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- 10/21/08: Remarks by Henrietta Fore, Administrator, USAID and Director of U.S. Foreign Assistance at the White House Development Summit
- 10/08/08: Remarks by Henrietta Fore, USAID Administrator and Director of U.S. Foreign Assistance at The President's Freedom Agenda
- 10/01/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at the Ceremony Marking the Full Operational Capacity of Africa Command (AFRICOM)
- 09/25/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at 2008 Millennium Development Goal Malaria Summit, New York - "U.S. Leadership in the Fight Against Malaria"
- 09/22/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at the White House Symposium on Advancing Global Literacy - "U.S. Commitment to Advancing Global Literacy"
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Testimony of Dr. Kent R. Hill
Assistant Administrator for Global Health
U.S. Agency for International Development
International Day on Zero Tolerance to Female Genital Cutting
Zero Tolerance Day Symposium
Academy for Educational Development
February 6, 2007
I am pleased to welcome you here and see so many people here from USAID, from the Population Reference Bureau, and our distinguished panelists in this commemoration of the fourth International Day on Zero Tolerance to FGC. Zero Tolerance Day was launched in 2003, as many of you know, by the First Lady of the Federal Republic of Nigeria, speaking on behalf of all the First Ladies of Africa, to stress that zero tolerance means that there is simply no justification in this day and age for the practice.
And we are here today because we are united with these notable African women - working collectively we can end the practice of female genital cutting or mutilation.
USAID began addressing this issue by officially recognizing it as a harmful traditional practice violating the health and human rights of women, and by opposing any practice of or support for FGC. The agency's goal is, flat-out, the elimination of the practice. We started an Inter-Agency working Group in early 1994 to assess USAID's approach to FGC, to raise awareness and to share information within and outside the agency, as well as to coordinate activities and funding in the different offices and bureaus of USAID. In the last few years, FGC was made a Global Leadership Priority with its own separate funding. The strategy for this effort was to work towards the abandonment of FGC through a multi-sectoral approach of sensitizing groups and adapting anti-FGC messages to local contexts, exploring new ways to integrate FGC into existing programs such as maternal and child health, family planning, and human rights approaches, focusing on high priority countries and integrating FGC into programs in all sectors.
Now I have looked at the list here, and I know that those who are present represent many different disciplines and approaches and this is the case because FGC is about more than gender and it's even about more than health. It touches so many aspects of women's lives - it touches their existence women, as mothers, as wives, as members of a greater community and as contributors to their nations.
And yes, FGC is a health issue. And it is a grave health issue, as a matter of fact. But it also affects child health and child mortality; it can be addressed from a good governance standpoint, it is a human rights concern; I'm glad to give a speech on human rights again, I've missed that, but here I get to do that. And it poses a potential impediment to a country's economic development. Indeed, it needs many disciplines and many approaches if we are going to succeed.
And we are here to share our experiences because much remains to be done. I was shocked at these statistics when I reviewed them in preparation for this speech. But in the world today, there are an estimated 100 million to 140 million girls and women who have been subjected to this operation. Currently, it is estimated that up to three million girls, most of them under 15 years of age, in sub-Saharan Africa, in Egypt and Yemen undergo the procedure each year. Three million girls. This figure does not take into account FGM in Indonesia and Malaysia where the situation is not yet well known or documented, but evidence suggests that the practice there, too, is widespread.
Because the practice is entangled in a complex social context, the fight against FGC has taken place within a cautious process of social and cultural change. We have all worked to find the right ways of helping people understand that what was formerly an accepted cultural norm, is actually a harmful practice. Sometimes progress has felt slow in coming. But the evidence is that it is taking place.
Speaking today are some of the world's foremost authorities on FGC, in fact, I doubt that there have been many occasions, if any, where you have brought so many people of this importance and with this depth of knowledge together to address one group. But it includes researchers. It includes religious leaders, health ministry representatives, media representatives, lawyers, donor colleagues, foundations, academicians, and there are others as well. These folks will share a wide array of experiences and learning spanning many disciplines and many approaches and they will describe to you their achievements and what is left to be done.
While I'm not going to deliver a "State of the Issue" address, I can report that since our last Zero Tolerance Day symposium four years ago, there have, in fact, been significant advances.
Let me give you an example. For the first time, we have solid information that shows that interventions actually work. We wanted them to work, but we can prove it now that they do work. Both USAID and UNICEF released publications this year that document successful programs that can serve as a model for countries, organizations and governments working to end this practice. Many of these successful efforts are driven locally and culturally-appropriate programs that rely on input and participation of local leadership and community members. We probably can't emphasize that point too much. The success rate goes up so phenomenally when it's not outside interventions but when we get buy-in from those who are involved and have to make the case and have the credibility to make the case on the ground there.
Many of these case studies show that incorporating gender and social equity issues, including empowerment of women and male involvement, in the change process is critical. Others show that FGC elimination projects that are integrated with health, economic, and social programs work far better than stand-alone strategies. Sometimes you have to sneak up on these issues. You can focus directly on the issues sometimes but a lot of times if you can find another way to get the message out in the context of another program, people will sort of have their defenses down and you start to insert information that once they understand, it begins to undermine the support for the traditional practices.
We have new statistics that show FGC prevalence rates are slowly declining - I wish that wasn't slowly, but it is declining - and attitudes towards the practice are slowly changing as more and more women oppose its continuation, and that is key. I know that women are often not empowered to have as much impact as we might like, but they are still a key component to beginning to really push the agenda here and we've got to convince more men to be a part of that campaign as well.
While we have always known that FGC has profound health and psychological consequences on women and girls, we now have, for the first time, landmark findings from the World Health Organization that show that women with FGC - now listen to this - are significantly more likely than those without FGC to have adverse obstetric outcomes and that infants of mothers who have undergone FGC are at an increased risk of dying at birth, compared with infants of mothers without FGC. You're going to hear more specifically about this today. But that is concrete evidence that we've got to take better advantage of getting the word out on.
And we have learned that one person can make a difference in a community. More and more people are working - in Africa and around the world - to make change happen through laws, religious teachings, and more. You will meet some of these people today and I hope you will be inspired by what they say about the progress they have made.
And we will be looking ahead at what is possible in the next 10 years. So much has happened in this field in the last decade. The effort began as a rights-based approach, which makes sense to me. But we now have social change arguments, much better than before. We have better health arguments than before. We have community-based approaches that blend governance and health to change how people think … and how they act. So much has happened, and so much more can, and should happen. And studies are ongoing which are underway on the primary infertility after genital mutilation in girlhood in Sudan, for example. There are strong grounds to suggest that FGC is a risk factor in the transmission of HIV. There is anecdotal evidence from girls and women who have undergone the practice referring to the severe psychological and psychomatic disorders that have resulted from this practice. There is interest in exploring further the social conventions that permit the practice. Our last panel will explore the future possibilities in greater detail and, I hope, leave you thinking about how you, too, can make change happen.
Let me just insert something from my comments here on this. I often talk about the importance to develop an "apologetic" for what we do that is important. An apologetic, I'm fond of telling people, if you develop an apologetic, it's not why you are sorry you are engaged in this campaign. An effective apologetic is to figure out a way to get inside the minds and the social and intellectual structures, emotional structures, religious structures, whatever it is, that contribute to the behavior that is abusive or simply wrong-headed. And if we can't get inside their heads to figure out what in the world would it take to change the cultural matrix which allows this thing to continue, we're just not as effective. You can even pass laws sometimes and that's an important part of it, but more important is to begin to change hearts and minds. Now, I'm of the opinion you're never going to quite do that with some of the people who are engaged, at least not for a generation, or two or three. But you can change around the edges, and you can undermine the support for those folks that can't be changed, but to do that you have to develop and apologetic. And my hope for you this day is that you'll get some information and do some hard thinking about how do we better make the argument, how do we better make the argument, that this practice simply must not stand. There is simply no excuse for it in the modern age.
And while we are here today to review accomplishments and pave the way for future successes, we're also here to reissue a challenge. There are still too many young women and children around the world every year who are subjected to FGC. We must use what we have learned to date to advance the dialogue. This can't just be another conference. We've got to generate more action. You have to bring new partners into the effort.
For example, I'd like to note that FGC is a grave public health issue not only, not only, in the developing world, but it's got to be understood as a concern for the U.S., for Europe, for Australia, and for Canada as well because of immigration. Right in our backyard. These issues are coming into the developed world. They put doctors in a very awkward place. We've got to figure out a way to address it in our backyard and not just halfway around the world.
And I want to thank each of you for taking the time to come out today. And you're already expert on a lot of this but hopefully, your being together today will allow you to hone your skills and get further inspiration to move on here. And I hope you leave this afternoon with a clearer picture of what you can and ought to do achieve zero tolerance. So, thank you very much.
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