Ghana: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC)

Released by the Office of the Senior Coordinator for International Women's Issues

Practice:
The form of female genital mutilation (FGM) or female genital cutting (FGC) most commonly practiced in Ghana is Type II (commonly referred to as excision). Other forms, such as Type I (commonly referred to as clitoridectomy) and Type III (commonly referred to as infibulation) are also practiced. The extent of the practice in Ghana as a whole is limited. These forms are generally practiced among a few groups in northern Ghana. There are also some migrants from neighboring countries who now practice it in southern Ghana.

With strong government commitment, extensive outreach by non-governmental organizations (NGOs), and a general receptivity to abandoning the practice, it is widely believed to be on the decline among the groups that practice it.

Incidence:
FGM/FGC is most prevalent in the Upper East Region. It is also practiced regularly in remote parts of the Northern Region, Upper West Region and northern Volta Region. In the southern part of Ghana it is practiced among migrants from the northeastern and northwestern parts of Ghana, from Mali, Togo, Niger, Burkina Faso and other neighboring countries. It crosses religious boundaries. Practitioners of various religions perform FGM/FGC.

Studies conducted in 1986 and 1987 showed the practice to exist mainly among the following ethnic groups in the far northern part of the country – Kussasi, Frafra, Kassena, Nankanne, Bussauri, Moshie, Manprusie, Kantansi, Walas, Sissala, Grunshie, Dargati and Lobi.

A number of studies over the past several years have been conducted producing differing estimates of the percentage of women who have undergone this procedure. In 1998, the Gender Studies and Human Rights Documentation Center estimated that it had been performed on 15 percent of the Ghanaian female population. The United Nations Population Fund (UNFPA) recently funded a study conducted by Rural Help Integrated, an NGO providing reproductive health care services in the Upper East Region. The study found that FGM/FGC had been performed on 36 percent of the Upper East Region's female population and estimated that between 9 and 12 percent of Ghanaian women nationwide had undergone the procedure.

In 1996, Amnesty International Ghana, together with the Association of Church Development Projects, estimated that 76 percent of all women in the Upper East, Upper West and Northern regions had been excised. They cited several cities in these regions where it is still widely practiced: Kasena-Nankana, Bolgatanga, Bawku East and Bawku West in the Upper East Region; Bole, Mamprusi, West Walewale and Zabaugu-Tatale Kotokoli in the Northern Region; Wa and Nandom in the Upper West Region; and Kodjebi, Worawora and Jasikan in the northern Volta Region.

The World Health Organization (WHO) has provided seed money for research projects to develop statistics.

Attitudes and Beliefs:
The practice among some groups in Ghana appears to have few spiritual roots. It is not perpetuated by religion, but rather by traditional tribal beliefs. Some believe it leads to cleanliness and fidelity of the woman. Others believe it will increase fertility and prevent the death of first-born babies. It is also seen as a way to suppress a woman's sexual desires and make her less promiscuous.

Other common beliefs are that children born to uncircumcised women are stubborn and troublesome and more likely to be blinded or otherwise damaged if the mother's clitoris touches them during birth. In some areas the presence of a clitoris in women suggests she is a man and must be buried in men's clothing and the funeral performed as a man's when she dies. Uncircumcised women are regarded by some as unclean, less attractive and less desirable for marriage. Social or peer pressure is also cited as a primary reason that some undergo this procedure. Soothsayers in Animist religions often condone the practice.

Type I:
Type I is the excision (removal) of the clitoral hood with or without removal of all or part of the clitoris.

Type II:
Type II is the excision (removal) of the clitoris together with part or all of the labia minora (the inner vaginal lips).

Type III:
Type III is the excision (removal) of part or all of the external genitalia (clitoris, labia minora and labia majora) and stitching or narrowing of the vaginal opening, leaving a very small opening, about the size of a matchstick, to allow for the flow of urine and menstrual blood. The girl or woman's legs are generally bound together from the hip to the ankle so she remains immobile for approximately 40 days to allow for the formation of scar tissue.

In Ghana, the procedures are performed by excisors known as "wanzams" (both men and women), the elderly in society (i.e. the traditionalists), mothers or traditional birth attendants (TBAs) who use unsterilized instruments such as knives and razor blades. No anesthesia is used and no antiseptic precautions are taken when the same instrument is used on multiple girls. The procedure may be carried out during adolescence, at marriage, during a first pregnancy or on babies as young as seven days old. It is usually done in exchange for goods or small livestock, with a higher price if the girl is not a virgin.

The 1998 Gender Studies and Human Rights Documentation Center's study reported that 51 percent of all women who have been subjected to this practice had it performed before the age of one. They reported that 10 to 14 year olds make up the second most targeted age group with more than 85 percent of all procedures performed on girls under the age of 15. The usual age for undergoing this procedure follows regional patterns. In the Upper East, it is most often performed during puberty as a rite of passage to womanhood. Communities in the Upper West and northern Volta regions more often perform this procedure on infants.

Outreach Activities:
The government of Ghana speaks out against this practice. Officials at all levels of the government speak out publicly against it. The current and former President, and the former First Lady, Ministers, the National Council on Women and Development (CWD), the Commission on Human Rights and Administrative Justice (CHRAJ) and several Members of Parliament and District Assembly men are strong voices on record opposing the practice. The media always places the practice in the context of regressive traditions, unbefitting of an ambitious nation. Articles covering officials' statements against the practice and efforts to inform the populace about the practice are common. NGOs target groups needing information on the subject.

The commitment of government officials and the media has created an environment supportive of the efforts of NGOs. The most successful of the programs to date have been the collaborative efforts of the Ghana Association for Women's Welfare (GAWW) and the Muslim Family and Counseling Services (MFCS). GAWW, founded in 1984, is a charter member of the IAC (Inter-African Committee on Harmful Traditional Practices Affecting the Health of Women and Children). It believes that other means, in addition to legislation against FGM/FGC, are needed to totally eradicate the practice. It believes education at the grassroots is needed to change tradition, superstitions and beliefs. GAWW brings resources including brochures, graphic educational films and models of the female genitalia to illustrate the procedures.

MFCS makes these efforts more effective because Islam and its leaders (who are males) are highly respected in the communities where FGM/FGC is practiced. The Director of MFCS, is himself a learned Quranic scholar, an Imam and a village chief.

GAWW and MFCS have been successful and have received invitations to speak in communities about the practice. Many practitioners and community leaders have renounced the practice. GAWW and MFCS have worked with local leaders (community, ethnic and political) to organize and conduct their workshops. They have given these leaders prominent roles in the process, recognizing their importance in the communities, to assure their support.

This groundwork has made the entire community receptive and has assured attendance at GAWW/MFCS workshops that are held throughout the country. Participants are given information on the harmful effects of this practice, the laws prohibiting the practice and the absence of Quranic imperatives for it. A very graphic film shows the procedure and consequences. The film has been very popular in getting the message across. All topics are addressed in an open forum where questions and comments are encouraged.

In an effort to provide continuing vigilance and follow up, the community leaders are encouraged to form watchdog groups from their own community. Local Imams are asked to speak out against the practice. Voluntary watchdog committees, 18 in Ghana, have been organized. These groups keep their ears open and approach those involved in impending FGM/FGC ceremonies. They intervene by notifying the police if necessary and even offer refuge to those wanting to avoid the procedure.

In addition to GAWW's collaborative effort with MFCS, GAWW members are active on a number of other fronts. They work with health officials to research the relationship of this practice to HIV infection and other sexually transmitted diseases. They consult with the Ministry of Education on incorporating education about this practice into the public school health curriculum. They conduct workshops to inform school health teachers about the detrimental health effects of the practice. GAWW also conducts workshops for midwives and TBAs and collaborates with the Red Cross Mother's Club to incorporate education about FGM/FGC into their reproductive health education program.

GAWW has organized workshops for former excisors to help them branch out into other work. Many have given up their work but now need help from NGOs on alternative means to earn a living. WHO, in cooperation with GAWW and MFCS, toured 210 villages in the Volta Region in early 1997 and identified 18 practitioners to provide information and instruction about this practice.

GAWW is very active in northern projects. In 1997, it held a series of workshops on the harmful health effects of the practice in the Volta and Upper East and Upper West regions. Workshops were also held in Jasikan, Kadjebi and Worawora in the Volta Region with 420 participants. Committees were formed after each workshop to ensure follow up. In the Upper East and Upper West regions, workshops were held for police, health workers, students and educators. The primary focus was the law making the practice a criminal offense.

The U.S. Agency for International Development (USAID) provides financial support to the Navrongo Health Research Center's efforts to bring reproductive health education and instruction about FGM/FGC to rural women and girls. Through the Center for Development and Population Activities (CEDPA), USAID supports MFCS' Youth Reproduction Health Project in Greater Accra and the Eastern Region. The project incorporates information and instruction about FGM/FGC into their programs.

In 2000, the U. S. Embassy's Democracy and Human Rights Fund awarded a grant to the Rural Women Association for workshops on this practice in rural communities in the Upper East Region. The Peace Corp in the north has incorporated information about this practice into their classroom lessons on reproductive health and in training courses for school health teachers.

Legal Status:
In 1989, the head of the Government of Ghana, President Rawlings, issued a formal declaration against FGM/FGC and other harmful traditional practices.

Article 39 of Ghana's constitution provides in part that traditional practices that are injurious to a person's health and well-being are abolished.

In 1994, Parliament amended the Criminal Code of 1960 to include the offense of FGM/FGC. This Act inserted Section 69A that states:

"(1) Whoever excises, infibulates or otherwise mutilates the whole or any part of the labia minora, labia majora and the clitoris of another person commits an offense and shall be guilty of a second degree felony and liable on conviction to imprisonment of not less than three years.

For the purposes of this section 'excise' means to remove the prepuce, the clitoris and all or part of the labia minora; 'infibulate' includes excision (Type II) and the additional removal of the labia majora."

There have been seven arrests under the Act since 1994 and at least two practitioners have been successfully prosecuted and convicted. In March 1995, police arrested and charged the practitioner of FGM/FGC on an eight year old girl and the parents of the girl under the law. In June 1998, a practitioner was sentenced to three years in prison for having performed this procedure on three girls.

There is no central record of arrests and convictions or any independent study to show the impact of the law.

There is the opinion by some that the law has driven the practice underground.

Protection:
The law in Ghana protects an unwilling woman or girl against the practice, but there is little real protection to turn to in many rural areas. All levels of government have come out strongly against this practice. Advocacy groups work to eradicate it. There is a history of enforcement against those who practice or threaten to practice FGM/FGC. There are indigenous NGOs and watchdog committees throughout the country who are prepared to intervene and have stopped practitioners by going to the police when necessary. However, their reach does not extend to many remote communities. The police are willing to and have cooperated to stop this practice from happening, but the ability of police to respond to remote communities in a timely or effective manner is severely limited.

Prepared by the Office of the Senior Coordinator for International Women's Issues, Office of the Under Secretary for Global Affairs, Department of State, June 2001

Released on June 1, 2001