Sexual Violence During COVID-19: Insights from an Addis Ababa Healthcare Professional

Hiwot Girma is a 26-year-old clinical pharmacist in Addis Ababa, Ethiopia. Together with Amref Health Africa, she is campaigning to end sexual and gender-based violence, particularly at a time when COVID-19 puts women and girls at even greater risk.

“My name is Hiwot. I’m a clinical pharmacist working at Ghandi Memorial Hospital as a drug information focal person. This is a specialised hospital that focuses on maternal and neonate childcare.

I also volunteer at the hospital’s sexual violence centre where I provide guidance, care and comfort for survivors of rape and sexual assault, along with medical advice.

I currently live with my brother and father because girls and women cannot leave their family household before they marry, even in the capital city. Although most people are stuck at home, I must still go out for work.”

What work do you do with Amref Heath Africa?

“I work as a youth volunteer in the AYAP (Amref Youth Advisory Parliament), which advocates for meaningful youth involvement in project implementation. I’ m also the new FGM Champion, meaning I visit other Amref projects and share information about this practice.

Fortunately, I haven’t gone through FGM because my mum and dad knew about the negative consequences. Many people still do not know about the complications. Just because I did not go through the cut, it does not mean that I should not fight for my sisters”.

How has COVID-19 affected your area, especially in terms of sexual violence?

“In Addis Ababa sexual violence largely centres around rape. In more rural areas, FGM is also performed on girls.  Lately it has been crazy in Addis Ababa – women and girls are getting raped, and the violence is increasing.

I think sexual violence during COVID-19 has risen, but the government doesn’t know the official reasons yet. Is it because everyone is at home or other factors? The Ministry of Women, Children and Youth Affairs is currently researching why the rape of women and girls is rising”.

How has COVID-19 affected you and your work with women and girls?

“At work, we have emergency triage corners set up. A nurse will take your temperature and test expecting mothers for COVID-19 when they enter. We always wear masks and gloves to give out medication, so nothing has changed there.

As I mentioned, sexual violence during COVID-19 is increasing.

My role is listening to women and girls about their experiences and the emotional impact. They are supposed to take HIV prophylaxis – a medication intended to help prevent the spread of HIV – as well as medicines to treat possible exposure to other STDs. So I also share information about those medicines and counsel them on their use”.

What motivates you to be an FGM Champion and fight against sexual violence?

“Because girls and women, I believe, should have equal opportunities. FGM is taking women and girls back – FGM causes sexual dysfunction, complications during childbirth, and things like anaemia. It also increases the risk of HIV due to exposure to unhygienic conditions.

We shouldn’t forget the medical side of it either. I heard from another medical professional that sometimes young women do not even know that they have been cut. One young woman did not know until she met a guy and decided to have a sexual relationship. Shockingly, sexual intercourse resulted in her bleeding to death. This could have been avoided.

It’s not fair that women go through these things; there’s no need. We need to make it safer for women and girls.

If we cannot protect and include women, we cannot achieve the things we want to accomplish as a country or a continent.

That is why I am passionate about participating.

We should not be afraid to fight FGM. Everyone should be responsible – whether they live in cities or the countryside. I believe everybody should say no to GBV, and everybody should come together to fight it”.

Hiwot joins four other pan-African champions in Amref Health Africa’s No More Violence: Daring to Speak Up campaign, designed to raise awareness about increasing rates of sexual violence during COVID-19.

COVID-19 is Leaving More Girls at Risk of Female Genital Mutilation and Child Marriage

The global COVID-19 pandemic is taking a particularly heavy toll on girls and young women across Africa.

Sadly, many girls in Africa are disenfranchised from birth.

They are born into poverty and vulnerable to inequalities in health and education, along with socio-economic and gender inequalities. Access to health and education is not automatic. Many girls remain marginalized throughout their lives, both geographically and economically. This exposes girls to collateral risks associated with poverty – and, at the moment, with COVID-19.

I have been lucky to be able to pursue my passion for the health and rights of women and girls for a number of years now. My work has focused on sexual and reproductive health, gender-based violence, female genital mutilation or cutting (FGM/C), and child, early and forced marriage. My experience has mainly been built by working with marginalized communities in Kenya that practice FGM/C – including the Maasai, Samburu, Kalenjins, Meru, and Somali communities.

Education Opens Horizons

In 2016, in the early years of my work in Kenya, I visited a rescue center in Samburu County. I was devastated by the reality of life for many Samburu children. Living a nomadic lifestyle in geographically vast areas, basic infrastructure to support health and education was lacking.

It took us a whole day to drive to the main town, Maralal, where the center was located. Along the road, I saw children herding cattle and goats within the national park, which is full of wild animals such as lions, elephants, giraffes, zebras, and antelopes.

The perplexing thing was that among the children were many girls, the youngest of whom looked about six years of age. Spending their days and evenings herding cattle in the woods away from home. Outside the protection of adult family members, means these girls are exposed to sexual and gender-based violence.

While visiting the center the next day, we found a newly rescued nine-year-old girl. She was rescued from forced child marriage to a seventy-year-old man who already had multiple wives. The young girl had just undergone FGM/C. Her wounds were still raw. She was brought to the center to heal and attend school, since she hadn’t previously had the chance to receive an education.

My colleagues and I were left debating how a girl will ever make it in life without an education, good health, or any future economic opportunities. For many girls in Kenya and elsewhere, their progress is curtailed and their horizons limited from childhood as a result of traditional practices which are linked to livelihoods.

Co-existing Crises Leave Girls at Risk

I can only imagine how much harder life is for girls in Samburu in the face of COVID-19. I have heard many horrific stories from my colleagues about how lockdown measures, combined with school closures and the subsequent dwindling of family resources and general livelihoods, have left more girls exposed to FGM/C and child marriage.

They are forced by their circumstances to be “sold” into marriage, either for money or cattle.

Unfortunately, in Kenya the COVID-19 crisis has also been accompanied by many natural calamities including a locust invasion, drought and flooding in many parts of the country, meaning that food is scarce.

Nomadic communities like the Samburu have been hit particularly hard. They rely on markets to sell their animals for money to satisfy their basic needs. When markets are closed, as they are currently, they cannot sell. The food crisis is likely to lead to even more girls being married in exchange for food for their families and a semblance of security.

At the same time, the focus of law enforcement in Kenya has been on stopping the spread of the coronavirus. This has resulted in many cases of gender-based violence, FGM/C and child marriage being shoved onto the back burner. As if they are not a crisis that deserves immediate attention.

Community activists working in Samburu have reported feeling powerless and hopeless. They are between a rock and a hard place, sometimes having to choose between reporting cases to the authorities and their lives being threatened.

Listening to Communities is More Important Than Ever

The Kenyan government has not embraced a multi-sectoral approach in dealing with the overall impact of COVID-19. Instead, they’ve taking a rather narrow approach to public health. Because of the focus on curbing transmission, fostering strategic engagement that includes stakeholders working in gender-based violence, FGM/C, and child marriage has been sidelined.

Including community systems in the prevention of and response to FGM/C and child marriage is more important than ever. More women and girls are now at risk of harmful practices and gender-based violence.

These strategies should include:

  • working closely with community advocates and activists,
  • working with community health workers who can play a significant role in surveillance of at-risk girls,
  • mapping them and linking them up with healthcare and legal services, and
  • setting up rescue homes and centers that could house them temporarily until the COVID-19 crisis subsides.
The majority or all of the safe centers or homes were ordered to close as part of the lockdown measures. The girls and women being housed in those centers were asked to return home in the midst of Covid-19. A doubly tragic situation for them.

So what can we do, in the face of these co-existing crises?

The greatest lesson that we can learn is that it is crucial to deliver multi-sectoral responses to FGM/C and child marriage. This means actors working together. A broader approach is needed. One that considers the wider socio-ecological aspects of livelihoods including education, health, emergencies, climate crisis and other factors which impact on the harmful practices of these communities.

State and non-state actors need to widen their nets and protect African children and girls in particular – who, as is so often the case, carry the heaviest burdens of poor health and well-being.

Dr Esho is the Director of the Amref Health Africa End-FGM/C Centre of Excellence; Secretary General, African Society for Sexual Medicine; and Associate Member, Africa Coordinating Centre for the Abandonment of FGM/C.

Finding My Voice & Protecting Girls from FGM/C

Most people who knew me as a child knew me as a very shy and timid little girl. Yet, today I am outspoken: I can argue with you on the subjects I feel strongly about! One of those subjects is gender equality. My passion is protecting girls and young women, in my own community and beyond, from female genital mutilation/cutting (FGM/C).

I work as a community facilitator with Amref Health Africa in Marsabit County, Kenya. The project is called Koota Injena, which means “come, let’s talk”. We work within four communities – the Borana, the Gabra, the Rendile, and the Samburu – to end FGM/C and early and forced marriage, and to redefine the value of girls.

My parents come from different communities. My mother comes from the Gabra community while my father is from the Borana. I have the most amazing parents who taught me the importance of embracing both these cultures and loving them deeply. Among the Borana and the Gabra, FGM/C is a deeply-rooted and culturally significant practice. The prevalence rate is around 98%, which tells you that almost every girl you meet will have suffered the cut.

“It’s only by talking openly that we will change things for good.”

The focus of Koota Injena, as the name suggests, is dialogue. In my community, like most African communities, it’s taboo for a young person to discuss cultural issues with clan elders. This is especially true for women and girls. Yet, I won’t give up. It’s only by talking openly with each other that we will change things for good.

No one can tell my story the way I can tell my story. That’s why I started speaking out. I decided, why not inspire people? Why not inspire young girls from villages deep in Marsabit County and make sure that they know the importance of education and that they know their rights.

Listening and Learning

All kinds of people cut their daughters, even political leaders, professors, and doctors. In Marsabit, we have women traveling from other countries (the UK, the Netherlands, the USA) to have their daughters cut, before returning home. Many of these people are highly educated. Yet they continue to believe that FGM/C is the right thing to do for their daughters.

That’s why I always say that it’s not just a question of education. It’s important to change mindsets and attitudes, too. I really believe that the work of changing culture can best be done by people from that culture. You have to meet people where they are. There is no one approach that works for all the different countries and communities where FGM/C is practised. We must listen and learn. And we need to make space for different perspectives and different voices.

Safe Spaces

In late 2019, I came to London for the first time and met local activists working to end FGM/C in the UK. I attended a workshop facilitated by Sarian Karim-Kamara, founder of the Keep the Drums, Lose the Knife collective, which brought together women from Sierra Leone, Kenya, and Guinea. Some were survivors of FGM/C, while some had been affected in other ways. They had friends or family members who had suffered the consequences of the cut or daughters they were trying to protect.

It was amazing to see these women, who didn’t know each other, speak so openly. They spoke not just about FGM/C, but about gender-based violence, relationships, family planning, reproductive health, and sex and pleasure. It was very emotional.

This is the same kind of safe space that we try to create in Marsabit. We have mother-daughter forums where women can talk about whatever affects them in their day-to-day lives. This is actually the most impactful part of the project: it’s the part people always ask for more of.

“You cannot force change.”

Meeting with these women reinforced to me the importance of understanding and respecting a culture before we try to change it. We all need to recognise that there are aspects of our cultures that are harmful to girls – but you cannot force change. 

Changing culture takes a lot of time. And people are not very receptive: first you’ll be insulted, you’ll be called names, and people won’t even come to your meetings. But as you keep talking with them, people will slowly come to you and they will want to speak out and tell their own stories.

If we are going to end FGM/C, we all need to take responsibility: start from your home and make sure you protect your daughters, nieces and sisters from this harmful act. We need more people to join us on the journey. Together, let’s end FGM/C!

Diram Duba is a survivor of FGM/C who works as a community facilitator with Amref Health Africa in Marsabit County, Kenya.

Building a movement around Khatna

This is part 2 in a two-part series on FGM in India. Read Part 1 here

Female Genital Mutilation (FGM) or “Khatna”, as it is referred to in India, is practised secretly among the Bohra community. Over the past year, several women from the community have spoken up about the practice while encouraging other women from the community to speak up as well.

I speak to Mariya Taher from Sahiyo, an organisation building a movement against Khatna on this issue and their work.

“More than a year ago, five women who felt strongly about the ritual of female genital cutting within the Bohra community came together to fight this practise. Each one of us had been working on the topic for many years,” Mariya said. Mariya is a social worker, activist and writer who lives in the United States.

The group includes a social worker, a researcher, two filmmakers and a journalist located in different parts of the world; and all of whom had already been speaking out against the practice of Khatna.

“As our collaboration grew, we realised the need for an organised, informed forum within the community that could help drive a movement to bring an end to Khatna. That is how Sahiyo, the organization, was born,” Mariya added.

Sahiyo is the Bohra Gujarati word for ‘saheliyo’, or friends. She said that the word reflected the organisation’s mission to engage in dialogue with the community to find a collective solution.

Working on collecting data

The silence around the practice in India among Bohra women and women of Indian origin who have experienced Khatna has led to very few details about the extent of Khatna. Sahiyo tackles this problem by first documenting the experiences and narratives of women, one story at a time.

“We realised that the way to end FGC was to build a movement from the ground up. This included first finding out how widespread it was amongst the community. There are no large scale studies at the moment. Only anecdotal evidence. This is all very important, but we knew to be able to really reach out to our community, we needed to carry out a type of needs assessment, this is why we carried out the first online survey on khatna in 2015,” Mariya notes.

However, there is growing evidence through the voices of women who have experienced Khatna that it is prevalent even among Bohra women who have migrated. “Hence, there was a need to ensure that we were focusing on how to stop the practice amongst Bohra regardless of where in the world they were. To carry out this work, we also understand the importance of community outreach and education,” she added.

Sahiyo through its work at the grassroots level is spreading awareness about the practice through dialogue, conversations, group discussions and seminars. They have also been providing peer counselling and informational support to families who are considering the practice, and have been able to provide women the needed psycho-social support by connecting them to appropriate social services such as counsellors or social workers.

“One of our core areas of work is building from the ground up. We have been working on community-driven awareness and advocacy initiatives aimed towards ending FGC, such as organising townhall discussions and dialogue with Dawoodi Bohra women, Dawoodi Bohra clergy, doctors and nurses, midwives and “traditional cutters”, media,” Mariya stated.

Backlash from the community

There is a fear of being excommunicated from the community for speaking up on the issue. However, Mariya feels positive about the progress the community is making. “We are increasingly receiving responses online from people who support the practice – people telling us that we are speaking out just to gain publicity or that we are interfering with religious traditions. Which in turn is actually a good thing, as earlier on in our work, people were silent in response to what we did. Now, the issue is known in the wider community, and the work around awareness raising that we are doing about FGC (Khatna) can’t be ignored. So, actually, their opposition is leading to further debates within the community about Khatna, which is a good thing.”

India Speaks Out on FGM and Sahiyo are running a campaign Each One, Reach One to break the silence against Khatna. You can support the work being done by Sahiyo by speaking up against Khatna or reaching out to someone you know who might have been subjected to the practice.

You can follow them on Twitter: @SpeakOutonFGM and @Sahiyo2016 and join the conversation.

Photos courtesy of Each One, Reach One.

Indian women speak out against FGM

This article is part 1 of a two-part series on FGM in India

Female Genital Mutilation (FGM) is traditionally known to be practised in 30 African countries. According to latest reports from international agencies like UNICEF, it is said that FGM has been done on at least 200 million girls.

I recently interviewed Masooma Ranalvi who began a campaign to encourage Indian women from the Bohra community to speak up against the practice. The practice is called Khatna locally and is classified as Type 1 FGM by the WHO. It is estimated that there are nearly 1.5 million Bohras globally who have undergone FGM but numbers on how many have been cut are still unavailable.

GG: I read about the campaign India Speaks Out on FGM through the article highlighting the petition in The Ladies Finger. Till I read this article, I had no idea that the practice existed in India. It is usually portrayed as an African issue. Your thoughts?

MR: Yes that’s true. It is India’s best kept secret. There is a reason behind it. We as Bohra women who were subject to it never spoke about the practice to anyone ever. It is an extremely secretive ritual and a shroud of silence around it. Beginning from the manner in which it is done, by deceit, by not even informing the girl child about what is to happen to her. And of course no information about the WHY of it. The pain and trauma resulting from this is repressed and suppressed and no one wants to reveal or talk about it.

Second factor is the shame behind talking about this. As women we have been taught never to talk about anything sexual, about our reproductive organs, our sexuality and sexual problems. Until we began to speak out in open. This has in turn inspired many women to do so.

GG: How long have you been working on this issue?

MR: Since last year.

[You can read her writing about her experience here]

GG: You have on multiple occasions spoken about your own experience of Khatna. You are also documenting the experiences of other Bohra women who have experienced it. Why do you think this is important?

MR: For one its important for women to speak out about it. It is cathartic. It helps release the anger, frustration, helplessness. Secondly, its important for the world at large to hear these stories of a hidden and secretive ritual that being carried on since centuries in our own backyard. This is your regular educated and savvy women, who are professionals, who do it to their daughters. Sometimes we need to show a mirror to ourselves, to see what and who we actually are. And finally and most importantly these stories are inspirational and help building solidarity with our other sisters and strengthen our anti FGM movement.

GG: What were the challenges you have faced while speaking up?

MR: The biggest challenge is to challenge the control of the clergy over the bodies and minds and lives of the adherents. The control is not just over the religious practices but over secular life as well. The control is deep and absolute and women or men who have even remotely challenged any practice have been threatened with repercussions. There is a strong and real fear of social boycott which has been used in the past to bring dissenters in line. Women fear for themselves and their families, their businesses and their social lives as well. The challenge for us is to break this fear psychosis and give them courage to speak out. Because this is a practice which harms us and our girls. We need to speak about it to banish it from our lives.

From February 6 (which is recognised as the International Day of Zero Tolerance for Female Genital Mutilation (FGM) by the United Nations General Assembly) to March 8 (International Women’s Day) India Speaks Out on FGM along with Sahiyo are running a campaign called Each One, Reach one.

GG: Through Each One, Reach One, what do you hope to achieve?

MR: The underlying principle behind it is to help break the silence now. The campaign aims to erase the secrecy around female circumcision and generate a healthy dialogue about it.During our  conversation, we want share stories about khatna: memories of the day when the cut was done, feelings and emotions towards the experience, the reasons given for the practice, the reasons behind the silence around the practice, the physical, psychological and sexual impact of the practice for women. A healthy conversation that is  respectful, rather than judgmental, moralistic or aggressive.

Apart from speaking out about Khatna, Masooma is also trying to draw the attention to the fact that United Nations doesn’t list India as a location where it is practised. This is a grave oversight and injustice to the women who it has been practised on and those who might suffer it. However the Sustainable Development Goals now make it mandatory for all countries to begin reporting on FGM. 

To help, Sign the petition to End FGM in India, and help spread the word and raise awareness! 

Featured image courtesy of India Speaks Out on FGM campaign. 

*Post has been edited to clarify the number of Bohra women estimated to have experienced FGM and to make a note of the SDG requirement to report on FGM. 

Let’s Talk About Adolescent Health

​There is a growing conversation among adolescents, communities, organizations, the private sector and other stakeholders concerning the future and health of adolescents around the world. There are close to 1.8 billion adolescents living in the world today. Many are healthy while others lack access to the vital health services and education they need to grow and thrive.  The leading growing issues include but are not limited to complications leading to pregnancy and childbirth, access to sexual and reproductive health services, gender-based violence and the over 2 million adolescents who are living with HIV. In order to ensure young people can transition well from youth to adulthood, these issues must be adequately addressed.

The renewed Global Strategy for Women’s, Children’s, and Adolescents’ Health, set to be launched in September 2015, is a roadmap for ending all preventable deaths of women, children, and adolescents by 2030 and improving their overall health and well-being, and builds upon the 2010-2015 Global Strategy for Women’s and Children’s Health launched by the UN Secretary-General. The Partnership for Maternal, Newborn and Child Health (PMNCH) has been organizing consultations to effectively inform a renewed strategy. Central to this conversation are the voices of adolescents and young people themselves.

Yesterday, we had an engaging conversation with youth and thought leaders addressing global priorities for adolescent health. The discussion included an amazing group of panelists including, Cecilia Garcia, Founder of Espolea and board member for PMNCH, Patrick Mwesigye from AfriYAN and Laura Laski, Chief of UNFPA’s Sexual and Reproductive health branch. The panelists candidly shared the challenges adolescents face in accessing health services, primarily including access to comprehensive sexuality education and SRHR health services. Opportunities related to improving adolescent health were also discussed. Adolescents are being engaged through working groups and various programs including one led by UNFPA in India and a second one in Argentina called program Sumar. There was an overwhelming agreement among the panelists that adolescents themselves must be involved in the conversation. Cecilia and Patrick both urged those watching to participate in the conversation online as well as to rally their national governments and other stakeholders to commit to prioritizing adolescent health and engaging youth in the post-2015 agenda.

Watch the Hangout

You can also read our Storify recap here.

Do you want your questions for adolescent health answered? Join the conversation!