Cross-border female genital mutilation / cutting (FGM/C) is on the rise in West Africa according to the UN, spurring the need to impose a region-wide law banning the practice, say experts.

Experts from the region met this week to discuss how to eliminate FGM/C across West Africa, at a conference sponsored by the UN Development Fund for Women (UNIFEM) in the Burkina Faso capital Ouagadougou.

A study sponsored by UNIFEM to be released in late October 2008 said  circumcisers or girls who undergo circumcision are increasingly crossing borders to perform or undergo the procedure to operate in countries with weaker FGM/C laws, and border police can do little to stop the flow.

"There is a lack of collaboration among governments across borders because the issue is so politically sensitive to manage,” said Dieneba Ouedraogo, coordinator of the International Centre for Research Training and Action (CIRFA). As a result, she said governments have shied away from collaborating on policies and legislation or on coming up with a joint communications strategy to try to dissuade people from crossing.

The World Health Organization (WHO) says FGM/C includes all procedures that intentionally alter or injure female genital organs for non-medical reasons. Up to 140 million girls and women worldwide live with the consequences of FGM/C, and three million girls in Africa risk undergoing the procedure each year.

Consequences can include excessive bleeding, problems urinating, childbirth complications and stillbirths. It is mostly carried out on young girls between infancy and 15 years old, according to WHO, and it is generally recognised as a violation of the human rights of girls and women.

Border populations vulnerable

Girls living near borders are most vulnerable to being forcibly moved, said Ouedraogo, particularly if they are living next to countries with weaker anti FGM/C legislation than their own.

In Mali, where there is legislation relating to FGM/C but it is poorly applied, the prevalence rate is 85 percent, which makes communities living near the border in Burkina Faso, Guinea, Cote d'Ivoire and Senegal vulnerable, said Traoré.

Circumcisers will always travel where they can work with the least restrictions, said Elize Dossou, FGM/C expert at the Benin ministry of family and children’s affairs. So, circumcisers travel from Burkina Faso to Niger to circumcise nomad Gourmantché girls, while populations in northern Benin tend to cross the border to be circumcised in Burkina Faso, she said.

Hidden victims

Because of this cross-border movement, the real number of FGM victims is unknown, according to Dossou.

Official FGM/C rates in Benin are 17 percent of women and girls, but she says the real number is higher.

According to UNIFEM families are sending their daughters to circumcisers to perform the practice at an increasingly young age to avoid being caught, which also distorts official figures.

At the meeting, UNIFEM officials called on health ministry and WHO officials who coordinate annual health and demographic surveys country by country to specifically target questions relating to girls 14 and under so those who underwent FGM/C would not be overlooked.

Toughen national laws

UNIFEM is also lobbying West African governments to adopt and implement laws to prosecute perpetrators of FGM/C wherever they practice, Cecile Mukarubuga UNIFEM’s Senegal-based regional director, told IRIN.

"If all countries legislate or review their laws to cover cross-border practices, I am sure it will eventually eliminate FGM,” Marian Tackie of Ghana’s Ministry of Women and Children Affairs told IRIN.

Among West African countries, only Ghana has reviewed its legislation to prosecute all perpetrators of FGM/C including those who perform outside the country, she said. In Ghana even the women who participate in the circumcision ceremony by shouting to drown out the screaming of the girls are subject to prosecution.

Most West African countries have some form of indirect or direct anti-FGM/C legislation, but in the majority it is poorly enforced, Tackie said.

But Lamine Traoré, coordinator for a project to eliminate FGM/C in Mali, said unless a region-wide law is applied, “countries which have weaker [anti-FGM/C laws] will become a hub for the practice.”

Regional law

Passing a regional law would involve appeasing leaders nervous about violations of their sovereignty, said Mukarubuga.

"It is true that border issues are sensitive, but legislation for the rights of women in the region does not violate the sovereignty of countries since it is a regionally integrated zone with mutually complementary economic and social interests, which this law would serve," she explained.

Applying such a law would also require tighter collaboration among border security officials, communities, and social welfare ministries, Mukarubuga said. At the moment, volunteer civilian surveillance teams work in villages along the borders of some West African countries to monitor and report circumcisers to the authorities, but without regional legislation, Doussou said, the border police cannot pursue them across borders.

Progress on this will not be possible unless governments, non-profits and civil society organisations work with religious leaders to try to shift their resistance. UNIFEM has started by setting up a network of 16 traditional leaders in Economic Community of West African States (ECOWAS) countries to try to raise awareness among families and religious leaders.

"There is still a strong resistance from all sides now, but governments need to do more to confront these traditions," said Traoré.

IRIN 

With cervical cancer cases rising across Sub-Saharan Africa, and 80 percent of women diagnosed too late to stop the cancer’s deadly spread, the World Health Organization (WHO) is recommending screening and vaccination programmes throughout the region.

“WHO is going to strongly advocate with donors and decision-makers to list cervical cancer as a public health priority…because with a vaccine we can save lives by preventing cervical cancer.” said Jean Gabriel Wango, head of family health at WHO in Ouagadougou.

The vaccine will help fight the Human Papilloma Virus (HPV), which if left untreated, can develop into cervical cancer.

A silent killer’s spread

"There is little investment in this disease and many of our women are unaware of it…so they die in silence,” said Sita Kaboré, president of Kimi, an association that runs cervical cancer screening campaigns in Burkina Faso.

A cancer physician at the UK-based Oxford University, David Kerr, says by 2020, 70 percent of the 15 million new cases of cancer diagnosed every year will be contracted in the developing world.

Cervical cancer is the most common tumour for African women, according to WHO. In Uganda, 80 percent of female cancer survivors suffer from cervical cancer, says Dan Murokora, a Uganda-based gynecologist.

But weak record keeping has hampered governments’ efforts to find out the disease’s morbidity rates; WHO advises governments to focus on record keeping in developing their prevention plans.

Screening

Cervical cancer is largely preventable but women need to be screened every three to five years to halt the deadly disease, according to Charlemagne Ouédraogo, a Ouagadougou-based gynecologist.

But in Sub-Saharan Africa, which lacks diagnostic equipment and national prevention programmes, only 5 percent of women are regularly screened for cervical cancer, according to WHO’s Boureima Hama Sambo, relegating most cases to late-stage, hard-to-cure diagnoses.

WHO is urging health ministries to make the HPV vaccine available in their national health plans to all 10 to 13-year- old girls in order to prevent the disease.

Reducing vaccine costs

The vaccine’s three doses cost a total of US$300, in a region where the average annual salary is about US$550, according to the UN Children’s Fund, UNICEF.

The Geneva-based Global Alliance for Vaccines and Immunization is expected to negotiate with pharmaceutical companies to bring the price down, while the UN, Program for Adaptation of Technologies in Health (PATH), and World Bank have pledged to help with costs so patients only pay US$45 for the vaccine.

Hurdling the cost barrier

For some of Africa’s health officials, this price reduction is key to their governments’ participation. "It is a good idea to integrate the HPV vaccine into programmes, but it remains too expensive. WHO and its partners need to assist countries to buy the vaccine first." says gynecologist Caroline Leite from Cape Verde.

WHO’s Sambo dismisses these cost concerns, and says the vaccine should be widely available soon. “We think that there is an expression of political will and we think that very soon we’ll be able to roll out the vaccine for these populations,” he concluded.

IRIN 

FAO Initiative Focuses on Local Production to Offset High Prices

FAO is moving into the final stages of an intensive month-long distribution of millet, sorghum, maize, cowpea and peanut seeds to 33 000 farmers in the regions of Burkina Faso that have been hardest-hit by a devastating combination of soaring food prices and severe weather that has vastly reduced the local food supply.

Prices across the region have been increasing steadily over the past two years, mirroring the outside pressures from international markets.

FAO has just finished one of the last distributions, of nearly 20 tonnes of improved seed varieties and just under 30 tonnes of fertilizers, in the villages surrounding Gourcy, the provincial capital of the arid Centre North region. Recent distributions covered much of the country’s eastern and central zones. In all for the current planting season, about 600 tonnes of improved seed varieties and 432 tonnes of fertilizers have been made available to impoverished farmers in Burkina.

“Last year’s rains began late, and when the rains came, they came in torrents. Crops, food stocks and seed supplies were destroyed, people’s livestock were killed and pasture lands to feed any surviving animals ruined,” said Jean-Pierre Renson, the FAO Emergency Coordinator in Burkina Faso and the acting FAO Representative in the country.

“In the 15 provinces where FAO is distributing seed, under these circumstances less than 10 percent of the food needed will be produced to feed people. We hope to boost that considerably now,” said Mr Renson.

In addition to seeds being provided of the main staple grains, quality vegetable seeds are also being distributed to be planted in the dry season, September-October, to take advantage of planting areas that with irrigation can still produce.

Preventive Measures

FAO is also training local producers in quality seed multiplication, to continuously augment the amount and quality of seed available, as well as to raise crop yields. And in September, Mr Renson said, it is hoped that by using a new strategy, FAO can intervene when there are early indications of hunger.

“Depending on funding, in September FAO would be able to help the women and children coming for treatment at the regional nutrition centres,” Mr Renson said. “FAO can act ahead of time in a sense, in that by giving the women seed packages to bring back to their villages, the local food supply there can be increased where there is hunger,” he explained.

In Burkina Faso, 23 percent of children suffer from acute malnutrition. More than 80 percent of the population makes a living in subsistence agriculture, and 45 percent of people live below the poverty line.

A Future in Rice

“In theory, Burkina Faso can be self-sufficient in producing enough of traditional grains to cover its food needs, but severe weather has been ruinous for the last few years,” said FAO Economist Benoist Veillerette.

He said that rice had increasingly become preferred by people living in the urban areas, as it was cheap and easy to cook, though overall it accounts for not more than 15 percent of grain consumption.

“However, now that prices are so high, with about two-thirds of the country’s rice being imported, this is a unique opportunity for farmers to invest in rice farming and improve their livelihoods, rather than struggle in subsistence farming,” Mr Veillerette said.

According to FAO data, in the capital Ouagadougou, rice was 87 percent higher at the beginning of June compared with the same period a year before.

The current FAO response under its Initiative on Soaring Food Prices in Burkina Faso comprises a number of emergency projects worth more than US$2.5 million. FAO has developed an extensive plan to breathe life into national agriculture, in part by leveraging the possibility to produce and profit from rice. The proposal, which would require some US$7.7 million in just the next few seasons, would involve developing water control methods for low-land rice farming around rivers and floodplains.

“Farmers now have a reason to produce rice, whereas before there was no incentive, especially since rice is consumed mainly in the cities,” Mr Renson explained.

FAO 

Doctors in Burkina Faso say fistula is being under-reported, and are launching a new project to offer free surgery to some of the affected women.

According to the government’s statistics, there were just 54 cases of fistula in Burkina Faso in 2007. But Aboubakar Coulibaly, a doctor in the national health system, said “Cases are being under-reported.”

The main causes of fistula are men raping and impregnating very young children, and prolonged obstructed labour, usually because women and child-mothers do not have access to even the most basic health facilities.

The UN Population Fund (UNFPA) says there were 86,140 ‘severe obstetrical complications’ reported in Burkina Faso in 2007, of which 73,000 occurred in rural areas where health coverage is poor.

Fistula, a severe medical condition caused when a hole develops either between the rectum and vagina or between the bladder and vagina, is only found in extremely poor countries which have not invested in proper healthcare systems, education, or protecting women and children.

In Burkina Faso the highest incidence is in the north in the Sahel region.

“Women in the Sahel are most exposed to fistula due to social reasons which stop them from attending health services, and the fact that they marry and get pregnant younger,” said Fatoumata Zampaligre, a director at the ministry of health.

The region accounts for nearly one million of Burkina Faso’s 14 million population.

The government says it has launched a US$4.7 million (euro 3 million) project to prevent and treat obstetrical fistula in this region.

The project covers the four provinces of Soum, Séno, Oudalan and Yagha, and is fully funded by the Duchy of Luxembourg.

It includes fistula repair operations, and a sensitisation campaign directed at community and political leaders and administrative officials advising against marrying and impregnating children, as well as performing cliterodectomies (female genital mutilation/cutting).

According to government statistics, only 26 percent of rural people in Burkina Faso have access to health services, and only 39 percent of women receive modern healthcare when they are giving birth.

Last year, government health facilities repaired just 14 fistulas.

IRIN

On the eve of World Population Day, Muslim leaders agreed to promote family planning among their followers at a meeting of the country’s principal Islamic organisations in the capital’s main mosque.

“The debates were fruitful. We explained to everybody that Islam was not against family planning and even recommended it”, Maiga Aboubakary, secretary-general of the Burkina Faso Islamic Organisation in Population and Development (RBOIPD), told IRIN.

The leaders have agreed to tour Burkina Faso’s 45 provinces and 13 regions in a “vast awareness-raising campaign” for family planning.

“Religious leaders must sensitise their community in mosques, during religious celebrations, weddings, and funerals on why family planning is so important,” Aboubakary told IRIN.

Siaka Traoré, advocacy and communication officer at the UN Population Fund (UNFPA) in Burkina Faso, said the meeting was a landmark. “We think that Islam has a sensitisation and education role; in that sense the choice of the venue for the meeting is very symbolic.”

According to the last census (2006) Muslims represent just over half of the country’s 14 million people.

According to UNFPA’s Traoré, religious leaders are an important target for family planning advocates because of the privileged role they play in the community. “Muslim leaders, being an instrumental part of the community, have an important role to play in family planning, and that is why we support this meeting between them,” Traoré said.

According to Aboubakary, many people think Islam’s principles stand against family planning, when in fact many of its precepts promote it.

Population growth

Burkina Faso’s population is currently growing at a rate of 3 percent, or by about 341,000 people each year, meaning it has grown overall from 5.6 million in 1975 to today’s 14 million. On average seven children are born to each family, and economists warn that the current five percent economic growth rate will need to reach 7.5 percent to meet the needs of the growing population.

According to the Ministry of Health, just 14 percent of couples regularly use contraception, while a 1994 study (the most recent available), concluded that a third of women aged 15-49 said they needed better family planning.

“Family planning is indispensable to a country’s development, its society and to individuals because it is through family planning that we can better organise family life, better feed and educate children, and give them the healthcare they need”, Traoré told IRIN.

Support is needed to boost the government’s modest national health programme targets which plan to increase coverage of contraceptive by just 3 percent by 2010. More ambitious is its drive to reduce infant mortality rates by 40 percent by 2010. According to the UN Children’s Fund (UNICEF), 122 out of 1,000 children born in Burkina Faso die before they reach their first birthday, and high infant mortality rates are a key factor driving high birth-rates.

Religious leaders did not make a decision on the contraception methods they would promote, leaving it to individuals to decide, according to Aboubakary.

But leaders will push for family planning to be the responsibility of every couple. “We have demanded that every woman should be accompanied by her husband for a family planning visit to a doctor. Women should not go alone because [family planning] must be the decision of a couple,” Aboubakary said.

IRIN

“[Health researchers] are currently collecting information so as to identify the factors explaining the recurrence of the epidemic in districts where populations have been vaccinated”, Ousmane Badolo, head of the epidemiologic surveillance department at the ministry of health, told IRIN.

Vaccination campaigns target people between 2 to 30 years old; according to the ministry of health, 80 to 90 percent of the victims of meningitis belong to that age group.

A total of 714 people have died since 1 January out of 7,184 cases.

Several different bacteria can cause meningitis which is an inflammation of the protective membranes covering the central nervous system. The Neisseria sero-group is one of the most important to watch because it often leads to epidemics, experts say.

Badolo, the epidemiologist, said that health research teams from the UN World Health Organization and US-based Centers for Disease Control and Prevention have come to Burkina Faso to investigate. “This is the first time that such research is being conducted,” Badolo said, adding that at this stage he could only guess why the vaccination programmes have not worked.

“Perhaps it is because of population displacement,” he said, “for instance in gold mining areas people are often coming and going.”

The health researchers will focus their work on the districts of Réo in the central west of the country, Boulsa in the central north, Titao in the north and in Sig-nonghin a district in the north of the capital Ouagadougou.

The populations in each of those four districts were vaccinated last year yet each has reached epidemic thresholds.

A total of five out of the country’s 55 districts have reached the epidemic threshold and 14 others are on alert.

Meanwhile, 3.5 million people have been vaccinated this year out of a population of 14 million. The government said it is in the process of procuring a million more vaccines with the help of UN Children’s Agency UNICEF.

People vaccinated against meningitis are supposed to have protection for three years but health officials have announced that meningitis epidemics have occurred in several areas where populations had recently been immunized.

“[Health researchers] are currently collecting information so as to identify the factors explaining the recurrence of the epidemic in districts where populations have been vaccinated”, Ousmane Badolo, head of the epidemiologic surveillance department at the ministry of health, told IRIN.

Vaccination campaigns target people between 2 to 30 years old; according to the ministry of health, 80 to 90 percent of the victims of meningitis belong to that age group.

A total of 714 people have died since 1 January out of 7,184 cases.

Several different bacteria can cause meningitis which is an inflammation of the protective membranes covering the central nervous system. The Neisseria sero-group is one of the most important to watch because it often leads to epidemics, experts say.

Badolo, the epidemiologist, said that health research teams from the UN World Health Organization and US-based Centers for Disease Control and Prevention have come to Burkina Faso to investigate. “This is the first time that such research is being conducted,” Badolo said, adding that at this stage he could only guess why the vaccination programmes have not worked.

“Perhaps it is because of population displacement,” he said, “for instance in gold mining areas people are often coming and going.”

The health researchers will focus their work on the districts of Réo in the central west of the country, Boulsa in the central north, Titao in the north and in Sig-nonghin a district in the north of the capital Ouagadougou.

The populations in each of those four districts were vaccinated last year yet each has reached epidemic thresholds.

A total of five out of the country’s 55 districts have reached the epidemic threshold and 14 others are on alert.

Meanwhile, 3.5 million people have been vaccinated this year out of a population of 14 million. The government said it is in the process of procuring a million more vaccines with the help of UN Children’s Agency UNICEF.

IRIN