The World Health Organization (WHO) defines unsafe abortion as “the termination of an unwanted pregnancy by persons lacking the necessary skills, or in an environment lacking minimal medical standards, or both”. According to WHO, unsafe abortions are found to end 47,000 lives annually while 3 out of four of them occur in Africa and Latin America. Unsafe abortions occurfrequently in developing countries with restrictive abortion laws and limited access to health care facilities.
Unsafe abortion and illegal abortion- Are they the same thing?
The environment in which an abortion takes place and whether the performer of the abortion is a licensed professional determines the safety of the procedure. An illegal abortion refers to when the law prohibits women from undergoing abortions unless certain conditions apply. Those conditions vary across countries and legal frameworks.However, restictions and conditions hinder the anonymity of abortions for women which compels them to resort to unsafe abortions as their situations do not meet legal requirements. In the MENA region, only Tunisia and Turkey have legalized abortion under all grounds in the first trimester. However, most countries in the region still entertain punitive and restrictive safe abortion laws. We will be exploring Sudan’s legal status in the matter particularly in this piece.
Unsafe Abortion in Sudan:
Unsafe abortion and limited access to safe abortion health services can be attributed to two main factors: cultural and legal restrictions.
In Sudan, gender roles are highly regarded and abided by. Women who choose to defy their reproductive role and undertake abortion are not only considered disgraceful, but are accused of rejecting God’s blessings upon them.
Despite the scarcity of data in Sudan, existing research indicates a high rate of unintended pregnancy which is a major reason behind why women and girls seek unsafe abortion. Unintended pregnancy is highly rampant due to factors associated with lack of awareness regarding contraception, lack of understanding for family planning, as well as systemic barriers to the different methods of contraception. The stigmatization of contraception is due to the culture’s entrenchment to gender roles and women’s tendency to produce offspring. Such an environemnt leaves women with no choice but to subject themselves to unsafe methods of abortion.
Abortion is a clear indication of misconduct. Added to that, in Muslim communities, having children is regarded as the most noble thing to do, so even the feeling of not wanting a child is a huge mistake. Part of women’s value, and in fact the most important part for women, is to be fertile and give birth to as many possible children, and women who even think of having space between deliveries is questioned. A woman’s femininity is measured by her ability to give birth to children.
The idea of unintended pregnancy is frequently associated with fornication and adultery. Fornication is the act of sexual intercourse outside a marriage contract. Adultery is sex outside of marriage whilst an individual is married. Fornication and adultery are widely believed to be forbidden in Islam and are punishable by 100 lashes. Thirty years of Islamist rule in Sudan has criminalized pregnancy outside marriage and labelled it as a blasphemous form of pregnancy. The use of the terms unintended pregnancy and illegal pregnancy interchangeably is key in contributing to the increase of Sudanese women and girls seeking unsafe abortions. Society’s demonization of women who seek an abortion has produced the notion that every woman seeking one has committed fornication or adultery and is exploring ways to avoid ostracisation. While this is the case for many, the explicit connection made between abortion and illegal pregnancy has created an appalling image on abortion which disregardes other situations such as unwanted pregnancies in a marriage and pregnancy as a result of rape.
In Sudan, the abortion law only protects women whose lives are endangered due to the pregnancy and women who are pregnant as a result of incest or rape.
A person who intentionally causes a woman to miscarry is not guilty of an offence where (a) the miscarriage is necessary to save the mother’s life; (b) the pregnancy is the result of rape which has occurred not more than 90 days before the pregnant woman has desired to have the abortion; or (c) it is proved that the quick unborn child has died in the mother’s womb. If the pregnancy is of less than 90 days’ duration, the person who performs the illegal abortion is subject to up to three years’ imprisonment and/or payment of a fine. If the pregnancy is of more than 90 days’ duration, the penalty is increased to up to five years’ imprisonment and payment of a fine. In both cases, the person may be subject to the payment of compensation.
While Sudan is the first country in the MENA region to legalize abortion in the case of rape, this legal text remains restrictive. Not only does it exclude unintended pregnancies in and outside of marriage, but it is highly unresponsive to the cultural and legal context of rape and sexual abuse.
The 1991 law reform to include rape came in resonse to the attention Darfur received after the documentation of sexual violence cases. However, after the ICC issued an arrest warrant for Omar Elbashir, the government expelled many of the humanitarian organizations who were leading the documentation of incidents as well as the distribution of post-rape kits in conflict areas such as Darfur. Nevertheless, this law reform was originally made on a gendered basis. Abortion was only legalized to preserve the honor of the women who have been raped and to sustain their future chances of marriage rather than a way of preserving their rights and dignity.
The gendered basis of the law reform is translated in how rape survivors don’t often entertain this right due to the faulty legal definition of rape. In order for a woman to access abortion services, she must first prove that she has been raped, a procedure which has been accounted to be futile, discriminatory and incriminating. In article 149 of Sudan’s Criminal Code of 1991, rape is categorized as adultery without consent which is criminalized in Sudan. Proving that sexual intercourse took place forcibly requires the victims to reach out to the police and attain what is called Form 8. Form 8 is given by the police after the victim provides proof of being exposed to sexual abuse.Only after receiving the form can a woman access safe abortion at a healthcare institution. Documenting form 8 is the role of the police. Because this form is the sole means of evidence for physical injuries and bruises in Sudanese courts (except for when the victim is a child) if injuries are not documented, the survivor may face incrimination for fornication or adultery.
With such aggravating conditions set in place to prove the occurrence of rape, many are discouraged. Those who do prove their rape often become subject to a prolonged trial process that is unlikely to end before the 90 days limit in which the abortion is legally permitted.
Considering the aforementioned cultural and legal restrictions for abortion in Sudan, it is no surprise that available data on this issue is scarce. However, according to Women Deliver “An estimated 25.1 million unsafe abortions take place [globally] each year. Every year, approximately 6.9 million women in developing countries are treated for complications from unsafe abortions, and complications from unsafe abortions cause at least 22,800 deaths each year.”
A study conducted in Khartoum reveals that 96.7% of women seeking abortion services do so for the treatment of post-abortion complications or after undergoing an incomplete abortion. This prevails how bureaucratic barriers and the culture of health worker are causing women and girls to seek unsafe abortions. Moreover, unsafe abortions lead to the hospitlization of of women and often times leaves them in critical conditions.
Demographics- can we identify certain groups:
Most existing content does not associate unsafe abortions with certain age groups, ethnicities or social classes. However, it does identify variances in the way unsafe abortion takes place in relation to people with different identities.
Unsafe abortion can be described as a class issue. Many women from the upper and middle-class have access to private clinics or connect with networks of doctors who are willing to help terminate their pregnancy. Some women are also able to access the black market or web to purchase medications that aren’t available in Sudan such as misoprostol. While women in lower socioeconomic statuses are left with no choice but to seek traditional and dangerous methods of abortion such as drinking herbs, ingesting various drugs and poisons, and inserting objects such as metals and wood into the uterus leading to critical complications that can cause death.
“I would see 16 cases of failed abortions on a given day. I would insert my hand and pull out syringes or leaves, unsanitary items that were inserted by midwives to induce a miscarriage,”
Nabil, a Sudanese doctor told IPS.
General lack of access to reproductive healthcare is more evident in conflict areas in Sudan where not only are the healthcare systems insufficient, but where sexual abuse and rape is pervasive. The use of rape as a weapon of war in Darfur was what led the Islamist Sudanese government in 1991 to legalize abortion in the occurence of rape.
In 2016, interviews conducted by Human rights watch researchers in rebel-held South Kordofan explored accessibility to reproductive health in the area. The researchers spoke to witnesses and victims of sexual abuse, local rebel authorities, and humanitarian aid workers.
Most of the women interviewed did not know what condoms were and were unaware of any other kind of contraceptive. Local aid workers informed the researchers that condoms are not available in the market despite the increase in gonorrhea, syphilis and Hepatitis b cases. Women are unable to protect themselves against sexually transmitted diseases, nor are they able to control their fertility.
Dr. Abdelahadi Ibrahim, a Sudanese Obstetrics and Gynaecology specialist, faced a 6 year jail sentence after being arrested for conducting safe abortions for women and girls. Dr. Ibrahim explained in an interview that he has carried out approximately 10,000 abortions during his 7 years of operation. He elaborated that 90% of the cases were university students, while the remaining 10% included the wives of migrant husbands and other kinds of cases. He believed that he was able to save 10,000 Sudanese families from the kind of instability an unintended pregnancy can cause, taking note that those families are not from planet “Mars”.
Displacement also plays a major factor. Current estimates suggest that women who are displaced due to conflicts are more vulnerable to sexual abuse which contributes to unintended pregnancy and unsafe abortion.
Seeking a safe abortion in Sudan- Bureaucratic barriers
In addition to the emotional trauma women and girls experience due to social stigmas and legal consequences, bureaucratic barriers also contribute in making this situation more burdensome.
According to the roadmap for reducing maternal and newborn mortality rates in Sudan, misoprostol is authorised to be used by mid-level health providers. In the contrary, this isn’t the case on the ground. The fear of health providers to use the materials in order to carry out illegal abortions caused for the implementation of strict procedures that are designed to prevent the “misuse” of the medication.
The Roadmap is not implemented. Decision makers are influenced by religious ideas and think that if midwives accessed the drugs they can use it for aborting unmarried girls and that would spread immorality. They are more concerned with morality than the lives of women.
An interview-based article explored the criminalization of abortion and looked into the policing of maternity wards. It highlighted the high level of security put in place at the entrances of those institutions especially in public hospitals. Any unescorted pregnant woman is a suspect of an illegal pregnancy.
“Are you married? Where is your husband? If you enter a maternity ward alone, you are a suspect”
Ideally, only a woman with Form 8 should be able to access a safe abortion service. However, whether she’s able to be admitted into the hospital depends on the present doctors’ moral judgement. Some choose to abide to their professional ethics in maintaining the patient’s privacy, disregard Form 8 and treat the case as a miscarriage. However, others choose to report them to the police. Such an act highlights health institutions’ common misuse of their authority especially when legitimized by law enforcement. Healthcare institutions and legal authorities often brutalize women who seek safe abortions. This takes place in the shape of derogatory remarks that are used to describe women pregnant outside of marriage.
Security staff and police treat women badly, as if they are the judges, even before presenting her case to the legal system. One time, a woman pregnant with twins was kept handcuffed the whole time, and she was discharged directly to the prison because of illegal pregnancy.
Seeking abortion unofficially- who can women reach?
The accessibility to safe methods of abortion in unofficial means carries a classist nature. However, even the existing networks led by healthcare and social workers who work on providing abortion pills have a confined reach out. The measures they take to ensure their safety means that women and girls can only reach them if they are aware such a network exists. This leaves many girls resorting to midwives who perform the procedure in unsafe conditions which later causes them post abortion complications. The problem with midwives does not only stop at health complications but also personal mistreatment of the girls they interact with.
“I know a girl who was circumcised by a midwife after an abortion and was told that this is to stop her from having sex again, it is clear that midwives could punish you or take advantage of your situation,”
Ali (A sudanese woman who has undergone an abortion unofficially)
What can we do?
In the light of Sudan’s current transition, there’s a glimmer of hope regarding women related legislation and women’s statuses. We have recently witnessed positive law reforms being made by the Ministry of Justice on issues such as FGM and a mother’s agency in her children’s mobility. However, there is no doubt that abortion is a notion that is extremely stigmatized,so the direction of this conversation remains undetermined.
The absence of legislation does not mean unsafe abortions are not taking place. Reflecting on what the context is telling us, certain action points can be made:
To work on increasing acceptance of safe abortion amongs local communities, policy makers, and health workers.
To further collect and share statistics
Research data on the consequences of unsafe abortion to women’s health and rights.
To strengthen individuals’ knowledge on family planning and the use of contraception through the implementation of comprehensive sexuality and reproduction education which can significantly lower the rate of unintended pregnancy.
Improve access to affordable contraceptive methods.
For as old as modern history tells us, the harmful notion and act of Female Genital Mutilation/Cutting has been prevalent within Sudanese communities. Years of advocacy and efforts to put an end to the act, on both a social and legislative level, have been consistent with the sentiments of women activists, civil society organizations, religious leaders, women, men, children and government bodies. Although those efforts are said to have commenced since the 40s of the past century, we can trace back the endorsement of national law that criminalizes FGM back to the year 1983, the same year which witnessed the introduction of Islamic Sharia law to the Sudanese legal framework. Almost 40 years later, a draft of a national law that criminalizes all forms of FGM has recently been passed in April 2020 under the hands of the two main political components governing Sudan’s transitional period: the sovereign council and the cabinet of ministers.
The piece aims to provide a comprehensive analysis of the different indicators and social dynamics that either validate or negate the effectiveness of this draft.
Note that the content of this piece will not explore the health and psychological effects of FGM on women and girls, nor will it examine the validity of arguments used to justify the practice with any degree of depth.
Background: Some Definitions & Numbers To Set The Scene
The World Health Organization (2007) defines female genital mutilation/cutting (FGM/C) as the ‘procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons’.
We often encounter the term female circumcision being used interchangeably with FGM/C; however, this has been deemed misleading as it implies that the procedure resembles that performed for males. The degree of cutting is far more extensive for girls; it is considered an impairment of their sexual and reproductive functions, and the consequential health complications go as far as being a daily experience of painful urination. It’s important to take note that the definition stated above doesn’t explicitly describe/classify the types of FGM/C performed for girls. But later into this piece we will look at how the type of cutting taking place is a key player which held a significant value in whether the act persisted or not, particularly in our Sudanese context.
Female Genital Mutilation/Cutting is a cross-continental, cross-national and cross-cultural act. A report produced in 2012 reveals that, worldwide, 140 million women and girls are experiencing the aftermath of the act and another 3 million more are at risk. In sub-Saharan Africa and the Arab States around 200 million girls and women were exposed to this practice since 2016 [2, 3]. It is practiced in about 28 African countries as well as countries in the Middle East and South-east Asia. However, the lived realities of girls who’ve survived FGM can be found all over the world due to the increasing waves of global immirgation.
The most recent measurement of FGM prevalence across Sudan is from the MICS 2014 which found that 86.6% of women ages 15-49 have undergone some form of FGM. This places the country in UNICEF’s ‘very high prevalence’ category. More than 12 million women and girls are believed to have undergone some form of FGM.
Moreover, the attention drawn towards eradicating FGM gained momentum because of the act being recognized and addressed in international frameworks. International frameworks include the Convention on the Right of the Child (1990), the International Conference for Population and Development (ICPD) in Cairo 1994 and the Declaration and Platform for Action of the Fourth World Conference on Women (FWCW), Beijing 1995.
Sudan has signed, even ratified, multiple international and regional conventions and treaties that condemn FGM and demand action against it, (those don’t include CEDAW or the African Charter on the Rights and Welfare of the Child). However, no pragmatic National Action Plans (NAPs) have been implemented in that matter.
Note that if a country signs a treaty, it merely indicates their agreement and compliance with the content of the document, while ratification means the country carries a legally binding obligation towards the agreement, under international law.
FGM in Sudan – The Cultural Perspective:
This part aims to explore the culture of FGM/C in Sudan, how has it emerged, why has it emerged, what sustained it throughout the years, and which the factors that we must focus our research on when trying to understand the act.
The act initially appeared in Sudanese communities through its affiliation to an old heritage called Pharaonic circumcision, a legacy that stood for hundreds of years, and is referred to in modern terminologies as infibulation. Infibulation (or “Type III” according to the WHO’s classification of FGM/C) is constituted by experts as the worst form of FGM to ever be practiced, in which all external female genitalia is removed.
The reason why girls are subjected to the act is that it contributes in inactivating most of their sexual capabilities and senses. This is a product of the belief that a female’s sexual temptations and desires must not exist at all, in order for her to remain socially respected and serve as a good marriage candidate. The marriageability factor can be explained more thoroughly by saying that Sudanese men tended, or might still tend to, favour marrying a circumcised woman, due to her supposed “pure form” and controlled premarital indulgence in sexual activities. Perceived religious obligations also encourage the sustenance of FGM, and when talking about FGM/C in the light of religious obligations, we must immediately bring attention to the idea of Sunni circumcision (Type I according to WHO’s classification). Sunni Muslims in Sudan can approximately constitute 97% of the population, with the rest adhering to Christianity and indigenous beliefs. Accordingly, we see religion being cited as a motive to practice FGM. The Sunni-considered form of cutting is less severe in the way it’s operated as only partial or full removal of the clitoris is done, but is similarly subsequent to health complications, and overall sexual and reproductive functions complexities. Nevertheless, the association of this form of FGM/C to religion has raised a lot of public debates and disputes regarding the act, and can be attributed to as an integral resistive force for legal reformists as we will explore later in this piece.
“We do Sunna, which is the Sunna (teaching) of Prophet Mohamed (PBUH) he told UmiAtia [a woman in Prophet Mohamed’s time] not to cut much and leave parts as they are. This is the Sunna. We should do it.”
The cultural beliefs surrounding the practice do not stop at controlled sexualities and religious obligations; they extend to views of “cleanliness” and “removal of unfeminine parts” of a woman. A study by the Sudan National Committee Against Traditional Practices (SNCTP) revealed that there’s a belief that during childbirth, if a baby’s head touches the clitoris, the baby will die; and in some areas it is believed that if FGM/C is not carried out, the clitoris will grow to dangle between the legs like a penis. Those cultural ideas are often associated with femininity, and how it’ll be enhanced by removing masculine parts (the clitoris), or to be smoother and more beautiful in the case of infibulation (Type III).
Furthermore, while those factors define the cultural motivations behind families choosing to expose their girls to the act, they give rise to another subtle motivation, which is acceptability within the group. Regardless of whether communities believed or made sense of those cultural beliefs, they were keen to perform the act all the same, simply because it’s a social norm. With that being said, social stigmatisation is placed at the forefront of reasons why combatting FGM/C has posed a national challenge for years to be accounted for. Abiding by those social norms positions families in a place of being accepted in the group, and therefore their social status remains intact.
“Mother, I’m scared”, in those words a girl relives the horror of her experience with FGM, an experience which she believes made her childhood “bloody”. She elaborates that the social popularity of the practice made them neglect her cries of pain as blood splashed between her legs, and instead her cries were superseded with the celebratory rituals done by the women of her family.
With the passage of time, people’s cultural perceptions towards FGM might have shifted, but the numbers still remained high. A study conducted in Niyala university explored male and female students’ rationale towards the practice, and most male students referred to religion as the the primary influence for the practice.eversibly, female students believed that religion was the least important reason for conducting the act, with traditional beliefs being the most important.
With the practice of FGM/C Type III appears another even more atrocious act known as “reinfibulation” or RI (adal in arabic, which is literal for correction and making something right). This is a procedure where genitals are re-sown after childbirth. RI is also culturally excused as a way of further tightening to mimic the narrow introitus of a virgin, meaning more pleasure for the husband, and a better chance of a preserved marriage. Significant numbers of women are affected by this form of re-circumcision (23.9% of ever-married women aged 15-49 who have ever given birth). However, this number lacks consistency, as in Kassala state for example, this number almost triples to account for 62.5% of women there. A study from 1983 showed that 80% of infibulated married women submitted themselves to reinfibulation at least 5 times.
“After the deliveries, there is blood and other secretions that have to come out, but the tightness from Reinfibulation (El Adel) prevents this and I myself suffer much from this and it has caused me health problems such as inflammations, but still I do it for my husband. But I just let my daughters undergo sunna, because it is a kind of cleanliness and protection for the girl.”
This section focuses on highlighting the relationship between the practice, and the demographics associated with it; mainly age, geographical locations, ethnicity and socioeconomic classes.
According to the 2014 Multiple Indicator Cluster Survey on Sudan, the age period in which the cutting takes place is mainly between 0-15 years of age, however 66% of girls are cut aged 5-9.
The former head of the National project to end FGM, Amira Azhari, quoted statistics produced by the 2010 Sudan National Household Survey (SNHS), stating that FGM prevalence on a national level has reached 65.5%, with 83.3% of the national figure concentrating in the River Nile states, and 83.4% in the Northern State. The lowest level of support for stopping FGM was found in East Darfur, with only 30.6% of the population expressing their condemnation of the act, while the highest support proved to be in Khartoum, with 70% expressing conforming views towards ending FGM.
Studies conducted throughout the years to track the prevalence of FGM in Sudan reveal that there’s a general higher frequency of the practice in the centre and north-west areas. They also tell us that there aren’t necessarily significant distinctions in FGM prevalence among urban and rural communities.
By referring to the multi-geographical and dimensional FGM studies that have been performed, we can say that the prevalence among most ethnicities is vaguely similar. However, the Fur, Hawsa and Umbarraro ethnicities haven’t been recognized to witness prevalence in FGM activity. Despite being prominent non-practitioners, cases were still reported due to their migration to practising communities. Reports have revealed that social pressure led them to indulge in the practice in fear of being labelled as “unclean”. Spread of FGM to new groups among southerners has also been identified as a result of their contact with urban northerners. This highlights the crucial role social stigmatisation plays in perpetuating for the act. The UNFPA states that ethnicity could possibly be attributed as the most significant factor in the occurrence of FGM, almost forsaking socio-economic classes and educational levels.
The relationship between the wealth of the family and whether their girl gets circumcised or not remains controversial. However, it is believed that women who’ve received higher levels of education, and are in the higher wealth quintile are more likely to condemn the act. This is further evident in how some surveys, such as the one conducted by Saleema initiative in a Sudanese university, disclosed that 56% of the girls were subjected to FGM, and the numbers are higher still for girls from rural communities, where there is less education and development. The association to education brings to light that younger women are less likely to cut their daughters, seeing as their opportunities to attain/complete higher levels of education were positively variant. Nevertheless, research has also raised attention to the fact that urban and more educated women were more inclined to perform Type I of FGM (clitoridectomy or Sunni circumcision), which contends to be less severe, rather than refraining from conducting the act altogether.
FGM in Sudan- The Stakeholders:
This section birefy indicates the different stakeholders involved in the FGM process.
Perpetrators: those constitute the individuals who carry out the cutting process.
Decision-makers: those are the groups who determine whether the act occurs or not.
Inciters: those are the groups not directly involved in the decision-making but have a great role in encouraging decision-makers to carry the act out.
By-standers: this refers to groups who might not entirely be in favour of carrying out the act, yet still choose not to interfere.
Preventers: this refers to groups who’ve had an influence in preventing the occurrence of the act.
FGM in Sudan- The Numbers, What Do They Tell Us & What Do They Don’t?
When trying to understand the magnitude of FGM practice in Sudan, it’s important to look into the different notions that make the numbers carry different meanings.
One of the issues that must be taken into consideration is how taboo of a subject FGM is. The figures in Sudan remain partial and incomplete as many cases remain unreported and unspoken about. Additionally, local communities have a hard time distinguishing between the different kinds of cutting that take place. In numerous occasions, it has been discovered that the data reported is faulty, as respondants state that they have not undergone FGM, when it’s later found that they have undergone type I of FGM (Sunni Circumcision). This tells us that there’s a misconception of type III (Pharaonic circumcision) being the only harmful one, and is therefore the one they’re being asked about when talking about genital mutilation.
It is also important to process the numbers comparatively. For instance, if a certain measurement of FGM at a certain time shows you the prevalence among older and younger age groups, you are able to draw conclusions about the rate in which the practice is increasing or decreasing. While those comparisons can be insightful, they can also be misleading, especially between the years 2014 and 2010, where the country witnessed mass migration of communities following the seclusion of Northern Sudan from Southern Sudan. It is therefore necessary to be aware of such confounding variables and account for them when analyzing the data.
FGM in Sudan- The Law:
In this section, we will review the different stages that FGM legislation has went through and how it was situated and defined throughout the years.
Note that up until April 2020, National Legislation did not:
Provide a clear definition of FGM
Criminalize the performance of FGM
Criminalize the procurement, arrangement and/or assistance of acts of FGM
Criminalize the failure to report incidents of FGM
Criminalize the participation of medical professionals in acts of FGM
Criminalize the practice of cross-border FGM.
Therefore, the table below will cover relevant laws.
First law that criminalizes FGM imposed under British colonial rule.
An article that prohibits FGM is added to the Criminal Act Law.
Sharia law is introduced and the FGM article in the Criminal Act is revoked.
Criminal Act Law of 1991:1. Section 138 defines ‘wounds’ inflicted on another person (both ‘intentional’ or ‘semi-intentional’) to include the loss of an organ or any of the senses, and sets out the penalties for committing the offence.2. Section 142 defines ‘hurt’ as causing pain to another person and is punishable accordingly.
Drafting of the Child Act, that was approved in 2010, was initiated.
Red Sea State introduces a law that criminalizes all forms of FGM. However, protests from the Beja ethnic group caused it to be revoked.
South Kordofan State being the first to adopt legislation explicitly against FGM – Prevention of Female Genital Mutilation Act (2008):1. Places responsibility on parents and guardians to protect females (up to 18 years of age) from FGM.2. Reporting incidents of FGM is the responsibility of all.3. This law also provides for the payment of compensation to the victim of FGM by the person who performed the act.
Article 13 was proposed to be added to the Child Act, to explicitly criminalize all forms of FGM. However, this was denied by conservative government individuals who associated FGM with Sunna.
Gadaref – the second state to introduce a law. Under Article 13 of the Child Law 2009, all harmful traditional practices (including FGM) are prohibited. This is applicable to all forms of FGM.
Child Act of 2010:1. Chapter II, Article 5 protects children (under 18 years of age) from all forms of violence, harm and physical and psychological abuse; sub-section (2)(k) specifically states: ‘This Act ensures the protection of a male, or female Child, against all types and forms of violence, injury, inhuman treatment, or bodily, ethical or sexual abuse, or neglect or exploitation.’
Following the death of an infant girl in Red Sea State from FGM in 2009, pressure to criminalize the practice increased again and the Child Act 2011 reportedly included the potential for FGM prohibition under Article 10, though only for the most severe type (infibulation, also known as ‘Pharaonic Circumcision’ in Sudan). The Ministry of Health, however, has yet to issue a decree; hence, to date, the law has still not been fully enacted.
South Darfur – third state to impose legislation. Under Article 11 of the South Darfur State Child Act 2013, all forms of FGM are prohibited.
An amendment to the Federal Criminal Act of 1991 was approved by the council of ministers to criminalise all forms of FGM under a new Article 141. It was still pending parliamentary endorsement, until recently passing.
National law that criminalizes all forms of FGM passed.
FGM Presence in The Constitution:
The Constitution of the Republic of Sudan 2005 (amended 2007) places various obligations on the State to protect women and children. Article 15 says that the State shall protect ‘women from injustice, promote gender equality and the role of women in family, and empower them in public life.’ Articles 28 and 33 state that everyone has ‘the inherent right to life, dignity and the integrity of his person’ and that ‘[n]o person shall be subjected to torture or to cruel, inhuman or degrading treatment.’ Although the Constitution does not specifically mention FGM, Article 32 refers to harmful practices in relation to the ‘Rights of Women and Children’: The State is obliged to ‘promote women’s rights through affirmative action’, ‘combat harmful customs and traditions which undermine the dignity and status of women’ and ‘protect the rights of the child as provided in the international and regional conventions ratified by Sudan’.
Efforts Towards Ending FGM – The Challenges:
Advocacy for ending FGM can be traced back to the 1940s. However, legal advocacy is said to have been initiated by a few non-governmental organizations in the 1970s. To the present day, those efforts persist through national and international agencies, as well as academic and research bodies being part of the movements. The 2001 National Action Plan on ending FGM, and the FGM concerned chapter in the reproductive health strategy by the federal ministry of health, both have set an environment more conducive to advocacy by groups concerned with the issue. A key body that is notable in the history of advocacy against FGM is the Sudanese Network for Abolition of FGM (SUNAF), the network took the lead in drafting relevant strategies and, more importantly, in regulating them among the members of the network.
In order to formulate a complete idea of the path advocacy took throughout the years, we have to look into the main obstacles the concerned bodies faced; what were the setbacks, who was responsible for them and why?
The believed association of FGM to Sunna, did contribute in decreasing the prevalence of Type III of FGM (pharaonic circumcision), but on the other hand, it has created an appealing and comfortable image for Type I. The masses of people shifted to the practice of Type I, which is assumed to be consequent to a declaration made by the National Islamic Jurisprudence Council in May 2005, which stated that FGM Type I is “religiously favoured”.
Activities performed by CSOs were at times perceived as attempts to enforce western ideologies on Sudanese communities. They were viewed as an outsider who’s keen on disrupting the natural pattern Sudanese cultures follow, and the natural journey that a Sudanese girl must undertake. Public comments made by the former head of the Sudanese Scholars Association, Mohamed Othman Salih, could be interpreted as forms of support for that rhetoric. He refused to draw the harmful similarities between the Pharaonic and Sunni circumcisions, and was inclined to regard Sunna circumcision as “honouring for a girl, palming for her face, and responsive to the need of her husband” (“مكرمة للفتاة، وأنضر للوجه وأحوج للزوج”).
Not only was he vocal about those perceptions, but he also denounced the advocacy efforts that aim to end all forms of FGM and urged the government to remain unresponsive to their interventions. He referred to those campaigns as “conspiring and supported by western bodies, and are looking to get rid of our beautiful traditions” (“تلك حملات مشبوهة ومدعومة من الغرب، وتريد أن تقضي على عاداتنا السمحة”)
FGM, being a taboo subject, is severely underreported, and the data that does make it to the papers lack the specificity in detail (e.g. the type of FGM that was conducted). In several occasions, it was found that both victims and perpetrators of the act weren’t aware of the operational distinctions between the forms of FGM being performed. These were barriers against using data to inform advocacy plans and strategies.
An Uncollaborative Stakeholder:
One of the most important stakeholders is the perpetrator, who, as stated above, mostly constitutes midwives and health workers. Those groups were considered key target groups for active CSOs, and by interacting with them, they were able to contribute in incorporating the midwives’ oath to not practice FGM in the curricula at midwifery schools. Although this addition might sound like solace to anti-FGM groups, its translation in real life wasn’t evident. Midwives risk being the recipients of massive backlash from their communities and circles, and end up deterred from taking the oath. Nevertheless, FGM is considered a highly profitable activity for them; the increasingly deteriorating economic conditions presented an obstacle for the positive utilization of the oath.
A Conflicting Actor in The Scene:
While government bodies were primarily part of the ending of FGM campaigning, conflicting ideas within the institution itself obstructed the processes of supporting movements and criminalizing the practice on a national level. Besides the different proclaimed views that they expressed through media platforms, conservatives within the government have bogged down the endorsement of article 13 in the National Act law that called for the prohibition of all forms of FGM. Despite the fact that the former President signed a national strategy to eradicate FGM, he ordered article 13 to be removed from the final version of the law.
According to an activist:
“We attempted to insert an article, article 13, in the National Child Law. But it was dropped by the President. He was under pressure from the ICC. He started to talk to the Salafists who advocate the Sunna circumcision. They say it is Islamic. Against this backdrop, the criminalization of FGM was portrayed as an intrusion from the West; That the National Council for Child Welfare, a government institution, was working for the UN. (…). The “no” came from the supreme leader himself”
Efforts Towards Ending FGM – The Opportunities:
Recent statistics show a high prevalence of 87% among women in a reproductive age (15-49), and a lower percentage of 31% among younger women (less than 15 years of age). This positive shift in the declination of FGM practice can to a great extent be credited to the efforts exerted by the different agencies previously stated. As we already investigated challenges in navigating communities, the brighter side of the picture can also be visited; what were the factors and opportunity areas that made advocacy feasible? What worked, who was involved in it and why did it work?
As the National Council of Child Welfare (NCCW) is the government body that coordinates the activities concerned with FGM, they collaborated with the various active parties in developing core strategies to be implemented across Sudan. In the heart of those strategies was the use of intergenerational dialogue to open a conversation onthe topic; a conversation that involves both victims and perpetrators. This was successful in reflecting how the intuitive cultural beliefs the perpetrators have can force a life long ugly reality on their victims.
The approach of depicting a positive image for a girl who hasn’t undergone FGM defined the slogan of one of the leading initiatives in the space: ‘Every girl is born Saleema; let her grow up Saleema.’ “Saleema” initiative described an uncut girl as being “pure, intact, unharmed”. This was not only positive, but it was different and it allowed for a reversed attitude to be born; the normally derogatory phrases that were directed against uncut girls were now recast into glorifying ones.
Public Declarations of Abandonment:
Public declarations of abandonment were heedful of the kind of danger social stigmatisation and acceptability within the group pose.
It has proven to instil a sense of encouragement and solidarity within individuals who are hesitant towards ending the practice, especially those who fear facing social consequences because of that. One of the leading communities who have expressed obstinate and explicit abandonment towards the practice of FGM were the residents of Tutti Island. Inhabited by 21000 people, Tutti is still regarded as an inspiring and pioneering example of how collective consensus coming from the people themselves is a strong tool in the combat against harmful practices.
“Tutti Island is a shining example of how a community can initiate and sustain an effort to end FGM,” says Dr Wesal Ahmed, team leader in WHO Sudan’s Women’s Health Unit. “We hope the other communities who have declared abandonment in the past four years can also sustain progress.”
The Use of The Religious Perspective:
To counterargue the association of FGM to Sunna was to bring forth religious text that condemns the distortion of God’s creation. They instated that FGM is a form of altering the natural body features females have. One of the campaigns that adopted this kind of approach was Almawada wal Rahma (Compassion and Mercy), which focused on advancingwomen’s rights and addressing violence against women through a religious lens.
Media Outrage & Mobilization:
Events that raise the attention of the public opinion, and by default the media, can be exemplified by the story of young Enaam Abdelwahab. Enaam lost her life at the age of only 4 due to a severe infection that she suffered from. The doctor following up with Enaam’s case insisted on dissecting the body and determining the cause of death, which was, rather unsurprisingly, her genitals being cut. Enaam’s story ignited fierce anti-FGM campaigns that were carried out through different media outlets.
The use of both modern and traditional media in advocacy was regulated on a federal and state level. Key informants and leaders’ messages were communicated to the public in local languages, and in the shape of radio programs, songs, as well as role plays. FGM relevant data was disseminated through daily newspapers and national TV channels. This activation of media channels helped in building momentum on a community level, and as a result made the work of anti-FGM advocates and legislators more feasible, specifically the groups involved in the Saleema campaign, which witnessed mass media mobilization. A media group conducted a review with the support of the UNFPA to track the efforts made in the eradication of FGM between the years 2000-2010, and results showed a total of 51 articles published on that matter, almost across all national newspapers. Male and female professional wrote in topics such as the legal status of FGM since 1946, the legal efforts made and their achievements, as well as statistical data that conveys the scientific figures attained from relevant national health surveys and studies.
The Recognition of Where The Stakeholders Are Situated:
While men are typically the decision-makers of the family, FGM is perceived by them as women’s business, and so they rarely interfere. Advocacy groups, on the other hand, soon discovered the kind of influence men can have on the process of ending FGM. Their access to other decision-makers in the bigger scheme (religious and tribal leaders) indicated that partnering with men and recognizing the transformative nature of their neutral stance is an important element in advocacy planning.
Ahmed, one of the male facilitators in the Saleema initiative, participated in a forum conducted in 2018, which aimed to allow advocates to share the challenges and milestones that they face in their anti-FGM work. He contributed by saying:
“I contacted all the Sheikhs (religious leaders) in the village and succeeded in convincing some of them, while others stayed neutral,” said Ahmed. “We continued our efforts with families, midwives, doctors, and youth. Many public sessions and conversations were conducted.”
Additionally, in Kassala, where FGM prevalence is high, the recognition of the male partner was effective in the sense that anti-FGM male networks were built. Sheikh Mohamed Saeed was one of the people from Wad Sharefai refugee camp who attended a training on FGM, and after being exposed to the information, he was motivated to challenge the ideas of religious leaders in mosques, as well as the camp community around him. He was therefore given the name of the “Champion of change” after successfully initiating a network of men within the camp, which is eager to advocate against FGM. In the words of Sheikh Mohamed Saeed, he said:
“For a long time I had the feeling that our women are suffering from the different types of violence, however, I thought life is like this.”
The Use of Evidence To Inform Activities:
The scope of anti-FGM work included awareness raising, advocacy, capacity building, research, and community-based projects. The use of statistics from national surveys on FGM, as well as medical studies was instrumental in drawing the attention of policy makers to the magnitude of the practice, and was informant to who should be targeted in campaigns. This led to the inclusion of male partners, key government officials, as well as religious leaders. Moreover, content relevant to health workers assisted in drafting the Medical Council Statement which set a fertile land for the FMOH strategy of 2001.
The Multi-Sectoral Constituent in Advocacy Groups:
Understanding how FGM must be tacked by a multi-sectorial approach, immensely extended the kind of institutions that engage in FGM concerned work. This can be seen in how the review of the 2001 Plan of Action, and development of a national strategy to abandon all forms of FGM, included different groups such as SUNAF (a collective of CSOs), academic institutions, legal experts and line ministries. The strategy was drafted after a thorough review of existing policies, surveys, and studies, as well as legal frameworks on a national, regional and international level. Similarly, this comprehensive approach was used in drafting the 2009 National Child Act bill, article 13, which criminalizes all forms of FGM. However, as previously mentioned, the article was removed by the council of ministers, following the release of a fatwa by the Islamic Jurisprudence Council that calls for the distinction between Pharaonic circumcision and Sunni circumcision.
As the years passed, the traditional depiction of the FGM practice has changed on both a cultural and legislative manner. Understanding those changes and the factors which have driven them is crucial in anticipating the kind of change we might see following the recent criminalization of the act.
A quite recently published research article looked into the shifts in FGM from multiple angles. Results concluded that the drivers of those cultural shifts are more likely to cause the normalization of the practice rather than its abandonment. Those cultural drivers, as identified by the research, are as follows:
Shift From Type III To Type I (From Pharaonic To Sunna):
As has been discussed in several sections in this piece, the appeal of Sunna circumcision has tremendously increased over time. This was primarily a consequence of religious teachings practiced in different settings, including the fatwa released in 2005 by the Islamic Jurisprudence Council stating that it’s religiously favourable, and secondarily to awareness raising interventions. The introduction of the idea that Type I is religiously favourable encouraged the masses of people to settle with this option, and awareness raising interventions motivated families to seek a safer way to perform FGM. The conflict between adhering to the logical decision to make and the cultural commitments produced a middle ground: Sunna circumcision. Although the midwives’ oath of not conducting FGM has been challenged by the social shaming and ostracising the women face upon expressing defiance, it was still associated to this shift in the practiced type. The knowledge they attained after taking the oath allowed them to provide explanations in their communities, and that also assisted in realizing the danger of the cutting and preferring to go with Type I.
Medicalization of FGM:
This shift is very dangerous and concerning as it gives FGM an embellished facade, and therefore a sustainable nature. For the longest time FGM was done under the hands of the older women in the family, ones who don’t hold any medical expertise. However, the practice has witnessed a shift in the perpetrators mostly being health professionals and midwives. Health campaigns warning of the complications FGM cause have raised fear in families, and in their refusal to risk their social statuses, as well as their attachment to traditional practices, they became inclined to take their daughters to health professionals. Health professionals being naturally perceived as people who will not inflict harm upon people drove families to believe that the procedure will be safe and free of negative health consequences. The health care professionals themselves are not any less guilty, perpetrating the act while being in full awareness of the real picture. They have tended to justify this behaviour by referring to the high demand of families desiring to circumcise their daughters, and that they might resort to even more atrociously unsafe methods had they declined. Some midwives also expressed opinions about how the oath they signed doesn’t refer to type I (Sunna), but only explicitly covers type III.
Shift in The Age of Cutting:
The shift in the practice of FGM moving from younger girls to older ones has been notable. This too is a result of the health awareness interventions that were able to reach a significant fraction of the population. People were inclined to think that an older girl might be less vulnerable and fragile and can therefore better heal from the cut. This shift is, however, not universal, as there is still an existing belief that young girls’ circumcision “cures illness”. That is besides the fact that the age factor is highly dependent on the ethnicity of the family.
Law Amendments, The Red Sea State, a Good Example:
Reflecting on the experience of the states in Sudan which have criminalized FGM can be of help in our current time.
Six states have laws in place, those being: South Kordofan, Gadarif, South Darfur, Red Sea, North Kordofan and The Northern state. Ever since their endorsement, no public information was available to refer on cases of arrest or court proceedings with relation to FGM. The situation in the Red Sea State can be looked into more thoroughly, seeing as the area is known for conservatism when it comes to women issues. As stated above, the initial criminalization happened in 2007, but the upsurge of protests headed by the Beja ethnic group caused it to be repealed. The Bejas practice infibulation (Type III), and refer to it using the term “kushabi”, which the group believes preserves honour, keeps away evil spirits and diseases, and is compatible with Islam. When the criminalization was reinstated in 2011, it was deemed successful, but activists had opposing views with regards to the activation of the law.
Interviews conducted in 2016 revealed that FGM has not been stopped due to significant loopholes in the legal text itself. Firstly, only Type III was criminalized. Secondly, it is not referred to as “infibulation”, nor is the term “kushabi” indicated anywhere, which gives room for the law to be circumvented. Nevertheless, the law stated that in order for it to be enacted, the minister of health must issue a decree, something which he hasn’t done in all his years of service. Lastly, the law lacks a penalty for the offenders. This drove activists to make statements regarding the Red Sea State law being a political compromise, made to please both the government conservatives and the international donors who have allocated vast sums of money expecting to see some sort of comforting change.
An FGM Advocate in The Red Sea Explained in a 2016 Interview:
“When the child law was tabled, it included criminalization of the pharaonic type only. There were some supporters for the criminalization of all types but they were not able to convince the session as many of the parliamentarians were there in 2007 during tribal opposition to the law. Forbidding pharaonic circumcision is a compromise satisfying the international organizations who supported the initiatives and who are supporting the education and other services in the state, and at the same time it avoids provoking the tribal leaders.”
Passing of Article 141 in Sudan’s National Criminal Act Law. What Can We Expect?
Law amendments are not new to the case of FGM, but the question we are trying to answer is: what degree of efficacy does this law hold in the face of the practice?
Culturally speaking, the shift doesn’t seem to embrace the root concepts that make FGM problematic, but only manifests a shallower level of awareness regarding its health effects. This is still positive, but wears a more perilous face, as it indicates that the underlying cultural beliefs are not really being challenged. We can directly see this in the medicalization issue that has previously been discussed. The insistence of health professionals to perpetrate the act despite taking the oath, and despite being in full knowledge of the danger, assures us that the enforceability of legislation is highly dependent on the organizational culture each health institution has.
On the other hand, we should ask ourselves: to what extent is this amendment and its implementation plan responsive to the different social issues that are deeply connected to FGM? As we’ve seen in the Red Sea State example, even the terms used to define FGM play a role in the activation of the law. Does this law consider the societal repercussions an individual can face if they report a case of FGM? Does this law consider the fact of FGM being a profitable activity for midwives? Does this law consider that the prohibition of the practice in relatively official settings can mean more girls being cut in even more unsafe methods, under the hands of unskilled women? Does the law realize the possibility of FGM practice continuing, but with total neglect of celebratory rituals, meaning the practice existing, but this time with no numbers to infer its magnitude?