Ending female genital mutilation as a global challenge: community empowerment and promoting change through dialogue, education, and advocacy

Francesca Simi, Laura Gentile

Amref Health Africa ETS - Italia

5 December 2024; accepted 9 June 2025

Summary. Female genital mutilation (FGM) includes all procedures involving the alteration or removal of female genitalia for non-medical reasons. It is often carried out on young girls and adolescents. FGM offers no health benefits and causes serious physical, psychological, and social problems affecting millions of women and girls around the world, particularly in Africa, the Middle East, and Asia. The reasons behind it are not religious but social and cultural. This practice is a violation of human rights and is condemned by international treaties such as the Maputo protocol and the Istanbul convention. Organisations like Amref Health Africa are working to eliminate FGM by involving local communities in the eradication of harmful practices while fully respecting cultural values. The success of projects in Kenya, which have significantly reduced the number of cases, is encouraging other countries to adopt similar strategies. In Europe, and specifically in Italy, projects such as P-ACT and Y-ACT involve institutions, young people, and migrant communities. They train professionals and activists to promote change and rejection of FGM. The most effective strategies have proved to be those involving education, advocacy and intergenerational dialogue, which highlight the importance of empowering women, young people and communities in the fight against FGM.

Key words. Female genital mutilation, community empowerment, gender-based violence, intergenerational dialogue, youth activism.

Introduction

According to the World Health Organisation (WHO), female genital mutilation (FGM) includes the partial or complete removal of external female genitalia, or any injury to these organs, done for non-medical purposes.1 It is usually performed in childhood or adolescence, depending on the social and geographical context.

FGM is not based on religion and has no health benefits. Instead, it stems from tradition, community identity, and family expectations. Some believe it is a religious duty, but no sacred text prescribes it. It is deeply rooted in society and seen as a part of cultural belonging. However, it causes serious physical, psychological, and social harm in both the short and long term.

According to UNICEF,2 230 million women and girls worldwide have undergone FGM. Four million girls are at risk each year. It is practiced in at least 30 African countries, from Egypt to Senegal, and also in the Middle East, Southeast Asia, South America, India, and Pakistan, among others. In Somalia, Guinea, Egypt, Mali, Sudan, and Eritrea, over 80% of women undergo FGM.

Migration has made FGM a global issue requiring international action.

Female genital mutilation is classified into 4 major types.3

Type 1: this is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/clitoral hood (the fold of skin surrounding the clitoral glans).

Type 2: this is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva).

Type 3: also known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching, with or without removal of the clitoral hood (prepuce) and glans.

Type 4: other harmful procedures, e.g., pricking, piercing, incising, scraping, and cauterizing the genital area.

Reasons and consequences

FGM is a harmful practice that violates the human rights and health of women and leads to serious physical, psychological and social consequences. Rooted in diverse cultural contexts, it symbolically enforces the control of women’s sexuality and reproductive health while defining their societal roles.

The reasons for FGM vary across regions and contexts. The main ones are:3,4

■ sexual reasons, controlling female sexuality to reduce a girl’s desire or to increase male pleasure;

■ sociocultural reasons, rite of passage to become a woman, a way to integrate young girls into society;

■ hygienic or aesthetic reasons, where genitals are believed to be obscene or a source of infection;

■ health reasons, to increase a woman’s fertility or to increase the chance of survival of the child during pregnancy;

■ religious reasons, the mistaken conviction that various religious scriptures prescribe the practice (though no such religious prescription actually exists in the scriptures).

FGM has no health benefits. It disrupts normal genital function and increases health risks and complications both in the short and long term. These include:

■ health consequences, such as: short-term infections, recurring urinary infections, haemorrhage, swelling, recto-vaginal fistulas, death, painful menstruation, pain during intercourse, difficulties and risks during childbirth, fetal distress and risks to the mother, infertility;3,5

■ psychological consequences, such as: anxiety, psychomotor agitation, phobias, intrusive traumatic symptoms (flashbacks, nightmares), secondary trauma during medical examinations, depressive symptoms, psychosomatic disorders, loss of trust in parents or other key adult figures, feelings of betrayal (which are increased in older children), rejection of family, feelings of impotence, passivity, and submission, shame, embarrassment, humiliation, lack of self-esteem, awareness of mutilation/disfigurement, abuse, and isolation, ambivalent feelings torn between cultural identity and opposition to the violation of physical and mental well-being;6,7

■ sexual consequences, such as: fear of the menarche, fear of sexual relations, dyspareunia (pain during intercourse), lack of sexual desire and satisfaction;4,8

■ social consequences, such as: isolation, devaluation of the woman’s role, conflicting models of femininity between the family of origin and the country of adoption; in the countries of origin in particular, lack of desire or infertility can be motivations for the request for divorce on the part of the husband, lack of self-determination, often in parallel with early forced marriage.9,10

Understanding the cultural reasons and consequences of this practice is essential to raise awareness and drive change among both professionals and communities.

Legislation

FGM is globally recognised as a violation of human rights.1 International laws in Africa and Europe classify FGM as a crime, yet it remains widespread. Countries that have ratified human rights treaties on FGM must implement measures to prevent and eradicate the practice, including laws banning it.

FGM first came to the attention of the public on a large scale during the ’70s and ’80s thanks to African women within the feminist movement. Previous attempts to combat FGM date back to the 1920s in Egypt and later attempts were made by Western governments in the 1940s, but these were rejected by the African communities.11

Public attention increased internationally with the WHO conference in Khartoum in 1979. On this occasion, the WHO recognised FGM as a significant public health issue. During the conference, representatives from 9 African and Middle Eastern countries developed the first four recommendations for the elimination of FGM, which included, for the first time, the need for specific health education and training programs.12 In 1990, the African Union (AU) adopted the African Charter on the Rights and Welfare of the Child which includes article 21: “Protection against harmful social and cultural practices”.

The same year, the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) published a recommendation for the eradication of FGM. Another step forward was taken in Africa in 2003 when the AU adopted the Maputo Protocol.13 Article 5 of the Protocol explicitly invites the signatory nations to prohibit all forms of FGM with the aim of eliminating the practice completely. In the most recent update in 2019, 49 countries had signed it.

During the Afro-Arab expert consultation on legal tools for the prevention of FGM held in Cairo in 2003, 25 countries adopted the Cairo Declaration on Female Genital Mutilation. On 6 February 2003, the United Nations declared the International Day of Zero Tolerance for FGM. In 2015 as part of the 2015-2030 plan of action, signed by 193 of the UN’s member states, FGM was included in the Sustainable Development Goal 5: Gender equality. In particular, Target 5.3 aims to eliminate all harmful practices including child marriage and FGM.14

In Europe, FGM has been condemned by two treaties: the Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR) signed in 1953 and the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence (Istanbul Convention), signed in 2014. A crucial aspect of the Istanbul Convention in combating FGM is article 44, which adds the concept of extraterritorial jurisdiction which allows for more widespread prosecution of perpetrators of the practice.15 Moreover, the latest European Directive 2024/1385 establishes a comprehensive legal framework for the criminalization and prevention of FGM within all EU member states. It also requires member states to implement victim support measures, including access to medical, psychological, and legal assistance. The directive must be transposed into national legislation by June 14, 2027.16

In Italy too, as in the rest of Europe, FGM has been condemned. Specific provisions have been included in the penal code and an ad hoc law has been passed. This not only prohibits FGM but it also prescribes a series of preventive measures in addition to assistance and rehabilitation for the victims of FGM (law no. 7, 9 January 2006 ‘Orders Concerning the Prevention and Banning of FGM’).

Despite legislative efforts, combating FGM requires a shift from a solely punitive approach to one that prioritizes social activism. Given the practice’s deep cultural roots, repression alone is insufficient for its eradication. Sustainable change depends on community-driven initiatives, education, and advocacy to challenge entrenched social norms and foster lasting behavioural transformation.

Community involvement, activism and setting-up services: from Amref’s experience in Africa to Europe (P-ACT and Y-ACT)

Involvement of the local communities is a pillar of the strategies of empowerment and social change; it reinforces the role of the community itself and promotes cooperation between communities, institutions, and services. Amref Health Africa has worked with activists and FGM-practicing communities to reduce cases and encourage abandonment. Since reasons vary by region, solutions must be adapted to each community. Amref Health Africa addresses FGM by actively engaging communities and understanding its deep cultural significance.17,18 For over a decade, it has worked closely with the Maasai in Kenya and Tanzania, developing the community-led alternative rites of passage (CL-ARP). This model preserves traditional ceremonies celebrating the transition from girl to young woman, replaces harmful cuts with sexual and reproductive rights education, and promotes community engagement to ensure girls’ education.

The approach begins with structured community outreach and intergenerational dialogues, ensuring the involvement of men, boys, and key community leaders in challenging harmful norms and behaviors. CL-ARP raises awareness of the dangers of FGM, promotes collective decision-making, and integrates traditional celebrations with discussions on health and empowerment, fostering a supportive environment for change.

A 2020 evaluation showed a 24% drop in FGM cases in Kenya’s Kajiado county over 10 years.19 Encouraged by this, Amref expanded the model to Ethiopia, Senegal, and Uganda. It also launched programs to train young ambassadors and community leaders to advocate for change. Alongside religious and social leaders, educators, and healthcare workers, they form a strong network that influences attitudes and supports ending FGM.

Community-based dialogue is necessary to present recognised and convincing arguments that lead people to choose to abandon this harmful practice. In Italy and Europe, Amref has successfully adapted and implemented strategies and programs proven effective in Africa. These initiatives have been extended to migrant communities, services, and institutions, with careful adaptation to the local sociocultural and institutional contexts. The most recent data indicate that there are about 87,600 women in Italy who have suffered FGM, 7,600 of which are minors, with an estimated risk between 15% and 24% for the girls in a population of 76,040 girls (0-18 years old) coming from countries where FGM is practiced.20 In recent years, Amref Italy has implemented various projects to prevent and combat FGM in Italy. The P-ACT project, funded by FAMI, aimed to strengthen services and institutions in Turin, Padua, Rome, and Milan through educational activities and a multidisciplinary approach. Initially, data were gathered on the educational needs of these cities. To prevent FGM, the focus shifted to raising awareness of the issue and its risk factors. This required the involvement of professionals from health, social services, education, law, and public safety to enable coordinated interventions. However, engaging all professionals and ensuring long-term institutional commitment proved challenging. Despite this, the project successfully promoted collaboration and an integrated approach to FGM prevention. Over two years, 618 professionals were trained, two regional protocols and a service network were established, and 27 professional associations were informed, with 10 taking action. The project also involved 70 policymakers, 14 of whom took concrete steps on the issue.

After a project dedicated to training and the construction of alliances with the services and institutions, Project Y-ACT (Youth in Action for Change) was launched, co-funded by the European Union. In 4 Italian cities, communities which practice FGM and young people with migrant backgrounds were actively involved in promoting lasting changes in behaviours regarding the practice of FGM at an individual and community level thanks to training and empowerment activities for young people belonging to the diaspora and to new generations in Italy, intergenerational dialogue and the communication and exchange of good practices. In the first year, 31 young people from migrant backgrounds were trained to promote actions to raise awareness.

The training included online and in-person sessions, meetings with African activists, discussions with community adults, and a national workshop with experts and institutions. In the second year, under local supervision, young participants led 300 awareness activities and five outreach events. Each city concluded with a final event presenting results and a joint Manifesto to end FGM. These results were shared at the European Parliament on 6 February 2025, for the International Day of Zero Tolerance for FGM.

To raise awareness further, young leaders launched a social media campaign, Diamo Voce al Silenzio (Giving Silence a Voice), #thevalueofthegirl, featuring a webpage, a series of video interviews, and a podcast. Engaging young ambassadors remains a key strategy for driving change from within communities, strengthening female empowerment and youth activism, despite challenges in maintaining participation and addressing diverse community needs.




References

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2. UNICEF. Female genital mutilation: a global concern. 2024.

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6. Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual consequences of female genital mutilation and the impact of reconstructive surgery: a narrative review. Health Equity. 2019;3(1):36-46.

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14. 28 too many. The law and FGM in Europe. Report. 2021 Dec. Available from: https://www.fgmcri.org/media/uploads/Continent Research and Resources/Europe/the_law_and_fgm_in_europe.pdf.

15. UNFPA. Analysis of legal frameworks on female genital mutilation in selected countries in West Africa. 2018. Available from: https://wcaro.unfpa.org/en/publications/analysis-legal-frameworks-female-genital-mutilation-selected-countries-west-africa-1.

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Authors’ contribution statement. Both authors contributed to the conceptual design, literature analysis, and critical revision of the manuscript. Both authors approved the final version for publication.

Conflicts of interest statement. Both authors are consultants of Amref Italia.

Correspondence to:

Laura Gentile

Via Aniene 30

00198 Roma, Italy

Email: laura.gentile@amref.it