You make an excellent point: Improving "preparedness" is precisely what governments at the municipal, regional, and national levels must focus on. The climate change scientists believe that extreme-weather events (hurricanes, flooding, storm surges, and the like) will take place more frequently and may well be more severe when they do occur.

To prepare for these risks, governments will need to: (1) make overdue investments in the basic urban infrastructure, especially in the areas of drainage, sanitation, and water supply, that the poor neighborhoods of their cities have lacked; and (2) form new partnerships with NGOs and relief and disaster preparedness agencies (such as the Red Cross/Red Crescent, and establish better links among international, national and regional weather forecasting agencies) so that actors and systems are in place to anticipate climate change hazards and respond effectively when these hazards materialize.

There is no inherent conflict between climate change adaptation in the cities of poor countries and the economic development agenda that has faced these cities. Much of what needs to be done in anticipation of climate risks has long needed to be done in any case.

In many cities---especially coastal cities---there are important business assets that lie exposed to climate-related risks. There is at least a possibility that coalitions will form in which the interests of the business community and the urban poor will be aligned. That has not often happened in the past, but we may see it beginning to occur in the future.

Climate change is such a complex phenomenon, and is expressed so differently from one place to another even within a given country, that I am sure there will be some cities for which the changes will prove beneficial at least to a degree. (Think for example about cities in what have been ice-bound polar regions, where new shipping lanes may open up.)

However, we need to recognize that the modern world is so inter-connected that changes in one place can have an influence on well-being in another place. At this point, knowing what we know today, it is awfully difficult to forecast what the net benefits might be for individual cities.

I agree with you that air quality is an under-appreciated factor in health. There is good agreement among the climate scientists that heat waves (magnified by the "urban heat island" effect) are likely to occur more often as climate change takes hold, and there is interesting research on the interactions between extreme heat and air pollution that makes the combination of the two more deadly. We are only beginning to see studies of cities in poor countries in which the joint effects of heat and pollution are examined---but I think more evidence is on the way.

I lived in Lagos myself and know exactly what you mean! There and elsewhere, it is very difficult for local governments in particular to prevent development from taking place in environmentally risky sites or in sites (such as mangrove swamps and wetlands) that serve as natural buffers in cases of storms and flooding.

I would like to see a concerted effort made to thoroughly educate the Nigerian press about the local risks anticipated from climate change and highlight the kinds of unwise development that will exacerbate these risks in the future. Not every country has such a loud and vigorous press, and although publicizing problems is only a part of the solution, it is an important part.

We often tend to think of city population growth in poor countries as being mainly caused by migration, but in fact the greater part of that growth is due to natural increase---the excess of urban births over deaths. And an important percentage of urban fertility is unwanted or unintended (according to the reports of the women who themselves had those births). Voluntary and effective urban family planning programs could reduce urban fertility in a humane and respectful way, and in so doing would (over the long term) cause city population growth rates to fall.

Family planning is by no means *the* solution to the problems presented by climate change in poor countries, but we should think of it as another helpful tool in climate change adaptation, one that has a proven track record of effectiveness.

There are at least two sides to the population growth question.

For the most part, it is population and (more importantly) economic growth in rich countries that has produced the emissions that have resulted in global warming. Although population growth rates in rich countries are now generally quite low, it is possible that some climate-related benefits would ensue from further slowing of growth in these countries. But I doubt that the effects on future emissions would be very large. I would point you to the research on emissions by Brian O'Neill and colleagues for estimates of these effects.

In poor countries, where urban and national population growth rates have been higher, slowing of population growth will reduce the costs of adaptation to climate change, by reducing the number of people likely to be exposed to climate-related risks. That is a long-term proposition, of course, but not one that we should ignore. As I mentioned in answering another question here, we need to give more attention to *voluntary* urban family planning programs. Those programs are well-justified on equity and reproductive health grounds alone; and their effects on future population growth are an additional justification.

Urbanization is a chaotic and messy process, but one that history teaches us is ultimately essential to economic development. As I've mentioned in response to other queries, migration is typically not as important to city population growth as is urban natural increase; but migration is too important to neglect.

I would advise the Ugandan government to tackle directly the problems you've mentioned: improve drainage, unblock canals and storm sewers, reorganize collection of the solid wastes that currently clog these canals, and invest in better urban sanitation and water supply. These are all high-priority human development needs in any case, and climate change will only magnify their importance.

There is a lot of discussion these days about environmental migrants, but not a lot of evidence on how many such migrants there are today, to say nothing of the future. Most migration that takes place in poor countries is from one rural place to another, and doubtless much of that is motivated by what you could describe as environmental factors, in the sense that one agricultural site may be preferred to another on the basis of local climate, soil quality, and the like. How much more of this movement will be produced by climate change is hard to say. Big numbers are being tossed around by some people, but the scientific basis for them is very slim.

Even so, I think we should look closely at one large and especially fragile ecosystem---the drylands, where nearly 2 billion people live---and focus on the cities in this ecosystem, which account for about 45 percent of those 2 billion residents---as we consider the likely consequences of increasing water scarcities in the future. We might see rising costs of agricultural production in the rural parts of the drylands, which may in turn magnify seasonal, circular, and longer-term migration to dryland cities. The combination of rising agricultural prices and migration may put the labor markets of the urban poor under particular stress. I would keep an eye on situations like that.

We demographers do not do a very good job in measuring migration, which leaves us essentially clueless where environmentally-induced migration is concerned, but I am hopeful that in the future much more emphasis will be placed on migration.

Great question. The IPCC began to take the social and economic implications of climate change more seriously in the last Assessment, and it seems that even more attention will be paid to these issues in the next Assessment. The urban poor in low-income countries ought to and, I believe, will figure centrally in these deliberations. Stay tuned!

The task of forming projections of climate change is being addressed by a very large group of climate and other geophysical and biological scientists. If you google "IPCC" you will be introduced to the research teams that have produced the forecasts, and will see what variables and methods they have employed.

There is certainly much more that needs to be known about the forecasts for sub-Saharan Africa specifically, and the next stage of the scientific conversation should (and no doubt will) involve more criticism and refinement of the global models by those with detailed local knowledge of such environments. Africa's geographers and physical scientists could make an enormously valuable contribution in connecting the global models to local realities.

My advice is to begin by (1) mapping in detail the poor neighborhoods of Lagos where flooding and other climate-related hazards already cause suffering and the loss of life and health. We know that flooding puts the young, women, and the elderly at special risk; and flooding is more damaging for the poor who live in homes too flimsy to withstand it.
(2) These maps of vulnerability (which might be produced via the upcoming census) should then be placed in the hands of the decision-makers at the municipal, state, and national governments who will need to make decisions about infrastructure investments, especially in the areas of drainage, solid waste collection (which if uncollected tends to clog canals and other drainage systems), sanitation, and water supply. (3) The investment needs also should be made known to the African Development Bank and other international agencies with greater resources. (4) To prepare for a future in which flooding and other extreme-weather events are likely to occur more often and with greater severity, new partnerships will need to be formed with the NGOs and relief agencies that can assist local governments in preparing for and responding to disasters.

Urban agriculture is already important in giving some city residents a measure of food security, insulating them to a degree from market-induced variation in food prices. Development of green spaces within cities will be one of the strategies that can ease "urban heat island" effects and thereby affect one important aspect of urban health. In some cases, at least, development of urban agriculture could be compatible with the development of green spaces. But I will defer to the experts on urban agriculture (I am not one of them) for more on this point.

On migration, there is little evidence that movement can in fact be stopped "at the source" (apart from special cases such as China pre-1980) and more importantly, no good reason for doing so. People move in search of better standards of living and a better life in general, and to deny rural residents access to the city is to deny them that opportunity for betterment. Naturally, flows of in-migrants do complicate the task of urban management and governance, but we should put our emphasis on improving management and governance and encouraging growth of a system of cities, not on trying to prevent migration, which is a futile exercise in any case.

There's much talk these days about the role that international remittances play in national development, but we seem to have lost sight of the (presumably much larger) role played by urban-to-rural remittances and other economic benefits that internal migration brings for rural residents and rural areas. Fostering rural-urban connections is part of good economic development strategy. The 2009 World Development Report of the World Bank made this case very well, I think.

I would agree with you that climate change does present positive opportunities---the urban adaptation agenda will involve making investments in drainage, waste collection, and so on to safeguard the slums and other city neighborhoods that already live with climate-related environmental threats. These vulnerable areas have not received the infrastructure they need---but I am hopeful that as climate change seizes the attention of policy-makers, they will at last view the environments of the urban poor as deserving of urgent attention.

Funds are beginning to be available for exactly this sort of research. Good urban climate adaptation research will require real partnerships to be formed between global researchers and local experts. In particular, sub-Saharan Africa has long had an unusually strong community of geographic researchers in and outside its universities; their talents will need to be tapped. There is also good physical science expertise in the region that will need to be joined to good social science---climate change research needs a healthy dose of both kinds of science.

Another person in our discussion also raised the issue of urban air pollution, which I agree is an under-studied aspect of urban health. There are some excellent research reviews available.

I am beginning to see research on air pollution in developing-country cities---Wuhan (China's "oven city"), Shanghai, and New Delhi come to mind in addition to Mexico City and other Latin American cities (which have a rich tradition of scientific studies).

I would put this question differently. Some of the most important *consequences* of global climate change will be expressed in terms of more frequent and more severe extreme-weather events, especially flooding, storm surges, and the like. Poor (or non-existent) systems of urban solid waste collection cause drainage canals and other outlets to become clogged, which makes flooding worse. On these grounds alone there is a need for more attention to urban waste collection.

The recent "underwater cabinet" meeting in the Maldives effectively drew attention to the most threatened of the small island states. Fortunately, the situation facing the Caribbean island states is not (currently) forecast to be quite that dire. In this region, there is still much to be done to safeguard the neighborhoods of the urban poor from the threats of flooding and (in some cases) landslides.

There will inevitably be cases in which some communities of the poor, living in highly threatened environments, will need to relocate. But relocation can be accomplished humanely, with full attention to the needs of the poor. In the wonderful journal Environment and Urbanization, one can find multiple case studies in which poor communities and governments functioned as partners in finding relocation solutions. I highly recommend the accounts in that journal, which would be instructive for the Caribbean as well.

I am an economist and demographer, and therefore not well equipped to address the physical sciences issues of irreversibility that you raise. But as I understand it, there is a broad general consensus that where climate change is concerned, we cannot afford to ignore either mitigation (reducing emissions) or adaptation (dealing effectively with the consequences).

If by mitigation, you mean with the aim of reducing emissions, then I would suggest googling the 2009 Urban Research Symposium (a World Bank conference held in Marseille at the end of June) where a number of case studies on this general theme were presented. I recall seeing several Latin American cases, but do not at the moment have the details for you.

Since violence is a symptom of a more fundamental failure of governance, it is difficult to foresee whether climate change as such will result in greater violence in either urban or rural areas. Surely this depends on how governments and civil society respond and adapt to the climate change challenges. But I would direct you to the recent National Intelligence assessment carried out by the U.S. government for the thoughts of security experts on these matters. There is concern expressed about the possible consequences in dryland regions, where water scarcities are already a big issue and where it seems likely that climate change might intensify the competition over scarce agricultural resources.

The needs of small and medium-sized cities are typically overlooked---but this is where (collectively) the vast majority of urban residents actually live, and these smaller places are generally short of technical expertise and managerial talents that would help them address needs in health and climate change. For instance, we hear a great deal about urban-rural imbalances in the distribution of public health personnel; but we hear much less about similar imbalances between large and smaller cities. Also, governments are decentralizing in many poor countries, and smaller cities typically lack the independent resource base and taxation systems that would allow them to sustain themselves in the absence of well-designed inter-governmental transfers. The shortages of resources that usually afflict small cities and towns are plainly evident in the levels of health in these places (with risks not unlike those of rural villages) and levels of poverty.

In general, we know very little about small and medium sized cities, which don't figure (by name) in the nationally-representative surveys by which we learn about demography, health, and the like. But in Latin America, several countries are making a concerted effort to get *census* data disaggregated and mapped for these smaller places, and that effort ought to be on the priority list for national statistical offices around the world. For climate change, health, and economic development in general, we need quantitative portraits of these smaller places, and usually it is only via censuses that we can get such portraits.

Comparing child poverty in the U.S. to that in developing or less developed countries is complicated. And it raises the question of whether poverty should be seen as an absolute concept or a relative concept. While many U.S. children who are deemed poor have more material wealth than poor children in other countries, the gap between the poor children and the middle-class children in the U.S. is enormous.

I would certainly agree with you that there is a strong case to be made for investing in children in terms of the country's future and remaining competitive an an increasingly globalized economy. I don't have a completely satisfactory answer to why seniors get so much more assistance than children, but here are a couple of thoughts. First, despite the warnings of demographer Sam Preston in his PAA presidential address in the early 1980s, the disparity between federal spending on children and elderly is not widely known. A recent series of reports by the group First Focus (including one released this morning), has made this situation more widely known but still there has been little debate about the disparity because relatively few leaders seem to be aware of it. Certainly, the fact that seniors vote and have powerful lobbying groups such as AARP, makes cutting senior assistance difficult.

It is noteworthy that prior to 1972, the poverty rate for the elderly was higher than that for children, but due in large part to government programs (social security, medicare, Supplemental Security Income- SSI), the poverty rate of the elderly has fallen while that of children has remained high. In 2008, the poverty rate for seniors (9.7%) was about half that of children (19.0%).

Recently released estimates/projections from Isabel Sawhill and her colleagues at the Brookings Institution indicate that the child poverty rate in 2009 will be around 21% and their projections indicate child poverty rates will stay above 20% for the next ten years unless something is changed.

About 75% of means-tested benefits for low-income families in the U.S. are noncash benefits, things like food stamps, health care (medicaid and SCHIP), free school lunches, and housing subsidies, for example. However, for each of these programs many eligible families do not participate. The fact that many of these programs are run in isolation from each other, with separate application forms, eligibility criteria, and documentation requirements, discourages some eligible families from applying. Recent efforts in some places to make these programs available in one central location have helped.

It is difficult to point to any one program that has had a major impact, but I think we saw a combination of programs all aimed as supporting the "working-poor" lead to a dramatic decline in child poverty in the late 1990s.

Let me illustrate this with one quick example. Prior to 1996 when cash welfare (AFDC then TANF) were de-coupled from medical care, if a poor working mother (usually in a job without health insurance) needed medical attention, she often had to quite her job so she would become eligible for welfare and thus medical attention for her child. The expanion of Medicaid and the implementation of the State Child Health Insurance Program (SCHIP) in the 1990s, allowed those mothers to continue working while they got health care for their children.

The high child poverty level in the United States relative to other developed countries is closely linked to a lack of government supports for low-income families in the U.S. When one looks only at income from work, several other countries have child poverty rates about as high as that in the U.S. But most other developed countries provide much more extensive support for poor families, which dramatically lowers their child poverty rates.

The poverty rate is much higher for children living with single parents. In 2008, the poverty rate for children living in female-headed families was 43% compared to 10% for children in married-couple families.

I think it is fair to say that the enactment of TANF in 1996 had some positive impact in the late 1990s, as the poverty rate for children in single-parent families fell. The impact of TANF was due partly to new requirements that welfare recipients work, but also because TANF provided more child care subsidies and other work supports to help single-parents meet their work and family responsibilities. Of course, this all took place in the context of a rapidly expanding economy in the late 1990s.

Since 2000 I think the record is less clear, partly because the economy never regained the momentum it had in the late 1990s, partly because the people left on welfare after 2000 were those with the most barriers to entering the workforce, and partly because in the post-2000 era, the government did not continue the expansion of programs to help working-poor families.

In the late 1990s, the British government set a goal of cutting their child poverty rate in half over ten years. They did not meet the goal of cutting it in half, but their concerted effort did reduce child poverty.

The targeted goal approach has been adopted by a few states (and cities) in the U.S., but it has highlighted some of the short-comings of our poverty measure which are documented in other responses, namely that a lot of the things governments do to reduce hardship (provide food stamps, housing subsidies, medical care) do not affect our poverty rate because our poverty measure only looks at cash income.

I am not sure we can end child poverty in the U.S., but there is clear empirical evidence that we can reduce it. The child poverty rate fell from 23% in 1993 to 16% in 2000... a remarkable decline in a relatively short period... the child poverty rate is now 19%. It is also clear that most other developed countries have child poverty rates much lower than ours.

The decline in child poverty during the late 1990s was due to a strong economy which provided jobs for most people. But the decline was also due to the fact that a number of government assistance programs to help low-income working families were initiated or expanded during that period. This includes things like expanded EITC program in 1993, the implementation of the State Child Health Insurance Program in 1997, and an increase in the minimum wage in 1997. These trends are discussed in more detail in my monograph entitled "Trends in the Well-Being of America's Children," published by PRB and Russell Sage Foundation around 2003 (available by calling PRB at 202-483-1100).

I am not sure that capitalism per se is the main culprit here. Many countries in Europe that would be considered capitalists countries have low child poverty rates. But as you point out, the U.S. system has done much less to help children in poor families than other capitalist countries. So maybe it is the American brand of capitalism rather than capitalism itself.

The official U.S. poverty definition compares a family's cash income to a set of income thresholds to determine if the people in the family are poor or not. The thresholds, which vary by family size, were developed in the 1960s and updated every year to account for inflation. The threshold for a 4-person family in 2008 was $21,834. A National Academy of Science study in the mid-1990s outlined a number of ways in which the poverty measure should be updated and improved. Legislation has been introduced in the U.S. House of Representatives (HR 2909) and the Senate (S 1625) to update the poverty measure.

The child poverty rate in the United States is much higher than most other developed countries. About 20% of children in the U.S. are poor compared to less than 5% in Denmark, Sweden, Finland, and Norway. A recent OECD study shows that while the U.S. has the second highest average income among the 30 countries in the study, it has the 4th highest child poverty rate. The only three countries examined in the study with a lower child poverty rate were Poland, Mexico and Turkey

There are two ways of answering this question. First since the official poverty measure does not take taxes into account (and Earned Income Tax Credit - EITC-- is a tax program), the income poor working families receive from EITC is not counted in calculating the official poverty rate. Second, if the income from EITC were counted as income, the Center on Budget and Policy Priorities estimates 2.6 million children would have been lifted out of poverty.

It is worth noting that the total amount the Federal government spends on on EITC (about $50 billion in 2008) is much larger than that spent on what is often viewed as the main cash welfare program for poor families, TANF ($18 billion).

It is important to recognize that the poverty rates in the 2008 ACS reflect income in 2007 and 2008. When the data for the 2009 ACS come out, the child poverty rate is likely to top 20%.

I think there is growing momentum for increasing the ACS sample size. I understand funding for such an increase is likely to appear in the Census Bureau's FY 2011 budget request.

It is also worth noting that increasing the sample size is not the only approach to producing more reliable local estimates from the ACS. If the Census Bureau could increase the response rates, that would have the same effect as increasing the sample size. Right now the Census Bureau sends out about 3 million ACS surveys every year, but only gets about 2 million returned.

While the shortcomings of the current poverty measures are well-documented, I think it is reasonably good at identifying a group of families in need and at identifying recent short term changes in need.

I think one of the most important things government can do is provide support for low-income working parents.... things like good quality child care, and medical care for their children. The expansion of those types of programs in the last half of the 1990s helped reduce child poverty.

It is clear that children of color make up a disproportionate share of the child welfare population, and this is a system that it underfunded almost everywhere in the country. And it is linked to poverty in two ways. Children in poor families are more likely to end up in the child welfare system and children who age out of foster care are likely to be poor as adults.

I am not sure what you mean by child budgeting?

Getting precise figures for budget allocation devoted to children is difficult for a couple of reasons... just getting data on expenditure is often difficult, especially at state and local area. Furthermore, many programs serve both adults and children and it is difficult to break out the children's portion.

Helping low-income working parents balance their work and family responsibilities and making low-income workers get a family-supporting wage. Three-quarters of children in poverty have at least one parent in the workforce. Supporting working parents through programs like EITC has received strong bipartisan support.

The most common definition of poverty in other developed countries is income below 50% of the median income in the country and it is my understanding that the share of benefits that are cash benefits is usually higher in other countries.

However, it is pretty clear that U.S. children trail those in other countries in a numbers of ways beyond income. A recent study of OECD countries by Johnathan Bradshaw, at York University in Great Britain, combined a large number of indicators of child well-being into an overall index, and the U.S. came out next to last of the 21 developed countries examined.

While voices for children in Washington are nowhere near as plentiful or as powerful as those for seniors, there has been a growing present in DC over the past 10-15 years. A relatively new organized called First Focus has done a great job of using data to get policymakers' attention for children's issues. And the Children's Defense Fund has been around a long time. Recently, a number of children's groups have joined together to form the Children's Leadership Council to give children a more organized and powerful voice in DC.

Also, Voices for American Children and the KIDS COUNT network that have both been around for more than 20years often provide a voice for children at the state level.

A number of foundations including the Annie E. Casey Founation, Casey Family Services, and Casey Family Program focus on improving the child welfare system. Having said that, the problems in the child welfare system are long-standing and difficult.

You are right that many work support programs are being cut just as people need them more. Given the budget calamity facing many states (and the U.S.), I am not sure what can be done about this, except fighting to save programs on the margins.

I believe most (but probably not all) low-income families want to work. But many of them need supports to help them get and maintain jobs, and I think it is in the best interest of the country to make sure parents working at low-wage jobs have sufficient resources to take care of their families. This may mean wage subsidies, health care, and other benefits from the government.

See the answer to Miss Warrens' question.

I think there is an increasing trend to use data-based budget allocations that use a more rational approach to allocating resources... so child budgeting fits neatly into this frame. However, the trend is slow, and uneven. As we all know, politics often gets in the way of rational decision-making.

Probably not... The U.S. approach has not worked very well.

Yes this is a practice that is continued even in the United States. FGC is a social convention necessary for good marriage and respectability within a given ethnic group, so it does not matter where one lives. In fact people often feel they must "prove" that they have not abandoned their traditions when they move to the West and even feel added pressure to continue. It is critical to include the diaspora groups in efforts to raise awareness on FGC as they greatly influence people in the communities at home.

People often believe that FGC is a practice recommended by Islam. Many participants in the Tostan program claimed that they wanted to abandon the practice but could not because it was a religious obligation. However, it is not a practice required or recommended by Islam and many well known religious leaders have spoken out against the practice. Tostan always works closely with religious leaders on a national and local level to inform people and answer their questions. We have found that as more and more participants learn the human rights violations associated with FGC and the negative health consequences, they have put pressure on religious leaders to speak up and support their efforts to abandon the practice. We believe that people at the grassroots level can exert strong pressure on all leaders (religious leaders, politicians, local authorities) to help end the practice. This is why it is important to provide in-depth and empowering education to community members in their own national language who will in turn demand action from their leaders.

When asking people why they practice FGC, they often respond - it's our tradition, it's our culture. People do many things because they have learned it from their parents and their society, often without questioning why they do it. They simply know that if they don't do something that everyone expects them to do, they could be marginalized or even excluded from their social group. Going against the expectations means risking intense disapproval and is difficult if not impossible for one person alone to do. A village mother, for example, would never dream of doing something that could harm her daughter's reputation or chance for marriage.

Thus,it is important to allow people who practice FGC to discuss the pros and cons of continuing or abandoning together without judgment, shame or blame involved. If people come to consensus as a group that FGC does not help achieve their goals of health, well-being, and harmony, they then need to reach out to the entire extended family to get them on board with the decision. This is why Tostan often holds inter-village meetings that allow people to debate and decide. This often leads to public declaration where the extended family comes together and makes the decision as a unified group. The public declaration marks the moment that the social norm has changed. No one is expected to practice FGC after the declaration, so no one individual is hurt by the decision.

Hi Kantroo,
The story of the communities that have made public declarations to collectively abandon FGC is the story of how this practice can be ended, and why more and more people are confident that FGC can become a thing of the past more rapidly than previously believed. As mentionned above, literally thousands upon thousands of people in Senegal have abandoned this practice, and many more are joining the movement. What is key is that this is not a "western" imposition; this is informed and empowered African communities making decisions for themselves, together, about their health, their human rights and responsibilities, and their futures.

At Tostan, we have never found that communities lack understanding of the value of human life. In fact, we have found the opposite--we work with villagers who care about others, people who seek peace and who endeavor to build strong community. We have also found them to be rational. If someone hasn't gotten all the information about something, they probably aren't irrational, they are often just uninformed.

Tostan found that introducing human rights education into our program allowed people to discuss the social practices that would help them to achieve their goals for a more positive future. This meant reflecting on traditions, often for the first time, maintaining positive ones and abandoning those that are harmful.

Henry, it is true that we are seeing this practice move underground in many countries. However, within the communities, the practice is not underground--people know who is cut and who is not. That is why the work of communities in Senegal has succeeded--because when communities are empowered and leading a movement, they can reach the people that no outsider could reach.

In one instance a village in Southeastern Senegal abandoned FGC but the cutter went to another village (that had not abandoned) to cut a girl. It was the women from her own community that took this case to court and even insisted that the woman go to prison. Since she had been part of the declaration, the others felt she had violated their trust and the pact made by the community.

It is important to inform people of the law, but more important to provide empowering education in national languages before enforcing a law--especially in countries where it is highly prevalent. Otherwise the law risks being very ineffective.

Irene, this is a very good point. In our experience in 7 African countries, men have emerged as strong leaders in the movement for FGC abandonment. We include men in the Community Empowerment Program and as they learn about human rights and responsibilities and realize the suffering the women have undergone, they begin supporting the end of the practice. In fact, a brilliant village man named Demba Diawara helped Tostan to understand that there needs to be agreement among all of the communities of the social network in order for abandonment to occur. He addressed his extended family with respect and led discussions in all these communities until people came to terms with the practice. His work led to the first public declaration of 12 interconnected villages on February 14, 1998. He has been one of the major leaders in the movement ever since.

Most men have told us: "We just didn't know!" As soon as the women begin explaining some of the problems they and their daughters have experienced, the men realize that the practice must not continue. Because the subject was previously taboo, no one ever discussed FGC, especially among mixed groups.

It is also important to note that there is no one group that can end this practice by itself--it requires a unified decision by all members of the extended family--men, girls, grandmothers, religious leaders, village elders, minority ethnic groups, majority ethnic groups, the cutters, the diaspora--everyone must be involved. Having the support of local and national government is also critical in this process.

Hi Kofi,

The practice may be driven underground--but it is impossible for it to stay underground for long when communities themselves are leading and managing the abandonment movement. This is because in communities that have abandoned, they no longer want girls to be cut--which makes it more difficult for families to consider cutting their girls, even "underground". The communities themselves then denounce cases after a declaration because they have ownership of the process and are empowered to act.

As to your second question, we have found that FGC is only one part of a much larger social system--and that these social systems continue even after abandonment, even if certain aspects have changed. When Tostan enters a community, we first invite the community to define and come to consensus around their goals and objectives for the future. They then learn about and debate human rights and responsibilities over a period of several months. By the end of these sessions, the participants have themselves decided which social practices will help them achieve their goals and which need to be abandoned. In other words, before the program, the participants were operating from a "script" that was handed down to them by their ancestors, society, etc. and which they had never questioned. At the end of the program, the participants have analyzed and debated their received "script" and are empowered to change this script where necessary for achieving their new, commonly determined goals.

As one village woman once told me once, "Our community is not a museum - things should always change for the better when necessary."

Au Sénégal, les milliers de villages qui ont abandonné collectivement l'excision ont pris cette décision historique avec fierté, sous l'arbre à palabres, et non pas de force, devant les tribunaux !

Lorsqu'on regarde l'exemple du pays où Tostan est né, on voit que l'histoire du processus d'abandon de l'excision ne vient pas de la mise en oeuvre d'une approche juridique, mais de l'appropriation par les communautés d'un programme d'éducation, basé sur les droits humains - en écho aux normes morales qui régissent déjà leurs modes de vie. Le processus d'abandon résulte de la prise de conscience collective des conséquences néfastes de la pratique ainsi que de l'importance de la protection des droits humains et de la possibilité d'un abandon coordonné, inter-communautaire.

L'approche de l'abandon de l'excision par le modèle communautaire – « l'abandon collectif » - porte ses fruits depuis 1997. Plus de 3548 communautés au Sénégal se sont engagées dans le mouvement ! Au vu de ses résultats, cette approche respectueuse, compréhensive et positive a été retenue non seulement par le gouvernement du Sénégal, mais aussi par l'ensemble des organismes des Nations Unies dans leur déclaration conjointe interinstitutions de 2008.
Les éléments fondamentaux qui ressortent de ce mouvement de masse en faveur de l'abandon de l'excision au Sénégal montrent qu'il est non seulement peu efficace mais encore contre-productif de focaliser les stratégies d'intervention des MGF sur l'approche juridique.

Le processus qui mène à l'abandon de l'excision est un processus multisectoriel : à tous les échelons et dans tous les domaines, l'action est concertée. Bien évidemment la justice est concernée, dans le sens où la protection des droits humains de la personne est en jeu, mais elle est concernée au même titre que la santé, l'éducation, la protection de la femme, la solidarité.
Au Sénégal, la loi de 1999 a suivi le processus d'abandon qui était en cours depuis le serment de Malicounda Bambara en 1997. La loi est venue accompagner le processus et reconnaître l'importance de l'engagement des femmes de Malicounda, Medina Cherif et Baliga. Elle a été fort controversée ; il est prouvé que la loi – non seulement du fait de la difficulté de son application mais aussi à la suite des violentes réactions qui ont suivi sa promulgation – n'a pas eu un impact direct sur la diminution de la pratique de l'excision. Dans des sociétés où la demande d'excision est universelle, la conséquence de la loi – la punition des parents ou de l'exciseuse – comporte moins de danger que la conséquence de ne pas faire exciser son enfant, qui serait alors isolé socialement et dont les perspectives de mariage seraient anéanties.

Peut-on considérer l'ensemble de la population d'un pays comme des criminels ? Nous ne le croyons pas. Les populations qui pratiquent l'excision pensent par là prendre une décision qui va assurer l'avenir des jeunes filles. On a vu certains effets néfastes de la loi se traduire par l'abaissement de l'âge de l'excision et par la pratique clandestine, renforçant les risques directs pour la santé des filles (voir la stratégie coordonnée pour l'abandon de l'excision en une génération, Unicef, 2005). Cela ne veut pas dire que l'approche juridique est inadéquate ; cela dépend de ce que l'on attend comme résultats. Si l'on veut favoriser l'abandon de l'excision de la part des populations, alors l'approche juridique est insuffisante et elle peut créer des réactions qui renforcent la pratique. L'amendement, l'adoption et la mise en application des lois doivent se faire en consultation avec la populations et ses leaders religieux et traditionnels. Elles doivent être accompagnées de campagnes d'éducation et d'information afin de promouvoir le soutien général de la population en faveur de l'abandon de la pratique.
Mais l'abandon de l'excision est avant tout le résultat d'un processus participatif, positif, d'évolution sociale au niveau communautaire. Les programmes, comme Tostan, qui ont réussi à faciliter ce résultat à grande échelle, ne portent pas de jugement. Voici un extrait de la déclaration conjointe des Nations Unies (OMS, HCDH, ONUSIDA, PNUD, UNCEA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM) : « Il est apparu que les programmes qui incluent des activités d'éducation permettant aux populations de faire des choix, des discussions et des débats qui prévoient des engagements publics et une diffusion organisée permettent d'obtenir le consensus et la coordination nécessaires pour un abandon durable de l'excision au niveau des communautés [...] l'éducation visant à une responsabilisation permet aux populations d'examiner leurs propres croyances et valeurs relatives à la pratique d'une manière dynamique et ouverte, qui ne soit pas ressentie ou perçue comme menaçante ».

Dearest Hanny,
Wow! Thank you so much for this wonderful note. You are such an important reference in the history of FGC abandonment. Tostan recognizes that without the research and activism of those like you who spent years in the field studying FGC, this grassroots movement would not be occurring today in Senegal and other countries. We really appreciate all that you have contributed, particularly given that it was even more difficult to discuss these issues years earlier. Demba Diawara, the villager from Keur Simbara who helped show Tostan the way forward, once told me that if we had raised this issue ten years earlier in his intramarrying communities, we might not have left the community alive as the subject was so taboo. Thus we have much to thank you for.
We are happy about the throwing down of knives but have found even more important the empowerment of thousands of women who are confidently abandoning this practice because they feel they have choices for the first time.
How I wish I could give you a big hug from me and from all these amazing women in Senegal!

Suite à l'évaluation du Plan d'Action National du Sénégal 1998-2001 pour l'abandon de la pratique de l'excision, et dans le cadre du mouvement d'accélération de l'abandon, le Gouvernement du Sénégal a organisé un atelier sous-régional à Dakar du 13 au 15 octobre 2008.

Cet atelier, rassemblant des acteurs locaux et des représentants des pays voisins du Sénégal (Gambie, Guinée, Guinée-Bissau, Mali et Mauritanie) a été l'occasion de discuter de la mise en place d'une approche partagée par tous ces pays face à un objectif commun.

Tous les participants se sont accordés sur le fait qu'une seule et même action concertée et commune permettra l'atteinte de l'objectif d'abandon total d'ici à 2015.
Cette conception d'une action transfrontalière correspond à la vision de diffusion organisée de Tostan. En effet, elle engendrera une action démultipliée, touchant les populations au travers des réseaux communautaires et culturels, en dépit des barrières géographiques et gouvernementales.

Par ailleurs, nous pensons que l'éducation de base, fondée sur une approche humaine, suivi des réunions inter-villageoises et des déclarations publiques d'abandon de l'excision sont indispensables. Ces déclarations sont des manifestations-clés dans le processus d'abandon et doivent bénéficier d'une plus large publicité. La communication et l'information du grand public jouent un rôle fondamental dans la prise de conscience à un niveau global. Il serait donc souhaitable d'inviter plus de personnes à participer à ces déclarations, notamment des populations de régions voisines dans le cadre strictement national, ainsi que des représentants des régions transfrontalières dans le cas de déclarations dans des régions frontalières.

I think alternative rites can work in areas where initiation rites are associated with the actual cutting as long as the alternative rites include empowering education for the entire community. Tostan has found that the most significant action one can undertake is a holistic, human rights based program of non formal education in national languages for all members of the community so that everyone is informed and unified in the decision to abandon the practice.

Gerry Mackie, an expert on Female Genital Cutting, has written on this subject in the following book: Female Circumcision in Africa: Culture, Controversy and Change. Bettina Shell-Duncan and Ylva Hernlund, eds. pp.253-281. Boulder: Lynne Rienner Publishers.

The chapter is entitled: Female Genital Cutting: The Beginning of the End.

It can be found on the Tostan website under - Resources.

Dr. Alumanah, this is so interesting! Thanks so much for sharing this information.

I attended a UNICEF conference last May featuring Cristina Bicchieri, a professor at the University of Pennsylvania who wrote a great book entitled: "The Grammar of Society". She explained that social norms are most often followed not because people have consciously chosen to do so, but rather because of the expectations of the others in the group. In some cases, people may very much want to abandon FGC but do not want to bring this up in public for fear of being seen as "traitors to their culture" in the eyes of others. Many people in the same group may secretly want to abandon but do not realize others also want to abandon and so continue to practice or refuse to admit they have abandoned so as not to feel the disapproval of society. This is what Professor Biccieri terms: "pluralistic ignorance".

One village leader explained to me that she had long wanted to abandon FGC but did not dare mention this to anyone. She said she listened on the radio to declaration ceremonies for FGC abandonment and was so happy. I asked her why she had not spoken out earlier to others in the community about ending the practice. "I dared not" she said "for fear of being ridiculed." It was only when her relatives from other villages who had abandoned came and spoke with her community that they publicly discussed ending for the first time. "I was so surprised to find out that my own neighbors were ready to stop and even my best friend! Her namesake died of a hemorrhage and her own daughter went to the hospital and I didn't know it!" she told me.
Perhaps people that you interviewed had the same fear of admitting to having ended the practice. Could the gifts and "benefits" perhaps have been used as a camouflage - visible signs of a ceremony needed to convince others that the practice continues? In this way, they are protecting themselves from potential outside judgement from other relatives who have not abandoned and would expect them to continue.

Yes Sally. This is very important in the Tostan program. Tostan feels it is critical that women learn about reproductive health and we address this not only in the health module but also in the first module of the program on Human Rights. We found that without first doing Human Rights education, women were afraid to discuss these issues with their husbands. Both the human rights and health modules gave the women the confidence and the information they needed to discuss convincingly with their husbands about the need for birth spacing. Tostan encourages a very gentle but firm approach and the men have been very supportive both in this area and also in ending FGC.

We at Tostan believe that the new administration will fulfill its promises to increase development support to the poorest and most marginalized communities around the world. We would humbly recommend, however, that they avoid repeating mistakes of the past by leveraging the best of our collective knowledge to create a new kind of development that sees individuals and communities in the developing world not as "recipients" or "targets" but as partners and collaborators in our common search for a better world.

Specifically, we would recommend:

-Using proven, cost-effective strategies to better involve local communities in all of the processes that determine how development programs are identified, conceptualized, planned, implemented, managed, and evaluated. Communities have a fundamental right to a strong voice in these areas--yet very often are not sufficiently listened to.

-Challenging US Government agencies and their partners to take a more holistic, comprehensive view of development and promote strategies that would allow programs to collaborate and reinforce one another, rather than running parallel programs seeking complementary aims without communication or discussion. To this end, the administration should seek to support programs that engage communities across a wide range of areas, providing a foundation for development that can then leverage the amazing knowledge that already exists within communities.

-Increasing the use of cross-cutting strategies that focus on relevant knowledge and practical skill sets in multiple areas--which can greatly increase sustainability and dramatically reduce development costs in the long-term. Beyond any specific goal related to a single area in health, economic development, democratic engagement, etc, a primary goal of all development programs should be to reinforce local capacity so that the community itself can lead future projects.

-Increasing the use of strategies that focus on building local and in-country skills rather than simply purchasing short-term fixes from outside "experts."

-Redefining accountability standards to be more stringent in evaluating results, while also taking into account the mounting evidence that points to the necessity of longer-term interventions. Just as transformations in civil society have taken (and continue to take) decades to happen here in the US, so too will they take such time in other countries. This does not mean that change cannot happen rapidly, just that we must be patient in waiting for movements and leaders to emerge.

-Increasing involvement of diaspora communities in development efforts in their home countries. These communities have unique insights into the realities of truly living in the global village, and their investments in their home communities can be combined with other development efforts to increase impacts. This can also be a wonderful point of entry to increase dialogue and improve relations with these communities in the US and Europe.

-Using of human rights as a tool for promoting human dignity and changing harmful social norms, notably by the US ratifying CEDAW, Convention on the Rights of Children, and upholding the Geneva conventions.

-Promoting dialogue and discussion as a means of resolving problems between countries. Solutions outside of diplomacy dramatically affect the life, lives, and livelihoods of the poor.

-Supporting financial and diplomatic involvement of the US in the renegotiation of climate change agreements post-Kyoto 2012 including funds for mitigation and adaptation projects in Sub-Saharan Africa (Senegal, Mali, Mauritania and many other countries are greatly suffering from deforestation, erosion, and desertification.)

[see above]

As I mentioned above, we have found that it is important to consider the timing, and to work to pass laws at the right moment so that they build upon community interest and will not be seen as an imposition on practicing communities and as unenforceable by laws. Typically, that moment can come later in the process of awareness raising and community abandonment, so that the law reinforces an existing movement rather than attempting to shift a norm through the law alone.

We have seen that the social penalties that emerge naturally when communities make collective decisions are indeed one of the ways this practice changes. Once everyone in the community has been reached, and been made aware of the decision to abandon FGC, and once people are aware of the consequences of FGC, and they are aware that a national law has been passed, then we would agree that ignorance is a harder argument to make.

However, we have also found that we need to be careful if we start blaming people for being ignorant. Most often they simply have not had access to information presented in an understandable and non judgmental way. I say that we have to be careful because, for example, even my own great grandparents would not have understood what germs were, and would probably have laughed at the idea behind germ theory (the man who discovered germ theory died destitute and a laughing stock). Now should I think of my great grandmother as "ignorant" and say I have no tolerance for her? Of course not. I think she was making decisions based on the information she had at the time. It may be easy to chalk up disparities to ignorance, because then it seems like it is people's own fault. But actually we have found that all communities, whether in West Africa, East Africa, or elsewhere, tend to take action when given trust and respect.

As I mentioned above, simply educating the women who perform the FGC operation will not get rid of the problem.

FGC is a social norm that is deeply rooted in a community as a whole. Evaluations have proven that these strategies of "compensating the cutter" are not effective--families either continue using others to do the cutting, or the cutters themselves return to the practice because of demand.

However, working with the cutters is extremely important, as they are very influential, and often have some of the most important experience and information about the consequences of FGC. But without the support of religious leaders, traditional leaders, influential men and women, diaspora members, and everyone else, the practice will not end.

In the long-term these women do need to find other sources of income--something that we at Tostan have tried to support, as we support many women by helping them generate additional income. But not as a strategy to end the practice of FGC.

We are now hopeful that Senegal can become mostly FGC free by 2012. Keep in mind that there will be individuals that never give up this practice, and also that this abandonment will not completely show up on the national surveys until all girls born recently have the chance to go through the age of cutting. So we may not know conclusively until 2020 or 2025, but we expect the national prevalence to continue declining in the interim.

Another example that comes to mind is Niger: the practice disappeared (for the most part) from Niger in the first half of the 20th Century, but the reasons behind this aren't clear.

What we do know is that it is almost impossible for this practice to change unless:
-community members have a chance to discuss the practice and its potential consequences
-community members have a way to see those in their social network publicly declare their abandonment of the practice.

We also know that it is likely that an entire community will either abandon or not abandon, but less likely that only a few people will give up the practice while others continue. There may be moments where this is true, but since the practice is tied to so many important values, the group that wants to stop will either have to a) convince others to join them b) go back to cutting or c) decide to remove themselves from the group.

What has been fascinating for us at Tostan is to learn the history of the abandonment of Footbinding in China, which followed a similar trajectory. This was an entrenched cultural practice that disappeared in one generation. (See Gerry Mackie article: The Beginning of the End on the Tostan website.)

It is important to note that abandonment of this kind has happened not only with Tostan's program, but with other programs, at a smaller scale.

As noted above, at Tostan we do not believe that social norms should be changed through outside penalties; and if penalties are involved they should be decided upon locally or, if nationally, in close consultation with the communities involved.

Ken, this is indeed the situation in some of the countries where we work, and we have found that once communities abandon the practice, they will then seek to use the law to enforce the new norm when necessary. And, we have found that while law enforcers may not want to actively pursue every potential case of FGC in a region where 96% of the population practices, they will certainly respond to a case when the community engages them in dialog and asks them to intervene and apply the law.

We totally agree that the whole community needs to be involved. However, we also have found that behavior change communication is not a stand-alone solution to this issue.

Many of those in the Behavior Change for Communication school of thought still conceptualize the problem as one of information--if we can just get the right messages to the right people, they will change their behavior. FGC is one area where this is not the case. In fact, we have found entire communities where individually most people wanted to abandon, but no one had actually abandoned. Why? Because information and individual willingness is not enough. If a mother decides not to cut her daughter, she needs a guarantee that her daughter will not be ostracized because she isn't cut. And that guarantee can only come about when she is able to verify that others also care about the issue and want to abandon too, and find a way to publicly coordinate a shared abandonment. That is when her daughter is safe, and this is why the public declaration is so important.

This does NOT mean that communication does not need to be happening at the international, national, regional, and local level. All it means is that this is not a case where we should expect behavior change. Attitude change, yes, but not behavior change.

By the way, we have found that community members themselves are the best "designers" of the messages. This is because no one else knows better how to talk to your mother about a sensitive issue than you do.

Can outside agents (whether from other parts of the country or other countries) help them work on these messages and test multiple approaches? Certainly. But the campaigns must be led locally and reflect a true belief. Just as we here in the US are suspicious of motives when we see others promoting a certain viewpoint, so too are the communities with whom we work.

We do understand that international groups will continue to distribute prescriptive messages aimed at ending this practice, and for this reason we are increasing our training capacity so that we can share our model and help people build upon what the communities of Senegal and beyond are doing. We are also building new partnerships and strengthening existing ones so that the messages coming out complement, rather than work against the efforts in our community members.

A, I'm very glad you asked this question.

In general, I would say that what adult women want to do to their bodies is their own decision, and should not be compared to a practice that is almost always done to young girl children. In fact, I have in the past said that I cannot disagree with some adult African and African American women that have decided to have the practice done to themselves--while I don't personally want to do it, it is their decision and their body.

Similarly, if women in the US are making this decision, I don't know how much room I have to criticize. Although I must tell you I think it is sad to see so many people who are already lovely and unique changing their appearance to respond to social pressure. And I think we need to change the appearance-driven nature of our societies so that we no longer expect this of anyone.

But I also know that some women who have had difficult births have more extreme complications, and/or difficulties in finding sexual pleasure. I do not want to lump these women in with those who may be simply fulfilling the social ideal of what they are "supposed to look like". And even then, the argument to me is primarily about consent, and to compare consent you would need to look at each individual case.

One more answer to your question: At Tostan we have never used the term "Zero Tolerance." In fact, we have begun to refer to February 6th as Community-Led FGC Abandonment Day to better represent that this is a community issue at heart, one that needs SUPPORT from all levels but will be LED through local and regional efforts.

It bears mention that the only way Tostan has found a road to abandonment is through tolerance, not intolerance. In fact, this topic only came up in our program because we were willing to treat communities with respect and let them draw their own conclusions based on objective information. By listening to people, understanding their needs, and encouraging them to take action on their own terms, we have found success.

Richard, that is an excellent question. There remains a small but sometimes vocal group of anthropologists who have argued that for the West to be involved in this practice at all is cultural imperialism. Some of these voices are African, some American and other nationalities. Honestly Tostan has not had too much concern with their objections of imperialism or colonialism, since ours is a 99% African organization; since we didn't introduce FGC as a topic--our community members did, on their own; and since the movement for abandonment has been led at the community level, not from the West.

Several anthropologists have also gone beyond charges of imperialism to argue that this practice is simply not physically harmful, and that all arguments of harm are constructed by the West. We have not given much credence to this claim, as to us the removal of a body part is harmful, and as this directly contradicts the stories and experiences we heard about from communities in Senegal. All of the arguments I have seen center on hypocrisy between the West and Africa, for example that we demonize FGC in Africa but say nothing when women do something similar in hospitals in the US. To that all I can say is that Tostan's mission is for Africa, and if the day comes that we work with US communities, and if those communities raise this as an issue, we will support them with the same fervency we have supported African communities.

Ironically Tostan shares many anthropologist's concerns about imperialism, which is why our program is so deeply rooted in local traditions and culture--song, dance, poetry, theater, and dialog in local languages are at the heart of our program. We believe that communities have a fundamental right to a leading voice in their development process.

Even our work in human rights and responsibilities centers on their application to African culture--far from presenting Human Rights as rules to be followed, we ask participants to debate and discuss them, decide how and if they are applied, and what actions may be appropriate.

Perhaps some anthropologist would prefer that Africa be left alone. We at Tostan however are seeing that change is coming to Africa regardless of whether we are there or not, and thus we would rather be there to be an advocate for communities in helping them lead their own development.

Hi J, I think my answers above have hopefully addressed this question. Religion and culture do take time to change, and can only change authentically and productively through internal means. Our program helps to facilitate this process so that communities can help decide what they want to work towards, and what they can leave behind.

Hi Mala, thanks for your question and your work. It is important that health professionals around the world be informed about this practice and trained to handle it both medically, and also in terms of understanding and respecting the realities of their patients.

A large part of Tostan's education program centers on helping participants understand the human body, disease and illness, the reproductive cycle, and many other related areas. While we are very careful to be respectful (for example facilitators have the option to use an "envelope of discretion" to show pictures that may been perceived as disrespectful or upsetting to certain community members), we have found that there is extremely high interest in this area, and very little objection from the community. I feel that this module is a key component in allowing women to discuss the issue of FGC fully.

Merci Mbeinda.
Nous pensons qu'en ce moment le Sénégal est en train d'expérimenter une réelle prise d'élan dans le processus d'abandon de l'excision. Il n'est plus question d'évolution en dents de scie en ce qui nous concerne. En effet, notre stratégie est très précisément centrée sur les réalités sociologiques des populations concernées.

C'est un peu la faute de Tostan si nous ne sommes pas plus connus du grand public. Mais suite à l'évaluation de l'UNICEF qui a été rendue publique la semaine dernière - une évaluation qui prouve de manière incontestable l'efficacité de notre approche - nous commençons à mettre en place des stratégies nationales et internationales qui nous permettront de partager les expériences de Tostan et de nos partenaires communautaires, afin que tous puissent mieux comprendre ce mouvement d'abandon de l'excision cette marche vers un développement durable et un épanouissement des communautés.

Les communautés n'ont de cesse de nous dire que le moment est arrivé et qu'ils comptent sur nous tous pour les accompagner et les aider à réaliser leur avenir.

Tostan believes that female genital cutting needs to be approached at the community level. Education and the empowerment of women over time through a holistic program can lead communities to abandon FGC together. This is critical for community-led growth, growth that leads to well-being and improved living conditions in general.

We do not believe that the practitioners, non-practitioners or the women who perform the FGC should be singled out from their communities. And simply re-training women who perform the FGC operation will not end the harmful practice. These women, along with their communities, need to be educated in basic yet critical topics of democracy, human rights, problem solving, health, hygiene, and management skills. These topics along with the creation of Community Management Committees (as Tostan calls them) ensure that a community works together for the present and the future by encouraging and empowering people to make important decisions and create income-generating activities that support their families.

Although they certainly participate in the practice, cutters do not cause the practice. They in fact offer a supply in response to the community's demand. Certainly, as members of the community, they have a role in creating that demand--but are not the sole reason for the practice. As long as communities want to do this practice, they will find ways to do it, even if one of the cutters has "laid down" her knife.

Hi Esia, I responded to this question in the pre-questioning phase. You will find my answer appearing shortly. Thanks so much for your interest and a good question.

Hi Professor Okolo, as you will see in some of my other responses, the campaign was started and is being continued by the women who once carried it out. Men are sometimes shocked by the practice, as they are not typically involved in it. Men have become some of our most dynamic leaders in this area.

Hi Appolonia,

This is an interesting question. In our experience, these officials respond best to the people who elect them. So when movements begin to abandon the practice, and the community approaches these officials in peaceful, constructive ways, they tend to respond well.

As I have mentioned in several other answers, we do not think it is the sole responsibility of the government officials to begin enforcing the laws. In some countries this would mean arresting millions of people, even their own families. So it is simply not feasible. What is required is a joint effort of all involved to end the practice in unison.

Similarly, while their inaction does send a message (that they are not holding people accountable to this law), their inaction does not cause the practice alone.

Rafat,

A great question--one I expected to see much earlier. There have at times been arguments to "medicalize" the practice of FGC so that it can be done in hospitals "safely." The communities we work with have rejected this argument because while it is only a partial solution--no medical practice is 100% safe--and it does nothing to address what they see as a key part of the equation--the human rights of the girl involved.

The promiscuity argument is a prominent one, but one that is not credible when communities investigate further.

We do think that women who have been cut have the right to determine what they believe about the practice, as it pertains to their experience. This is one major reason why we have never used the term "mutilation"--we do not want to call women who have been cut "mutilated."

It is important to note that Tostan works with populations who do not abandon the practice, and populations who don't practice at all. Abandonment is not a pre-requisite for being in our program or having access to full services from Tostan. Our entire model is based on real decisions being taken from the heart--the heart of individuals and the heart of the community and its social network. If people are seen to be "faking," it simply won't work, and the movement would disappeared long ago.

Hi Meskerem. As you will see in my response to A Thompson below, we at Tostan do not use the "Zero Tolerance" approach. And when we expanded our program to East Africa--specifically Somalia and Djibouti--we were told that the only reason we were accepted was because we did not judge people for carrying out this practice, and met them where they are.

As I noted above in my response to Limia, my recommendation to you would be use media and other communications avenues to reinforce work at the community level, rather than trying to convince people to abandon through messages. You can also use the radio to encourage discussions and dialog. And remember that social change takes time. In the North of Senegal, it took us almost 6 years of careful, grassroots work before communities began discussing abandonment.

As you mention, these are deeply felt, deeply held traditions, and each person in each community may perceive them differently. And, even if you were to find a "magic" message that worked for many people, as I mentioned above they may still not be able to abandon, because they also need to find a way to coordinate their abandonment without risking social condemnation.

Social norms are often practiced without full knowledge of "why"--for example hand shaking in the West. I can go ask 100 of my friends why they shake hands, and none or very few of them will give me the real reason: because they are supposed to. Now imagine that I ask them "Hey! why are you still shaking hands? Are you ignorant? Stupid? Don't you know this is dangerous?! Zero Tolerance for Hand-Shakers!"

Their answers will quickly become defensive, and they will begin to find all kinds of reasons and justifications--my father did this, we do this at my church, etc. What is ironic is that these practices--both FGC and handshaking--DO have incredibly complex value systems associated with them. But we wont always get those as responses on a survey.

So while it is fascinating to look at all the reasons people gave to you for keeping this practice, keep in mind that these may not always be the actual reason. Each person's decision will be motivated by a lifetime of experience and complex layers of moral norms, social norms, legal norms, etc. And as I mentioned above in relation to Dr. Bicchieri's article, many people will not have made an active decision based on a careful argument. They will simply do the practice because they perceive it to be "normal."

Bonjour Fatou,
Question 1 - L'expérience de Tostan nous a montré que l'abandon de l'excision ne peut se faire qu'à partir d'un consensus de la famille étendue. Il arrive que des familles veuillent abandonner l'excision mais sans consulter les autres membres de leur groupe, il est quasiment impossible de prendre cette décision. C'est pour cela que Tostan facilite des rencontres inter-familles dans leur pays et même avec les ressortissants de la Diaspora. Pour Tostan, l'étincelle qui déclenche cette prise de décision est le Programme de Renforcement des Capacités Communautaires, tout particulièerement le module sur les Droits Humains. C'est pour cela que nous nous sommes fixé pour objectif d'atteindre les zones où les populations n'ont pas encore pu bénéficier d'un programme d'éducation de base en langues nationales.
Question 2 - Nous prévoyons de faire un séminaire de partage au mois de mars avec tous les partenaires de la société civile et du gouvernement sur l'approche qui a abouti à ce mouvement historique pour l'abandon de l'excision. Actuellement nous mettons en oeuvre le programme Tostan dans plus de 450 communautés à travers tout le pays et nous soutenons les participants du programme dans leurs activités de sensibilisation auprès des populations ne bénéficiant pas directement du programme.
Plusieurs déclarations d'abandon de l'excision sont prévues pour 2009. Une déclaration nationale d'abandon est prévue en 2012.
Question 3 - La compensation financière ou la reconversion des exciseuses n'a jamais été au centre de la stratégie de Tostan pour l'abandon de l'excision. Nous pensons que l'abandon durable ne se fera qu'à partir d'une décision collective de tous les membres de la communauté et de la famille étendue - jeunes, adultes, leaders traditonnels et religieux, et exciseuses. Les évaluations de Population Council ont montré que la stratégie qui se concentre sur les exciseuses n'a pas donné de résultats durables.

L'excision est une pratique qui dure depuis plus de 2,000 ans. Elle est donc profondément ancrée dans les normes sociales des groupes ethniques qui la considèrent comme un critère de respectabilité et de bonne réputation pour leurs filles. D'après notre expérience, la seule façon de promouvoir l'abandon de l'exicision, c'est l'éducation!

Sally, These subjects are addressed in the health module of the Tostan program. Very important. We wish our participants had more access to good health facilities. Unfortunately this is not the case in most of the areas where we work.

Hello Susan!
Many people in the US help Tostan by contributing funds to adopt villages so that community members can benefit from our Community Empowerment Program which lasts three years. All information on this can be found on the Tostan website - www.tostan.org
The support from individual donors like yourself have greatly contributed to ending FGC in Senegal and other African countries.

Great question Andrea. Tostan does not use a judgmental approach but rather informs and educates people so that they can make their own decisions. When people themselves make the decision to abandon because they understand the human rights and health issues involved, the decision is sustainable. Former practioners themselves are then the ones reaching out to their relatives and neighbors to recruit others for abandonment, not outsiders.
All Tostan field staff (over 800 people) are local African volunteers who live in villages of their own ethnic group for 3 years. Participants are thus empowered by their peers. Tostan facilitates this process of deliberation and consensus around this and other important issues in the communities.

Jennifer I am sure many people are asking this same question. Recently an external evaluation implemented by Macro Int (the organization that actually does the DHS studies in African countries) indicated that over 75% of those who abandoned through public declaration 10 years ago in Senegal really did abandon. This has made us very confident in promoting the strategies that we have developed in partnership with communities in Senegal and other African countries.

UNICEF has played a major role in supporting this movement over the past 10 years.

Ghislaine thanks for your support! Men play a very important role in the abandonment process and we include them in almost all activities of the program. Tostan made a mistake years ago by focusing only on women's rights and this alienated many men. In 2000, we rewrote our modules to discuss PEOPLE'S RIGHTS - those of women, men and children. The response was amazing. The men were so much more supportive when they realized they had human rights and responsibilities and they became much more involved in the movement for human dignity for ALL. Village religious and traditional leaders are now some of the most active in the promotion of human rights and health for women in the countries where we work.

Nina, The case of Sierra Leone is very special. However, we think that our respectful and holistic approach would work there because it doesn't set out to target just this practice. Several NGOs from Sierra Leone came on a study trip to Tostan last year and spent a week learning about the program and discussing with participants who had abandoned the practice. They were quite enthusiastic.

We have implemented the Tostan program in the Forest Region of Guinea with similar ethnic groups as Sierra Leone and they are already planning their first declaration for the abandonment of FGC this year. It would be great if you could witness this declaration as I'm sure it would give you many ideas!

Winning the Conrad N Hilton Humanitarian Prize was an immeasurably significant moment for Tostan. It put us onto the international stage in a major way but more importantly recognized the work of thousands of community members, local facilitators, and our staff over the past two decades.

Our work has remained the same--to help communities lead their own development, but the Prize fund, the visibility and respect that came with it have allowed our expansion to happen much more swiftly.

Thank you for your question, very interesting to hear that. Yes, we believe that communities around the world can always benefit from exchange and dialog with others. It is important to understand that often, a default response to hearing about another ethnic group or country that has changed their behavior is to simply say "well, things are different there--it wouldn't work here." But we have seen that when people are given the chance to visit and have one-on-one discussions with others who have made brave, difficult choices, it really can make a difference. Not only are these encounters inspiring, but they also help to redefine what is possible. Once you have met people that gave up this practice on their own terms and while maintaining their culture and dignity, it is much harder to argue that this would be impossible. The demonstration effect is huge, whether from neighbor to neighbor, or from Africa to Colombia.

Tostan's training center is busy most of the time. We train trainers, facilitators, local elected officials, and participants from all over Senegal, but have also received trainers from Mauritania, The Gambia, Somalia, Djibouti, Guinea Bissau and Guinea.

In many ways, these sorts of questions can only be answered case by case--i.e. did the cutter know fully about the law? Was she pressured by the family? What other circumstances were involved? Has the law been applied fairly and consistently? This is why it is crucial to have fair and balanced judiciary systems that can apply the laws of the state in a consistent manner but taking each set of circumstances into account.

As I noted in my responses to other questions, I do not feel that legal enforcement of laws against FGC are the best way to address this issue, at least not as a first point of entry. After communities have been informed, and after many have declared abandonment, then perhaps is the time to enforce the law. But as I mentioned elsewhere, it is almost impossible to enforce a law on FGC when prevalence in practicing groups normally hovers around 80-90%.

A side note: it is important not to let the national data confuse the issue. In Senegal, for example, you will see a prevalence of 28% in the last DHS. However, that does not mean that this percentage is evenly distributed. In fact, it is the opposite. In many areas, it is nearly zero, while in others it is above 90%. Enforcement in the 5% areas is feasible; in the 90% areas impossible.

International organizations can identify local religious leaders who have been active in movements to support FGC abandonment and facilitate their travel to other regions and countries to discuss with people who share the same belief.

Tostan sent several religious leaders to Egypt to discuss fgc with highly respected religious authorities and they came back empowered by the conversations and debates held.

Law-makers and parliamentarians are critical, but not key, to the process of FGC abandonment. It often depends on whether or not they themselves come from practicing groups or not. If not, their efforts will be seen as culturally motivated. If they are from a practicing community and want to abandon, this could be influential--however it would depend on their tone. If their message was one accusing communities of being "barbaric" or "primitive" or "ignorant", and seeking to "eradicate" or "fight" them, then those messages would likely not be received well at the local level. However if that person was committed to positive change and continued to express their opinions while also showing respect in other ways, he or she may find success.

It should be said Sierra Leone is a special case because this practice is associated with secret societies. But the general principles I have outlined in my other responses would likely still apply.