Using our research tools, we have been able to achieve the following:
The 1st International Conference on Harmful Traditional Practices was a historic milestone in the fight against FGM in Gambia. Before over 200 participants from Africa and Europe, the Vice President of Gambia, the Spokesperson for the National Assembly and the Grand Imam of the Banjul Mosque presided over the opening ceremony, in public affirmation of their commitment to this endeavour.
For the first time, experts and governmental and non-governmental institutions gathered to debate the issue of FGM and explore strategies to prevent it. Numerous NGOs from Gambia, Senegal, Burkina Faso, Kenya, Tanzania, Nigeria and Ethiopia shared their experiences with international agencies like the WHO, UNFPA and UNICEF, and with a delegation from the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC). In witness to their firm decision to create synergies, the Brufut Declaration was signed.
The conference was held in Brufut, Gambia in May, 2009, organised on the initiative of the Interdisciplinary Group for the Prevention and Study of Harmful Traditional Practices (GIPE-PTP) and the NGO Wassu Gambia Kafo, with the support of the Universitat Autònoma de Barcelona, the Ministry of Health and Social Welfare of Gambia, the University of Gambia and United Nations agencies (WHO, UNFPA and UNICEF).
In 2004, Dr Adriana Kaplan filmed the documentary "Initiation without mutilation", directed by Sebastián Risler, which put forward an alternative rite of passage that excludes the first phase of the ritual (the physical phase), in which the mutilation takes place, but maintains the subsequent phases of cultural transmission and social belonging. In a country in which all preventive measures for female genital mutilation (FGM) had been banned, the documentary was given a surprisingly warm welcome.
The Vice-President of Gambia described it as culturally respectful and, in 2006, a request was made to translate it into the five main local languages (Mandingo, Fula, Sarahole, Jola and Wolof), adding to the existing versions in Spanish, English and Catalan.
Sustainability and appropriation are at the heart of our interventions. To make sure medical students do not begin their careers without having acquired the skills needed to identify and treat the effects of female genital mutilation (FGM) and, at the same time, are aware of the role they can play in preventing this practice, we have developed an academic curriculum that includes FGM as a cross-disciplinary element.
For four years we have worked alongside the University of Gambia and the Cuban Medical Mission, the driving force behind the creation of the School of Medicine and Related Sciences (EMCA). The result is a curriculum that devotes 30 hours to FGM, distributed between 6 subjects (Anatomy, Physiology, Gynaeco-Obstetrics, Paediatrics, Psychology and Community Medicine). This curriculum was approved by the Ethics Committee and the Senate of the University of Gambia and then implemented not only in Medicine, but also in the School of Public Health and all nursing and midwifery schools in the country.
In 2008, Wassu Gambia Kafo developed the first clinical study ever conducted in Gambia on the effects of female genital mutilation (FGM) on the health of women and girls. The results show that FGM is still practised in the country's six regions and causes injury to one in three women and girls.
A second clinical study was carried out in 2010 to obtain detailed information on the long-term consequences of the practice in Gambia, including its impact on childbirth and neonatal health. This study shows that women who have undergone FGM and their babies have four times as many chances of suffering complications during the birth as those who do not present FGM.
In Gambia three out of every four women and girls have suffered some kind of female genital mutilation (FGM), which means they will need medical treatment for decades to come. Although healthcare workers are at the forefront of the care cycle for cases of FGM and in a privileged position to discourage the practice, our studies reveal that they are unaware of its effects and share ideas about it that are unfounded. There is an obvious need to train these workers to identify, treat and prevent FGM, so we have developed a training programme tailored to the country's cultural context.
In 2011, our work was rewarded by the signing of an agreement with the Ministry of Health and Social Welfare, United Nations agencies (UNICEF and WHO), the Universitat Autònoma de Barcelona and Wassu Gambia Kafo, to develop the National Training Programme on FGM for Healthcare Professionals. This programme targets 1,500 healthcare workers (in medicine, nursing and midwifery) and is being implemented all over the country under the direction of Wassu Gambia Kafo, with positive impacts on the health of women and girls.
We have extended our training programme, through the Ministry of Health, to include traditional midwives, who, due to the lack of qualified personnel and the centralisation of healthcare resources, attend to almost half of the births that take place in Gambia. Traditional midwives are chosen by the members of their community and live among them, sometimes acting as "circumcisers". We train them to identify and predict childbirth complications caused by FGM and understand their negative impact on health and the role they can play in preventing these.
Designing policies and actions for the prevention and treatment of female genital mutilation (FGM) requires knowledge of the characteristics and geographic distribution of the population affected by this practice. The map of FGM in Spain, based on data from municipal population registers, shows the size of the female migrant population from FGM-practising countries, and its geographic distribution. This unique tool can guide the development of preventive policies and actions and is available to those who wish to turn intercultural challenges into opportunities for growth, helping to defend the rights of women and girls.
The map was first developed in 2001 and is now in its fourth edition (2006, 2010, 2013).
We have respectfully presented the results of our clinical studies on the effects of female genital mutilation (FGM) to the Gambia Supreme Islamic Council and to the imams and ulama of West Africa. The international colloquium "Islam and *FGM", held in Nouakchott (Mauritania) in September, 2011, and organised by United Nations agencies and the German Agency for Cooperation for Development (GIZ), saw the promulgation of a fatwa (resolution) acknowledging FGM to be a harmful traditional practice, and also a pledge from several Islamic authorities to discontinue it.