FGM is a health, social and economic problem that should be addressed through on-the-ground interventions and technological solutions
The prevalence of FGM varies worldwide, but is majorly present in some countries of Africa, Asia and the Middle East. As of 2024, UNICEF estimates that worldwide 230 million girls and women had been subjected to one or more types of FGM – Image taken from Last Mile4D’s Journey, available on YouTube – all rights reserved
Executive Summary
In an age when technology is driving so much of human behavior, why in the 21st century are we still struggling with the millennial old practice of Female Genital Mutilation/Cut (FGM/C)? FGM/C is the intentional altering or injuring of the female genitals for non-medical reasons. It harms, injures and robs millions of girls of their full life potential.
The World Health Organization (WHO) estimates that 230 million women have undergone FGM/C globally[1]. The health implications of FGM/C abound, causing significant physical and psychological harm including infections, hemorrhage, fistula, birth complications, sterility and death. It is also a leading factor in child marriages and the leading cause of school dropouts, reducing chances for socioeconomic improvements of girls. The scars of FGM/C reverberate throughout the life of a girl, with physical ailments and poverty that become chronic and irreversible. Although the practice is illegal in most countries, enforcement has been elusive as the practice takes place in the shadows and in secret. It is a silent crime guarded by taboos against exposing and speaking of it, with girls being shunned, shamed and made outcasts when they share their pain.
The primary reason this practice continues is because addressing FGM/C is not systematically documented, hence there is little data from which to develop prevention strategies. While rates of FGM/C per capita have decreased in some parts of the world, the absolute number of women and girls undergoing this ritual has risen dramatically due to explosive population growth.
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Last Mile4D is a non-profit based in Washington, DC that designs and implements education and training programs with a focus on the health and safety of women and girls living in the most remote and underserved areas of the developing world known as the “Last Mile” communities.
The Problem
FGM impacts three million girls a year and is a human rights violation that causes short and long term physical and emotional harm to girls, creating systemic economic inequality, gender education gaps, and leads to early marriage. All these dynamics injure the girls physically, emotionally and perpetuate a cycle of poverty, shackling the girls to unpaid farm and domestic labor.
The lack of actionable data about FGM exacerbates the problem by making prevention elusive. The problem becomes clear when reviewing available FGM/C research from UN agencies (e.g., UNICEF, UN Women, UNFPA) and WHO’s country specific FGM/C data. These data are static and not sufficient to develop and implement real-time prevention strategies.
And what is offered as solutions are weak because they are siloed strategies that fail to address all the main drivers of the problem. There is an emphasis on raising awareness about the practice without raising and incorporating the girls’ voices. They are not action oriented and do not engage communities at large.
They lack an integrated data collection strategy, and they fail to include community and stakeholder training. They also lack an integration of law enforcement authorities to enforce the existing anti-FGM laws. We are running out of time to reach the UN Sustainable Development Goals (SDGs), Goal 5.3 that aims specifically to eradicate FGM by 2030.
Solution
As the global community moves towards gender equality and creation of a feminist ecosystem how do we prioritize stopping FGM/C? Experience shows that the key is to attack all the economic, social and cultural drivers of a practice that violates the rights of girls. The practice is supported by a veil of tradition, culture and religion, making it impervious to methods that rely on law enforcement and international treaties to solve the problem.
International treaties and passing laws outlawing the practice of FGM/C are necessary but insufficient. On-the-ground, community-based programs that pick up where treaties and laws leave off do exist. But priority needs to be given to scaling up these programs that have proven effective when measured by results-based evidence and data. The report on “Effectiveness of Interventions Designed to Prevent or Respond to Female Genital Mutilation” in 2021 points out that over the past decade, despite intensified efforts to conduct research globally on best practices in addressing FGM, its application to scale has not occurred. This is largely due to the limited application of existing evidence to refining program and policy implementation (Ashford, Naik and Greenbaum, 2020).[2]
Resources need to be applied to scaling up programs that use these best practices. One of the best practices that needs to be reinforced is moving beyond using data solely for peering backwards in time for diagnostic purposes, and making real-time data actionable in a way that prompts in-time intervention. Technology needs to be employed to make this leap from diagnostics to actionable data. There are methods available for integrating data that alerts community workers on which girls are specifically at risk, which girls have been trained on how to seek safety and which girls require immediate intervention and rescuing.
A pilot program funded by Grand Challenges Canada, in Kuria, Kenya demonstrated the effectiveness of using evidence-based data for the purposes of intervention. Last Mile4D pioneered its V4D early warning system, using solar-powered technology and an online platform to provide a trifecta approach consisting of the following components: (1) education: using carefully designed educational modules to train and motivate targeted communities to eradicate FGM, (2) monitoring: conducting periodic, real-time tracking of the risk level of the girls, (3) crisis intervention: setting up a hotline, law enforcement points of contact and, if necessary, safe housing for girls who face imminent cutting.
Using this three-pillar approach since 2019 Last Mile4D has enrolled 5,000 girls, engaged 11,000 community members, and has sheltered over 200 girls. The program was piloted in 10 schools, with staff members monitoring 1,096 girls ages 9-17 who were enrolled in the program for over 18 months.
Of the girls, 9% had already been cut and 60% said they were at risk of being cut. This statistic was a shock to key stakeholders given the hidden nature of the practice, but it prompted them into action. Using this data as a baseline, Last Mile4D sensitized parents, government officials, and leaders through a series of videos and community meetings. 34% percent of fathers of the enrolled girls were sensitized about FGM and 71% of the mothers. After the program, 96% of parents signed declarations not to cut their daughters and 92% of parents agreed to advocate for eradication of FGM.
LastMile4D’s pilot program in Kenya combined three main components: 1) education to motivate targeted communities to eradicate FGM, 2) periodic, real-time monitoring by trained field workers of a cohort of schoolgirls at risk of FGM, and 3) crisis intervention including a hotline, law enforcement point of contact and alternate housing for girls facing imminent cutting – Image taken from Last Mile4D’s Journey
By monitoring the enrolled girls with technology and by providing protection, there was an increase in girls’ confidence to speak out about FGM from 46% at baseline to 99% at endline. Furthermore, girls who knew what to do if in danger of FGM increased from 53% at baseline to 98% at endline. Over the course of the pilot, no participating uncut girls experienced FGM/C. The program also helped the girls celebrate success by introducing tree-planting since 2022 as an alternative rite of passage. Over 2,500 trees have been planted symbolizing the girls who have been spared the scourge of FGM/C.
These initial findings from this pilot program in Kenya demonstrate its promise for scaling up in the future. By using real-time data on FGM, engaging communities, shifting their norms, and providing law enforcement interventions, Last Mile4D has attacked FGM/C from all angles.
Studies show that parents would often prefer to end FGM but are unwilling to subject their daughters to the social stigma of not undergoing it. The Last Mile4D success rate shows that if the stigma driver is addressed, there is demand for ending this practice. The promising results from this FGM program indicate that community engaged FGM/C programs with real-time monitoring need to be scaled up and replicated elsewhere.
Conclusion
Because FGM/C is a health, social and economic problem, on the ground interventions and technological solutions need to attack the practice from all three angles. Technology can be used to collect real-time actionable data that will then be used to marshal community and law enforcement resources to save the girls. The more girls that are saved and see the benefits, the more advocates there are for changing the social, cultural, and economic norms that perpetuate this practice. Programs like Last Mile4D can make a dent in this horrible practice and break the cycle that keeps women and girls mired in economic and social dependence. If scaled up sufficiently, there is a fighting chance of reaching UN SDG 5 goals to end FGM/C.
[1] https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
[2] https://www.unicef.org/documents/effectiveness-interventions-designed-prevent-or-respond-female-genital-mutilation
