Why is Egypt still performing so many female genital mutilations?

Why is Egypt still performing so many female genital mutilations?
Despite being made illegal, FGM is still commonplace, with most cutting operations performed by doctors who should know better.
8 min read
08 March, 2019
Around 500,000 Egyptian girls will face genital mutilation this year [NurPhoto]
Despite a century of efforts to end the practice, female genital mutilation (FGM) is still highly prevalent in Egypt.

The National Population Council, housed by the Ministry of Health and Population, was put in charge of Egypt's 2015-2020 FGM abandonment national strategy, entirely funded by foreign donors from the European Union.

But in 2017, one European donor froze its funding, saying the NPC was incompetent. The European Union and UNDP also subsequently interrupted their financial participation following what they described as a "lot of internal issues and difficulties" at NPC.

Three years after the national strategy was launched at Cairo's luxurious Grand Nile Hotel, NGOs' initial concerns may have proven to be right. 

The former National Population Council team "didn't implement any real actions in the field but spent lot of money on showy conferences and consultancies" said Randa Fakhr al Din, head of Kamila, a coalition of 120 local organisations against FGM.  

She suspects that more than half of the NPC's funds were diverted or misused. Vivian Fouad, who had helped run the NPC, refused to answer what she called "unprofessional questions", but UN agencies, the European Union, anti-FGM activist Mona Amin and current National Population Council teams all denied the allegations.

Yet investigations conducted by The New Arab depict a neither black nor white picture, but a net of intertwined challenges and accumulated weaknesses that could explain the still-high FGM prevalence.

The new NPC head, Amr Hassan, said he had found a mostly empty office after his leadership nomination in December 2008. He is now "trying to reinitiate the strategy and change the way it was implemented with the aim to eradicate FGM".

FGM performed by doctors - despite ban

Egypt, with a total population of 95 million, has the highest number of FGM victims, with 87 percent of women aged 15-49 circumcised, according to 2015's Egypt Health Issues Survey. The number is slightly down, from 91 percent, in 2008.

Although a slight decrease has been noticed in younger generations, with 70 percent of 15-19-year-old girls having undergone FGM - down from 81 percent in 2008 - a majority of women and men still support the practice

Four female genital mutilations out of every five are performed by doctors in private clinics and local hospitals

In most other African countries where FGM was once popular, opinions have shifted and many now stand against it

Although repeatedly declared forbidden in Islam by al-Azhar muftis, half of Egyptians think cutting their girls is a religious requirement.

Despite being criminalised in 2008 and prison penalties made more harsh in 2017, four female genital mutilations out of every five are performed by doctors in private clinics and local hospitals.

Only three cases in which the girls being circumcised died have ever been brought to court.  

Beyond mere words at the first international declaration to eliminate FGM in Cairo in 1994, has any action been taken in Egypt? In the 1990s Egypt's "First Lady", Suzanne Mubarak, advocated for women's rights campaigns and established a national hotline for FGM.

Then, between 2003 and 2018, UN agencies and several western governments allocated $19 million to six government-backed programmes aiming to criminalise the practice and raise awareness in hundreds of Egyptian villages with the highest FGM prevalence.

For the most populous Arab country, which every year receives $1.3 billion in US military aid, this funding sounds like a drop in the ocean of Egyptian priorities. The government itself never even dedicated a specific budget line to the fight against FGM.

After the 2011 revolution, Islamist MPs even proposed legalising FGM once more - and the then-president, Mohamed Morsi, refused to condemn the practice.

During that time, the National Population Council was focused on saving the law rather than driving change, explains Mona Amin, a former programme coordinator.

The rejection by a constitutional court of reinstating FGM's legality was by itself "a vital breakthrough", Amin wrote by text message after refusing a formal interview.

Limited financial resources and political support have halted genuine efforts, argues Caritas, a Christian NGO. "What do you expect when you have to face opposition from some religious leaders, while only mobilising political support in the very last couple of years?" asked Magdy Helmy, who participated in the first UNICEF programme to promote FGM-free villages between 2003-2009. 

Around 70 villages made public declarations against FGM, but no final evaluation has ever been made to reveal the precise decline in numbers of circumcised girls within these villages.

"The issue remains too sensitive for authorities to allow such local data investigation," says Magdy Helmy. She estimates at least 60 percent of girls in those vilages were saved from genital mutilation.

Suspicion over NGOs

This first ambitious and unmonitored initiative has evolved into more pragmatic campaigns that either aimed to reduce FGM prevalence by 40 percent - or didn't even set quantitative objectives. The European Union funded one of the biggest National Population Council projects between 2011 and 2017, with 4.6 million euros ($5.2m), under the title Abandonment of FGM and empowerment of families.

It planned "to mobilise ministries, the medical community, universities, NGOs and media" but "was designed without a clear and well-developed logical framework, with clear objectives, outcomes, outputs and activities" reported a 2017 independent evaluation by International Consulting Expertise. 

In seven years, just 440 junior district attorneys and 80 doctors had received training on law enforcement and the harmful impact of FGM.

In the same period in Ethiopia, a country with a similar-sized population as Egypt, where 65 percent of women have undergone FGM, no fewer than 286 midwives were trained, 2,200 health care providers were equipped with knowledge on FGM and training sessions were organised in 240 law enforcement bodies to establish surveillance mechanisms.

The political and security turmoil following Mubarak's fall did prevent technical interventions. NGOs recall almost all activities were suspended in 2011. While Egypt was struggling to establish a new democratic rule, the crackdown on NGOs and media campaigns also fuelled paranoia about the international influence in the country.

Among dozens of human rights defenders facing prosecution, two women rights organisations are still under investigation. Restrictions and increasing pressure on civil society even affected organisations who wanted to support the national strategy on FGM abandonment. 

"We proposed to Egyptian authorities to get involved along them and participate in the strategy, but they refused," said Randa Fakhr al Din, who is also member of The New Women Foundation who worked "on minimal awareness activities" with 150 imams.

Around ten national NGOs were selected by National Population Council to be their partners; a few were also part of the Kamila anti-FGM coalition.

Political inertia and bureaucracy to blame?

After the military's overthrow of Islamist President Mohammed Morsi in 2013, Egyptian authorities may have been overwhelmed by security threats and scared to open another front against a deep-rooted tradition, suggests Magdy Khaled. In 2014, Khaled was the country director of United Nations Population Fund (UNFPA), one of the UN agencies supporting anti-FGM programmes.

He proposed to update the obstetrics and gynaecology curriculum for medical students and introduce an FGM component - but "the proposal stayed two years on the table of Supreme Council of Education".

"The country was too afraid to talk about FGM and reproductive health at this time," he said. The medical schools finally had their academic programme updated in 2017.

"Any financial agreement is a lengthy and heavily bureaucratic process where lots of entities get involved and are way less flexible than in other [Middle East] countries," adds Ivan Surkoš, European Union ambassador in Egypt.

In 2016, Egypt's Ministry of Foreign Affairs delayed an approval to allocate European funds for half a year without explanation, therefore preventing a series of activities. In 2017, the Ministry of Justice even refused to sign off on the European proposal for an additional $5.2m funds designed to enhance law enforcement around FGM criminalisation.

Bureaucracy is not only an Egyptian shortcoming, according to Fatima al-Zanaty, who supervised the DHS survey measuring FGM prevalence evolution. "Lots of these international funded outreach programmes were overlapping and not complementing each other," argues the science politics professor from Cairo University.

[It is] due to peer pressure from women who still believe the practice should continue on others who are hesitant or keen to end it

Two years before Mubarak's fall, UN agencies, the UNDP, UNICEF and UNFPA funded three parallel plans put forward by the National Council of Childhood and Motherhood, headed by Suzanne Mubarak, the wife of the then-president.

"There was no duplication," says Randa Aboul-Hosn, the UNDP representative in Egypt. What, then, is behind the slow rate of change? "[It is] due to peer pressure from women who still believe the practice should continue on others who are hesitant or keen to end it," she said.

Eradication of FGM by 2025?

A new plan for 2020-2025 is already on track to replace the existing national strategy, with the aim not to reduce but totally eradicate the culturally entrenched practice through education and law enforcement. 

"The new NPC under the new leadership has committed itself to a much more proactive and strategic approach," states UN resident cordinator Richard Dictus. Civil society and international organisations seem to agree.

For the first time in 20 years, all UN agencies in the field will work on the same work plan and within the same coordinated budget.

"[Egyptian authorities] are now listening to us," says Amal Fathy, the head of the Tadwein NGO. "Everybody realised efforts were not enough and we should try another way. Because we have limited resources, I would, for instance, propose to work on the people less resistant to change, or those who are already hesitant [to go through FGM] in order to a have a quick impact while continuing mass media campaigns for the whole country."

Men are at least as much involved as their wives in the decision to circumcise their daughters, she said. Targeting those already considering not putting their loved ones through the ordeal would be a total shift in approach, focusing on urban areas that have lower rates of FGM survivors and supporters than in rural areas; for instance, Cairo, where just 35 percent of women have undergone circumcision.

But even if the current trend shows a decrease in circumcision - especially in urban areas - the total number of women who must live with their genitals mutilated may increase, due to population growth. In Egypt this year, around 500,000 girls will be cut, according to UNICEF.

Ariane Lavrilleux is a journalist based in Cairo.

Follow her on Twitter: @AriaLavrilleux