FGM Initiative Second Interim Report (full) September 2012 by Esmée Fairbairn Foundation

The FGM Initiative SECOND INTERIM REPORT September 2012 By Eleanor Brown

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

CONTENTS Executive Summary ........................................................................................................................ 3 1. Introduction .............................................................................................................................. 9 1.1 Key Findings to Date ........................................................................................................... 9 1.2 Report Structure ................................................................................................................. 10 2. Progress of Initiative ................................................................................................................ 11 2.1 Overall Influencing Factors ............................................................................................... 11 2.2 Activities ............................................................................................................................. 11 2.3 Outcomes ......................................................................................................................... 13 2.3.1 Identifying ‘Need’ .............................................................................................................................. 13 2.3.2 Raising Awareness ............................................................................................................................. 13 2.3.3 Reaching Wider Groups ..................................................................................................................... 15 2.3.4 Working with men ............................................................................................................................. 15 2.3.5 Working with Volunteers ................................................................................................................... 16 2.3.6 Working with Religious Leaders ........................................................................................................ 16 2.3.7 Integration of a rights-‐based perspective .......................................................................................... 18 2.3.8 Working with policy-‐makers and practitioners ................................................................................. 18 2.4 Challenges .......................................................................................................................... 21 3. Issues for Discussion ................................................................................................................ 23 4. About the Funders and Evaluators…………………………………………………………………………………………25

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.

•

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

•

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

•

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

•

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.

•

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.

•

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

•

Referrals to projects, from either women and young girls ‘at risk’, or women affected by FGM, were low.

•

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.

•

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.

•

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. •

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.

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

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;

•

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.

•

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?

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.

1. Introduction 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.

•

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

•

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

•

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

•

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

1.1 Key Findings to Date At the outset of the project, a baseline study was conducted on FGM using participatory ethnographic research techniques (PEER) at the community level. Project workers in the initiative were trained on the use of PEER and conducted the baseline among their communities’ social networks. Findings highlighted that;

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FGM is not openly discussed, even within affected communities, and respondents across the country held widely different views. However, it is clear that some families still experience strong pressure to circumcise daughters.

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Girls may be circumcised against their parents’ will, typically at the wish of their grandmother.

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Young women in their late teens are also vulnerable to FGM.

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Type 4 FGM, which includes pricking, piercing or incision, is more widely accepted in the UK than other ‘more severe’ forms. Often referred to as ‘sunnah’, type 4 is seen to have important religious and symbolic qualities, and is considered by many not to constitute a form of FGM (though by law, it does).

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Across the country, respondents drew a distinction between the views of older and younger people on the issue of FGM. Older generations were held almost universally responsible for ongoing support for FGM.

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Levels of awareness and perceptions of the UK law on FGM were varied: in some areas, few people knew about the law, whereas in others, knowledge of the law was widespread.

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Men were generally less supportive of FGM than women believe them to be, indicating a divide between what men really think, and what women believe them to think.

A further interim report, conducted at mid-term of the project (in 2011), 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.

•

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.

•

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

•

Referrals to projects, from either women and young girls ‘at risk’, or women affected by FGM, were low.

•

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

1.2 Report Structure This report presents the key findings from a monitoring and evaluation update assessment conducted at the beginning of the final year of the current initiative (Quarter 1 2012). The lead consultant for the project conducted rapid reviews with all 14 of the projects in the initiatives, which included; •

A review of their current workplan and M&E framework.

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An update on their activities – core activities, successes & achievements.

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A review of challenges and the strategic implications for the initiative as a whole.

As this was intended to be a rapid review, this report does not include a review of the outcomes achieved to date of the initiative as a whole. This report presents: an overview of the projects’ activities and a summary of the progress to date; a review of challenges and barriers and lastly a discussion over strategic implications for the initiative.

2. Progress of Initiative 2.1Overall Influencing Factors Several factors were identified throughout the course of this interim update which may be acting to influence the impact of the projects, and as such, do carry implications for the strategic direction of the projects; 1. Continuing climate of austerity: this has noticeably impacted on some organisations, and their projects. This has often resulted in less availability of partner organisations to work with and do outreach into new communities. However, as projects often work through social networks and/or faith communities, to a large extent this impact has been contained. In a few cases, organisations’ own overall capacity has been vastly reduced, or staff have had to spend much more time fund-raising for additional activities. 2. Related to this point is the retraction of the statutory sector: many of the projects had made good strategic relationships in their local areas with agencies such as Safeguarding partnerships which could link projects into further forums, for instance, into work with schools (many projects reported finding this difficult without this kind of support and backing). Cuts in these agencies have however often affected project worker’s abilities to make or maintain these links. Projects which exist under a wider violence against women agenda have often been more successful in keeping a strategic vision for FGM in their local areas. Many projects also view this retraction as a lack of focus on health inequalities particularly among specific communities. 3. Re-organisation of the NHS: many of the projects have seen increases in referrals to them, and want to build on this by engaging with health practitioners (GPs, GP nurses, midwives) to increase the identification and referral of women affected by FGM. This is being made harder in some cases by the re-organisation of the NHS, as it is often not clear who and how projects should link to. This may also affect project’s abilities to keep FGM on the agenda, as in some cases the shadow Health and Well-being commissioning boards offer limited opportunities for third sector partners to engage. 4. FGM on the agenda: Some project workers reported that FGM is now becoming much more visible and talked about – there is an increased reporting about the practice among the UK media, and in some cases, a higher rate of referral and identification of women/girls at risk of FGM. Many of the projects have included this awareness in their strategies for how they talk about and address FGM. The projects are still reporting good progress against the outcomes of the initiative (see below)

2.2 Activities At this point in the project (entering the third year), many of the projects have gone through an initial period of experimentation, piloting and researching of the FGM in the affected communities where they work, and are solidifying these ‘lessons learnt’ into a concerted programme of work. Most of the projects are still using workshop and face to face methods to raise awareness about FGM. The deep sensitivities around FGM are still a barrier to wider dissemination of

information/anti-FGM methods, and all projects were concerned about the risk of stigmatizing certain ethnic groups in their work on FGM (discussed in more depth below). In choosing methods to widen the impact of their work, some projects successfully used approaches to develop community-level leadership and championing of anti-FGM among different groups. ‘Lessons learned’ about non-stigmatizing approaches are discussed in greater depth below. Many of the projects have worked with volunteers to help them to achieve greater reach and uptake of messages about FGM. Several projects have, for instance, focused on youth-led work and activities to highlight awareness about FGM. Others have used ‘community champion’ models - all of these approaches use and actively work with volunteers. In some cases, work with volunteers has focused on their role in information and message dissemination. The most successful cases of work with volunteers has used capacitybuilding approaches, which has had better reach into mixed audiences and different ethnic groups. All projects have embraced work with religious leaders, having often found that misconceptions about religious misconceptions are often used as justifications for maintaining FGM. The first interim report found that this work was often arduous, with lack of clarity over anti-FGM messages among religious leaders. Projects have continued to use female-led networks within religious institutions (such as female Koran teachers) to disseminate messages about FGM, and have also worked hard to identify religious leaders who are informed and willing to speak out about FGM. Activities under this part of the initiative include a multi-faith forum on FGM, and a DVD that includes religious leaders discussing how FGM is not a religiously condoned practice. Nonetheless, several projects are now critically analyzing how the move the work with religious leaders forward. Many projects have produced materials such as information packs, leaflets and posters for wider dissemination. A principle aim of these materials is to encourage basic knowledge and engagement among health and social work practitioners in FGM. In some cases, projects have taken a strategic decision to produce materials that could encourage debate, discussion and engagement with FGM as a practice – this includes OSCA’s forthcoming DVD of a play produced using qualitative narratives on FGM. This consolidates work on women’s voice on FGM in affected communities, and is an example of effective sharing of a strategic vision across the initiative. There was a noticeable divergence among the projects in terms of the under-lying theory of change that projects perceived themselves to be using, and implications for how their programmes of work had thus progressed, and what activities they have focussed on. Many of the projects now situate tackling FGM within a rights-based framework, and within a wider concern over violence against women, which they view as necessary to counter justifications of less severe forms of FGM (types 1 & 2). For these projects, messaging initially may have focused on health aspects, child rights and concerns over FGM, but at this stage have now often progressed to include deeper discussion over women’s reproductive health rights. This may also be reflective of a growing confidence in community advocates, who report that discussions on FGM often involve discussion on sexual morality, parenting and of control of women in what is reported to be a sexually permissive culture.

2.3 Outcomes 2.3.1 Identifying ‘Need’ The broad reach of the FGM initiative means that the projects are often located in very different contexts, and this has clearly influenced where they perceive ‘need’ to be located. In some areas, there are much more dense populations of newly arrived groups, who may be highly mobile – those in some part of London for instance, may choose to move on to other areas. In other areas, there are more ‘settled’ communities, where community-based projects have used their more long-standing reputation and engagement with communities to produce bolder resources using ‘voice’, moving beyond face to face and workshop-type formats. At the outset, many projects identified working with women who were themselves affected by FGM as both ethical imperative, as well as a ready means of reaching women in affected communities, to encourage reflection and enable them to make different choices for their own daughters if they may be at risk of FGM. Project workers who offer support to women affected by FGM has become one of the services most in demand, with clearly increasing rates of referrals in several projects, an indicator of rising levels of trust in some communities. This work has also been important in gaining insights into where to focus efforts to address FGM – for instance, in linking the types of arguments used to support FGM with efforts to address it, and in identifying communities where ‘need’ is highest. Some of the better known agencies, such as BWHAFS, are identifying emerging communities with high levels of reported FGM, as practitioners increasingly refer these cases to them. However, it was also evident that not all of the projects are well placed or able to provide support to women affected by FGM, and that in some places, the sensitivities around FGM are still acting as a barrier to accessing these kinds of inter-personal support. The evidence to date suggests that FGM will be and is a practice that evolves dynamically, for instance, as awareness increases of the law, or as people become more aware of more focus on the issue. Groups engaged in these ‘community conversations’ are well placed to identify how FGM is evolving. 2.3.2 Raising Awareness Legal Aspects Many projects are still reporting that levels of awareness about the legal aspects of FGM is low among the general communities in which they work – this is particularly in projects which are working with new participants, and demonstrates the continued need for projects to focus on the basics of FGM awareness-raising. Many of the groups are reporting that newly arrived communities (not surprisingly) have little awareness of the law, and that members are often unlikely to have access to channels where they would gain this awareness. Many of the project workers reported that participants in awareness-raising activities are shocked to find out the length of the sentence for committing FGM, or that the offence is punishable even if committed abroad. In some areas, however, there have been efforts to better integrate this message into channels that target newly arrived communities, for instance, through ‘Welcome Packs’ that people disbursed to some areas are given. The focus on ‘raising awareness’ however demonstrates the complexity of tackling FGM. Some of the project workers felt that there is a risk in these kind of simple message around

FGM, not only in pushing the practices to become less visible (making it harder for women to access care), but also in further alienating people from services. Related to this point is interventions that address attitudes towards child protection. While actual prosecutions of those who have practised FGM are reported to be known to be low, much of the preventative messaging around FGM revolves around the risk of losing children in cases where it may be practised. Though these cases are still low in numbers, the evidence demonstrates that this threat is actively used by members of concerned family or others to prevent FGM (for instance, in increasing referral rates to community organisations by concerned relatives). However, as will be explored below, this has in some cases meant that there has been a rather heavy handed response to safeguarding ‘children at risk’, and in some cases, there is a risk that messaging being given out by agencies themselves are too punitive. As one respondent highlighted, “the key message that women are getting from these services is ‘you are barbaric, you will break the law, we are scared of you’”, and thus that these messages need to be tempered. The ‘best practice’ examples of projects working on the legal aspects of FGM also include more insightful discussions about duty to protect, the reasons for the law, and other messages that involve in various ways consent and the sanctity (religious and non-religious) of bodies. Health Aspects of FGM Many if not all of the projects have focussed on discussing the health effects of FGM – many have assumed that understanding of the negative health aspects of FGM axiomatically entail non-support of FGM. Health-related counter-arguments are some of the more effective, easy to understand and to deliver messages. Discussion of these aspects of FGM have been important in linking ‘harm’ to the practice – it was often reported that those who worked with women who had had FGM done that they did not link the health problems that they had been experiencing with FGM, but that when this then became clear, some would be more open to not supporting FGM. The strength of health-related arguments provide strong support for countering pro-FGM arguments, but there has been a risk identified early on in the evaluation of the initiative that ‘less harmful’ forms of FGM (such as ‘Sunna’) would become more acceptable, and that thus there was a need for more rights-based counter-arguments. Many projects reported that one of their major challenges were still women who had had FGM but had experienced no health problems themselves, and some projects are now advocating that a rights-based focus should come to the forefront of the strategy. Increasing Awareness of FGM In some projects, there were some reports of resistance to talking about FGM, partly in response to its increasing prominence. This may not be because people are supporters of FGM per se, but was often reported to be due to a lack of prioritization as communities or some ethnic groups faced other issues that they felt were of greater importance (immigration, young people, the impact of communities of the counter-terrorism agenda). There is an ongoing issue about how FGM is talked about, specifically its association with some ethnic groups (such as Somalis) and how this is presented. However in some cases it was clear that there was resistance to FGM as an issue being more widely talked about, especially if it is perceived as increasing this association with

certain ethnic groups. Many of the projects have been careful to negotiate these sensitivities, but have clearly had to confidently put the case that this is an issue that needs further public discussion. The development of participatory resources that can be used and stimulate public discussion are thus a key indicator of success in moving increasing the anti-FGM ‘voice’ and reaching wider audiences. As will be explored below, a key outcome has been the development of more confident advocates among the community-based organisations, and this has been reflected in the strong development of some counter-arguments to FGM, and the confidence with which these are delivered. There is clear evidence that some of the advocates are developing more certainty over which approaches ‘work’, and how these messages are more effectively delivered. 2.3.3 Reaching Wider Groups It was noticeable that in this phase of the project, some of the projects have moved beyond some of the social groups which could be seen as ‘easy wins’ – for instance, it has been a common finding that younger people are easy to mobilize and have taken part in the earlier phases of the project. At this point, many of the groups have started to include and target other groups, and this has included working with men, working with policy-makers and practitioners (explored below), and across different ethnic groups. There is some evidence that these approaches have some advantages, but implementation of this approach has been patchy across the projects. BSC, for instance, has implemented workshops that have targeted both women of Somali and Sudanese descent, and conversations about the different ways in which FGM is practised appear to have broken down firmly held beliefs that it is a concrete, immutable practice. These discussions highlight cultural variations in the practice, and the harms that these bring. While initially projects have wanted to focus perhaps on ethnically/cultural groups which whom they are more familiar, mixed audiences have in fact worked well, and advocates are developing more confidence that this approach works. 2.3.4 Working with men To date, there have been several key findings in working on FGM with men, which the projects which are attempting to work with men have highlighted. Firstly, there is an assumed demand from men for FGM in women, but there is little evidence that this is currently an ongoing, widespread pattern of demand. This may vary significantly by cultural group however, and there is simply not enough evidence of this at present to validate this. Work with men to date has corroborated research findings that men have low levels of knowledge of what the act of FGM actually entails, or its health consequences. Mixed forums have worked well in providing information on this, and these events have highlighted how some men are willing to publicly voice their opposition to the practice. This is crucial to break down the assumption that women who do not have FGM face few future marriage prospects. There is clearer evidence that opposition is more visible among younger generations, echoing their female peers. Screenings of OSCA’s film and play on FGM also resulted in public discussion and openly voiced support from male members of the audience. BSWAID has also continued to provide inter-personal support and health advocacy in the FGM clinic in Birmingham, and has found little if any support from FGM among male partners accompanying their female partners to clinical services.

Nonetheless, there is a common finding across projects that men have been difficult to engage, and that projects are often facing opposition in their attempts to engage men. Across a range of projects, it was common to find that men viewed FGM as a ‘female problem’, and thus would not join in groups or activities on this issue. Some projects have tried to use religious leaders to work with men, but again, have met with little success. Lack of engagement from men may mean that men are simply not interested, or do not see the relevance of FGM to their own lives, rather than being covert supporters of the practice. Often in inter-personal work, men state quite clearly that they do not support FGM, but if this work is to move forward, then relying on these inter-personal methods is not going to reach many people. It is clear that this avenue of work requires further development, working with ‘lessons learned’ to date. Despite disappointing progress in this area, the ‘best practice’ examples of working with men have encompassed a shift in viewing FGM as a practice that is uniquely directed by women on girl children (for instance, of the grandmother towards the girl child), towards a practice where men should be involved in the decision-making within the family, with an equal duty to protect. Men appear to be being more responsive in mixed audience forums, where FGM can be presented as a ‘general’ issue, and where fruitful discussions on the impact on FGM can be had. 2.3.5 Working with Volunteers Many of the projects are working with volunteers which can lead to more effectively increase the reach of projects beyond the work of project workers alone. Many of the projects use a capacity-building approach, working with a network of community-based volunteers. As is commonly found in projects that use volunteers, project workers do need to dedicate resources and time to not just recruiting, but also maintaining and training up new recruits, to keep the momentum among volunteers going. There is also wide variation in the approach to working with volunteers among the projects – organisations who have more experience in this work, and with more available resources to support volunteers, clearly can embrace a much more developed model of working with volunteers. BSWAID, for instance, have now developed four groups and despite losing some funding and having to cease support to two of these groups, they are still active. BAWSO has also actively developed a capacitybuilding model, which has developed informal networks of women affected by FGM in new communities. In some cases, however, it is still apparent that volunteers are being principally seen as a mobilizing or informational resource, rather than being active champions of antiFGM work. This probably needs further probing – skills and capacity development may require further expertise that smaller organisations struggle to find. This is a crucial issue for the initiative, as it considers workable models that can extend the reach of anti-FGM work in future phases. 2.3.6 Working with Religious Leaders There are several important outcomes that have been achieved through engagement with religious leaders. It has rightly been a focus of the work, as early research found that FGM is commonly believed to be a religiously-sanctioned tradition. In some cases, there is still anecdotal evidence that a few religious leaders have been openly condoning ‘less harmful’ FGM, such as ‘Sunnah’ (Type 1), but on the whole religious leaders have been strongly supporting of FGM, often viewing it as a cultural practice. In fact this view appears to have

acted as a barrier to engaging religious leaders, who do view themselves as having a mandate to rule on ‘cultural matters’. Many of the projects are working with religious leaders in some way. The initiative also funded a separate piece of work, led by organisations within the initiative (Manor Gardens and others), to have clear religious-based messaging on FGM being against religious principles. This was also built on by OSCA’s multi-media work, which also included religious messaging. Many of the projects appear to be waiting for this resource to be available for wider dissemination, to start integrating these religious messages into their prevention work. Identifying religious leaders who are supportive, informed, and willing to take part in advocacy events has been a key outcome achieved in the project, which has demanded the investment of a lot of resources. It is also clear that another key outcome has been that project advocates themselves have become more confident in using and deploying counter-arguments that have a religious principle. This includes, for instance, arguments for the sanctity of bodies (that altering bodies is against God’s creation), or that maintaining a ‘clean body’ (before praying) is harder when FGM is practised. This contrasts with earlier stages of the project, when advocates were uncertain of how to engage with religious principles (principally within the context of Islam), and whether there was a clear religious anti-FGM mandate. Some projects have also made clear in-roads into religious social networks, for instance, AAF and other projects work with women only networks, such as ‘Sister Circles’, or with female religious teachers in ‘Madrassas’, who have themselves become keen advocates. Many of the projects seem to be holding out for a speech in Friday prayers as an indicator of success of engagement with religious leaders, but it’s not really clear if this is actually a feasible desire, or if this is really necessary for tackling under-lying beliefs. Some projects have also found that they have invested substantial amounts in liaising and engaging with a particular set of religious leaders, and then finding that other mosques/faith leaders have wider networks in other communities. The scale of work required for engaging with religious leaders is clearly a daunting task for most projects, and it also leaves unanswered questions of how and what advocates in more remote communities, such as those outside of London, will do if they cannot engage local religious leaders. There are issues to be articulated about how to best capitalize on this area of work. While some are still continuing with this stream of work, others feel that religious institutions are inherently male-led and conservative and unlikely to engage more widely in FGM – this may be overly pessimistic. Where religious leaders have been engaged, it’s clear that they have done so under the guise of a wider role, reaching out to their communities, rather than delivering religious teachings within their own sphere. As advocates point out, there are religious leaders who have enthusiastically supported advocacy, and who are valuable resources to clarify religious positions. Some involved in this stream of work want to see development of a peer-led approach – highlighting that this work is nascent, and that there is a risk that religious leaders will find themselves isolated unless they are also brought into a peer supported network. While projects have identified religious supporters, these people are best placed to identify other religious entities for scaling up this work, and ensuring that it is not a disparate collection of efforts in the individual communities where projects work. In the meantime, it is recommended that organisations focus on using female social networks within religious institutions, and make better use of resources that have been developed through the initiative that counter beliefs that this is a religiously sanctioned

practice. Future learning should focus on sharing religious counter-arguments that have ‘worked’, and how to integrate these with a rights-based approach (see below). 2.3.7 Integration of a rights-based perspective Integration of a rights-based approach to work against FGM was viewed as essential by some projects. It has become clear that some organisations, who are more broadly involved in either a domestic violence or violence against women agenda, are more willing and active in integrating a rights perspective. However, this has been patchily implemented in other projects. As explored above, those organisations that do talk about and engage with a rights agenda see this approach as being vital to combating all forms of FGM. In practice, it is interesting to note that some projects appear to be co-locating a rights-based perspective along religious arguments – there are clearly some synergies among these that have been used. This is especially clear in projects that have talked about the role of the parent towards children (at risk of FGM), which religious leaders have discussed in some forums, for instance, talking about the importance of respecting the child’s right to consent or refuse certain cultural practices. In a few cases, there is a clear need for some projects to gain more understanding of a rights-based approach, instead of viewing it as an abstract concept with limited applicability to their work. This has been a consistent finding of evaluation reports which needs further exploration – there may be concerns particularly in Muslim communities that talking about rights of women will entail portraying women as oppressed, as these advocates refute the need for a rights-based argument on the basis that the women that they work with are empowered. This may be partly also due to the gendered nature of the ways in which FGM is practiced, for instance, in Somali communities, this is primarily viewed as a practice that is led and decided by women, which is not the case among other African ethno-cultural groups. However, this is to fundamentally misunderstand the gendered nature of social relations. It is also important to note that advocates in this situation tend to be more comfortable emphasizing the importance of child rights, and not of adult women’s rights, which in the longer-term may make empowering adult women’s voices less focused. Future learning events are planned to address the integration of rights-based approaches, and advocates need practical examples of the conversations that this approach entails. While the initiative has not been prescriptive of the kinds of approaches that can be taken to activities, project workers should at least be conversant with these approaches, and how they can be applied in counter-arguments. In the longer-term, the ‘value added’ of the initiative will be stronger if the strategic vision for the integration of a rights based approach across all ages/life course is clarified. 2.3.8 Working with policy-makers and practitioners Work with policy-makers Work with policy-makers has progressed rapidly in many of the projects, but in some cases has been hampered by cuts and the flux in the health and social care systems. Some of the most demonstrable impacts have been in groups that have been in liaising with Safeguarding committees, and those that have a political commitment to developing local responses to violence against women also appear to be more able to push forward and integrate FGM into local strategies. In Birmingham, for instance, BSWAID have been able to have FGM included in the violence against women and children strategy, and in London

AAF advocated successfully for this in Lambeth, and consequently a local DV centre that is currently being set up will also be doing sign-posting to AAF for clients affected by FGM. Cuts to safeguarding committees are however taking their toll – several projects have found that their work is more arduous and that entry into schools, for instance, is becoming harder as Safeguarding leads no longer actively push for this entry point. In some cases, subcommittees work with FGM advocates, particularly those led by midwifery staff and adult safeguarding leads. FGM policy forums, such as that set up in Birmingham, have greatly facilitated engagement with practitioners, but have found maintaining engagement arduous in an era of cuts. A few projects have been trying to make headway into the newly formed Health and WellBeing Commissioning Boards, with limited success. However, this is a critically important local policy forum, where future decisions about reproductive health and other services probably including those for women affected by FGM, will be made. More concerted efforts need to be made to engage with this forum as it evolves. Future engagement with local policy leads needs to explore what impact local level advocates have had the development of local policy and to tease out what has had an influence, since the FGM agenda is also being more widely pushed. Engagement with health practitioners Some of the most clearly demonstrable impacts of activities has been joint working with health staff, most prominently midwives, especially those involved in delivering specialist clinical services. Joint working has worked well in mixed forums, and advocates have felt that the credibility of health staff’s voice has been an important component in tackling proFGM sentiments. Advocates are nonetheless aware of the need to widen this approach to other health staff involved in the identification, assessment and referral of women affected by FGM. This has often meant General Practitioners, and a few projects have made good headway in developing resources for GPs, raising their awareness of the issue of FGM in the communities where they work. It has nonetheless been the predominant pattern that groups trying to establish contacts with clinical commissioning groups and individual GP practitioners have met with a lukewarm response. Thought needs to be given on how strategic links can be made with health practitioners beyond general approaches. GPs often work on the basis of development of ‘special interests’ – greater traction would be gained by working with GPs who are already interested in family planning/reproductive health and sexual health. Research has shown that identification and referrals of women who have been physically abused increases when GPs know where to refer to, and have developed a trusting relationship. A key focus of future learning should be to look at how GPs have become involved in other areas of reproductive health and testing the applicability of these approaches to FGM prevention. Better use could be made of already available resources, for instance, GPs have access to an online elearning programme on FGM. Groups could promote this more effectively, as rather than aiming to deliver training themselves. There are also numerous national guidance for health care staff that are available and that advocates can use to engage and support health practitioners’ involvement.

Engagement with Social Care practitioners Though absolute numbers of referrals from social care agencies remain low, it is evident that projects and FGM advocates have become known to local social care agencies. Perhaps it’s a reflection of the integration of FGM into local response to violence against women and children (VAWC) policies, but there is clear evidence in some cases of social workers actively seeking out engagement with FGM projects. BAWSO’s resource pack for professionals was initially designed for health professionals but has come to also be relied on for social workers. Projects are in some cases being seen as a valuable local resource for work with families with children ‘at risk’ of FGM. This has been important for projects, who are in individual instances following this up with families who do actively support FGM. However, the implications for the projects’ work is mixed – while it was hoped that addressing FGM would be mainstreamed and that social workers, among other practitioners, would be more supported to raise issues to do with FGM and to have these difficult conversations, in practice they appear to be relying on FGM advocates to become more involved. While this is to be welcomed, local social care departments of course do not pay for this work. In the individual instances where advocates have been contacted, they have a clearly valuable role in supporting families in culturally sensitive ways, and it’s not entirely obvious that this supportive approach to delivering these messages would happen without the advocates’ involvement. This is likely to be the reality in the era of austerity. There is nonetheless more that could be done to temper and guide a more appropriate response by social services, and a few project advocates still felt uncertain of how they should respond when contacted by concerned people reporting a potential case of a child ‘at risk’. Expertise in child protection and responding to these kind of cases could be shared more widely. Organisations who work in violence against women, for instance, routinely give this kind of advice, and are much more confident in responding to these kinds of requests. As explored above, there is also a need for some work to be focused on confidently guiding and engaging with social care and child protection responses. The ‘best practice’ responses, such as that used by BSC, have recognised that there is a risk that messaging that focuses on child protection in and of itself can further alienate an already alienated population, and create further distrust. Fear of social workers, and of children being taken away from families, is described as being widespread in many African communities, and this can be interpreted in part as resulting from a cultural clash of values of parenting methods. BSC have thus also included sessions that further understanding of social workers, their role and how they can support families, as well as why child protection policies are in place. In some areas, there is a very heavy handed social work/child protection response – this may be a greater risk in smaller urban areas. For instance, in Liverpool all children of women from countries where FGM is highly prevalent with children are put on the child protection register, and in an area of East London, individual cases of women with children are also being referred to social worker agencies. In some cases, it is clear that local policies should clearly dictate the risk criteria under which cases should be referred for a risk assessment. Work with Schools A few projects have gained entry into schools and conduct awareness-raising sessions. In some cases this was a stated aim of project activities, but which did not come to fruition. Some groups have found making contacts within schools difficult – others have decided to

re-focus their efforts on places such as Children’s Centres or to work with parents associations. Projects have therefore found ways to work around the school environment without necessarily focusing on female school children in and of themselves. This is a complicated component of projects’ work, especially if the focus is on getting national impact. Schools have a very strong Safeguarding role, and those cases that have been identified have often originated from identification by school authorities. They appear to have more potential for involvement in the identification of young women at risk than, for instance, GPs do, and this has been broadly reflected in greater responsiveness of schools to the issue compared to GPs. Sessions in schools also can only expect to deliver general awareness of FGM to a generalist audience (which may include numbers of people from affected communities, however), which contrasts with other more youth-led work. Several projects however had deep qualms about using schools as a location for awareness-raising sessions with young women/girls themselves, and this appeared to reflect community concerns in these areas. There was a concern that FGM would become predominantly associated with some communities (principally Somali groups). Projects have been careful to talk about the range of geographical areas where FGM is practised, but there is still a concern that this approach will stigmatize children from affected communities. Awareness-raising in schools could probably focus more on integrating FGM into wider messages about violence against women and children.

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

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

3. 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. f) 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 has been some progress in working with mixed audiences and in attributing responsibility to a wider range of actors – including religious leaders, men, and younger people in their role in protecting younger siblings. 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’). g) 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? h) 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. i)

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. j)

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.

About The Funders and Evaluators Esmée Fairbairn Foundation

Trust for London

www.esmeefairbairn.org.uk

www.trustforlondon.org.uk

Esmée Fairbairn Foundation funds the charitable activities of organisations that have the ideas and ability to achieve change for the better. Its primary interests are in the UK's cultural life, education and learning, the natural environment and enabling disadvantaged people to participate more fully in society.

Trust for London is one of the largest independent charitable foundations in London, providing grants to the voluntary and community sector of over £6 million per annum. It aims to enable and empower Londoners to tackle poverty and inequality, and their root causes. Established in 1891, it was formerly known as City Parochial Foundation.

Kings Place, 90 York Way, London N1 9AG

6 Middle Street, London EC1A 7PH

t: +44 (0)020 7812 3700

t: +44 (0)20 7606 6145

e: info@esmeefairbairn.org.uk

e: info@trustforlondon.org.uk

Registered Charity No. 200051

Registered Charity No. 205629

Rosa

Options UK

www.rosauk.org

www.options.co.uk/uk

Rosa is the first UK wide fund for projects working with women and girls. Rosa’s vision is of equality and social justice for women and girls and a society in which they:

Options UK is the UK programme of Options Consultancy Services Ltd, a leading international provider of technical assistance,consultancy and management services in the health and social sectors.

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are safe and free from fear and violence;

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achieve economic justice;

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enjoy good health and wellbeing;

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have an equal voice.

Options UK was launched in early 2006 to provide technical expertise to service providers, policy makers and commissioners in the UK. Working with the NHS, LocalAuthorities and Third Sector organisations,the multidisciplinary Options UK team provides fresh, innovative and practical advice, support and solutions to providers and commissioners of health and social care services.

Rosa will achieve this by championing women and girls, raising and distributing new funds and influencing change. Ground Street,

Floor

East,

33-41

London EC1V 0BB. t: +44 (0)20 7324 3044 e: info@rosauk.org Registered Charity No. 1124856

Dallington

Contact: Eleanor Brown 20–23 Greville Street, London EC1N 8SS t: +44 (0)20 7430 1900 e:e.brown@options.co.uk