Dr. Besser's Notebook: Women's Rights in Senegal

PHOTO Mollie Melching has created Tostan -- a non-profit organization dedicated to ending female genital cutting.

"When everyone wears no clothes you don't notice that you are naked."

Demba Diawara speaks in parables. It makes it very hard for me to understand him-- that and the fact that he speaks Wolof, a language native to Senegal. Thankfully, I have with me to translate, Molly Melching, a 60-year old woman originally from Illinois.

Molly wears a long purple boubou and sunglasses. You might think that she would look incongruous in this little Senegalese village but in fact, I can't imagine her looking more at home anywhere in the world. We're sitting under the shade of a large neem tree talking with Demba, an elderly religious leader about something unspeakable, female genital cutting.

In many parts of the world, female genital cutting has been performed for thousands of years. The United Nations estimates that 3 million girls are cut each year. The practice is most prevalent in parts of Africa. The procedure, usually performed without any anesthetic refers to the ritual removal of part or all of the external genitalia for non-medical reasons. In its most severe form, the clitoris and labia are removed and the vagina is almost entirely sealed. It is a brutal act.

There are no medical benefits of cutting; on the contrary, it is an extremely dangerous and often debilitating procedure. Apart from the incredible pain and trauma of the act itself, girls can die from hemorrhage and infection. Complications are often life-long. Women are at increased risk of infertility, childbirth difficulties, and urinary tract problems, the worst being fistula - a connection between the urinary tract and the vagina. Women with this complication continuously leak urine, and many are forced to live away from the rest of the village. Added to all this is the inability to ever have a fulfilling sex life.

For decades, international bodies have condemned the practice and many governments have made it illegal but there is little evidence that these measures actually decreased the number of girls who get cut. In many places it was simply driven underground.

What has been effective is the work of a non-profit organization called Tostan, a Wolof word meaning "breakthrough." Tostan uses education to improve knowledge and skill training to promote effective communication. The focus of Tostan is not female genital cutting; it is literacy, problem solving, women's health, negotiating, and human rights. Students are empowered to take their knowledge and make decisions to improve their lives. There is no condemnation of traditions, beliefs or practices. Women learn the health consequences of cutting and they make the connection between human rights and the right to health.

Those who have been taught through Tostan go on to teach others, eventually spreading education within the entire community. Through this gentle process, communities reach their own conclusions: for the good of their daughters, cutting must stop. To ensure openness and trust, members of the community rise together in a public forum and declare an end to the practice.

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