Female Genital Cutting in The Gambia: A Case Study of Tostan by Sarah Kopper MPP Essay submitted to Oregon State University in partial fulfillment of the requirements for the degree of Master of Public Policy Presented June 1, 2010 Commencement June 2010 Master of Public Policy essay of Sarah Kopper presented on June 1, 2010 APPROVED: Rebecca Warner, representing Sociology Bryan Tilt, representing Anthropology Janet Lee, representing Women’s Studies Sarah Kopper, Author ABSTRACT The World Health Organization (WHO) defines female genital cutting (FGC) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons” (WHO, 2010). This practice has existed in Africa for thousands of years, but over the past few decades it has captured the attention of Western audiences and development organizations. One organization that has received a considerable amount of attention is Tostan, a NGO that implements a human-rights based, non-formal educational program in West and East Africa. Tostan vaulted onto the international scene in 1997 when it began facilitating the first public declaration abandoning FGC. To date, close to 5,000 communities in 5 countries have publically announced their abandonment of FGC in front of political leaders, religious leaders, and other communities in their area. This essay is a case study that explores why Tostan’s program and approach have led to FGC abandonment in The Gambian context. Using curriculum review, classroom observation, and interviews with staff and participants, I found that Tostan’s success stems from its use of a holistic, respectful approach that incorporates community values. An application of the multiple streams policy framework and innovation and diffusion policy models enrich the findings by bringing further insight to FGC at the national level. ACKNOWLEDGMENTS There are numerous people who have contributed to the success of this essay. First, I would like to thank my committee. I appreciate your flexibility, suggestions, and insight. I am particularly grateful to my chair, Becky Warner, for her detailed feedback and commitment to my project. Despite her busy schedule, she has always made time to help me improve as a researcher, writer, and student. I feel a deep sense of gratitude for the MPP program and its director, Brent Steel. Thank you for developing a program that effectively meets different students’ needs, including making it possible for me to leave the country for two terms and still graduate on time! This essay would not exist if Tostan had not given me the opportunity to live, work, and conduct research in The Gambia. Throughout my stay I received numerous insights from the Director of Monitoring, Evaluation, Research, and Learning—Cody Donahue. He not only helped with the logistical details, but also offered insight into research design and the intricacies of the Tostan program. I appreciate both his support and friendship. I would also like to thank all of my fellow volunteers—life as a Toubab in West Africa would not have been the same without you. A special thanks to Katie Fair for her optimism and confidence that I could successfully complete this project. There’s no one I’d rather speak terrible French with in the Salim Boutique. Finally, I would like to thank my wonderful group of family and friends who helped me laugh at myself during this process, even when I felt like I’d rather cry. Neil, I would not have made it through this experience without your patience and understanding. In the future, I will try not to leave the country for extended periods of time without taking you with me. I can’t wait to take on the world with you by my side. Table of Contents INTRODUCTION...................................................................................................................................... 1 RESEARCH QUESTION ............................................................................................................................................... 2 DESCRIPTION OF THE CASE AND RESEARCH SITE ............................................................................................... 2 Tostan......................................................................................................................................................................... 2 The Gambia and the Upper River Region ................................................................................................... 6 ESSAY OUTLINE ......................................................................................................................................................... 8 A NOTE ON TERMINOLOGY................................................................................................................................. 8 BACKGROUND ON FGC AND ABANDONMENT EFFORTS..........................................................10 TYPES OF FEMALE GENITAL CUTTING, PREVALENCE, AND ASSOCIATED HEALTH RISKS.........................10 Types of FGC ..........................................................................................................................................................10 Prevalence ..............................................................................................................................................................11 Health Risks ...........................................................................................................................................................12 REASONS FOR THE PRACTICE AND ITS ORIGINS ................................................................................................13 Rite of Passage......................................................................................................................................................13 Control of Women’s Sexuality........................................................................................................................14 Religious Practice................................................................................................................................................15 Social Convention and Marriageability.....................................................................................................16 APPROACHES TO ABANDONMENT ........................................................................................................................17 Right­to­Health Approach...............................................................................................................................17 Human Rights Approach..................................................................................................................................20 National Laws and International Agreements.......................................................................................20 An Economic Strategy: Compensation for Cutters ...............................................................................22 Public Declarations ............................................................................................................................................22 SUMMARY..................................................................................................................................................................26 METHODS ...............................................................................................................................................28 CASE STUDY METHODOLOGY ................................................................................................................................28 Curriculum Document Review.......................................................................................................................28 Classroom Observation.....................................................................................................................................29 Participant and Staff Interviews ..................................................................................................................30 METHODOLOGY LIMITATIONS...............................................................................................................................36 RESULTS..................................................................................................................................................37 CURRICULUM REVIEW ............................................................................................................................................37 Trust, Respect, and Dialogue in CEP Sessions.........................................................................................38 FGC Specific Sessions..........................................................................................................................................38 CLASSROOM OBSERVATION ...................................................................................................................................43 Accommodating Classroom Atmosphere..................................................................................................43 Familiarity and Trust with Facilitator and Between Participants ...............................................44 STAFF INTERVIEWS.................................................................................................................................................45 Holistic Approach Based in Human Rights ..............................................................................................45