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Fixes looks at solutions to social problems and why they work.

Like every other girl of her era in her part of southern Ethiopia — and most girls in the country — Bogaletch Gebre was circumcised. In some regions girls are circumcised as infants, but in her zone it happened at puberty. It was around 1967, and she was about 12. A man held her from behind, blindfolded her and stuffed a rag in her mouth, and with his legs held her legs open so she could not move. A female circumciser took a razor blade and sliced off Gebre’s genitals.

Gebre nearly bled to death. She stayed at home for about two months, and after she healed, she was presented to her village, ready for marriage.

Unicef estimates (pdf) that between 70 million and 140 million girls and women globally are circumcised. The practice is widespread throughout Africa, and in some countries of Asia and the Middle East. In Ethiopia it is done by Muslims, Christians and Jews. (Gebre’s region of Kembata-Tembaro is a largely Protestant area of some 700,000 people in Ethiopia’s south.) No major religion endorses circumcision. Communities that practice it have in common that they are traditional societies where female sexuality is viewed mainly as a potential threat to family honor — in Kembata-Tembaro, the practice is called “cutting off the dirt.” To keep girls from promiscuity and ruin, the clitoris and often the labia are cut off to deaden sexual sensation.



Female circumcision, also known as female genital mutilation or genital cutting, is one of several traditional practices in Kembata-Tembaro that express men’s power over women. Domestic violence is tolerated, even expected. Another practice is bride abduction — men claim a wife by kidnapping and raping her; after the rape she must marry the rapist to avoid disgrace and preserve her family’s honor. There is also widow inheritance, in which a wife must marry her dead husband’s brother. “Women were not considered any better than the cows they milked,” said Gebre.

Some girls die from genital cutting, of infection or blood loss. But it can also lead to death later. It creates complications in childbirth, with higher risks for baby and mother. (One of Gebre’s sisters died in childbirth as a result of being cut.) It leads to repeated urinary and bladder infections and to fistula. With infibulation, the most severe type of circumcision, the vagina must be cut open later for intercourse and childbirth.

Today, however, cutting has vanished from Kembata-Tembaro, as have bride abduction and widow inheritance. A study (pdf) done for the Innocenti Research Center, a research arm of Unicef, found that cutting had only 3 percent support in 2008 — down from 97 percent in 1999. This is a remarkable achievement. There is nothing more difficult than persuading people to give up long-held cultural practices, especially those bound up in taboo subjects like sex.

The change happened because of an organization that Gebre and her sister Fikrte started called Kembatti Mentti Gezzima-Toppe, which means “women of Kembata working together.” It is now known simply as KMG-Ethiopia.

When Gebre was 6 or 7 she began sneaking off to school for an hour or two on her way to fetch water. She became the first girl in her district to go beyond 4th grade. She went to Israel to study microbiology and then to the United States, where she did doctoral research on epidemiology. But in 1997, when she was about 42 (she does not know her actual age) she returned to Kembata-Tembaro to try to help. This year her work won her the first African Development Prize of the Belgium-based King Baudouin Foundation, which comes with an award of 150,000 euros — nearly $200,000.

KMG relies on a method called community conversations. It was developed by Dr. Moustapha Gueye, a longtime organizer of anti-AIDS community networks in Africa, who then took the idea to the United Nations Development Program (pdf). But it is built on the ancient African practice of talking things out — community elders gather under a tree and discuss a problem again and again until they reach consensus. Gebre was the first to apply community conversations to the issue of cutting.

In the last decade, many countries in Africa have seen a marked drop in the practice of cutting. This is thanks to organizations working all over the continent. One of the groups best known in Western nations is Tostan,which works with local organizations in eight African countries.

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All of the successful methods have one thing in common — a factor that is also responsible for the success of the Positive Deviance strategy I wrote about in February: “You must allow the community to decide for themselves rather than condemning,” said Gebre. “To make people understand the harm that comes to their children you can’t come in and tell them ‘you are doing bad and must stop.’”

Changing the law is a step, but only one step. In many places where cutting is outlawed, it is widely practiced in secret. “It doesn’t stop when they superficially raise their hands, or when religious leaders say ‘we declare it will stop,’” said Gebre. “It has to come from inside the community. It has to be discussed over and over again, in the African tradition. That’s how change comes.”

Gebre did not start out using community conversations. KMG began by taking a survey of local practices, and then presented the results in meetings with community members, stressing how these practices harmed the community and made the village less prosperous. KMG attacked the problem with the standard good strategies: it trained young women and men whom it then deployed to train others in their communities, holding workshops with different groups like students, village leaders, uncut girls and the women who worked as circumcisers.

The meetings were popular and demand was high. But when U.N. development program asked that KMG try a pilot project using community conversations, Gebre quickly realized it could fill a gap: it was a way to engage the community for the long term, and for the community to make its own decisions.

“From there, community conversations became our medium of social organization,” she said. KMG asked communities to choose people to be trained as facilitators, then trained hundreds of them. A pair of facilitators — one man, one woman — would lead a group of 50 people, which is small enough that everyone can take part in discussion. Each week, on a Saturday or Sunday, the group would meet for two to four hours to talk. The groups were both uniform — all girls, all elders, all traditional birth attendants — and mixed. Each month, the facilitators would meet to talk over problems and collect an honorarium of about $4.50.

The subject at first was not cutting, but AIDS — a disease that was terrifying Ethiopia. Communities wanted to know how to keep it from spreading. The facilitators presented basic facts about AIDS, and the 50 people began to talk about how to keep the community safe. Condom use led into how women could negotiate condom use, which led into power relationships, which led into gender rights, and then to practices like cutting, and its dangers.

Where do these practices come from? the facilitators asked. The Bible and Koran, people said — but no one could point to where. In fact, they weren’t in any religious book, the facilitators said, and most of the world didn’t do them. This was news. “Till then women had taken their position in society as God-given and natural,” Gebre said. “Now we are telling them, ‘This is a man-made role. Men have put women’s position in that role, and we can come out again, because it is man-made.’”

Outsiders had been telling the people of Kembata-Tembaro for centuries not to cut their daughters. But Gebre had credibility. It helped that she was local, and herself circumcised — “I am part of them. They trust me that I will not bring something that is harmful, that will destroy their culture,” she said. KMG also built trust by bringing practical help. The group offered health services, planted trees and built schools. A village needed a bridge, and had organized people to build it. But there was no money for materials. Gebre contributed her $5,000 life savings, and the bridge was built.

It also helped that KMG was not judgmental. “Your assumption should be that there is nobody in the world who would hurt their children knowingly,” Gebre said. “When they were taking me out to be cut it was celebratory. My mother, though, was crying — she was saying ‘I wish they could do away with it.’ But my mother didn’t have a choice. Her role as a mother was to prepare a proper girl for marriage, to prepare a daughter to be a good wife. Otherwise nobody would marry her.” No parent wants her daughter to be disgraced and excluded from local life.

Eventually, 85 percent of people in Kembata-Tembaro joined one or more community conversations, and participants were encouraged to discuss what they had heard with family and friends over coffee or during long walks to fetch water. As the conversations were winding down in a village, each group chose 10 members for a committee to continue the work. They became the villages’ watchdogs on cutting — in some cases rescuing girls whose families tried to circumcise them in secret.

Not surprisingly, young girls were the most eager to abandon cutting. After an early series of conversations with girls, 78 girls pinned a paper to their school uniforms saying “I will not be cut. Learn from me.” In September, 2002, Kembata-Tembaro had its first public marriage of an uncut bride; she and the groom wore signs announcing their pride, there were hundreds of bridesmaids and 2,000 people in attendance. It was the first of many such weddings. Instead of the seasonal events celebrating the marriageability of cut girls, Kembata-Tembaro began substituting events celebrating uncut girls. They got a silver pendant that said “I am whole.” October 29 had always marked the end of the circumcision season, but in 2004 that day was chosen for a rally to celebrate uncut girls. It was held in a soccer stadium and 100,000 people attended.

Related More From Fixes Read previous contributions to this series.

The Unicef report describes how resolutions abandoning cutting and other harmful practices were first passed in the community conversation groups, and then moved up — winning approval at village assemblies and then endorsement by subdistrict and district governments, which also began to enforce the prohibitions.

This is the reverse of the usual top-down strategies, and it worked. Unicef found that by 2008 circumcision had been almost completely abandoned. Government enforcement helped — but probably more important was that social stigma against uncut girls had vanished. Remarkably, Haile Gabriel Dagne, the Addis Ababa University professor who wrote the report, found that some families “unwillingly tolerated that their daughters remained uncut to improve their daughters’ marriage prospects.”

Dagne contrasts KMG’s successful approach with others that did not work as well. In the Wolaita zone, conversations did not lead to the end of cutting. The meetings were too large for people to be more than spectators, and were run by government officials, not villagers. “Decisions to abandon were not truly collective and community-based, but rather made by individuals who feared legal consequences,” wrote Dagne.

Community conversations are now spreading through Ethiopia in areas of all religions. Gebre said KMG was reaching six million people in southern Ethiopia. The conversations range more broadly than health and gender violence. “We use it for everything – governance, social empowerment — anything we do, community conversation has become our tool,” said Gebre.

In 2004, the Ethiopian government made community conversations a major piece of its H.I.V.-prevention strategy, and Gebre’s group became the first trainers, all over the country. Ethiopia, which was hard hit by AIDS, had the biggest decline (pdf, p 11) in the rate of new infections of any country in Africa – over a 90 percent drop between 2001 and 2011. Unaids considers community conversations a keystone of that achievement.

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Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and the author, most recently, of “Join the Club: How Peer Pressure Can Transform the World” and the World War II spy story e-book “D for Deception.”