Female Genital Mutilation in Mauritania: a LWF team visitation report.

The desert is the first thing that strikes the visitor to Mauritania, which covers 90% of the territory. The heat, the huge expanse of sand, and the traditionally clothed people make an indelible impression. Culturally, Mauritania is a fascinating confluence of Arab North Africa and Black Sub-Saharan Africa. Arab-Berber Maures are divided into two groups: White Moors and Black Moors. Three main African tribes (Pular, Wolof and Soninke) comprise the Black portion of the population. Islam (Sunni) is the religion of 99.4% of the population. 52% of the population, are under 18 (UNICEF, 1998). Well over half the women have given birth by this age. Poverty remains widespread, touching more than half the population. Literacy rate is 38% (New Internationalist, 1995). Rate of access to health facilities and drinking water (outside of Nouakchott) is 35%, and the life expectancy is 50.5 years (World Factbook, 1999).

The great droughts of the early 1970s caused massive problems in a country where 70% of its inhabitants were nomads. People who had been wanderers in the desert lost their herds of camels, donkeys, goats, and sheep. Made destitute, they flocked to Nouakchott and other urban areas to a radically changed way of life. Today only 15% remain nomads. LWF-WS-Mauritania entered this area with an intervention in environmental and human crisis in 1974. Beginning with emergency relief, the LWF work has evolved over 26 years into rehabilitation and development. As the only LWF program in Francophone West Africa, LWF-WS-Mauritania is a stabilizing presence in this nation of environmentally displaced people.

Female Genital Mutilation (FGM) is practiced for the following reasons: with the misunderstanding that it is prescribed by religion and is a perpetuation of culture. The understanding is also that it aids in the control of sexual desire in women, ensuring chaste and docile behavior. The clitoris is perceived as the creation of Satan and therefore had to be excised. The age of excision ranges from birth to ten years of age but in majority of cases it takes place between the second week and the second year of a young girl's life.

It is evident that the Prophet Mohammed was aware of the existence of this problem but had neither condemned nor recommended it. There is no specific stipulation either in the Koran, or in the Islamic laws that are the Charia and the Sunna of the Prophet Mohammed or in the hadiths. The lack of recommendation has made ipso facto an optional practice. One of the beliefs accounted in the contact meeting was that the first woman to be excised was Hagar, the wife of the patriarch Abraham and the mother of Ishmael as a punishment from Sara the first wife, in retaliation against the marriage. This illustrates that this practice existed prior to Islam. There are also non-Muslim ethnic groups in Africa who practice FGM. Therefore religion cannot be cited as a reason for the practice. In fact Islam places the health of human beings above all else.

Without exception, all the practitioners are older women with low economic status. They are often illiterate. 64% of practitioners are married, therefore their husbands are in charge. 34% are elders or divorcees, with economic difficulties. Four of the practitioners of excision were present at a meeting and courageously expressed that their motives for performing these operations are only because it is an inherited profession from their ancestors and is a way to support themselves financially.

There are four types of excision ranging from removal of the clitoris to excision of the clitoris with partial or total excision of the small labium, scraping of the entire vulva of a woman including the clitoris and the small and large labia as well as infibulation which includes the scraping of the entire vulva and then stitching the remaining opening closed. Consequences of this include hemorrhage, severe trauma due to extreme pain, a wound that takes a long time to heal. There is also the possibility of tetanus infection, difficult childbirth or sterility, and fistulas. When a woman suffers from fistulas, the urine and the stools may pass through the vagina. This is very difficult to repair and leads to social exclusion of the woman because she must live separately from the rest of the family. Binding of the labium can make it impossible to have sexual relations. This is a reason for many divorces.

It was not until the 1970s that this phenomenon was described in Mauritania for the first time. It was during the emancipation process of Mauritanian women that one of their leaders, Aissata Kane, denounced FGM for the first time. Now there are several NGOs working towards addressing the concerns of women, such as The National Forum for the Defense of Women's Rights (FNPDF) and the Association for the Defense of Mauritanian Women's Rights. With the creation of the State Secretariat on Women's Affairs (SECF) in 1992, Mauritania found a favorable place to debate the question of FGM. Of course, there is always a reference to Islam, as well as a tight collaboration between religious leaders and medical professionals regarding the question of rights and women's health.

This is the context in which the LWF felt the need to organize a team visit of women leaders to Mauritania. The service of the LWF Field office that is very well recognized by the Government of Mauritania and the good rapport built by its services primarily made this visit a possibility.

The issue was very sensitive. One cannot talk of health care to women who are mostly without access to knowledge of their own bodies and its care. One dare not touch either culture or religion as an entry point. One cannot talk to men who are mostly the decision-makers since talking about women's bodies would be considered inappropriate. So the first strategy was to select a team who knew what to do about it. The team was comprised of Mrs. Parmata Ishaya, LWF Vice-President for Africa, Dr. Mary Jansen Van Raay, LWF Council member, Mrs. Huda Abu Gharbieh, LWF Jerusalem staff, Mrs. Gaitana Mint Mohamed, Mauritania State Secretariat of Women, Mrs. Houleye Tall, LWF Mauritania staff and Mrs. Aissata Kane, as consultant and facilitator.

Their methodology was to approach the issue as one that affects the health of women and children. Their interactions included Government officials, NGOs, medical personnel, religious leaders, the practitioners themselves and women. Here are some of their findings.

Some of the interactions with men brought out interesting responses. The following is from a father, Adama Ba:

   "The practice of excision is a tradition strongly tied to Mauritania as a
   [majority] of the population practices it without consequence as it is
   neither forbidden nor authorized by the Charia. I think that to come to
   terms with this poor tradition in Mauritania, it is necessary not only to
   sensitize those involved (the women), but also to sensitize all of civil
   society, local elected officials, religious chiefs, and communicators
   working for the media (press, radio, and television). I also believe that
   the doctors and the religious chiefs should be used as a resource to fight
   this practice. The doctors because they know the ravages that are caused by
   this practice and the religious chiefs because they can give acceptable
   council and provide reason to a society that is rather set in its ways. In
   the end, I think that every couple should pledge never to excise their
   daughters."

According to Religious leader Diagana, tattooing has the same connotation in Islam, as Risala Ibn Abi Zeid Mohammed Abdallah Al Qairawani knows the optional character of excision. He explained that if these practices still continue it is because the population is led to believe that there is a religious foundation. However he prefers to propose an improvement in the conditions of excision (better anesthetic, medical instruments used, and knowledge of anatomy. Other members advocate the abandonment of the practice fully, while some others think it will disappear or decrease with time.

Mr. Mohameden ould Tah, a theologian, talked of the political status, administration, and laws adopted in Mauritania in favor of women, conforming with the traditional and religious customs of society. He insisted upon the connection between the practice of FGM, poverty, and ignorance.

The local groups concluded that the practice of excision is not a part of the essence of Islam. Its origins are in the Pharaonic rites of ancient Egypt, the birthplace of African civilization. They unanimously agree that health should be placed above all and as the medical field is opposed to this practice, their advice should be adhered to. The ban of excision by legislation (law) must be tackled with prudence because this practice is deeply rooted in culture They agreed that all the participants who are strongly against this practice must consult one another periodically, unify their theses, harmonize their arguments and adopt, despite criticism, a firm intention to put a stop to this practice. They also agreed that one must work to persuade the population to dare to oppose this practice. One must also spread these messages to all areas of the country. It is also the opinion of all the people present that awareness building should be primarily aimed at religious leaders who have moral authority and who are listened to when they speak.

The principal RECOMMENDATIONS OF THE PARTICIPANTS of several meetings are as follows:

* Increase and continue awareness-building campaigns against the practice of FGM in urban and rural areas;

* Adopt a national legislation forbidding the practice of FGM;

* Sensitize the authorities on necessity of classifying these practices as a public health problem and integrating it into the national health policy;

* Harmonize the national legislation with the international norms ratified by our country, in particular the CEDAW and the CRC; and

* Reenergize the commissions already created at the level of the Minister of Health and Social Affairs (MSAS) and the State Secretariat on Women's Affairs (SECF) to continue the fight against harmful practices.

RECOMMENDATIONS OF THE TEAM:

1. Intensify the awareness-building campaigns through all members of civil society;

2. Edit the illustrated brochures; produce brochures in all languages spoken in Mauritania that encourage the decrease of FGM;

3. Prepare FGM posters and documentation to be distributed in schools and in public centers;

4. Strengthen collaboration between partners (women, female associations, government, religious), by having partnership activities;

5. Stimulate national awareness by working with a national forum of the Government and civil society (information, communication and training);

6. Hold annual workshops to assess the results within the SECF and community;

7. LWF should include a section on the topic of FGM in all activities in their intervention areas in the rural area;

8. Teach practitioners other skills to replace FGM;

9. Create income generating activities for the practitioners; and

10. LWF field projects should have awareness-building activities within their development activities in close collaboration with regional offices of SECF and health centers.