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Friday, 10 July, 1998, 14:58 GMT 15:58 UK
Female 'circumcision by words' gains ground
Kenyan women
'Circumcision by words' is catching on in parts of rural Kenya
A new ritual which provides an alternative to female circumcision could become one of the most significant measures for improving women's health worldwide, according to a report in The Lancet.

Ntanira Na Mugambo, also known as 'circumcision by words', has been developed in rural areas of Kenya by local and international women's health organisations.

Started as a small project in 1996, it has already meant that 300 young women have avoided the traditional process of female genital mutilation.

Ntanira Na Mugambo involves a week-long programme of community education about the negative effects of female genital mutilation, culminating in a coming of age ceremony for young women.

Controversial

Female genital mutilation has become one of the most political areas of women's health. It is mainly carried out in western and southern Asia, the Middle East and large areas of Africa.

It is also known to take place among immigrant communities in the USA, Canada, France, Australia and Britain, where it is illegal. Around 100 million women have been circumcised and it is estimated that two million a year undergo the process which is potentially fatal.

There are three main types of circumcision: one involves removal of the tip of the clitoris; another involves total removal of the clitoris and surrounding labia and in the third, infibulation, the clitoris and labia are removed and the vagina is sewn up, leaving only a small opening for urine and menstrual blood.

The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls 'unclean' and unmarriageable if they have not been circumcised.

Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.

Unsanitary

Health workers say that the operation is often carried out in unsanitary conditions with no anaesthetic and can lead to serious infections. Some girls die as a result of haemorraging, septicemia and shock.

The Lancet
The Lancet: Ntanira Na Mugambo could reduce female circumcision
It can also lead to long-term urinary and reproductive problems.

Due to health campaigns, female circumcision has been falling in some countries in the last decade. In Kenya, a 1991 survey found that 78% of teenagers had been circumcised, compared to 100% of women over 50. In Sudan, the practice dropped by 10% between 1981 and 1990.

Several governments have introduced legislation to ensure the process is only carried out in hospitals by trained doctors.

Less confrontational

Egypt has banned the operation altogether, but there is significant opposition to change because of the traditional nature of the process and health workers think a less confrontational approach, such as Ntanira Na Mugambo, could be more successful.

It has been developed by the Kenyan organisation Maendeleo Ya Wanawake and the international women's health organisation, the Program for Appropriate Technology in Health (PATH), following studies into its use and cultural norms and expectations.

Originally piloted in one community in 1996, it has now extended to 13. Health workers claim its success is due to its whole community approach to the issue.

The girl is secluded for a week and undergoes classes in reproduction, anatomy, hygiene, respect for adults, developing self-esteem and dealing with peer pressure. Her family also undergoes health education sessions and men in the community are taught about the negative effects of female circumcision.

Writing in The Lancet, Cesar Chelala says: "Because the rite does not exert a blunt prohibition on female genital mutilation being practised in Kenya, but offers an attractive alternative, it is possible that it may become the most successful strategy towards more widespread elimination throughout the world."

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