TRAINING AND INFORMATION CAMPAIGN ON THE ERADICATION OF FGM
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Gambia Committee on Traditional Practices Affecting
the Health of Women and Children (GAMCOTRAP)
with support from FOKUS/NKTF
External review of:
TRAINING AND INFORMATION CAMPAIGN
ON THE ERADICATION OF FGM,
The Gambia
After the group meeting in Mannekunda, Basse (Amie and Ylva on the left, alkalo on far right). The elder
man in white in the front row told me: “This may be a women’s affair, but it affects us men, as well. One
Evaluation of our
of my wives took Program Components:
daughter back to her mother’s house to be circumcised. The girl died. We didn’t
use to know the bad effects.”
• Former
Community sensitization
circumciser (next to Ylva) was given seed money to start a soap business; she says people have
• stopped
Training
even tryingempowerment
and to bring girls to her toofcut.
targeted groups: Traditional birth attendants
(TBAs), circumcisers, traditional healers, traditional communicators, youth,
community based facilitators (CBFs), including strengthening of IEC capabilities
• Promotion of gender equity issues
• Empowerment of youth, including school curriculum development
• Creation and support of networks for people living with HIV/AIDS (PLWHA).
• Video documentation
• Organizational development and institutional sustainability
• Promotion of partnership with Norway
Final Report, March, 2009
Ylva Hernlund, Ph.D., Anthropologist
Table of Contents Executive Summary................................................................................................................................ 5 Results........................................................................................................................................................5 Conclusion and Recommendations..................................................................................................................6 Background of Evaluation/Methodology.............................................................................................. 7 Background to the project....................................................................................................................... 8 Country Background.............................................................................................................................. 9 Terminology............................................................................................................................................ 9 The Practice of FGM in The Gambia................................................................................................... 9 Prevalence............................................................................................................................................... 9 Types........................................................................................................................................................11 Background to Global anti-FGM Campaigns...................................................................................... 11 Gambian anti-FGM Campaigns........................................................................................................... 13 Actors........................................................................................................................................................13 Strategies and Challenges.............................................................................................................................13 GAMCOTRAP.................................................................................................................................... 14 Organization.............................................................................................................................................14 Mission Statement......................................................................................................................................15 Aims...................................................................................................................................................... 15 Objectives..................................................................................................................................................15 Approaches and Methods.............................................................................................................................15 Best Practices......................................................................................................................................... 17 Results................................................................................................................................................... 19 Discussion of objectives reached as proposed....................................................................................... 21 General Observations..................................................................................................................................21 Objectives Met as Proposed..........................................................................................................................22 Unanticipated Outcomes..............................................................................................................................23 Challenges and Adaptations.........................................................................................................................23 Monitoring and Reporting...........................................................................................................................24 Cost Effectiveness.......................................................................................................................................24 Partnership with Norway.............................................................................................................................24 Conclusions and Recommendations..................................................................................................... 25 Sources Cited........................................................................................................................................ 26 Appendix 1: Terms of Reference.......................................................................................................... 27 Appendix 2: Sources of Information Gathered in The Gambia.......................................................... 31 Appendix 3: Networks in which GAMCOTRAP participates............................................................. 51 Appendix 4: Activities completed from Under the FOKUS funded Project from 2006 to 2008......... 52 Appendix 5: Cluster Diagram............................................................................................................... 53 Appendix 6: Contributions from other donors..................................................................................... 54
Acronymes
AEO Alternative Employment Opportunity
AIDS Aquired Immune Deficiency Syndrome
CBF Community Based Facilitators
CBO Community Based Organization
CPA Child Protection Alliance
CRR Central River Region
FGM/C Female Genital Mutilation/Cutting
FLE Family Life Education
FOKUS Forum for Kvinner og Utviklingsspørsmål (Forum for Women and Development)
GAMCOTRAP Gambia Committee on Traditional Practices Affecting the Health of Women
and Children
GAMYAG GAMCOTRAP Youth Advocacy Group
HIV Human Immunodeficiency Virus
HTP Harmful Traditional Practice
IAC Inter Africa Committee
IEC Information, Education, Communication
IGA Income Generating Activities
NGO Non Governmental Organization
NKTF Norsk Kvinnelig Teologforening (Norway Women’s Theological Association)
PLWHA People Living with HIV and AIDS
RH Reproductive Health
SHR Sexual and Human Rights
SRH Sexual and Reproductive Health
STI Sexually Transmitted Infection
TBA Tradititional Birth Attendant
TP Traditional Practice
UNCRC United Nations Convention on the Rights of the Child
URR Upper River Region
VAW Violence against Women
VDC Village Development Committee
WR Western Region
Executive Summary
In The Gambia, a majority of women struggle with poverty, lack of education, and constraints on
their decision-making power regarding their own reproductive and sexual health. The Gambian chapter
of the Inter Africa Committee (IAC), the non-governmental organization (NGO) Gambia Committee
on Traditional Practices Affecting the Health of Women and Children (GAMCOTRAP), has for over
two decades been engaged in a campaign of education, sensitization, and activism aimed at eliminating
harmful traditional practices, focusing in particular on abolishing Female Genital Mutilation (FGM) and
early marriage, as well as promoting education and empowerment for women and girls.
The main purpose of this external evaluation was to focus on the implementation and outcome of
the three-year project “Training and Information Campaign on FGM,” funded by NKTF/FOKUS,
Norway. This summative end-of-project evaluation seeks to provide information on the extent to which
project objectives were achieved, on challenges, lessons learned from the experiences, use of resources,
and organizational capacity and needs. Lessons learned about best practices are to be shared for others
to replicate and, while it has been made explicit that no further funding is available from NKTF/
FOKUS for the continuation of these project activities, it is hoped that the findings of the evaluation
will form a basis for securing additional support for GAMCOTRAP’s ongoing efforts.
The evaluation was participatory and designed in close collaboration with the funders and beneficiaries,
and included document review, group meetings with beneficiaries from all the target groups in each
of the project regions, as well as in-depth interviews with GAMCOTRAP staff, beneficiaries, board
members, and partners.
Results
According to GAMCOTRAP’s reports, the information project was carried out in each of
the proposed regions a total of 117 communities. The project directly reached an estimated 2,193
beneficiaries. GAMCOTRAP estimates that an additional 10,965 indirect beneficiaries were reached
(using a multiplier effect of 5; see Appendix 2).
Representatives were trained from all the proposed target groups, which in the proposal were identified
as (primary beneficiaries): women and girls, and (secondary beneficiaries): women group leaders, village
heads, district chiefs, religious scholars, traditionalists, circumcisers, TBAs, traditional healers, and
people living with HIV/AIDS.
The broader aim of GAMCOTRAP is to sensitize communities with the ultimate goal being a
reduction in FGM prevalence and increased empowerment of women and girls, while the specific focus
of this project was to: train traditional birth attendants, circumcisers, and traditional healers in order
to upgrade their skills and awareness regarding the harmful effects of FGM; establish networks of
people living with HIV/AIDS; partner with traditional communicators and train youth drama groups;
intensify Family Life Education and HIV counseling; enlist the support of traditional decision-makers;
and enhance the IEC capacity of community health-providers and traditional healers.
While all stakeholders realize that it is near impossible – especially in the short term – to apply
objective metrics to assess actual reductions in prevalence rates of harmful traditional practices, this
5
evaluation found that all the secondary sub-goals of the proposal appear to have been achieved to
various degrees (at times exceeding them) and included: nine training workshops held, three videos
produced, 15 drama groups trained, 16 schools reached for Family Life Education, 9 networks created
for PLWHA, a Dropping of the Knives ceremony held with 18 participating former circumcisers and
their communities, with an additional 60 circumcisers having declared their commitment to participate
in the second such ceremony.
One of the major strengths of GAMCOTRAP is its sustained efforts over time and the consistency of
its approach and message. While methodology has been adapted over time (as well as from community
to community, depending on need), the basic mandate has remained the same, and no effort is made
to conceal the true agenda of the organization. While in the past GAMCOTRAP has often been the
target of criticism, insults, and even threats, it appears that over time a major shift has taken place
in public awareness and attitudes, and that the overall impression of the organization is positive.
Although methodological trends in anti-FGM interventions come and go, the patient consistency of
GAMCOTRAP’s approach appears to be paying off, as many beneficiaries explained that “change takes
time,” but that they are now ready to consider GAMCOTRAP’s message.
Conclusion and Recommendations
It appears that at this time GAMCOTRAP stands at an important crossroads. After many years
of sustained effort often involving extreme challenges, a shift appears to have taken place, as many
Gambians are now ready to receive and consider GAMCOTRAP’s consistent message. This three-year
project is seen by GAMCOTRAP staff as having been particularly crucial in effecting change, and there
is a great sense of urgency in building on the current momentum.
Major activities of the project have been consistent with proposed objectives, and all sub-goals have
been achieved to various degrees, while important progress appears to have been made towards reaching
the broader goal of gender empowerment and the abandonment of harmful traditional practices.
GAMCOTRAP staff point to the need to expand geographically to areas of the country that remain
unreached by campaigns and call for improved communication between various NGOs working on the
issue of FGM in order to prevent overlapping in the same regions while ignoring others.
Beneficiaries of the project agree with GAMCOTRAP staff that it is important to continue to focus
on outreach and capacity building, while pursuing the continued commitment of traditional circumcisers
to drop their knives. Community members unanimously stressed the need for consistent follow-up in the
form of additional workshops, improved support for CBF’s, and expanded AEOs for former circumcisers
(this was not originally proposed as part of the FOKUS funding). There is a perceived need to expand
efforts with youth groups and to continue working on revising FLE curricula, as well as to strengthen
and expand work with networks of PLWHA. In addition, it is crucial to continue the outreach efforts
of improving IEC capacity of traditional health practitioners and to expand the important dialogue
currently underway between Gambian emigrants (particularly in Spain and Norway) and their home
communities.
This evaluation recommends that GAMCOTRAP continue its community outreach while striving
to strengthen its administrative capacity, particularly in the area of reporting, auditing, and effective
communication with donors. This evaluation strongly urges for more sustained support from funders,
while calling for improved dialogue between GAMCOTRAP and their supporters, as well as continued
efforts to improve communication among Gambian organizations working on similar issues.
6
Background of Evaluation/Methodology
FOKUS/NKTF contacted Ylva Hernlund in 2008 to conduct an external, summative evaluation
of GAMCOTRAP’s three-year project on education against FGM. The evaluator had previously
encountered the organization during her year-long dissertation research in 1997-98. Its staff welcomed
her with open arms in 1996, continuing to include her in their activities throughout the research, allowing
access to a diverse range of research angles: archives in the GAMCOTRAP office library; individual
interviews with staff and board members focusing on their personal histories of arriving at an anti-FGM
position; observation of staff meetings (including budget discussions and planning sessions); preparations
for workshops and campaign events; symposia and press conferences; and youth outreach activities.
GAMCOTRAP staff invited her to travel with them on “trek” to rural areas, at one point even asking
her to assist in leading small group projects by students carrying out Rapid Rural Assessment exercises.
Through these travels she not only got to see firsthand how educational workshops are conducted, but
also enjoyed the informal camaraderie of a group of women always enthusiastic about debating issues
and reminiscing about their rich histories as gender activists.
This report, although primarily based on a field visit in December 2008 and a dissemination exercise in
February 2009, therefore also draws on this previous experience observing the work of GAMCOTRAP,
and reflects comparisons drawn between the climate for such interventions in 1997-1998 versus today.
In discussions with Amie Bojang-Sissoho and Dr. Isatou Touray, the reflection emerged that this time
period in the late 90s, in retrospect, may have marked the most difficult moment of such campaigns; and
this evaluation reflects the observation that a great deal of change has taken place over the last decade
regarding public attitudes to and responses to GAMCOTRAP’s work.
Data were gathered in The Gambia in December 2008 through interviews with GAMCOTRAP staff,
volunteers, and Board members; archival research of reports and campaign materials including videos;
interviews and group meetings with beneficiaries from all the targeted groups in a number of communities
(26 total) in each of the regions included in the project; interviews with representatives from other NGOs
involved in anti-FGM work as well as GAMCOTRAP partner organizations (the evaluator used an
independent translator). In addition an electronic survey was conducted with five stakeholders in Norway.
As the field visit was very brief, it was not possible for the evaluator to directly confirm the numbers
of communities and beneficiaries reached; and this draft report additionally uses information from the
nine project reports which were submitted to FOKUS/NKTF throughout the duration of the project,
as well as a Data on Activities-file submitted by GAMCOTRAP staff to the evaluator at the conclusion
of the data gathering.
In February, 2009, a three-day workshop was held in The Gambia, attended by GAMCOTRAP
staff, the evaluator, and Mette Bråthen Njie and Hanne Slåtten from NKTF (unfortunately the FOKUS
representative was at the last minute unable to attend, due to illness). This meeting involved further
document review, discussions about the experience of the partnership between Norway and The
Gambia, an assessment of administrative and reporting procedures, and a thorough team-review of the
first draft of this report, during which all stakeholders were given an opportunity to add comments and
information and suggest further revisions to be included in the final report.
In addition, a partner meeting was held on February 25 at the TANGO office in Kombo (see
Appendix 2 for a list of attendees). Although the written draft report was not distributed, its major
7
findings were discussed, along with presentations by NKTF, GAMCOTRAP staff, and the President of the Board; and there was a screening of one of GAMCOTRAP’s videos. The remainder of the day was spent on a group discussion during which beneficiaries spoke about their experiences with the TV project, and the NKTF representatives were able to ask follow-up questions (the evaluator was also able to interview TANGO’s Director, who had not been available during the December visit). Note: While the production of this report has been a truly collaborative effort, the evaluator naturally takes responsibility for any errors or shortcomings. Background to the project The Feminist Action Group from the 1980s pioneered work on information campaigns regarding FGM in hospitals, churches, and civil society in Norway. Anne Berit Stensaker (1930 - 2003), who was a priest and member of the Norwegian Female Theologian Committee, Norsk Kvinnelig Teologforening (NKTF), was engaged in work against female genital mutilation (FGM) from 1980. This commitment led to a lot of information about both the work and the team, but this information was never systematized. In 2004, some members of NKTF were involved in archiving this material. This work led to a contact with Mette Bråthen Njie, who had received a scholarship to work on the theme of FGM. She is a trained nurse with close relations to The Gambia, and had visited and brought back information about some of GAMCOTRAP’s work and methods. After meeting with Mary Small at GAMCOTRAP, she was impressed by the way they worked, but saw the lack of resources. NKTF also learned more through meeting with Torild Skard, feminist and former UNICEF Regional Director for West Africa (1994- 1998), who knew of GAMCOTRAP’s work. After further visits to The Gambia, NKTF in 2005 decided to apply for funding from a project supported by the TV Action Campaign (through Norwegian TV) on ”Violence against Women,” where one of the sub-topics was FGM (along with Women in Conflicts, Trafficking, and Violence in Close Relationships). The TV project was that year dedicated to FOKUS (Forum for Women and Development), where one NKTF member had previously worked. Also in 2005, Dr. Isatou Touray was invited by FOKUS through NKTF, coordinated by Mildrid Mikkelsen, to attend a TV-Campaign meeting in Norway. FOKUS previously knew about her work through the Inter Africa Committee (IAC) and other NGOs. This visit made it possible for GAMCOTRAP to present its work to the donor community in Norway with the hope of gaining support for its work to eliminate FGM in The Gambia. It also created an opportunity for GAMCOTRAP to meet with its partner organization, NKTF, to get to know each other and discuss the proposal to end FGM, which was submitted to FOKUS. The Norwegian team consists of five women: Tone Marie Falch, Hanne Slåtten, Yvonne Anderson, Caroline Revling Erichsen, and Mette Bråthen Njie. During the visit, Isatou Touray presented the proposal to the team of women and it was discussed intensively and agreed upon. Dr. Touray was made to understand from this visit and the meetings held between FOKUS/NKTF and GAMCOTRAP that FOKUS gives support to countries by pairing local Norwegian organizations with other existing NGOs abroad. The partnership was mutual and accepted by both NKTF and GAMCOTRAP because their vision, mission, and objective resonate with each other. Having agreed to work together, GAMCOTRAP’s proposal was accepted and NKTF was made responsible for facilitating the project with support from FOKUS (FOKUS has no direct co-operation with GAMCOTRAP, 8
but supports the project co-operation that takes place through FOKUS between its member organizations
and their local partner organizations). To that effect, a project agreement was made between NKTF and
GAMCOTRAP with FOKUS funding to ensure the realization of the project, which operated from
2006 – 2008.
Country Background
The Gambia is one of the poorest countries in the world, dependent from the moment of its
independence to rely on foreign assistance for its survival. The population growth rate (1990-2006)
is estimated at 3.4% per year, infant mortality rate (under 1) at 84 per 100,000 live births, maternal
mortality 730; life expectancy at birth 59 years (UNICEF 2009). The overall literacy for women is
26.9%, 55% for males (Government of The Gambia 1993; more recent UNICEF study does not provide
these numbers). School enrollment is (2000-2006) 79% for males and 84% for females at the primary
level, with 51% males and 42% females at the secondary level (UNICEF 2009). Agriculture provides
60% of productive employment (Government of The Gambia 1993; more recent UNICEF study does
not provide these numbers). There is also a limited impact of tourism, fisheries, “re-export” trade, light
industries, and products from livestock. Continual economic decline has hit women especially hard.
Many Gambians, especially young and middle-aged men, see the only way “out” as a literal escape to
labor markets in the Global North, thus creating a massive movement out of the country with female-
headed households left behind.
Terminology
While other terminology is used in other contexts (such as “female circumcision,” “female genital
cutting,” FGC, or FGM/C), the preferred terminology of GAMCOTRAP is Female Genital Mutilation
(FGM), which will be used throughout this report.
The Practice of FGM in The Gambia
Prevalence
All existing studies agree that female genital mutilation is practiced by a substantial majority of
Gambians. Earlier local studies report that 79% (Singateh 1985) to 83%1 of all Gambian women have
undergone some form of genital mutilation, while others use the Hosken report’s estimate of 60%
(Touray 1993). A Gambian government study (Daffeh et al. 1999) puts the prevalence rate at 80%
overall. More recently, the MICS (Multiple Indicator Cluster Survey) study for UNICEF, “Monitoring
1. Estimated by a 1991 KAP (Knowledge-Attitude-Practice) study, carried out by the Monitoring and Evaluation Unit of
the Women’s Bureau as part of the “Safe Motherhood” component of a Women in Development Project Report.
9
the Situation of Women and Children” estimates that of all women aged 15-49, 78% have undergone
FGM, while 64% of mothers in the same age-group have at least one daughter who has undergone the
practice (UNICEF 2009), seemingly indicating a reduction in prevalence.
These numbers, however, hide the complexity of who in The Gambia is actually practicing FGM and
why. Daffeh et al. caution that previous literature on FGM in The Gambia has displayed “a gap between
theory and practice, with regard to ethnicity” (Daffeh 1999). Daffeh et al. go on to assert that in the Gambian
case, the “ethnic classifications with regard to FGM are much more complex than was hitherto apparent”
(ibid). They are referring to general statements, such as “Wollofs don’t practice female circumcision,”
which various Gambians commonly repeat without qualification. When Wollof girls do undergo FGM, it
has usually been explained as due entirely to pressure from individuals of other ethnic backgrounds that
causes co-wives or schoolmates to “join” their peers in circumcision. It appears, however, that the rate of
circumcision for girls who identify as Wolof (but could have multi-ethnic heritage) is actually quite high.
The Daffeh report presents more nuanced data on ethnicity, focusing on the variation in circumcision
according to ethnic sub-group and ancestral geographic origin. Thus, they argue, for certain sub-groups of
Wollofs FGM is as strong a tradition as it is for Mandinkas and Serahules, among whom the practice is said
to be virtually universal. A total of 96% of Jolas circumcise females, again with variation across sub-goups
(ibid). The authors of the 1999 report conclude that the only ethnic groups in The Gambia that do not at
all practice FGM are the Creoles, the Lebanese, and the Manjagos (ibid).
Although these numbers do throw light on a previously poorly understood area, ethnic and even
sub-ethnic labels are not entirely reliable as indicators of whether a girl will undergo FGM or not. It is
important to note that marriage across ethnic lines is very common and relatively unproblematic in The
Gambia, and that it is typical to encounter Gambians whose relatives come from two or more ethnic
groups. The age at which girls are circumcised is also somewhat tied to ethnicity, although not in any
simple way. Serahule communities generally practice FGM in the first week of the girl’s life, coinciding
with her naming ceremony. In other ethnic communities, the age of circumcision may vary widely.
When initiations take place in a communal context, a group of girls may include infants, young children,
and even teenagers, depending on how long the ritual cycle is until another big celebration rolls around.
In general, however, there is clearly a trend in The Gambia, as elsewhere in Africa, to “circumcise” girls
at a younger and younger age.
Additionally, geographic location impacts prevalence rates. Project reports from The Gambia typically
refer to urban versus rural areas, but it can be a bit difficult to define the two (according to the 2009
UNICEF study, 72% of urban women have undergone FGM, 83% of rural). The Gambia has no true
cities – the capital of Banjul is a sleepy town of a mere 50,000 or so. Most population growth is taking
place in the nearby peri-urban areas of Bakau and Serrekunda – sprawling, densely populated towns
predominantly populated by rural migrants. The 1993 Gambian census bases its definition of “urban”
on: commercial and institutional importance, majority of population engaged in non-agricultural work, a
population of 5,000 or more, high population density, and the presence of some infrastructure. In terms
of FGM, however, prevalence rates in The Gambia do not correspond to facile assumptions of rural
“traditionalism” and urban “progressiveness.” As evidenced in GAMCOTRAP’s reports on its campaign
activities, community abandonment of harmful traditional practices can often be found clustered in very
remote rural areas otherwise considered “traditional,” while the practice remains entrenched in “urban”
centers such as Bakau and Brikama. Additionally, there is – despite the very small size of the country – a
great deal of regional variation in the reach of anti-FGM interventions. Despite past attempts to coordinate
the efforts of various NGOs involved in anti-FGM education and activism, in reality certain regions (such
as the Basse area in URR) have been targeted by sensitization efforts of several different groups, while
other areas (in particular on the North Bank) remain essentially unreached.
10Types
WHO classifies FGM into the following types:
I. Clitoridectomy (removal of part or all of the clitoris)
II. Excision (removal of the clitoris and all or part of the labia majora)
III. Infibulation (removal of and suturing together of the external genitalia)
IV. Unclassified.
For The Gambia, reports on the most common procedure vary (more recent WHO and UNICEF
studies do not report types for The Gambia). According to one study, a majority of women (44.3%) had
undergone Type II, with 21.4 Type I (Singateh 1985). Another one estimates 56% as having undergone
Type I, 19% Type II (Daffeh et al. 1999). Both studies agree that 6-7% of Gambian women have
undergone “sealing” (notoro), a non-suturing form of infibulation which falls under Type IV, but is unique
to The Gambia (recent research with circumcisers by GAMCOTRAP suggests that this rate may be
higher, but these data have not yet been analyzed). This practice is thought to be particularly prevalent in
areas of the eastern part of the country, as was indeed evidenced by the frequency with which discussions
about the health effects of sealing came up in the evaluation field visits to the Upper River Region.
Background to Global anti-FGM Campaigns
Identifying the most effective and appropriate methods for eliminating FGM is among the most
contested issues surrounding the practice. Early colonial interventions alternately employed strategies
based on the alleged adverse health effects of the practice and discourses framing the practice as
uncivilized, barbaric, and unacceptable in the eyes of Christianity. Such campaigns have reappeared
several times throughout the last century, each time with a slightly different focus. In the 1970s and 80s
the practice was identified as “genital mutilation” and became targeted for “eradication” as a public
health problem (see Hosken 1978). Some, particularly in the West, approached the practice as a human
rights violation, often using extreme rhetoric which has caused a bitterness to still linger over the debates
surrounding the practice and its elimination. Although often offended by the sensationalist manner in
which the issue was discussed by outsiders, many African women have over time invited assistance from
Western donors, and current efforts are largely supported by outside funding being channeled through
indigenous women’s organizations.
A series of conferences and international meetings have been held to address strategies for eliminating
FGM, starting with the 1979 Khartoum seminar on Traditional Practices Affecting the Health of Women
and Children. After an initial reluctance to address the issue, the World Health Organization organized
a meeting at which representatives from a number of African countries began identifying strategies for
eliminating the practice. In the late 1980s, WHO issued an elaborate plan for action, and other major
agencies have since joined the global campaign with their own platforms.
There are several, not mutually exclusive, ways in which to approach anti-FGM campaigns: as a
human rights’ violation, as an infringement of the rights of the child, the right to sexual and bodily
integrity, and/or as to the right to health. Many of those who organize against genital mutilation do so
based on a broader concern for the human rights of women and children, while others also express a
11concern for women’s sexuality. A number of scholars and activists, however, have concluded that the
most “sensitive” and least controversial angle from which to argue for the elimination of the practice is
that of the right to health and bodily integrity.
A number of African nations have passed legislation against FGM, although enforcement mechanisms
vary. Many feel, however, that outright legislation against the practice, especially during the early stages
of abandonment, is highly problematic as it pits community members against each other, penalizing
individuals acting in good faith within their cultural framework, and potentially driving the practice
underground and reducing the likelihood that those who need medical attention will receive it.
The “development and modernization” approach suggests that overall improvements in socioeconomic
status and education, especially for women, will have far-reaching social effects, including a reduced
demand for FGM. The empirical data do not consistently support this conclusion, however, and many
argue that changing social conditions will not automatically change strongly held beliefs and values
regarding female “circumcision,” but that targeted intervention issues on the harmful effects of the
practice are needed as well.
The “convention theory” of abandonment argues that practices such as FGM are conventions locked
in place by interdependent expectations in the marriage market and that once in place such conventions
become deeply entrenched, since those who fail to comply also risk failing to reproduce (Mackie 2000).
Therefore, education about adverse consequences does not suffice, but must be accompanied by a
collective convention shift. This approach, which has been carried out in practice by the Senegalese
NGO Tostan, uses basic education leading to public declarations in which communities who historically
intermarry join in denouncing FGM.
It is common for activists to argue that one of the reasons that FGM is so “entrenched” is that it
constitutes an important source of income for those performing the procedure. Consequently, some
eradication efforts have focused in part on schemes to compensate circumcisers for lost income. Critics
(see Mackie 2000) argue that this is a misguided functionalism: although circumcisers immediately do
cause circumcision of girls, they do not cause parents to want circumcision for their daughters and
thus do not directly cause the continuation of the practice. Others point out that circumcisers may
receive compensation for not practicing while continuing to do so in secrecy. However, in contexts in
which circumcisers are prestigious community leaders, their genuine conversion is crucial and it may
be an important strategy to provide at least symbolic, and perhaps limited material, support to those
circumcisers who have already had a change of heart, thus motivating them to stick to their decision,
which is distinct from “bribing” people to stop.
Some groups and communities have experimented with alternative, non-circumcising rituals, for
example in Kenya and The Gambia. The success of such an approach has not been documented,
however, and there are reports from Kenya that girls who have undergone “ritual without cutting” have
later been coerced into actual genital cutting.
While these approaches have been discussed separately, in reality most campaigns combine a variety
of strategies into an integrated approach.
12Gambian anti-FGM Campaigns
Actors
The Gambian campaign can be traced back to the early 1980’s when a small group of women,
most of who are to this day involved in work against FGM, began an organized effort to abolish genital
cutting. It started through the Women’s Bureau, which represented The Gambia at a general meeting
in Dakar of the Inter Africa Committee (IAC) in February of 1984. Due to the perceived need to
address FGM separately from the broader goals of the Women’s Bureau, the Gambia Committee of the
IAC was then created and, in 1992, its name was changed to GAMCOTRAP (Gambia Committee on
Traditional Practices Affecting Women and Children).
In the early 1990’s the splinter group BAFROW (Foundation for Research on Women’s Health,
Development and the Environment) was established, and GAMCOTRAP moved to its present location.
By the late 1990s a newer group, APGWA (Association for Promoting Girls’ and Women’s Advancement
in The Gambia), focused on alternative non-cutting ritual. In later years, a number of other organizations
have in various ways been involved in anti-FGM work.
Strategies and Challenges
Those involved in efforts to abolish FGM have through the findings of several research studies
been able to design more appropriate strategies. It has been found, for example, that in the Gambian
context there is a great need to address the widespread but unfounded belief that female “circumcision”
is a religious injunction in Islam. In her 1993 report, Isatou Touray argues that the practice can
only be approached as a health issue after or simultaneously with approaching it from a sociocultural
and religious angle. The vast majority of Gambians are Muslims (90%+) and FGM is often seen as
somehow associated with Islamic identity. Activists stress, however, that the Qu’ran does not require
female “circumcision,” that not all Islamic groups practice FGM, and that many non-Islamic ones
do. In contexts in which Islam is to various degrees invoked as associated with the continuance of the
practice it is often the focus of intense local theological debates, and a great deal of effort by scholars
and activists has concentrated on demonstrating the lack of scriptural support for enforcing FGM,
as is particularly evident in GAMCOTRAP’s close collaborations over time with religious leaders.
In addition, this debate has benefitted from the recent Rabat Declaration (2007), in which Islamic
scholars from many nations openly opposed FGM. The evaluation confirmed that many Gambians
bring up the issue of religion and have come to see the practice of FGM as separate from religious
requirements.
Currently a number of African countries, including neighboring Senegal, have passed laws against
FGM, while The Gambia has not done so. Interviewees pointed to the difficulties that ensued when
the law was passed in Senegal and there was an increase in demand for cross-border circumcision
in The Gambia – a situation that is still encountered by some circumcisers in URR who live close to
the Casamance border. Although far from all respondents expressed support for national anti-FGM
legislation as a strategy at the present time, GAMCOTRAP has through the duration of the FOKUS
project identified increasing calls from communities for such legislation, which the organization now
supports.
13In the absence of anti-FGM legislation, up to the present, attempts have been made to bring charges
under existing assault laws when girls have been circumcised against their wishes and those of their
families, so far unsuccessfully. GAMCOTRAP submitted a draft of areas for inclusion in law reform on
women’s rights, including FGM, in 2008, after a request by the Law Reform Commission, and became
involved as advocates in the Awa Nget case (Asemota, 2002a, 2002b) with the help of funds raised
through the Urgent Action Fund through Equality Now’s Africa Region.
Anti-FGM work has at times been considered highly controversial in The Gambia. In 1997, the then-
newly elected Gambian government issued a decree which banned the broadcasting on state radio and
TV (the only TV station in the country was controlled by the government) of any programs “which either
seemingly oppose female genital mutilation or tend to portray medical hazards about the practice.” This
information came to the public in 1997 when Dr. Isatou Touray was conducting a gender class for media
practitioners and issues of traditional practices were discussed in order to create awareness amongst
media practitioners.
It was during this class that a media directive dated 17th May 1997 banning any form of advocacy
against female genital mutilation on national radio or television was accessed. GAMCOTRAP responded
to the directive by making a clarion call to the President of the Republic in an open letter dated 27th
May 1997. After massive protests – from in particular GAMCOTRAP, aided by an international letter-
writing campaign organized by New York-based Equality Now – the decree was lifted, although with so
little publicity that many people are still unclear on what is and is not legal to broadcast.
Vice President Isatou Njie-Saidy, herself a women’s rights activist who has previously been involved in
the campaign against FGM, was later quoted as stating that the government’s policy will be to “discourage
such harmful practices,” and that NGOs will not be prevented from working against the practice (Forward
with The Gambia newsletter July 7, 1997). Head of State President Colonel (Retired) Yaya Jammeh, in his
annual address marking the 1994 July 22 military take-over, clarified the government’s position as being
opposed to FGM, but stressed that any campaign must be conducted in a culturally sensitive manner.
Yet, later he issued a statement that activists “cannot be guaranteed that after delivering their speeches,
they will return to their homes” (Observer newspaper, January 25, 1999).
GAMCOTRAP
Organization
GAMCOTRAP was established in 1984 as the Gambian chapter of the Inter Africa Committee.
It is an NGO, with non-profit status, registered with the NGO Affairs Agency and The Association
for Non-Governmental Organizations (TANGO), an umbrella organization that registers, monitors,
and supports Gambian NGOs . GAMCOTRAP has a General Assembly, Board of Directors, and
Executive Committee. The General Assembly is the supreme organ of GAMCOTRAP and is composed
of the representatives of communities and all other affiliates. The elected Board of Directors includes
a President, Vice President, and Treasurer, as well as other individuals with varied expertise relevant
to GAMCOTRAP’s work. Like all NGOs registered by TANGO, GAMCOTRAP has a Constitution,
Action Plan, and Guiding Principles, and has been registered under the Company Act as a Charity with
the Attorney General’s Chambers.
14GAMCOTRAP collaborates with the Women’s Bureau, which advises the government on all policy
matters affecting Gambian women. In addition, GAMCOTRAP participates in an ongoing manner in
a number of networks on the international, national, and grassroots level (see Appendix 3).
Mission Statement
“GAMCOTRAP’s mission is to create awareness about traditional practices in The Gambia. We aim
for the preservation of beneficial practices (such as breastfeeding) as well as the elimination of harmful
traditional practices.
GAMCOTRAP is committed to the promotion and protection of women and girl children’s political,
social, educational, and sexual and reproductive health rights.
We support any national and international declarations protecting these rights, in particular the
Convention on the Elimination of All Forms of Discrimination against Women, The Convention on the
Rights of the Child, and the Protocol of the African Charter on Human and People’s Rights and on the
Rights of Women.”
Aims
“To create and raise the consciousness of men and women about traditional practices that negatively
affect the health of children and women, whilst encouraging positive practices. In addition, we aim to
protect the rights of children and women by involving them to participate in decision-making processes.”
Objectives
1. To carry out research into traditional practices that affect the sexual and reproductive health
of women and girl children in The Gambia.
2. To identify and promote traditional practices that improve the status of girl-children and women.
3. To create awareness of the effects of harmful traditional practices on the health of girl-
children and women, in particular FGM, nutritional taboos, child/early marriage, and wife
inheritance.
4. To promote and encourage the education of girls at all levels.
5. To sensitize and lobby decision- and policy-makers about sociocultural practices that are
harmful to the health of girl-children and women.
6. To promote and protect the human rights of girl-children and women.
7. To create awareness of international and national instruments that address discrimination
and violence against girl-children and women.
8. To influence policies in promoting and protecting women’s and children’s rights.
9. To highlight a rights-based approach to activities.
10. To solicit funds locally and externally for the purpose of carrying out the above objectives.
Approaches and Methods
GAMCOTRAP believes that the elimination of harmful traditional practices has to be approached
through research, training, and advocacy. It employs a multi-pronged approach that seeks to match the
15appropriate strategy to specific community characteristics, with its work consisting primarily of carrying
out educational and “sensitization” campaigns, as well as lobbying. Its staff members visit schools
(including organizing essay and poster competitions), hold press conferences and symposia, produce
videos, and organize workshop for health workers, traditional healers, TBAs, circumcisers, and youth.
GAMCOTRAP has remained adamantly opposed to alternative rituals, and subscribes to a philosophy
of ultimate total abandonment of FGM, “zero tolerance” and advocates for the passing of national anti-
FGM legislation. Recently the organization has intensified its efforts to build dialogue with emigrant
Gambians in the diaspora, spreading awareness of the legal consequences of sending foreign-born girls
“home” for “holiday circumcisions.”
GAMCOTRAP sees the main factors influencing the practice of FGM in The Gambia as being:
1. Sociocultural.
2. Religious
3. Other factors (including ignorance/poverty of practitioners).
Its methods, therefore, are grounded in varied approaches, including: awareness-raising, grassroots-
sensitization regarding HTPs, collaboration with respected religious leaders able to address scriptural
issues, community education about the harmful effects of FGM, and support for circumcisers committed
to ending the practice.
Training workshops are organized by first dividing participants by village, then into groups (such
as young or old women or men, TBAs, circumcisers, traditional healers), then having all participants
come together into a “plenary” discussion. This way, “everyone has to face everyone.” This is especially
important when men and women each claim that it is the other group that requires that FGM be
practiced. Participants are asked to first list the traditional practices they are aware of in their community
and later to rank them as “positive,” “negative” or under “lack of consensus.”
An important component of awareness-raising is the use of visual aids, including anatomical
models and a slide show that presents adverse health effects of genital cutting, but GAMCOTRAP
hopes to develop its own materials based on Gambian cases). While some activists from other groups
expressed disagreement with the method of “shocking” trainees with graphic images of health effects,
GAMCOTRAP staff sees this “awakening” as central to the process of attitude change (and point out
that the goal is not to “shock,” although this is sometimes the effect). The evaluation, as well, found that
most beneficiaries, when asked what had most affected their attitudes to FGM, responded that they
had become aware of the adverse health consequences. When probed to explain more about what
specifically affected their change in attitudes, a majority of beneficiaries interviewed mentioned the
visual aids and pointed out that “health is the most important thing for human beings.” They stressed
that “seeing is believing” and that although many of them had previously been told that FGM is harmful,
they did not believe this to be true until they saw the photos of actual women and girls suffering adverse
consequences (such as retention of urine and/or menstrual blood, and severe keloid scarring). This led
to realizations that the beneficiary herself and/or someone close to her had also suffered these health
effects, while perhaps having attributed them to other causes.
GAMCOTRAP activists argue that there is little resistance to showing these visual materials to groups,
including those of mixed age and gender, although they always preface such viewings with a warning
and make it clear that anyone is free to leave (which religious elders occasionally do), and the images are
only presented at the end of the training session when group discussion and general sensitization have
already been concluded. The evaluator was struck by the nearly universal mention by respondents that
16it was the images that had made them see the truth in the anti-FGM message. In addition, videos are
shown during the training workshops to reinforce the message on the harmful effects of FGM, as well as
the spread awareness of HIV/AIDS.
GAMCOTRAP tailors its educational approach to the target group and each community’s discussions
take on their own character according to local needs and concerns. When a major tumbling block during a
community discussion appears to be religion, clarification is provided by a resource person. In workshops
with traditional healers, information on HIV transmission is disseminated as these practitioners are
often the first point of contact and need training in how to recognize signs and encourage patients to
seek testing. Traditional birth attendants ask for kits and more training and are encouraged to use ICE
on FGM after the birth of any girl. In the Wuli workshop there was a discussion on the definition of
“early” marriage and what sharia has to say about a girl’s preferred age at marriage.
In several communities, women expressed their fear to seek family planning for fear of being accused
of infidelity, while men said they approved of married women spacing births but would not agree to
contraceptives being made available to unmarried young women. In Foni, there was an expressed
concern with domestic violence, which women stated is often justified by religion, which was refuted by
a religious scholar, who argued that men and women need to be partners in marriage.
Youth were engaged in discussions on reproductive health, and health threats such as poverty, drugs,
alcohol, and early pregnancy. Brochures were handed out, as were condoms, and they were encouraged
to, anonymously put their questions about sex in a box, the “Secret Clinic,” to be answered in front
of the group. Youth asked for drama groups, video, and sometimes made statements such as that they
will burn the jujuyo (traditional circumcision hut), conduct Peace Marches, and report the names of
any circumcisers still practicing (GAMCOTRAP clarified that they will only sensitize, not bring legal
action).
One particularly crucial target group consists of the ngangsingbas, traditional circumcisers. As opposed
to elsewhere in Africa, FGM is never performed by male practitioners or by female health professionals.
GAMCOTRAP has taken particular care to reach these women, who retain their important role in
society after abandoning the practice. Eighteen former circumcisers participated in the Dropping the
Knife celebration of May, 2007 (see Results), and GAMCOTRAP states that currently more than sixty
others are committed to abandoning the practice and participate in the next Dropping of the Knife.
Best Practices
GAMCOTRAP’s self-assessment identifies its major strength as lying in its staff of committed
activists. Dr. Touray and Ms. Bojang-Sissoho are both circumcised Mandinka women with a deep
understanding of both the cultural and religious context and Gambian political realities. While acutely
attuned to the need to follow local etiquette, they are resilient and courageous, and consistently display
remarkable flexibility and insight (as well as compassion and humor) when dealing with often rapidly
changing circumstances in the field. They are extremely well-versed in not only international human
rights protocols but also Islamic theology, and can engage in culturally and religiously sensitive dialogue
with a wide range of individuals and groups, always ”taking the pulse” of which approach is most
appropriate with a particular person or community. This ability is something that can not be learned
through formal training, but can only be found in a true ”insider.” Additionally, they are both extremely
17effective public speakers with fluency in several local languages. The TV-project has been especilly
instrumental in freeing up Dr. Touray to work full-time on coordinating the project.
GAMCOTRAP does not employ an approach of stressing charismatic personalities. Although both
Amie and Isatou are indeed well known and respected in the communities in which they work (and their
names at times show up in praise-songs) they stress that ”GAMCOTRAP is not Amie or Isatou.” The
groundwork that they have done over so many years could be continued by other dedicated activists,
and there is evidence of training of junior staff and volunteers and the transfer of competency, as was
particularly demonstrated by the active participation in the dissemination exercise of Musa Jallow and
Omar Dibbah. This philosophy was also evident during the field visit (as was also the case during the
evaluator’s travels with the group in 1997-98) – GAMCOTRAP staff behave in an extremely humble
way when ”on trek.” They use very modest accomodations, eat simple food, and work long hours without
ever complaining about discomfort or fatigue. GAMCOTRAP staff meet community members on their
own terms, joining them in their work and domestic responsibilities. They are acutely aware of farming
cycles and women’s domestic labor burdens and make a genuine and concerted effort to empathize with
the realities of the people they are trying to reach. GAMCOTRAP also has a firm policy of not handing
out cash to praise-singers, kanyelengs, and others. Instead, they budget for a collective contribution to be
given at the end of the visit to a designated group of women.
GAMCOTRAP are veterans in the field of anti-FGM activism and are anchored in long-term
relationships with the communities they serve, and their approach is characterized by frankness and
transparency. While remaining attuned to the need to show respect (especially for elders, dignitaries, and
individuals with particular prestige) the activists never conceal their agenda nor make excuses for their
convictions. Because there has been no attempt throughout the sustained campaign to veil the message
or hide it within other agendas, GAMCOTRAP appears to have ultimately gained the respect of the
populations they have worked so long to sensitize.
While never straying from the agenda that was set out at the inception of the Gambian IAC chapter,
it is evident that GAMCOTRAP staff display flexibility and adaptability in tailoring their message to
specific community realities and are open to making adjustements in campaign approaches over time.
Thus, there has in some communities been a greater emphasis than in others on refuting the allegation
that FGM is a religious injunction and breaking the taboo of men as sole custodians of religion; and
GAMCOTRAP shows great skill in utilizing collaborations with religious scholars. They also display a
great deal of insight into geographic and ethnic variations in the practice of FGM; and presentations
are angled to best resonate with community realities. During the field visit, this was particularly evident
in the advice offered regarding reproductive health care surrounding consummation of marriage in
communities practicing ”sealing,” (an important component of the strengthening of IEC capacity of
the traditional healers who are usually the first to treat these cases), as well as in discussions about Spain’s
anti-FGM law in villages that have seen many of its young people emigrate there.
When asked what changes have emerged in their campaign strategies over time, they pointed to
the increasing use over the last few years of traditional communicators and drawing on the cultural
centrality of dance, song, and music. Also, in the past, there was more of a strategy of training a few
representatives from each of many communities, while they have now realized that this places too much
of a burden on a few people to return to their communities and try to recount all that they learned
in training and alone attempt to effect collective change (this was also expressed in some of the field
interviews as extremely challenging by attendees who pleaded for the support of workshops to be held
in their communities). Now they focus instead on mass meetings and collective change through targeting
a ”cluster” of villages centered around a major community (see Appendix 5 for adiagram) aimed at
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