Eritrea: Eliminating a Hanmful ) Traditional Practice W ~~23569 emale genital mutilation is wide- practice was totally incompatible with spread throughout many regions the efforts to improve the social status * of Africa and elsewhere. It is usu- of women in the society. ally perpetrated during early childhood Expatriate visitors to the field who and has serious consequences for the were informed about the practice of medical, gynecological, and obstetrical genital mutilation among Eritrean no- well-being of girls. These effects per- mads, and others abroad who heard sist throughout the childbearing years about these practices were outraged and beyond. Less often recognized are and immediately insisted that the sur- the psychological suffering, humilia- gical infibulation be forbidden, with tion social dignity and self-concepts of severe penalties for those who contin- the girls and women subjected to this ued to this harmful traditional prac- r I traditional practice. tice. These expatriates failed to under- Infibulation that is usually performed stand either the delicate balance be- during early childhood is the most radi- tween liberation forces and the civilian cal and destructive form of female population, or that the overall policy of genital mutilation. It also has the most the independence forces to unify the destructive gynecological and obstetri- country depended on cooperation and cal consequences. The practice of in- close working relationships among all fibulation was traditionally wide- sectors of the population. Most outsid- spread throughout the Lowlands of ers further assumed that, at the Eritrea, and particularly among the no- present time, it was primarily the men No. 41 mads. During the thirty-year war for who perpetrated these mutilations on February 2002 Eritrean independence, the medical department of the liberation forces that treated not only the combatants IK Notes reports periodically on but also the civilian populations in the Indigenous Knowledge (IK) initiatives liberated zones frequently had to treat in Sub-Saharan Africa. It is published girls and women with major gyneco- by the Africa Region's Knowledge and logical and obstetrical disorders. The Learning Center as part of an evolving logical and obstetrical disorders The 4 IICpartnership between the World majority of these were directly related Bank, communities, NGOs, develop- to genital mutilation. The question ment institutions and multilateral ,0OWAL ^ was therefore discussed in detail organizations. The views expressed in among the combatants as to what mea- this article are those of the authors T MI.F |among the combatants as to what mea- and should not be attributed to the sures could be taken to ease this dread- World Bank Group or its partners in ful burden on women to prevent seri- this initiative. A webpage on IK is AND>O~^tkvv+ ~ ous medical complications. At the available at //wwwworldbank.org/afr/ same time it was recognized that this ik/default.htm 2 ticipate in repeated month-long workshops conducted by nurses and doctors on a voluntary basis. At these workshops 1 K N o tes TBAs were given detailed information about the severe would be of interest to: harmful immediate effects of hemorrhage and infection; as well as about the serious long-term gynecological conse- Name quences, increased infant and maternal mortality, and the like. They also underwent courses in modern sterile tech- Institlition nique, obstetrical practices, etc. As is the practice at Eritrean workshops, the transmission of information was fol- Address lowed by active discussion. Thereafter, the TBAs returned to their villages. Although there were no systematic follow-up studies, an- ecdotal reports suggested that there was a gradual reduction in the adverse consequences of genital mutilation as the TBAs applied their new knowledge. However, it could not be expected that the practices were abandoned altogether dur- should be addressed to: ing, or even after the war. Since independence, the National Association of Eritrean Women makes frequent visits to the Editor: IK Notes nomads to continue these discussion based on mutual re- Knowledge and Learning Center spect and cooperation. The general impression is that the Africa Region, World Bank 1818 H Street, N.W., Room J5-055 practice is slowly disappearing. Washington, D.C. 20433 E-mail: pmohan@worldbank.org Impact The quickest solution for stopping the practices of female women. Historically, the nefarious practices were no doubt genital mutilation (and the one proposed by foreigner infor- instituted by males on females, but over centuries women mal advisors) might at first glance appear to be to forbid the had assimilated the cultural importance of the practice, on practice and to impose penalties on those who continued the the premise that women who were not infibulated or circum- practice. Howvever, in view of the delicate relationship be- cised were in danger of becoming sexually promiscuous or of tween the independence forces and the civilian population it becoming prostitutes. To preserve their respect in the com- would in any case have been politically inappropriate to im- munity, women therefore insisted on the mutilation, and in pose such legal measures. Moreover, the practices *vould many countries still do today. have merely continued underground. Instead, the indepen- The medical department of the Eritrean independence dence forces relied on the inherent intelligence and willing- forces therefore made the decision not to forbid the practice ness of the TBAs to modify their gynecological practices in the lowlands or to impose any penalties on those who con- gradually, once they were given the necessary modern medi- tinued the practice. They recognized that trying to stop it by cal information as to how they might modify them, and to force would only alienate the population and drive the prac- educate the civilian population by practice rather than by tice underground. Instead, voluntary meetings were called fiat. This approach also laid the groundwork for the continu- at which Traditional Birth Attendants (TBAs) who were the ing education of women by women after independence-an civilians who performed the infibulations were invited to par- additional step towards assuring the equality of women. This article was written by Peter H. Wolff M.D., Harvard Medical School, Boston MA 02115, USA.. For more informa- tion, e-mail: wolff p@tch.harvard.edu