The 23rd of June 2019, I attended a symposium about the prevalence of Female Genital Mutilation/Cutting (FGM/C) in the Netherlands entitled 'Every Girl Counts' (in Dutch: Elk meisje telt). The symposium was organized by Pharos and took place in theatre De Vaillant in The Hague. During the symposium, the research results of a study on FGM/C prevalence entitled "Female Genital Mutilation (FGM) - Size and risk in the Netherlands" (in Dutch: Vrouwelijke Genitale Verminking: Omvang en Risico in Nederland) was presented. The programme of the symposium can be downloaded here.
Pharos (Dutch Centre of Expertise on Health Disparities)
Pharos is a centre of expertise in the field of health disparities in the Netherlands. The organization aims to reduce major health differences in the Netherlands, as there is currently a significant difference between groups in terms of quality and accessibility of care and prevention. The organization's main expertise focuses on sustainable improvement of the quality, effectiveness and accessibility of care, especially for people with limited health literacy, non-western migrants and refugees. Pharos is also the 'national knowledge centre' or 'Focal Point' for the prevention of FGM/C in the Netherlands. For more information, please see their website.
Opening of the symposium
The symposium started by a wonderful speech of the chair: Shantie Jagmohansinh. She currently works for the municipality in Rotterdam as a senior policy manager in the field of violence against women and child abuse. She introduced the theme of the symposium and explained that there is nothing wrong with cultural traditions as they can be very beautiful. However, some of those traditions are very harmful as they interfere with the right to self-determination and a safe domestic life. She recited a poem by the Somali writer Dahabo Ali Muse, that expresses the pain caused by FGM/C: “It is what my grandmother called the three feminine sorrows: the day of circumcision, the wedding night and the birth of a baby.”
After her speech, Leon Noorlander, deputy director of Pharos, welcomed the audience. He gave a short presentation of the work of Pharos, including the research they have conducted in various fields over the past years. He also introduced the study "Female Genital Mutilation (FGM) - Size and risk in the Netherlands," which was carried out in 2018/2019 in collaboration with Erasmus MC on prevalence and incidence of FGM/C in the Netherlands. The research was funded by the Dutch Ministry of Health, Welfare and Sport. You can find the rapport here and an infographic with main research results here.
Quantitative part of the research
Ramin Kawous (Researcher and Project Manager at Pharos) conducted the quantitative part of the research and present the results afterwards. He explained that the main aim of this part of the study was 1) to estimate how many women that have undergone FGM/C live in the Netherlands (prevalence), and; 2) to estimate how many girls that currently live in the Netherlands are at risk of being cut in the future (incidence). In short, they found that at the 1st of January 2018, approximately 95.000 women live in the Netherlands from countries where FGM/C is prevalent (mostly Somalia, Egypt and Ethiopia). Approximately 41.000 (43%) of those 95.000 women have undergone FGM/C and approximately 15.000 underwent the most severe form of FGM/C (infibulation). It has been estimated that 4.200 of 38.000 girls aged from 0 to 19 years are at risk to undergo FGM/C in the next 20 years.
Qualitative part of the research
Anke van der Kwaak (researcher at KIT Royal Tropical Institute) presented the results of the qualitative part of the research. The aim of this part of the study was to map the knowledge, attitude and norms in relation to FGM/C. In total, 55 people were interviewed (40 women and 15 men) from countries where FGM/C is the most prevalent, both first and second generation. The period they had stayed in the Netherlands varied from 1 month to 47 years. The following topics were discussed during the interviews: (1) socio-demographic characteristics (including country of origin and years of stay in the Netherlands), (2) knowledge about FGM/C (including on health risks and legislation), (3) attitude towards FGM/C, and (4) subjective norm (including social pressure). In short, they found that the participants (especially women) have a lot of knowledge about FGM/C, including the harmful health consequences, but that social pressure to continue with the practice is still very strong. Some interviewees said for example that they are afraid to go on vacation to their home country. Another finding of their study is that the Dutch legislation about FGM/C is unclear, which I found very interesting. In addition, Anke explained that there is no indication that FGM/C happens inside the borders of the Netherlands, but there have been rumors that it happens in other countries. Lastly, the research found that it is (still) hard to bring up a conversation about FGM/C.
After the research was presented, we watched a play about FGM/C from the Foundation 'Me & Society'. The performance was about a girl who is afraid to talk to her boyfriend about FGM/C. Her aunt and grandmother share their experiences with her and encourage the girl to bring up the conversation. As the topic of FGM/C is often not discussed among young people and young adults (for example because of cultural differences, but also because of shame, fear, prejudice or ignorance), the aim of this performance is to make the topic of FGM/C more accessible and to create a safe environment to talk about it. This performance has been done at many high schools and the working method proved to fit well in relation to opening up the taboo subject. At the end of each performance, the students are questioned and involved in a discussion by dialogue counselors. At the symposium, the audience was given the opportunity to ask questions. The actors shared their experiences in terms of reactions of students and explained that during the group discussions after the play, young people come to them with their stories and ask for help. To my mind, this is a beautiful example of how a sensitive topic as FGM/C could be discussed among people from a younger generation.
Speech of the Ministry of Health, Welfare and Sport
After a short break, Marieke Kleiboer (Director of Social Support) gave a short presentation about the efforts of the Dutch government in relation to FGM/C. She explained that the interest in FGM/C at the political level in the Netherlands fluctuates, but that it is important to always keep on working in the field of FGM/C, and especially to increase awareness about the practice. In addition, she stressed that there is a need for professionals (including health professionals and teachers) to recognize symptoms of FGM/C at an early stage.
After the plenary presentations, four one-hour expert sessions were organized simultaneously. The aim of these sessions was to have an in-depth discussion about a specific theme and to formulate recommendations in relation to policy development for the Ministry of Health, Welfare and Sports. After these sessions took place, the chair of each session gave a summary of what has been discussed.
Session 1: Prevention
Marthine Bos (Project Manager Prevention FGM/C, GGD IJsselland) led the session with the theme prevention, which resulted in the following points of attention: 1) FGM/C should be incorporated as early as possible in education programs of the health care sector and in the curricula of students. 2) There should be more attention for building bridges between the Netherlands and countries of origin as we can learn from each other in terms of how to prevent FGM/C. 3) Social media can play an important role in that regard. 4) Chain partners should meet more frequently with each other: first on local levels, then on regional, national, but also at international levels. 5) information about FGM/C should reach a large variety of people: not only girls and women, but also elderly and men.
Session 2: Health care
Marjan Groefsema (Project Manager FGM/C, GGD GHOR Netherlands) led the session about health care. The session resulted in the following action points: 1) All physicians should have basic knowledge about FGM/C. 2) An overview should be developed for victims of FGM/C per region in the Netherlands with information about each profession that victims could contact. 3) A national fund should be established for women who have undergone FGM/C, but who do not have the means to get the necessary help in terms of health care. 4) Health care sessions should be organized where midwives share their knowledge so that victims are referred to the right person/organization/authority.
Session 3: Law enforcement
I was invited to chair the session about law enforcement, where we identified several problems in relation to the Dutch law prohibiting FGM/C as well as problems related to FGM/C as a ground for asylum: 1) The first problem related to FGM/C asylum cases, as the Country of Origin information (Ambtsberichten) of the Ministry of Foreign Affairs often does not provide a correct picture of the situation on the ground. 2) Another problem in asylum cases is the lack of knowledge and cultural sensitivity about the context in which FGM/C takes place among officials who work at the Immigration & naturalization service. It was therefore suggested that these professionals should be trained on FGM/C. 3) In the third place, it was suggested that the different ministries that are working in the field of FGM/C in the Netherlands should collaborate more (for example the Ministry of Health, Welfare and Sports and the Ministry of Justice and Security). 4) In relation to the law criminalizing FGM/C, a well-known problem that was discussed is the lack of court cases. 5) The last point we discussed was one of the research findings, namely the lack of knowledge on legislation prohibiting FGM/C in communities. We discussed how we could make sure that the law is clear for everyone, especially for communities from practicing countries.
Session 4: Research
The final session about research was led by Alex Burdorf (Head of the Department of Public Health of the Erasmus University Medical Center). Three idea’s for further research were discussed in his group: 1) Mapping the best practices on how to eliminate FGM/C, as there is a great diversity in possibilities. 2) How to make it easier to recognize girls who are at risk at undergoing FGM/C and to identify who is responsible for what group? 3) What methods/approaches the countries of origin use for preventing FGM/C?
At the end of the symposium, we watched a video of Pharos which summarizes the main research results. Shantie Jagmohansingh closed the meeting with the poem cited above: “I appeal to all peace loving people to protect, to support and give a hand to innocent little girls.” Afterwards, there was time for drinks and networking.I would like to thank Pharos for the invitation to attend this symposium and to chair the session on law enforcement. I really enjoyed it!