fear of public backlash towards Muslims. Enrollment packets could be significantly shortened to make the participants feel more comfortable. Groupthink. Childcare. Provide childcare information and referrals to the women in the program.

The OCP Girls (ages 12-18) Prevention of FGC among girls living in the US Program is specific to Erie site. Sessions are held one hour per week for eight weeks using the "Girl Power" curriculum. Topics include Weeks 1 & 2 Self Concept Weeks 3 & 4 Friendship Weeks 5 & 6 I Can Weeks 7 & 8 Healthy Boundaries Primary goal of the “Girl Power” curriculum is to increase at-risk girl’s confidence in decision making about their bodies.

Provider Presentations Goal: Provide community education for social service and medical providers to increase culturally-sensitive care for women impacted by FGC. Topics include An introduction to FGC The Traditional Beliefs, Values, & Attitude Towards FGC Complications of FGC Strategies for Involving Individuals, Families, & Communities in the Prevention of FGC Professional Ethics and Legal Implications of FGC

Provider Presentation participants Other Health professionals include: Dentists, Pharmacists, and Reproductive Health clinics. Other Social Service Providers include: Non-profit organizations, Community leaders, State, Public School Administrators.

Challenges and Lessons Year 1: Outreach Researched material geared more towards other providers (i.e. law enforcement agencies) to keep everyone engaged. Year 3: Ongoing Funding Feedback: Some participants believed the presentation was geared more towards healthcare. Initiated conversations with women in impacted communities for suggestions on how providers can start conversations about FGC. Fear of bringing up the topic. Lack of data/rates of FGC in MN. Beginning of the program: The program was new so getting it out there was difficult in the beginning. However, we created flyers and shared them among our twin cities network groups and eventually we were able to get the word of the program out. The biggest challenge at the end of the program was that the word was finally out and there were a lot of people that were/still are interested in the presentation at their organizations, clinics, schools and churches. Fear of brining up the topic: Some health care workers and most Non-health care workers did not know how to bring the conversation up with the people they worked with.  Fadumo received a lot of questions about how to know, how to ask and what to say. Lack of data in the United States: Participants were always quick to inquire about statistics and data of FGC in America. Lessons: Fear of brining up the topic: Most women in the workshops believed that if the provider started the conversation in a non-threating general way they would feel comfortable to provide answers. However, most women did not believe they could start the conversation with the provider. This is why their FGC related needs are not address because both parties are too afraid to start the conversation for fear of how it will be perceived.

Evaluations (Center for Community Outreach, Research, and Evaluation, Penn State) Women’s Workshop Data suggest that the curriculum is effective and well-received. Participant engagement, comfort, and consideration of the material increased over the course of the workshop. Greatest increase in knowledge: legal issues surrounding FGC. The program increased women’s sense of empowerment and desire to share information with others in their community. Chart notes: The results show that as the workshop progressed, facilitators were able to improve participant engagement, comfort, and consideration of the material. Participants seemed to grow more comfortable in the workshop starting at session 3, when some more quiet participants started to engage in group discussions. By session 5, discussion among participants appeared to be open and honest, with participants sharing personal stories about their emotional experiences, how they have advocated against FGC prior to the workshop, and how they may bring the topic up with their families. Session 6 seemed to be the most impactful to participants, as most of attendees were unaware of the legal issues surrounding FGC in the United States. It seems that the legal ramifications of FGC, both in the United States as well as ‘vacation cutting’, were very eye-opening for most of the attendees. In fact, one facilitator noted that the legal information made a “lightbulb go off” in participants’ minds about the purpose of the workshop and the importance of the information being presented. By session 7 participants seemed to be very comfortable with the information, even if they did not completely agree.

Evaluations Men’s Survey Most men reject the idea that FGC is beneficial and agree that it is a violation of human rights. Variation in men’s comfort level in talking about FGC with their families. Men agreed that their opinion of FGC has become more negative since moving to the U.S. and that ending FGC would not threaten their way of life. Most men noted that they would be comfortable if their wives or daughters did not undergo FGC. In addition to gathering information about attitudes and beliefs about FGC from female participants, data was gathered from 55 male participants. The men were asked to provide information about their age, marital status, ethnicity, country of origin, and education. They then answered 15 questions about their attitudes and beliefs about FGC using a scale from 1 (strongly disagree) to 4 (strongly agree). Of the 55 men, 40 provided demographic data

Other Outcomes IIMN Erie Both Erie and IIMN Hosted 2 Women’s Health Fairs. Partnership with Erie School District continues to host Girls Empowerment Session Connected with other OWH grantees: Increased referrals for FGC reversal procedures for women through medical case management. Joined Network to End FGM/C Partnership with Edinboro University and Mercyhurst University continues to host Provider Trainings. BRYCS resources (brochures, Raising a Girl Handbook) FGC reversal: A lot of the women where not aware that there was any BRYCS: Pamphlets of BRYCS community conversations with your doctor for women and girls who have experienced FGC were distributed to women and clinics. Coordinated 3 focus groups of women in impacted communities to provide BRYCS with feedback before the dissemination of “Raising a Girl: A Handbook for Newcomer Mothers and Daughter.”

MN FGC prevention and outreach working group December 2017 - June 2019 Four committees engaged in information gathering. Impacted Communities Health Care Legal & Law Enforcement Other Professionals Developed State-Wide Recommendations.

recommendations: release in Early Fall 2019 Impacted Communities recommendations include: Engagement and education should be led by communities, honoring the voices of women who have experienced FGC. Communities need education about health effects, laws, and lack of religious mandates. Impacted girls & women need expert, culturally-appropriate care. Professional recommendations include: More training on FGC cultural background and health complications. Agencies including CPS, law enforcement, 911 services should develop protocols and Coordinated Community Response. CPS recommendations include: Greater transparency about processes and outcomes. Create state-wide consultation service or network.

Questions? Micaela Schuneman mschuneman@iimn.org Dylanna Grasinger DJackson@uscri-erie.org