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117-623: Tostan takes a holistic, integrated approach to development by facilitating human rights-based, non-formal education programs, most notably the Community Empowerment Program (CEP), which aims to support and empower participants and communities to lead their own development. The organization employs over 500 people and works to foster and promote community engagement in projects relating to literacy, health and hygiene, child welfare, human rights and democracy, environmental sustainability, and economic empowerment. Although Tostan

234-522: A "self-enforcing social convention " to which families feel they must conform to avoid uncut daughters facing social exclusion. Ellen Gruenbaum reported that, in Sudan in the 1970s, cut girls from an Arab ethnic group would mock uncut Zabarma girls with Ya, ghalfa! ("Hey, unclean!"). The Zabarma girls would respond Ya, mutmura! (A mutmura was a storage pit for grain that was continually opened and closed, like an infibulated woman.) But despite throwing

351-429: A 1988 poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again. Despite the evident suffering, it is women who organize all forms of FGM. Anthropologist Rose Oldfield Hayes wrote in 1975 that educated Sudanese men who did not want their daughters to be infibulated (preferring clitoridectomy) would find the girls had been sewn up after

468-432: A child's sex by eliminating external traces of androgyny," Janice Boddy wrote in 2007. "The female body is then covered, closed, and its productive blood bound within; the male body is unveiled, opened, and exposed." In communities where infibulation is common, there is a preference for women's genitals to be smooth, dry and without odour, and both women and men may find the natural vulva repulsive. Some men seem to enjoy

585-982: A community level. In 2013, Molly Melching was honoured with a 'Women of Impact' award at the 4th Annual Women in the World Summit. In 2002 Melching received the Sargent Shriver Distinguished Humanitarian Award from the National Peace Corps Association for her work with Tostan; it is awarded to returned Peace Corps volunteers who continue to make a sustained and distinguished contribution to humanitarian causes at home or abroad or are innovative social entrepreneurs whose actions will bring about significant long-term change. Female genital cutting Female genital mutilation ( FGM ) (also known as female genital cutting , female genital mutilation/cutting ( FGM/C ) and female circumcision )

702-561: A community that independently abandons FGC without the agreement of surrounding communities effectively ruins its daughters’ prospects for marriage. As a result, ending the practice in a sustainable way requires widespread agreement among communities whose children intermarry. After learning himself about the risks of the practice, Diawara decided to walk from community to community in the Thiès Region of Senegal, where Malicounda Bambara and Keur Simbara are located, to raise awareness about

819-496: A joint statement in 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons". The procedures vary according to the ethnicity and individual practitioners; during a 1998 survey in Niger, women responded with over 50 terms when asked what was done to them. Translation problems are compounded by

936-733: A new module called Bridging the Gap, which aims to foster closer relationships between local communities and newly decentralized local government structures in Senegal. With the support of UNICEF, Tostan led trainings in local languages for local government officials on human rights and responsibilities, corruption, good governance, and local-level budgeting, while also adding a training for Community Management Committees on how to best collaborate with local government to ensure community needs are responded to in local budgets. Tostan offers several additional programs to communities that have successfully completed

1053-473: A newfound understanding of their basic human rights, led the women of Malicounda Bambara , a village in western Senegal, to decide collectively to abandon the practice. They declared publicly before Senegalese and international media in June 1997 that they would no longer cut their daughters. Surrounding communities, angry that they had not been consulted and uncertain about the motives the women had for renouncing

1170-427: A pouch for the girl to wear. A single hole of 2–3 mm is left for the passage of urine and menstrual fluid. The vulva is closed with surgical thread, or agave or acacia thorns, and might be covered with a poultice of raw egg, herbs, and sugar. To help the tissue bond, the girl's legs are tied together, often from hip to ankle; the bindings are usually loosened after a week and removed after two to six weeks. If

1287-534: A result of the practice, because complications may not be recognized or reported. The practitioners' use of shared instruments is thought to aid the transmission of hepatitis B , hepatitis C and HIV , although no epidemiological studies have shown this. Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supplied

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1404-526: A significant percentage of infibulated women and girls reported a less severe type. In 2017, during an international meeting of 98 FGM experts, which included physicians, social scientists, policymakers, and activists from 23 countries, a majority of the participants advocated for the revision of FGM/C classifications proposed by the WHO and other UN agencies. The experts agreed on legal prohibition of reinfibulation and ritual pricking. They also expressed worry over

1521-486: A space where participants feel comfortable and safe expressing their opinions freely, Tostan's approach strongly emphasizes democracy and human rights: during the CEP, for example, community members learn about these concepts through ideas that are already present in the community and are visible in their daily lives. In the same vein, Tostan takes a non-judgmental approach when broaching sensitive topics, offering community members

1638-504: A study by Nigerian physician Mairo Usman Mandara, over 30 percent of women with gishiri cuts were found to have vesicovaginal fistulae (holes that allow urine to seep into the vagina). FGM harms women's physical and emotional health throughout their lives. It has no known health benefits. The short-term and late complications depend on the type of FGM, whether the practitioner has had medical training, and whether they used antibiotics and sterilized or single-use surgical instruments. In

1755-403: A team of Senegalese cultural specialists developed a program called the Community Empowerment Program (CEP), a curriculum that engages communities by working in their own language and making use of a blend of modern and traditional African methods of learning, such as dialogue, theater, and dance. The program was first launched in 44 Senegalese communities, expanding to 350 by 1994. Prior to 1997,

1872-405: A traditional cutter using a blade, FGM is conducted from days after birth to puberty and beyond. In half of the countries for which national statistics are available, most girls are cut before the age of five. Procedures differ according to the country or ethnic group. They include removal of the clitoral hood (type 1-a) and clitoral glans (1-b); removal of the inner labia (2-a); and removal of

1989-526: A way of practicing their recently acquired literacy skills, has been integrated into the CEP in all communities with adequate cell coverage. Tostan considers the use of mobile phones and SMS texting an effective method of accelerating positive social transformation by connecting communities, amplifying the voices of women, youth, and marginalized groups, and providing a platform for the exchange of ideas. Past external evaluations of Tostan have found instances where community members were not able to make full use of

2106-662: A way that attempts to respect and build on local context, believing that such an approach enables participants to more easily expand their understanding and develop greater insight into their practices and beliefs. All Tostan sessions are conducted in local languages, and facilitators typically come from the same ethnic group as the community they are serving. To date, Tostan's programs have been implemented in 22 different languages, including Wolof, Serer, Fulani, Soninké, Mandinka, Diola, Sousou, Malinké, Pulaar, Kissi, Guerze, Creole, Bambara, Hassaniya, Serehule, Bamanankan, Somali, Afar, as well as French, English, and Arabic. In order to create

2223-443: A way that is appropriate for the local context, after which participants articulate a shared vision of the future of their community and identify goals to make its realization possible. This happens through a process of dialogue and consensus-building among members of all groups: men and women, elders and youth, members of different social classes, ethnic groups, castes, and religions. The knowledge obtained in program sessions then helps

2340-502: Is also a belief that infibulation increases hygiene. Common reasons for FGM cited by women in surveys are social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasure. In a study in northern Sudan, published in 1983, only 17.4 percent of women opposed FGM (558 out of 3,210), and most preferred excision and infibulation over clitoridectomy. Attitudes are changing slowly. In Sudan in 2010, 42 percent of women who had heard of FGM said

2457-593: Is also known in Arabic as khafḍ or khifaḍ . Communities may refer to FGM as "pharaonic" for infibulation and " sunna " circumcision for everything else; sunna means "path or way" in Arabic and refers to the tradition of Muhammad , although none of the procedures are required within Islam. The term infibulation derives from fibula , Latin for clasp; the Ancient Romans reportedly fastened clasps through

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2574-470: Is best known for its success in accelerating the abandonment of harmful traditional practices, particularly female genital cutting and child marriage , across Africa , the organization has also achieved positive results in the impact areas of governance, education, health, economic empowerment, and the environment, as well as in the intersecting issues of child protection, empowerment of women and girls, and early childhood development. In 2007, Tostan received

2691-582: Is common, the practice's many variants are reflected in dozens of terms, often alluding to purification. In the Bambara language , spoken mostly in Mali, it is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath"). A common Arabic term for purification has the root t-h-r , used for male and female circumcision ( tahur and tahara ). It

2808-660: Is concentrated in northeastern Africa, particularly Djibouti, Eritrea, Somalia, and Sudan. In surveys in 2002–2006, 30 percent of cut girls in Djibouti, 38 percent in Eritrea, and 63 percent in Somalia had experienced Type III. There is also a high prevalence of infibulation among girls in Niger and Senegal, and in 2013 it was estimated that in Nigeria three percent of the 0–14 age group had been infibulated. The type of procedure

2925-625: Is increased. The WHO estimated in 2006 that an additional 10–20 babies die per 1,000 deliveries as a result of FGM. The estimate was based on a study conducted on 28,393 women attending delivery wards at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III. The reasons for this were unclear, but may be connected to genital and urinary tract infections and

3042-534: Is insufficient to bring the practice to an end regardless of the strength of their conviction that it should be abandoned. The Community Empowerment Program (CEP) is the centerpiece of Tostan's programming. It is a three-year, non-formal curriculum based on fundamental human rights that provides participants, adults and adolescents alike, with a strong foundation of knowledge and skills with which to improve their lives and generate effective solutions to community problems. The curriculum begins with human rights learning in

3159-824: Is often linked to ethnicity. In Eritrea, for example, a survey in 2002 found that all Hedareb girls had been infibulated, compared with two percent of the Tigrinya , most of whom fell into the "cut, no flesh removed" category. FGM is mostly found in what Gerry Mackie called an "intriguingly contiguous" zone in Africa—east to west from Somalia to Senegal, and north to south from Egypt to Tanzania. Nationally representative figures are available for 27 countries in Africa, as well as Indonesia, Iraqi Kurdistan and Yemen. Over 200 million women and girls are thought to be living with FGM in those 30 countries. The highest concentrations among

3276-581: Is performed on young girls between the ages of two and five, though adolescents also often undergo the practice. Type II female genital cutting (see FGC classification ) is the most common type of FGC in West Africa , the region in which Tostan conducts most of its work, though Type I FGC is also performed. Type III FGC, known sometimes as infibulation, is the most severe form and is rare in West Africa. In 1997, Tostan began providing information about

3393-482: Is removed; Type III is equivalent to the UNICEF category "sewn closed"; and Type IV describes miscellaneous procedures, including symbolic nicking. Type I is "partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans)". Type Ia involves removal of

3510-401: Is satisfactory or whether more is to be cut off. After the clitoris has been satisfactorily amputated ... the circumciser can proceed with the total removal of the labia minora and the paring of the inner walls of the labia majora. Since the entire skin on the inner walls of the labia majora has to be removed all the way down to the perineum, this becomes a messy business. By now, the child

3627-411: Is screaming, struggling, and bleeding profusely, which makes it difficult for the circumciser to hold with bare fingers and nails the slippery skin and parts that are to be cut or sutured together. ... Having ensured that sufficient tissue has been removed to allow the desired fusion of the skin, the circumciser pulls together the opposite sides of the labia majora, ensuring that the raw edges where

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3744-596: Is the cutting or removal of some or all of the vulva for non-medical reasons. FGM prevalence varies worldwide, but is majorly present in some countries of Africa, Asia and Middle East, and within their diasporas. As of 2024 , UNICEF estimates that worldwide 230 million girls and women (144 million in Africa, 80 million in Asia, 6 million in Middle East, and 1-2 million in other parts of the world) had been subjected to one or more types of FGM. Typically carried out by

3861-554: Is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion . Adverse health effects depend on the type of procedure; they can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain , the development of cysts , an inability to get pregnant, complications during childbirth, and fatal bleeding. There are no known health benefits. There have been international efforts since

3978-539: The Conrad N. Hilton Humanitarian Prize , the world's largest humanitarian prize, for its "significant contributions to the alleviation of human suffering." Tostan was founded in 1991 by Molly Melching , an American educator and human rights advocate, with the original goal of providing non-formal holistic education programming to rural communities in Senegal . Relying heavily on feedback from local communities, Melching and

4095-807: The Indonesian Ministry of Health and Indonesian Ulema Council both say the clitoris should not be cut. The prevalence rate for the 0–11 group in Indonesia is 49 percent (13.4 million). Smaller studies or anecdotal reports suggest that various types of FGM are also practised in various circumstances in Colombia , Jordan , Oman , Palestine , Saudi Arabia , Malaysia , the United Arab Emirates , India, and among Kurdish communities in Iran but there are no representative data on

4212-465: The Kono people of Sierra Leone , who in 1992 underwent clitoridectomy as an adult during a Sande society initiation, argued in 2000 that it is a male-centred assumption that the clitoris is important to female sexuality. African female symbolism revolves instead around the concept of the womb. Infibulation draws on that idea of enclosure and fertility. "[G]enital cutting completes the social definition of

4329-841: The UNESCO King Sejong Literacy Prize . In September 2007, Tostan was awarded the Conrad N. Hilton Humanitarian Prize for its "extraordinary contributions toward alleviating human suffering." In 2010, Tostan and its founder Molly Melching were recognized by the Skoll Foundation with the Skoll Award for Social Entrepreneurship. Tostan received an 'Award in Action' by the Cécilia Attias Foundation for Women in 2012, recognizing their work in improving health systems and maternal care at

4446-576: The UNICEF , international FGM rates have risen significantly in recent years, rising from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many effected countries. Aid agencies define the prevalence of FGM as the percentage of the 15–49 age group that has experienced it. These figures are based on nationally representative household surveys known as Demographic and Health Surveys (DHS), developed by Macro International and funded mainly by

4563-595: The United States Agency for International Development (USAID); and Multiple Indicator Cluster Surveys (MICS) conducted with financial and technical help from UNICEF. These surveys have been carried out in Africa, Asia, Latin America, and elsewhere roughly every five years since 1984 and 1995 respectively. The first to ask about FGM was the 1989–1990 DHS in northern Sudan. The first publication to estimate FGM prevalence based on DHS data (in seven countries)

4680-424: The clitoral hood only. This is rarely performed alone. The more common procedure is Type Ib ( clitoridectomy ), the complete or partial removal of the clitoral glans (the visible tip of the clitoris) and clitoral hood. The circumciser pulls the clitoral glans with her thumb and index finger and cuts it off. Type II (excision) is the complete or partial removal of the inner labia , with or without removal of

4797-430: The urethra opening may still be obstructed by scar tissue. Vesicovaginal or rectovaginal fistulae can develop (holes that allow urine or faeces to seep into the vagina). This and other damage to the urethra and bladder can lead to infections and incontinence, pain during sexual intercourse and infertility . Painful periods are common because of the obstruction to the menstrual flow , and blood can stagnate in

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4914-507: The 15–49 age group are in Somalia (98 percent), Guinea (97 percent), Djibouti (93 percent), Egypt (91 percent), and Sierra Leone (90 percent). As of 2013, 27.2 million women had undergone FGM in Egypt, 23.8 million in Ethiopia, and 19.9 million in Nigeria. There is a high concentration in Indonesia, where according to UNICEF Type I (clitoridectomy) and Type IV (symbolic nicking) are practised;

5031-467: The 1970s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are often poorly enforced. Since 2010, the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood. The opposition to

5148-575: The 1980s, FGM was widely known in English as "female circumcision", implying an equivalence in severity with male circumcision . From 1929 the Kenya Missionary Council referred to it as the sexual mutilation of women, following the lead of Marion Scott Stevenson , a Church of Scotland missionary. References to the practice as mutilation increased throughout the 1970s. In 1975 Rose Oldfield Hayes , an American anthropologist, used

5265-582: The 2000s, as demand for its programming grew, Tostan continued to expand, opening national offices in Guinea (2003), The Gambia (2006), Mauritania (2007), Guinea-Bissau (2008), and Mali (2009), in addition to now-closed offices in Somalia , Sudan , and Djibouti . In recent years, Tostan has launched two large-scale campaigns, known as the Generational Change in 3 Years Project (GC3Y) and

5382-515: The Aawde (meaning "to plant the seed" in Pulaar ), which contains modules on local language literacy, small enterprise development, and basic numeracy. Teaching methods consist of interactive exercises, such as small-group work, case studies, and action-research projects. These methods draw on modern and traditional African oral techniques, including theater, storytelling, dance, artwork, song, debate, and

5499-1043: The Barefoot College, including 13 women from Senegal, five from Guinea-Bissau, 5 from Djibouti, and 2 from The Gambia. Tostan offers two modified versions of the CEP. Known as the Prison Project and the Youth Empowerment Program, these programs are aimed at groups that ordinarily would not have access to the traditional CEP but who can still benefit from the curriculum. The Prison Project was first launched in 1999, and it aims to help detainees reintegrate back into their communities, which it accomplishes by building their knowledge of human rights and equipping them with practical skills to launch income-generating activities. Tostan also facilitates family mediations to help integrate former detainees back into their communities upon release. The Youth Empowerment Program typically takes place in urban areas, where

5616-730: The Breakthrough Generation Project in 2017, again directly reaching 150 communities over a period of three years in Guinea, Guinea-Bissau, Mali, and The Gambia. Since 2014, Tostan has been in a partnership with the Bill and Melinda Gates Foundation to improve its monitoring and evaluation systems, and the organization now uses a results framework developed in cooperation with the foundation that measures impacts in five key areas: health, governance, economic empowerment, environment, and education. In 2015, in response to widespread interest in its community-led model, Tostan open

5733-563: The Breakthrough Generation Project, in an effort to promote the empowerment of women and girls and the abandonment of harmful traditional practices in West Africa . During the Generational Change in 3 Years Project, which lasted from 2013 to 2016, Tostan implemented the CEP in 150 communities across Guinea , Guinea-Bissau, Mali, and Mauritania, reaching over 9,000 people directly and leading more than 350 communities to abandon FGC, child marriage, and other harmful traditions, in addition to pledging to support human rights. Tostan subsequently launched

5850-425: The CEP contained six modules, covering problem-solving skills, health and hygiene, child mortality prevention, financial management, leadership and group dynamics, and feasibility studies for income-generating projects. In 1997, Tostan added a seventh module on human rights and women's health that also included information about the possible health effects of female genital cutting (FGC). After going through this module,

5967-420: The CEP's core program to include conflict analysis and prevention, mediation and communication techniques, and the role of women in peace and security. It has since been implemented in Senegal, Guinea-Bissau, and Guinea. The Reinforcement of Parental Practices (RPP) module, which aims to help parents and the wider community stimulate early childhood brain development in order to better prepare children for school,

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6084-496: The CEP. These programs aim to help communities retain the knowledge gained in the CEP and contribute to the development of conditions in which that knowledge can be put to its fullest use. The Peace and Security Project (P&S) was launched in April 2012 and seeks to establish links between community-led initiatives promoting peace and regional policy makers, in order to contribute to peace and security at all levels. This module expands

6201-516: The Creative Director of Tostan, and was succeeded as CEO by Elena Bonometti. Under her leadership, the organization is looking to develop effective scaling models for its programs and training seminars, build upon its organization structures in order to support such a move to scale, continue improving results measurements, and explore further research opportunities by developing partnerships at the national and international levels. Although

6318-921: The FGM status of all their living daughters. The highest concentrations among girls aged 0–14 were in Gambia (56 percent), Mauritania (54 percent), Indonesia (49 percent for 0–11) and Guinea (46 percent). The figures suggest that a girl was one third less likely in 2014 to undergo FGM than she was 30 years ago. According to a 2018 study published in BMJ Global Health , the prevalence within the 0–14 year old group fell in East Africa from 71.4 percent in 1995 to 8 percent in 2016; in North Africa from 57.7 percent in 1990 to 14.1 percent in 2015; and in West Africa from 73.6 percent in 1996 to 25.4 percent in 2017. If

6435-564: The Fulani in Chad, while in Nigeria the Fulani are the only large ethnic group in the country not to practise it. In Sierra Leone, the predominantly Christian Creole people are the only ethnicity not known to practice FGM or participate in Bondo society rituals. Kenyan FGM ceremony  — Stephanie Welsh, Newhouse News Service Dahabo Musa, a Somali woman, described infibulation in

6552-600: The Solar Power Project, in partnership with the Barefoot College in India, Tostan has given rural African women who have completed the CEP the opportunity to train as solar power engineers. Following six months of training at the Barefoot College, the women return home with skills that enable them to bring power to their communities and earn an income for themselves and for their Community Management Committee. From 2009 to 2016, 25 Tostan participants attended classes at

6669-583: The Tostan Training Center (TTC) in Thies to external participants. At the TTC, it offers a 10-day training program on its approach to community-led development in both English and French for community activists, members of local, national and international organizations and governments, and representatives from academia and the media. In 2017, Melching transitioned from the position of CEO to become

6786-486: The Tostan program is holistic, Tostan has been widely recognized for its success in accelerating the abandonment of child marriage and female genital cutting (FGC), a tradition that has existed for centuries in most parts of Africa . According to UNICEF , FGC is a "self-enforcing social practice" or social norm to which families feel they must conform in order to avoid being ostracized by their community. In general, FGC

6903-472: The WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria and Niger. These were removed from the WHO's 2008 definition because of insufficient information about prevalence and consequences. Angurya cutting is excision of the hymen , usually performed seven days after birth. Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour, and other conditions. In

7020-602: The case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once (for example, to close an opening regarded as too wide or re-open one too small). Common short-term complications include swelling, excessive bleeding, pain, urine retention , and healing problems/ wound infection . A 2014 systematic review of 56 studies suggested that over one in ten girls and women undergoing any form of FGM, including symbolic nicking of

7137-537: The chance to make use of the knowledge and skills gained over the course of the CEP. The funds are controlled and distributed by the CMCs, which decide interest rates and the length of loans that they will grant. The Child Protection module, designed in 2010, provides special training for Community Management Committees on how to handle issues that relate to the well-being of children. It aims to build consensus around children's rights while simultaneously building awareness of

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7254-581: The chance to reflect thoughtfully and meaningfully on what they believe and why without self-censoring because of a fear of criticism from outside. Tostan's theory of change is based largely on the work of Gerry Mackie , a researcher at the University of California, San Diego who hypothesized in a 1996 American Sociological Review article that female genital cutting, like the practice of foot-binding in China , would end quickly once people began ending

7371-402: The child squats on a stool or mat while adults pull her legs open; a local anaesthetic is applied if available: The element of speed and surprise is vital and the circumciser immediately grabs the clitoris by pinching it between her nails aiming to amputate it with a slash. The organ is then shown to the senior female relatives of the child who will decide whether the amount that has been removed

7488-481: The clitoral glans and outer labia . Type IIa is removal of the inner labia; Type IIb, removal of the clitoral glans and inner labia; and Type IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM. — Swiss Medical Weekly Type III ( infibulation or pharaonic circumcision), the "sewn closed" category, is the removal of the external genitalia and fusion of

7605-404: The clitoris (Type IV), experience immediate complications, although the risks increased with Type III. The review also suggested that there was under-reporting. Other short-term complications include fatal bleeding, anaemia , urinary infection , septicaemia , tetanus , gangrene , necrotizing fasciitis (flesh-eating disease), and endometritis . It is not known how many girls and women die as

7722-465: The clitoris. An infibulated girl may be left with an opening as small as 2–3 mm, which can cause prolonged, drop-by-drop urination , pain while urinating , and a feeling of needing to urinate all the time. Urine may collect underneath the scar, leaving the area under the skin constantly wet, which can lead to infection and the formation of small stones. The opening is larger in women who are sexually active or have given birth by vaginal delivery, but

7839-616: The community to achieve these goals in an organized fashion. Instead of focusing on what is lacking or making value judgments, Tostan asks participants to think about existing community resources and how to build on them. The CEP continues to refer back to human rights throughout the course of the program. The program is divided into two phases: the Kobi (meaning "to till the soil" in Mandinka ), which contains modules on democracy, human rights, problem-solving skills, health and hygiene, followed by

7956-629: The countries for which national figures were available in 2000–2010, most girls had been cut by age five. Over 80 percent (of those cut) are cut before the age of five in Nigeria, Mali, Eritrea, Ghana and Mauritania. The 1997 Demographic and Health Survey in Yemen found that 76 percent of girls had been cut within two weeks of birth. The percentage is reversed in Somalia, Egypt, Chad, and the Central African Republic, where over 80 percent (of those cut) are cut between five and 14. Just as

8073-486: The country a national prevalence of eight percent. The practice is sometimes an ethnic marker, but it may differ along national lines. For example, in the northeastern regions of Ethiopia and Kenya, which share a border with Somalia, the Somali people practise FGM at around the same rate as they do in Somalia. But in Guinea all Fulani women responding to a survey in 2012 said they had experienced FGM, against 12 percent of

8190-402: The country. As of January 2019, 5,423 formerly practicing communities have publicly abandoned all forms of FGC in Senegal and many more have done the same across West and East Africa. External evaluators have noted that the pledges made are generally respected by a large majority of community members, though some resistance to abandonment is still present in communities that have declared an end to

8307-582: The culture that practices FGM and learn that their condition is not the norm, but within the practicing culture, they may view their FGM with pride because for them it signifies beauty, respect for tradition, chastity and hygiene. Studies on sexual function have also been small. A 2013 meta-analysis of 15 studies involving 12,671 women from seven countries concluded that women with FGM were twice as likely to report no sexual desire and 52 percent more likely to report dyspareunia (painful sexual intercourse). One-third reported reduced sexual feelings. According to

8424-528: The current rate of decline continues, the number of girls cut will nevertheless continue to rise because of population growth, according to UNICEF in 2014; they estimate that the figure will increase from 3.6 million a year in 2013 to 4.1 million in 2050. Surveys have found FGM to be more common in rural areas, less common in most countries among girls from the wealthiest homes, and (except in Sudan and Somalia) less common in girls whose mothers had access to primary or secondary/higher education. In Somalia and Sudan

8541-782: The curriculum of the CEP is adjusted to make it more relevant to young people going through the education system and searching for employment, helping them to develop the skills needed to be successful. Tostan's donors include the Greenbaum Foundation, the Swedish International Development Cooperation Agency (SIDA), UNICEF , UNFPA , USAID , the Wallace Global Fund, and the William and Flora Hewlett Foundation , among others. In August 2007, Tostan received

8658-565: The dangers of FGC. In February 1998, thanks in large part to his efforts, 13 neighboring villages declared their decision to join the Malicounda Bambara pledge. Since then, Tostan's approach has successfully encouraged nearly 9,000 communities in Africa to abandon both female genital cutting and child/forced marriage, another harmful practice with which FGC is often associated. The government of Senegal has since adopted Tostan's FGC model and continues to apply it in its work to end FGC in

8775-453: The data. FGM's origins in northeastern Africa are pre-Islamic, but the practice became associated with Islam because of that religion's focus on female chastity and seclusion. According to a 2013 UNICEF report, in 18 African countries at least 10 percent of Muslim females had experienced FGM, and in 13 of those countries, the figure rose to 50–99 percent. Bill and Melinda Gates Foundation Too Many Requests If you report this error to

8892-597: The development of intellectual faculties in young children. Over the course of the RPP Module, "facilitators share...techniques that enrich interactions between parents and their young children and are all linked to children’s basic human rights to education and health. These techniques include speaking to their young children using a rich and complex vocabulary, asking their children questions and helping them respond, playfully copying their children, telling them stories, and describing objects in detail to them." The RPP Module

9009-500: The effort of penetrating an infibulation. The local preference for dry sex causes women to introduce substances into the vagina to reduce lubrication, including leaves, tree bark, toothpaste and Vicks menthol rub . The WHO includes this practice within Type IV FGM, because the added friction during intercourse can cause lacerations and increase the risk of infection. Because of the smooth appearance of an infibulated vulva, there

9126-528: The first time, implementing an initiative called the Prison Project in a Senegalese prison in Thiès , the third-largest city in Senegal and the then-location of Tostan's headquarters. The Prison Project consists of a modified form of the CEP that aims to provide detainees with the resources to help them to develop valuable income-generating skills, restore contact with their families, and reintegrate smoothly into society, thereby also reducing recidivism rates. During

9243-418: The following: (1) cut, no flesh removed (symbolic nicking); (2) cut, some flesh removed; (3) sewn closed; or (4) type not determined/unsure/doesn't know. The most common procedures fall within the "cut, some flesh removed" category and involve complete or partial removal of the clitoral glans. The World Health Organization (a UN agency) created a more detailed typology in 1997: Types I–II vary in how much tissue

9360-548: The foreskins or labia of slaves to prevent sexual intercourse. The surgical infibulation of women came to be known as pharaonic circumcision in Sudan and as Sudanese circumcision in Egypt . In Somalia , it is known simply as qodob ("to sew up"). The procedures are generally performed by a traditional cutter ( exciseuse ) in the girls' homes, with or without anaesthesia. The cutter is usually an older woman, but in communities where

9477-549: The grandmothers arranged a visit to relatives. Gerry Mackie has compared the practice to footbinding . Like FGM, footbinding was carried out on young girls, nearly universal where practised, tied to ideas about honour, chastity, and appropriate marriage, and "supported and transmitted" by women. FGM practitioners see the procedures as marking not only ethnic boundaries but also gender differences. According to this view, male circumcision defeminizes men while FGM demasculinizes women. Fuambai Ahmadu , an anthropologist and member of

9594-410: The harm presented by "the lawfulness of both female genital cosmetic surgeries and male circumcision" in the negation of FGM/C prevention campaigns. The participants, however, differed in their views on the ban of female genital cosmetic surgeries and regular vulvar checkups of female children. Standard questionnaires from United Nations bodies ask women whether they or their daughters have undergone

9711-436: The help of the "little knife". This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis. Type IV is "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization. It includes nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into

9828-588: The information gained during Tostan's programming because of a lack of resources and infrastructure. In an effort to address this shortcoming, Tostan offers Community Development Grants of between US$ 300 and 1,000 to CMCs and individuals during and after the CEP, which are often used either to fund community development projects or to start a community rotating microcredit fund. These funds can enable people, notably women, to launch their own income-generating activities, helping them to support their families and give back further to their communities, in addition to giving them

9945-415: The inner and outer labia and closure of the vulva (type 3). In this last procedure, known as infibulation , a small hole is left for the passage of urine and menstrual fluid , the vagina is opened for intercourse and opened further for childbirth. The practice is rooted in gender inequality , attempts to control female sexuality , religious beliefs and ideas about purity, modesty, and beauty. It

10062-605: The insult back, the Zabarma girls would ask their mothers, "What's the matter? Don't we have razor blades like the Arabs?" Because of poor access to information, and because practitioners downplay the causal connection, women may not associate the health consequences with the procedure. Lala Baldé, president of a women's association in Medina Cherif, a village in Senegal, told Mackie in 1998 that when girls fell ill or died, it

10179-708: The male barber has assumed the role of health worker, he will also perform FGM. When traditional cutters are involved, non-sterile devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks, and fingernails. According to a nurse in Uganda, quoted in 2007 in The Lancet , a cutter would use one knife on up to 30 girls at a time. In several countries, health professionals are involved; in Egypt, 77 percent of FGM procedures, and in Indonesia over 50 percent, were performed by medical professionals as of 2008 and 2016. The WHO, UNICEF, and UNFPA issued

10296-582: The more extensive FGM procedures. Infibulated women may try to make childbirth easier by eating less during pregnancy to reduce the baby's size. In women with vesicovaginal or rectovaginal fistulae, it is difficult to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such as pre-eclampsia harder. Cervical evaluation during labour may be impeded and labour prolonged or obstructed. Third-degree laceration (tears), anal-sphincter damage and emergency caesarean section are more common in infibulated women. Neonatal mortality

10413-466: The organization to expand more easily into new countries and cultural contexts. Tostan also values external research and supports external reviewers in carrying out their evaluations. Over time, new modules have gradually been integrated into the CEP. Since 2009, the Jokko Initiative, which teaches participants how to use a mobile phone to send messages, both as a means of communication and as

10530-436: The possible health effects of female genital cutting in the CEP in a module covering human rights and women's health. Tostan had at first hesitated to raise the issue of female genital cutting in its programming, believing it to be too sensitive and liable to undermine its work, but insistence from employees in the field eventually led the organization to include information about the practice. This new information, together with

10647-466: The practice collectively in order to preserve a woman's ability to marry within their ethnic group. Tostan, with Mackie's advice and input, has since developed this idea into a wide-ranging theory of change which hypothesizes that FGC can be sustainably abandoned only if both individuals and their extensive social networks are implicated in the decision-making process, as one person or one community alone, given their links to so many other groups and networks,

10764-421: The practice is not without its critics, particularly among anthropologists , who have raised questions about cultural relativism and the universality of human rights. According to the UNICEF, international FGM rates have risen significantly in recent years, from an estimated 200 million in 2016 to 230 million in 2024, with progress towards its abandonment stalling or reversing in many affected countries. Until

10881-403: The practice should continue. In several surveys since 2006, over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, the Gambia, and Egypt supported FGM's continuance, while elsewhere in Africa, Iraq, and Yemen most said it should end, although in several countries only by a narrow margin. Against the argument that women willingly choose FGM for their daughters, UNICEF calls the practice

10998-430: The practice, reacted with hostility. An imam from the nearby village of Keur Simbara, Demba Diawara, made it clear to Melching and the Tostan staff that such a monumental social change would be difficult for the women of one village alone to sustain. In areas where FGC is practiced, it is common for a girl to marry into another family that lives in a neighboring village. Because not cutting a girl impacts her marriageability,

11115-596: The presence of scar tissue. According to the study, FGM was associated with an increased risk to the mother of damage to the perineum and excessive blood loss , as well as a need to resuscitate the baby, and stillbirth , perhaps because of a long second stage of labour . According to a 2015 systematic review there is little high-quality information available on the psychological effects of FGM. Several small studies have concluded that women with FGM develop anxiety, depression, and post-traumatic stress disorder . Feelings of shame and betrayal can develop when women leave

11232-588: The prevalence in these countries. As of 2023 , UNICEF reported that "The highest levels of support for FGM can be found in Mali, Sierra Leone, Guinea, the Gambia, Somalia, and Egypt, where more than half of the female population thinks the practice should continue". Prevalence figures for the 15–19 age group and younger show a downward trend. For example, Burkina Faso fell from 89 percent (1980) to 58 percent (2010); Egypt from 97 percent (1985) to 70 percent (2015); and Kenya from 41 percent (1984) to 11 percent (2014). Beginning in 2010, household surveys asked women about

11349-551: The remaining hole is too large in the view of the girl's family, the procedure is repeated. The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. In some areas, including Somaliland, female relatives of the bride and groom might watch the opening of the vagina to check that the girl is a virgin. The woman is opened further for childbirth ( defibulation or deinfibulation ), and closed again afterwards ( reinfibulation ). Reinfibulation can involve cutting

11466-407: The role participatory decision-making methods can play in their work. Tostan uses the feedback it receives from participants and local leaders, both religious and secular, to regularly update and revise its programs, embracing an approach that emphasizes adaptation and adjustment based on the needs of learners, the socio-cultural context of the area, and program design elements, making it possible for

11583-477: The sharing of personal experiences. Tostan believes that the collective changes made by villagers must be self-sustaining. To this end, Tostan helps establish Community Management Committees (CMCs) that implement development efforts proposed by community members after the program's end. The CMCs are composed of 17 democratically selected members, at least nine of whom are women, and all receive training from Tostan on how to perform effectively in their positions and on

11700-415: The situation was reversed: in Somalia, the mothers' access to secondary/higher education was accompanied by a rise in prevalence of FGM in their daughters, and in Sudan, access to any education was accompanied by a rise. FGM is not invariably a rite of passage between childhood and adulthood but is often performed on much younger children. Girls are most commonly cut shortly after birth to age 15. In half

11817-445: The skin has been removed are well approximated. The wound is now ready to be stitched or for thorns to be applied. If a needle and thread are being used, close tight sutures will be placed to ensure that a flap of skin covers the vulva and extends from the mons veneris to the perineum, and which, after the wound heals, will form a bridge of scar tissue that will totally occlude the vaginal introitus. The amputated parts might be placed in

11934-408: The task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with

12051-836: The term female genital mutilation in the title of a paper in American Ethnologist , and four years later Fran Hosken called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females . The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children began referring to it as female genital mutilation in 1990, and the World Health Organization (WHO) followed suit in 1991. Other English terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those who work with practitioners. In countries where FGM

12168-520: The tools to make their own decisions. In 1997, using the Tostan program, Malicounda Bambara in Senegal became the first village to abandon FGM. By August 2019, 8,800 communities in eight countries had pledged to abandon FGM and child marriage . Surveys have shown a widespread belief, particularly in Mali, Mauritania, Guinea, and Egypt, that FGM is a religious requirement. Gruenbaum has argued that practitioners may not distinguish between religion, tradition, and chastity, making it difficult to interpret

12285-425: The tradition. Tostan states that its approach follows the philosophy of noted Senegalese scholar Cheikh Anta Diop, who emphasized that the process of development should be educational for everyone involved in the process, NGO workers and community members alike, and that it should be conducted in a way that makes the fullest possible use of existing knowledge and traditions. Tostan therefore conducts its programming in

12402-680: The type of FGM is often linked to ethnicity, so is the mean age. In Kenya, for example, the Kisi cut around age 10 and the Kamba at 16. A country's national prevalence often reflects a high sub-national prevalence among certain ethnicities, rather than a widespread practice. In Iraq, for example, FGM is found mostly among the Kurds in Erbil (58 percent prevalence within age group 15–49, as of 2011), Sulaymaniyah (54 percent) and Kirkuk (20 percent), giving

12519-458: The vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood. Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III: The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and

12636-474: The vagina and uterus. Complete obstruction of the vagina can result in hematocolpos and hematometra (where the vagina and uterus fill with menstrual blood). The swelling of the abdomen and lack of menstruation can resemble pregnancy. Asma El Dareer , a Sudanese physician, reported in 1979 that a girl in Sudan with this condition was killed by her family. FGM may place women at higher risk of problems during pregnancy and childbirth, which are more common with

12753-449: The vagina to tighten it. Labia stretching is also categorized as Type IV. Common in southern and eastern Africa, the practice is supposed to enhance sexual pleasure for the man and add to the sense of a woman as a closed space. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia. A definition of FGM from

12870-683: The various moral, social, and legal norms that affect children. In 2013, a new project called Ndimaagu ( Pulaar word for 'dignity'), was piloted in 55 communities in Tambacounda, a city in the southeast of Senegal . The project integrates additional classes on gender into the CEP, offers trainings on violence prevention for local authorities, traditional and religious leaders, and builds partnerships between Community Management Committees, non-governmental organizations, governmental institutions, community leaders, and service providers responding to gender-based violence in Senegal. In 2017, Tostan piloted

12987-681: The women of Malicounda Bambara , a village in western Senegal, decided collectively to abandon the practice of FGC, starting a movement that has since led nearly 9,000 African communities to abandon the practice. Tostan worked exclusively in Senegal until 1997, when it began implementing the CEP in communities in Burkina Faso in a six-year partnership with the NGO Mwangaza Action, which ultimately resulted in 23 Burkinabe communities declaring their intent to permanently abandon FGC. In 2002, Tostan expanded its programmatic offerings for

13104-502: The women's confusion over which type of FGM they experienced, or even whether they experienced it. Studies have suggested that survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that 73 percent had undergone it. In Sudan in 2006,

13221-524: The wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. Type III is found largely in northeast Africa, particularly Djibouti, Eritrea, Ethiopia, Somalia, and Sudan (although not in South Sudan). According to one 2008 estimate, over eight million women in Africa are living with Type III FGM. According to UNFPA in 2010, 20 percent of women with FGM have been infibulated. In Somalia, according to Edna Adan Ismail ,

13338-499: Was attributed to evil spirits. When informed of the causal relationship between FGM and ill health, Mackie wrote, the women broke down and wept. He argued that surveys taken before and after this sharing of information would show very different levels of support for FGM. The American non-profit group Tostan , founded by Molly Melching in 1991, introduced community-empowerment programs in several countries that focus on local democracy, literacy, and education about healthcare, giving women

13455-489: Was evaluated by researchers from Stanford University in 2016, which showed, among other results, that children whose caregivers had gone through the RPP Module had increased the number of their utterances by 32% more than their peers in control settings, and it was also found that children in RPP communities made significantly greater gains in language milestones and expressive vocabulary than children in non-RPP communities. Through

13572-520: Was first implemented in 232 communities in Senegal in 2013. The module tries to overcome certain social norms and traditional practices which have been shown to hinder the brain development of infants. Many West Africans in both rural and urban areas believe that infants must be protected from dangerous spirits, and, in order to protect them, certain parents avoid looking newborn babies in the eye and speaking regularly and directly to them, actions which recent advances in neuroscience have shown to be crucial to

13689-443: Was written by Dara Carr of Macro International in 1997. Questions the women are asked during the surveys include: "Was the genital area just nicked/cut without removing any flesh? Was any flesh (or something) removed from the genital area? Was your genital area sewn?" Most women report "cut, some flesh removed" (Types I and II). Type I is the most common form in Egypt, and in the southern parts of Nigeria. Type III (infibulation)

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