FGM Initiative Second Interim Report September 2012 Summary

The FGM Initiative SECOND INTERIM REPORT SUMMARY September 2012

By Eleanor Brown

Contact: Eleanor Brown, Head of UK Programmes Options Consultancy Services Ltd 20-23 Greville Street London EC1N 8SS 020-7430 1900 www.options.co.uk/UK

Executive Summary

This report presents the key findings of the second interim report (September 2012) of the independent evaluators of the FGM Initiative. The Female Genital Mutilation Initiative aims to safeguard children from FGM through community-based, preventive work. This UK-wide initiative was established by three independent charitable organisations: Trust for London, the Esmée Fairbairn Foundation and Rosa (the UK Fund for Women and Girls). The initiative is supporting fourteen organisations across the UK over a three-year period. The objectives of the initiative are: •

To raise awareness among affected communities about UK law and the health and psychological risks of FGM.

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To increase the confidence of women, men and young people within affected communities to reject this procedure as part of their identity.

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To increase the skills and capacity within affected communities to influence individuals, groups, and statutory agencies.

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To strengthen the voice of women and communities speaking out against FGM.

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To improve co-ordination of activities amongst voluntary and community groups and statutory agencies working on this issue.

Key findings from the first mid-term evaluation report (in 2011), in brief, found that: •

The projects were well grounded in the communities where they were working, and often used innovative means of targeting communities in the places where they lived, worked and played.

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Many projects had taken on the difficult task of engaging with religious leaders and felt that this offered an opportunity to tackle beliefs supporting FGM.

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Projects faced greater challenges in addressing ‘less severe’ forms of FGM, commonly known as ‘Sunnah’.

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Referrals to projects, from either women and young girls ‘at risk’, or women affected

by FGM, were low.

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There was an identified need to engage with men, who were found to not be as supportive of FGM as commonly thought.

The activities, focus, reach and impact of the community-based projects have been in part formed by overall influencing factors, which projects are reported to have included:

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Continuing climate of austerity: this has noticeably impacted on some organisations, and their projects, reducing staff time for direct project implementation, and of partner’s abilities to work in partnership with the projects.

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Related to this point is the retraction of the statutory sector, which has especially affected links with Safeguarding partnerships and work in schools. Many projects also view this retraction as a lack of focus on health inequalities particularly among specific communities.

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Re-organisation of the NHS: making it more difficult for project workers to link to appropriate health champions (GPs, GP nurses, midwives) to increase the identification and referral of women affected by FGM. This may also affect project’s abilities to keep FGM on the agenda, as in some cases the shadow Health and Wellbeing commissioning boards offer limited opportunities for third sector partners to engage.

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FGM on the agenda: there is an increased reporting about the practice among the UK media, and many of the projects have included this awareness in their strategies for how they talk about and address FGM.

Key Findings – Project Outcomes Identifying Need The projects are being implemented in a variety of contexts, and ‘need’ identified varies according the communities where they are working. Many of the projects have focused on working with newly arrived migrant communities, and in working with women who have themselves experienced FGM. Health and social care practitioners have increasingly referred women affected by FGM to project workers, and have increasingly relied on the projects to provide inter-personal support to these women. However, in some cases, stigma and the sensitive nature of FGM still acts as a barrier to women accessing this kind of interpersonal support.

The practice of FGM is likely to evolve dynamically and the community projects are well placed to conduct these ‘community conversations’ and to identify how these practices changing.

Raising Awareness Projects continue to find that awareness of the legal aspects of FGM is low, with little discussion of the illegality of FGM in the communities where they work. In some cases, strides have been made to integrate legal awareness into materials targeting newly arrived communities, such as ‘Welcome Packs’ in dispersal areas. ‘Best practice’ in the projects that work on the legal aspects of FGM include more insightful discussions on the full implications of the FGM law in the UK context, including an approach that is focused on protection and Safeguarding of both women and children in affected communities. Several projects identified a risk of a heavy handed approach to FGM if focused on purely legal aspects, potentially making it harder for women and children to access care.

Health-based arguments have been widely used by the projects, and have been found to strongly support anti-FGM stances. However, as the previous interim report found, a remaining challenge is those who advocate ‘less severe’ forms (such as Type 1 of FGM, known as ‘Sunnah’). Some projects are now advocating that a rights-based focus should come to the forefront of the strategy.

In some cases, there was some resistance to wider discussion of FGM among communities due to rising awareness and visibility of the issue of mainstream media, underlying the importance of the initiative’s aim to take a capacity-building approach to developing confidence to speak out against FGM in affected communities.

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Reaching Wider Groups In this phase of the initiative, some of the projects have been active in moving beyond the ‘normal’ social groups where they work: some of the groups have started to work with men, engaging health and social care practitioners, and across different ethnic groups. Work to date with men has confirmed low levels of awareness of FGM, what the act itself entails, or of the health consequences for girls and women. Projects have also found very little direct support among male partners of women accessing health services. Nonetheless, there is a common finding across projects that men have been difficult to engage with, and view FGM as ‘a female problem’. The ‘best practice’ examples of work with men have included mixed forums (inter-generational, as well including both men and women), where men’s role in decision-making and protection of girl children within the family.

Many of the projects have worked with volunteers in order to maximize their reach using scant resources. Some projects however still view their volunteers as a principally informational and mobilizing resource. Those projects who have had greater reach have taken a capacity-building approach to developing community champions.

Working with Religious Leaders Early research identified that people often believed FGM to be a religiously condoned practice. In some cases, projects have experienced religious leaders actively supporting ‘milder’ forms of FGM (such as Type 1), in many cases, other religious leaders have viewed is a predominantly cultural practice. Many of the projects have targeted work with religious leaders. There is evidence that some of this work has been harnessed across the initiative, with a sub-group focused on developing a religious forum against FGM, development of materials that incorporate religious anti-FGM messages (including by religious leaders themselves), and active engagement by some with leading religious institutions.

Nonetheless, there are issues on how to best capitalize on this area of work, with some advocating a peer-led approach to working with religious leaders and disseminating better information on FGM’s cultural (not religious) origins. Many of the projects have in the meantime worked well with informal and female-led religious networks, which should continue in future phases of the work. Better sharing of religiously-based counter arguments could be made, and integrated into a rights-based framework, and using resources that have already been developed.

Integration of a Rights-based Perspective The integration of rights-based perspectives has been patchy across the projects in the initiative, with some actively advocating the need for this approach. Many of the projects have made good progress particularly in linking with health and social care practitioners through actively linking FGM to a violence against women and children agenda. Some projects are clearly also co-locating rights-based alongside religious messaging, and there are clear synergies to be exploited here.

In some cases, there was a clear need for a deeper understanding of rights-based approaches in some projects, instead of viewing this approach as an abstract concept with limited applicability.

Work with policy-makers and practitioners Groups and projects working within a ‘violence against women’ agenda often appear to have made better in-roads and links with health and social care practitioners, and in developing

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local responses to FGM. There are good examples of successes in getting FGM onto the local agenda, and in partnership working with a range of statutory agencies. There has been good partnership working with specialist health staff, (including midwives and consultants in specialist services) – many advocates reported that the credibility of health staff’s voice has been important in tackling pro-FGM sentiment. Though the numbers of referrals from social workers remains low, it is also clear that FGM projects and advocates are becoming increasingly relied on to engage with families in more in-depth preventative work, and in conducting this work in cultural sensitive ways (while remaining strongly anti-FGM).

Greater traction could be made in working with wider groups, such as GPs, who are involved in the identification, assessment and referral of women affected by FGM. There is also a clear role for projects in advocating for more appropriate (and less heavy handed) responses to the identification of children and women at risk of FGM. Work in Schools Some of the projects have found that young people are very actively engaged in voicing their opposition to FGM, and can be mobilized for a range of different anti-FGM activities. Work with schools, who have a strong Safeguarding remit, has been a focus of a number of projects. However, making inroads into schools has been consistently reported as a challenge by many projects. Some advocates also have expressed qualms about the risk of stigmatizing particular ethnic groups (for instance, Somalis) from affected communities.

Awareness-raising in schools could probably focus more on integrating FGM into wider messages about violence against women and children.

Challenges In brief, projects stated that they faced some challenges;

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A climate of austerity: projects are less likely to be able to access other sources of funding for project ‘add-ons’ – in the past this has funded some of the project activities with high number of participants (such as public events). Funders need to critically evaluate whether future phases should include a pot of funding for other kinds of events.

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Evolving landscape in statutory agencies: this report has discussed at length the effects of cuts in statutory agencies in both health and social care. Projects have had some successes with putting FGM on the local policy-making agenda. Future M&E activities should evidence this more clearly, and think critically about how to further this aspect of the work, as this may ensure access to services that support women and better protect those at risk of FGM.

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As some practitioners become more involved in the identification of women and girls at risk of FGM, there is an emerging need for projects’ to act as cultural translators and guide a firm but appropriate response by safeguarding agencies.

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As noted in previous evaluation reports, health-based arguments cannot entirely address and tackle support for ‘less severe’ forms of FGM.

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Related to this point, in some areas rights-based approaches are misunderstood and not embraced.

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Engaging with men is recognized as being an essential component of tackling FGM – but many projects have found this work challenging. Work with men appears to work better in mixed forums, and more learning needs to be done on how to effectively work with men.

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While there have been many successes in working with religious leaders, this has been a very time intensive and painstaking part of the work. There remain challenges in engaging with religious leaders in many areas, and strategic thought needs to be given as to how to further develop this work. A religious ‘voice’ lends strong credibility to voicing opposition to FGM, but more could be done to build on this approach.

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The sensitivity of FGM as an issue in some spheres is still a barrier to voicing opposition and tackling FGM.

Issues for Discussion This report aimed to be a rapid review of the projects’ progress to date, analyzing critical issues that projects are facing at this stage in their development.

There has clearly been rapid development of some aspects of the project, and the initiative faces some critical decisions about next steps in capitalizing on progress to date. The issues highlighted below are ones which have been consistently raised across projects, and recommendations for action to tackle these areas are also given. a) Strategically engaging with those in communities affected by FGM FGM is such a wide ranging issue – in effect as an issue it touches on and involves many different social actors, despite often being presented as a practice performed uniquely by women on girl children. There are difficulties and confusion however in how to reach those who support FGM (potential perpetrators) – should projects endeavour to reach those groups, or build a stronger voice among those affected and at risk? For instance, what about older groups – those who are harder to change, who more staunchly support FGM as an inherent expression of cultural life?

It may be helpful for projects to think about what strategic approach they are taking, and what this implies for the groups that they want to target as a whole – is it a population level approach (targeting all groups equally), a targeted risk reduction approach (including those who are ‘at risk’ only), or a wider approach inclusive of those ‘affected’ (those who have experienced FGM, and those ‘at risk’, and ‘gatekeepers’). b) Strategically Engaging with Policy-Makers While there is some evidence of a better response to FGM, projects need to critically evaluate how to best keep the issue on the agenda at a local and national level. In the age of austerity, there is a risk that inclusion of FGM into local policies becomes a tick box exercise, without the resourcing and commitment to take the work forward. To date, projects have engaged with practitioners and policy-makers who have a duty to respond, but need to also evaluate how they can make strategic partnerships with those who can also champion FGM in professional networks. Peer to peer responses are also a possibility.

Some of the organisations view themselves clearly within a wider violence against women agenda, and certainly these projects have brought strategic and resourcing advantages to their work on FGM. To what extent should the initiative more clearly situate itself within this agenda, and in that case, how would it better support all projects to integrate a rights-based approach to their work?

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c) Negotiating Cultural Sensitivities The sensitivity of FGM as an issue is cited by some as a key challenge that they still face.

Projects have had many successes in supporting and empowering women to voice their opposition, and are clearly the best placed to judge, negotiate and advocate their way around these sensitivities. As FGM moves onto the agenda, other stakeholders will become involved in the identification, assessment, support and referral of women and girl children at risk. Can learning on working at community level now be built on for other agencies to conduct this work, and ‘best practices’ be distilled? This may entail a clearly overall structure for the initiative to share lessons learned and mobilize more resources around this issue. d) Expanding the Reach of the projects Resources such as OSCA’s DVD and outputs of the faith forum are some of the important resources that have been developed, and which could have greater reach. Coupled with good results from mixed forums, this suggests that there is also a role to be developed for multi-media resources. However, if the initiative is going to make best use of this approach, there needs to be both effective co-ordination, and capacity-building in the use of these resources. e) Positive Messaging Some stakeholders wanted to start seeing more ‘positive’ messaging around FGM. While clearly this is a practice which has caused great harm and devastation, and thus it makes positive messaging difficult to envisage, it is nonetheless an area that could be developed in future phases of the project. Other issues in reproductive health rights, such as women’s right to abortion, have similarly been won by both public health arguments, and positive messaging about valuing women’s rights to choose.

Some projects have worked hard to widen their reach, and to shift attitudes towards FGM, in effect, instilling values of a communal responsibility to protect children who may be at risk within communities. Positive values, such as those about protection, responsibility and duty towards each other, consent and respect, should also be involved in messaging, but there are definitely wider lessons to be learned about the positive values that can be talked about.

This is most clearly demonstrated in religious messaging, where learning on ‘good’ messages could be shared, but messaging on parenting and communal responsibility also apply.

A key strength of the project to date has been on not focusing overly on quantitative outcomes, but on harnessing methodologies that lead to understanding of how FGM is talked about by people affected by it, so is in a good position to be able to harness these ‘conversations’ into messaging that resonates.

Funders Esmée Fairbairn Foundation

Rosa

www.esmeefairbairn.org.uk

www.rosauk.org

Registered Charity No. 200051

Registered Charity No. 1124856

Trust for London www.trustforlondon.org.uk Registered Charity No. 205629

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