When women become defensive about use of the word “mutilation” in the term female genital mutilation, preferring to call it “modification” or “cutting”, Dr Caroline Munyi knows she has to tread carefully.

Encountering such attitudes during a pilot programme in Cork raised a red flag for her that women thinking like that almost certainly underwent the practice themselves. It also meant their daughters were probably at risk too.

Munyi was leading an ActionAid programme that aims to raise awareness and to change mindsets in a non-judgmental way. She worked over 12 weeks with up to 100 migrant women, men and girls living in three direct provision centres.

It is estimated that 5,790 girls and women living in Ireland have experienced FGM and some 2,639 girls here may be at risk of being subjected to it.

“It is happening here and girls are being taken out of Ireland to be cut,” she says, explaining that we are only likely to hear about it being done here if something goes wrong and it comes to the attention of health professionals, who must report it.

Under 2012 legislation, not only is FGM prohibited in Ireland, but it is also a criminal offence for someone in Ireland to take a girl to another country to undergo it.

For Western Europeans, it is hard to even start to understand how removing part or all of a girl’s external genitalia – most commonly between the ages of four and 10 – could be regarded as anything less than barbaric.

Cultural norm But for those who have grown up with FGM as a cultural norm for generations, it’s a different matter. Unicef (the United Nations Children’s Fund) estimates that it is still practised in roughly 30 countries, with prevalence rates among females aged 15-49 as high as 98 per cent in Somalia, 97 per cent in Guinea and 90 per cent in Sierra Leone. In such communities, the belief that girls are not marriageable if they have not undergone FGM drives parents to perpetuate the practice, to prevent their daughters becoming social outcasts.

ActionAid’s AFTER programme uses a “reflect and action” approach that has proved effective in countries such as Kenya and Liberia. (The acronym of the title stands for Against Female genital mutilation/cutting Through Empowerment and Rejection).

Exploring the concept of human rights in various cultures, rather than simply condemning the practice, allows migrants to grow their understanding, says Kenyan-born Munyi, “so they do not feel something has been taken away. The moment they feel it is being taken away, they feel threatened.”

Dr Caroline Munyi, who grew up in Kenya, said: “It was quite normal for girls as young as eight to talk about what was going to be done.” Photograph: Cyril Byrne Growing up in the village of Gicegeri in Embu, north east of Nairobi, she remembers girls she played with talking openly about FGM, yet she always knew it was not something her mother, a teacher, would have had performed on her or her sister.

“It was quite normal for girls as young as eight to talk about what was going to be done,” she says. But when she was sent to boarding school at the age of 10, where pupils were daughters of professionals, it wasn’t spoken of. They were much more into the world of Mills & Boon, she says with a smile, sitting in ActionAid’s Dublin headquarters.

Munyi came to Ireland 10 years ago, after being awarded a scholarship to study for a degree in development studies at Kimmage Manor in Dublin. She has since done a Masters and completed her PhD in masculinity and gender-based violence at the Irish School of Ecumenics in Trinity College, Dublin, in 2016.

Low levels of awareness Cork was chosen for the AFTER pilot because it is the second most populated city after Dublin, yet a regional study of organisations working with migrant communities there indicated a low level of awareness of the issue. Of the 16 organisations that participated in the survey by ActionAid, only three knew Irish law relating to FGM and seemed well informed.

Migrant men, women and girls were invited to separate workshops starting last March. But at the first session for men, only four turned up and they made it clear that they regarded FGM as a woman’s issue and not one they were supposed to get involved in.

So, says Munyi, it was pointed out that every man has a mother, and maybe sisters, a wife and daughters. Those with daughters seemed most interested.

“The first tool we use is a body map, to explain what happens in FGM to their nearest and dearest,” she says. Starting with non-taboo parts such as ears and eyes, they look at what each does and how they would feel if something happened to it, before getting to female parts associated with human reproduction.

There are four types of FGM, as classified by the World Health Organisation:

Type II includes that, along with partial or total removal of the labia minora (two small folds of skin that extend backward on each side of the opening into the vagina).

Type III, the most drastic, involves cutting and positioning the labia minora and/or labia majora (the larger outer folds of the vulva) to create a stitched seal over the vagina orifice, with or without cutting of the clitoris.

Type IV covers all other harmful, non-medical procedures to the genitalia such as piercing, incising and cauterisation.

It is generally carried out by an older woman in the community, usually without the use of anaesthetic or antiseptics. The cutting instrument could be a razor blade, knife, scissors, piece of glass or scalpel.

All the procedures ensure women are unlikely to get any pleasure out of sexual intercourse, thereby “making them less likely to be promiscuous – that is the main reason. It’s crazy,” says Munyi. Type III will prove that a woman is a virgin before marriage.

‘Sad and withdrawn’ The men on the programme “became very sad and withdrawn”, says Munyi, as they were shown the effects of FGM and the male role in this culture was examined.

“Men in this particular culture will not agree to marry a woman who has not been cut. If men in this community said ‘no’, this practice would stop like this,” she says, clicking her fingers.

“You don’t know and you don’t ask, it’s very sensitive,' she says about whether or not participants had direct experience of FGM themselves Instead, affected women face a lifetime of health complications, ranging from the initial agonising pain and risk of haemorrhage and infection, to difficulties in menstruation, urinary tract problems, painful intercourse, obstetric issues and post-traumatic stress disorder.

“FGM is a form of private control over women and anybody who can control you in private can control you in public,” says Munyi.

There are social as well as health consequences. Girls are growing up with mothers who are not assertive, believing it’s okay to be beaten by your husband and it’s a message passed on to boys and so the cycle of female inequality continues through the generations.

In an evaluation of the AFTER programme, that is being presented in Dublin on Tuesday (February 6th), ActionAid notes that while only four men attended the first session, “by the third session the men had started attending in large numbers without being reminded and were eager to contribute to group discussions. They took the initiative to engage with other men in the direct provision centre and spread awareness about the dangers of FGM.”

Munyi sums up the programme for the women’s group as an empowering journey from where they viewed the practice as “cutting” to seeing it in a new light, as “mutilation”. In working on attitudes, it’s “important for them to know where cultural practices stop and human rights take over”.

There was a lot of tears along the way, she says. They needed to offer counselling services to participants, which was not something they had envisaged, because the programme raised deep-seated issues.

“You don’t know and you don’t ask, it’s very sensitive,” she says about whether or not participants had direct experience of FGM themselves. Undoubtedly, some of them had – “you can tell from arguments about ‘cutting’ that they probably have and it is something they don’t condemn”.

Many of the women encouraged their daughters to attend the girls’ group, which didn’t start until the end of May, and they also acted as facilitators in some sessions. They said they wished they knew at that age what the girls were learning here.

With the girls, aged eight to 18, Munyi says they did a lot of role plays, looking at associated problems such as arranged or forced marriages. The participants were able to empathise with girls their age being cut and married off – so different to their own lives here in Ireland, attending school and being looked after by others.

She recalls one child saying: “An eight-year-old girl is supposed to be busy being a child and not a wife.”

Communicate effectively The girls’ sessions paid particular attention to how to communicate effectively if they think something may be going to happen to them. They imagined scenarios and role-played how to approach, say, a teacher, or the manager of the direct provision centre, with concerns about their safety.

“These girls have voices,” says Munyi, stressing that it is important to make them aware of what could happen and how to seek help.

With more than 4,800 women, men and children living in 32 direct provision centres across Ireland, she believes it would be very good to be able to replicate the programme elsewhere.

ActionAid says that lessons learned from this pilot for future FGM-prevention programmes in Ireland include the need to involve boys in the discussion. It also concludes that it is more effective to engage migrant communities while they are in the direct provision centres, rather than after they leave.

Participants in the pilot programme will be presented with certificates by the Tánaiste Simon Coveney at a ceremony at the Nano Nagle Centre in Cork this Friday, February 9th.

Energised by the programme, these groups are keen to keep the conversation on gender violence and inequality going, says Munyi but they “need somebody to hold their hand to go to the next level”.

Due to the constraints of their living conditions in direct provision centres, they are very vulnerable, she points out, adding: “Although we have created awareness, what is their capacity and their ability to act on the issues?”

MIGRANT VOICES ON THE ACTIONAID PROGRAMME

“Human rights cannot make sense to so many of us because we did not encounter them in our homes” – participant from Nigeria.

“We teach girls shame. Close your legs. Cover yourself. We make them feel as though by being born female, they are already guilty of something. And so girls grow up to be women who cannot say they have desire. Who silence themselves. Who cannot say what they truly think. Who have turned pretence into an art form” – participant in girls’ club.

“It is important to imagine how women feel when these bad things are being done to them. How would you feel if it was your sister, mother, daughter, at the receiving end of violence being perpetuated under various guises such as culture and religion” – participant in men’s forum.

“It is important to keep on talking about bodies and how they function. We women suffer a lot in silence and talking can go a long way in helping us to help each other and especially in ensuring our young daughters do not grow up to be like us. It is important for our girls to break the shackles which have bound us for generations. Our mothers never taught us to be different from them and I think that is the biggest obstacle which has held us women from realising our potential” – participant in women’s empowerment sessions.

Treatment and support A combination of medical treatment and psychological support is offered at the only specialised clinic in Ireland for women who have undergone female genital mutilation.

It is a weekly, drop-in session run by the Irish Family Planning Association (IFPA) in Dublin, although most women prefer to make an appointment as they may be travelling from other parts of the country, explains IFPA’s policy officer Alison Spillane.

The FGM clinic opened in mid-2014, but the IFPA has worked closely with the migrant women’s network AkiDwA and the National Women’s Council of Ireland since 2008, raising awareness and campaigning for legislation that was introduced in 2012.

Women can also attend our counsellors here for psychological support and we would find there is quite a high uptake of the counselling service IFPA medical director Dr Caitriona Henchion sees the majority of clients attending the clinic. She talks to each woman about the type of FGM she’s had, gives advice on pain management and discusses issues such as fertility.

“If women wish, or need,” says Spillane, “they are referred to a gynaecologist in the Rotunda Hospital for what is called deinfibulation” – that is opening up the vaginal area of a woman who has undergone Type III. “Women can also attend our counsellors here for psychological support and we would find there is quite a high uptake of the counselling service.”

About 50 women have made multiple visits to the clinic since it started and they come for a variety of reasons.

“For some it can be for help with ongoing pain, for other women, maybe they are starting to date, develop relationships or thinking about becoming pregnant.”