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KAMPALA, Uganda, 24 June--At a round table on reproductive health and rights, the manager of a community project in East Africa and the representative of a north European non-governmental organization (NGO) offered suggestions on how to eliminate the practice of female genital mutilation (FGM) in indigenous and migrant populations. The meeting also considered other forms of violence against women, and the prospects for self-sustaining reproductive health programmes run by NGOs.
Fifty experts from around the world are attending the Expert Round-table Meeting on Ensuring Reproductive Rights and Implementing Sexual and Reproductive Health Programmes, Including Women's Empowerment, Male Involvement and Human Rights. The UNFPA-organized event at the International Conference Centre here is part of ICPD+5, a year-long evaluation of progress in the five years since the 1994 International Conference on Population and Development (ICPD) in Cairo.
The tone of Wednesday morning's discussion on FGM--under the theme of gender-based violence--was set by Jackson Chekweko, project manager of one of the world's most successful efforts to eliminate the scourge.
Uganda's Reproductive, Education and Community Health Programme (REACH) has ended the practice in the eastern district of Kapchorwa, just two years after its launching in 1996.
Jackson Chekweko, project manager of Uganda's Reproductive, Education and Community Health Programme (REACH), which has ended the practice in the eastern district of Kapchorwa, just two years after its launching in 1996. The UNFPA-supported programme works with elders, peer educators and health workers to create positive cultural values and empower girls through education. REACH's involvement of community elders in free discussion of FGM and other reproductive health issues resulted in the 1998 United Nations Population Award being given to the Sabiny Elders' Association.
The award will be presented in New York next month.
REACH succeeded, Mr. Chekweko told participants, by separating FGM from the cultural values it was supposed to serve, proposing alternative activities to sustain those ideals, and reaching out to the custodians of community ethics. The approach grew out of a 1995 workshop of leaders, local elders, politicians, clergymen and youth representatives.
The new approach was sought after a 1989 effort by the Ugandan Government and some women's activists to ban FGM in Kapchorwa led to a backlash in the district's Sabiny community, which took offense at what they saw as attempts of "outsiders" to judge their culture as barbaric.
The number of women who accepted FGM increased substantially as a sign of resistance to outside interference. At one point, Kapchorwa District even passed a law requiring the circumcision of all women.
Mr. Chekweko recommended that culture-sensitive actions to empower women and curb FGM should be taken in other parts of Africa, where it is practised in nearly 30 countries. He said local communities should occupy central positions in implementing any programme, and that governments in consultation with communities should design laws to protect women from all forms of violence. Discussions of FGM should be included in school curricula, and culture-sensitive research undertaken. Those who earn their income by performing the practice need to be shown alternative ways to support themselves, he added.
Ylva Sorman Nath, of the Foundation of Women's Forum in Sweden, spoke about efforts to eliminate FGM in her country, where it is practised among some Somali migrants. Sweden has banned FGM as a violation of women's rights and independence, and has incorporated guidelines about the practice into education and mother/child health programmes.
"Legislation is a tool, but it has to be combined with preventive work," she stressed.
Ms. Nath said a project in the city of Gothenburg works with Somali doctors, African migrants, nurses, and schools to discourage FGM. These efforts have succeeded in curbing the practice, even though many Somali women still feel it is necessary to keep their daughters eligible for marriage. She proposed encouraging religious leaders to emphasize that the practice is not required by any faith, and asking the media to highlight the ills of FGM and encourage its elimination.
Wanda Nowicka of the Federation for Women and Family Planning, a Polish NGO, argued that the health and education sectors in her country needed to adopt a stronger stance to fight violence against women, one which recognizes that "women and girls are victims of violence simply because they are women". She recommended sex education that promotes gender equality, and the use of the media and advocacy tools to end the "culture of silence" on gender-based violence.
Among many who spoke in the subsequent discussion, Anika Rahman of the Center for Reproductive Law and Policy noted that "violence against women is global; it's endemic." Said Malika Ladjali of the World Health Organization, an Algerian, "In my country, 2,000 women were killed in two years just because they were women."
The round table then moved to the theme of access to reproductive/sexual health and family planning services. A session on the participation of the private sector, including NGOs, in the provision of reproductive and sexual health services focused on PROFAMILIA, a financially self-sufficient NGO which provides more than 60 per cent of Colombia's family planning services along with legal services specializing in family law. Maria Isabel Plata, the group's executive director, spoke about the group's experience, and answered questions about its applicability in other countries.
"A successful sexual and reproductive health programme generates its own momentum," she stated. PROFAMILIA started distributing contraceptives 30 years ago, at a time when pharmacies would not carry them. It encountered opposition from the medical profession and the Catholic Church, but the Government "left us alone," and the programme grew by offering quality services. While donor support was critical to this success, the group now has enough income to subsidize services in poor and hard-to-reach communities and for teenagers, a development facilitated by recent reforms in the national health system.
Ms. Plata stressed the importance of NGOs being politically independent and constantly correcting their mistakes. She also said the reliance on cost-recovery prevents abuses. "We sleep better knowing people have to pay for a tubal ligation or vasectomy. No one is going to pay for something they don't want."
The presentations of technical papers were followed by discussions.
Participants later broke into four working groups for more detailed deliberations that will lead to recommendations on key future actions.
Their themes are: policies for sexual and reproductive health; designing quality sexual and reproductive health services; access to services; and creating the conditions for implementing sexual and reproductive health and rights.
On Thursday the experts will hear presentations by NGOs based in the United States and South Africa, on the creation of conditions to necessary to implement sexual and reproductive health and rights. The round table will conclude with the adoption of recommendations of key future actions. These will be proposed to The Hague Forum on ICPD+5 in February 1999, and to the June-July 1999 special session of the UN General Assembly that will conclude the review process.