Berkley Center

Katherine Marshall: Good afternoon. This is Katherine Marshall at the Berkley Center for Religion, Peace, and World Affairs, meeting with Sean Callaghan, who will introduce himself. The focus of our discussion today is on female genital cutting, particularly in the United States, where Shawn has done some research and is about to do some presentations. We'll also discuss some of the broader implications of the global awareness about this as a human rights and a health issue: what seems to work, what doesn't, in the context of an organization that Sean has been involved in for some time. 

But perhaps you could just introduce yourself and the particulars of the context that you're working in. And then we can turn to this quite fascinating subject of what is happening in the United States and what is not happening in the United States.

Sean Callaghan: Thank you, Katherine. Yes, Sean Callaghan, working as operations manager for 28 Too Many. The name comes from the 28 African countries where FGM is currently practiced. We're a U.K.-based research institute looking at FGM/FGC across the whole of the continent. Looking at it both in terms of what's happening in each country, trying to really present research in a way that is useful for policy makers and activists at the country level, and then also looking at cross-cutting thematic issues: law, anthropology, religion, and most recently what's happening in the diaspora, which is what brings me to this conversation today.

Marshall: So, what is happening in the diaspora? Particularly in the United States.

Callaghan: I was in a conversation probably six, eight months ago, which was one of those conversations where you go home and then you stay up all night looking at the data. What I did is I went to the International organization of Migration [IOM] dataset. Where do people move to? And I cross-multiplied that with prevalence rates from the countries of origin of those people and then put that into a tableau map and said "What's the picture they're showing me?" And it showed me a couple of interesting things. 

There's quite a lot of diaspora movement within Africa, which I'm not sure that any of the activists in Africa are quite wrapping their head around. I mean the obvious one we know about is the Somalis in Kenya, but there's, you know, what's happening down in South Africa, what's happening across West Africa in terms of movement of people, and so on. Huge populations in the Middle East and a complete black hole, because there's no legislative frameworks really there. In the Gulf states, a lot of Africans from very high prevalence rate countries who are there: Sudanese, Egyptians, Ethiopians, Somalis, Eritreans, and so on. And then, in the European Union and particularly the U.K. and then the U.S. The U.S. has an at-risk population of about double the U.K.’s population in terms of potential prevalence rate.

Marshall: So roughly how many people would that be?

Callaghan: There’s some 2013 research from the U.S. census data that suggests it's around about 500,000 people across the U.S. that are affected. So, the piece that started to interest me is where? Where in the U.S.? Where in the U.K.? And once you get down to the city and even the neighborhood level, what is the demographic mix of people in that neighborhood that are at risk? Because FGM/FGC is such a vastly differing practice depending on where you come from: the age of cutting is anywhere from birth to 15, 16 years of age.

The reasons for cutting are vastly different: the religious background and the motivations for cutting are vastly different and the type, and even the cutters are different. So the whole thing looks different. And therefore your interventions, your prevention, your prosecution, and even your social services structures that you need to provide would be completely different if you were talking about a Nigerian community or a Somali community for example. I took the ... The first thing is that I took the data sets and I started to drill down in the U.K. I looked at ... I took that RM data and then I took national census data, I took social security data, and I took a school enrollment data, and they all agreed with each other in terms of the percentages and the most at-risk populations and so on. In the U.K., for example, essentially half of the at-risk population comes from two countries: Nigeria or Somalia. 

I was then able to take that and break it down to the zip code level and start to look at where in London, for example, do the Somalis live? Where do the Nigerians live?

Marshall: So the at-risk definition is based on the incidence levels in specific countries?

Callaghan: In specific countries they're from, and that's pretty much how everybody's doing it at the moment, and I approached it from. I think there's two drivers that suggest how at risk you are. The one is how recently did you relocate into the diaspora. And my sense is that the more recently [you] relocated, the more you're tied to the practice back home. And then, secondly, the more densely you're living in community with others from your host, your original community, the more you're going to retain the diaspora, the cultural markers in the diaspora. 

I was looking for, in the U.K. for example, I was looking for data on country of birth for example, because that told me these were people that moved recently within their lifetime, and then secondly I was looking at age-specific data. I was looking at primary school enrollment data and then I was looking for the communities where there's a higher density of people living together. 

So, across the whole of London, they might be a 100,000 people, but in this neighborhood there's 10,000 or 20,000 in this one zip code. That tells me that probably things are more sustained in that neighborhood than they are maybe in the more dispersed areas-

Marshall: And what's the best source of data on what's actually happened to people? What kind of cutting? Is it self-reporting? Or is it coming out of hospitals?

Callaghan: In the U.K. ... Well, let’s go back to countries of origin. In countries of origin there's essentially two data sets that everybody's using, the Demographic and Health Surveys [DHS]…

Marshall: Which is basically self-reporting.

Callaghan: Which is self-reporting. And the MICS, which is the UNICEF data sets, which is also self-reporting. In the U.K., there is a mandatory reporting requirement for health workers, so any woman or child that comes into a health facility and is noted as having FGM, the health authorities are required to report. 

The challenge with that is, that communities that are continuing to practice would simply go to health professionals that are supportive of the practice who they wouldn't disclose, and it's clearly obvious when a woman who comes into labor who has had type three; and it's really not very obvious when a woman comes into labor who is type one. There's a significant and a reporting reality in the U.K.That is not the same in the U.S. There's no mandatory reporting requirements here as far as I can ascertain. That's certainly one of the things that organizations like AHA Foundation are calling for is strengthening laws to create mandatory [requirements].

Marshall: Which foundation?

Callaghan: AHA Foundation [Ayaan Hirsi Ali]

Marshall: AHA.

Callaghan: Based out of New York.

Marshall: Okay.

Callaghan: And their whole mission is to strengthen the legislative framework around FGM in the U.S. At the moment, about half the states have legislation banning FGM, and the other half don't. They've got a really helpful map on their website where they break that down into five or six categories. A really strong law and a full and adequate law, a law that needs significant, and yet a weak law needs real work, and then no laws at all.

What's significant about that is when you do that same mapping of prevalence rates across the U.S., and obviously it clusters in the big cities because that's where people live together, and it clusters across a couple of key states. When you overlay that with the states that have or don't have laws, you start to identify the real challenges.

The state of Washington, for example has, according to that survey, about 25,000 at risk population, with no legislation at all covering FGM and so, you know, laws don't prevent FGM, but they certainly do signal an intention that this is not okay in our society and so, that enables activists, community workers who are working to shift cultural norm that ... The laws are not going to shift the cultural norm, but it gives them another level to work with.

Marshall: How would you describe the activist community, and where are they most active in the United States?

Callaghan: There are classically two kinds of activists that I see. There's a lot of amazing grassroots people working in their neighborhood, in their community with the families that are close to them and who are completely under the radar, and underresourced, and undersupported. Ignored by just about everybody, but I think that's where the real change comes: I think it's those deeply embedded grassroots activists, and I've had the privilege of meeting some of them for example, in the U.K., where it'll be ... I met this one guy, and he was telling me his story. 

He's Somali. He managed to get out of Somalia years ago, at the time of Black Hawk Down, you know, that sort of the whole mess of a civil war, by hitching rides on fishing trawlers down the coast until he got to Cape Town. Then he was sort of supported by the Somali community in Cape Town and eventually got himself, I don't quite know how, to Heathrow and then claimed asylum. And then you know, a long story, but he now lives in a community in the Midlands in the U.K. His thing is, he has conversations over tea in the cafes with men, and he debates gender and FGM in marriage and that with Muslim men and Christian men, in the neighborhoods and slowly, slowly is getting the conversation to happen around "How are you treating your wife? How are you treating your girls? What about your grandkids?" Just shifting the dialogue. Somebody like that has enormous impact in his neighborhood.

There's definitely another group who kind of do the conference circuit, who do the speaking circuit, who are plugged into the UN, who are funded by the big INGOs, and they clearly have a really important role of putting the issue on the agenda. The fact that it's now in the SDGs as 5.3 and so on. It's because of people like them, but they're not sitting often on the ground in that café having those conversations so, it's those different movements from the top and from the bottom, and we need both. 

There's a third group of those of us that aren't survivors or from the practicing communities who are engaged in supporting programs and doing research, in funding, and I would consistently be calling those of us that are outside of the context to not be intervening directly but to be supporting those who are on the ground and particularly to be shifting our funding and our efforts to the much, much more grassroots activists. 

That really means Twitter and it means Facebook and it means WhatsApp and it means talking to villages and people. It's a much more dispersed intervention and engagement. So as an organization that really describes our, sort of, two-prong approach: we do this research, we try to package up knowledge in a way that turns data into actionable intelligence but then-

Marshall: I like that – “data into actionable intelligence.”

Callaghan: Yes. And then take that and make it available to policymakers so that they can drive the policy frameworks, but equally make it available to grassroots activists so that they can really work it from the ground up. 

So that means our website is now fully available in English, French, and Arabic. Our research gets translated further down into Amharic and into Swahili, so that it becomes available to people, and we publish these wonderful 80 page reports, which nobody is going to really read unless you're very committed. 

We then publish six- to eight-page key findings documents and a PowerPoint presentation that goes with that in multiple languages, freely downloadable, so activists can use that ... on the ground, but we've just done this massive law project where we worked for two years with 125 lawyers from about 40 countries around the world to map out the legislative framework in all 28 of the African countries. 

What international treaties have they signed up to like the CEDAW [Convention on the Elimination of All Forms of Discrimination Against Women]?

What is their constitutional frameworks? What legislation specifically bans FGM? What other legislation, like medical malpractice or child protection legislation, is there that covers FGM? 

What are those laws actually saying in plain speak? What are the penalties related to it? What are the holes? Does it cover cross-border crime? Does it cover the procurement as well as the performance of FGM? Does it cover medicalization of FGM and so on? 

And then make recommendations, so we have all of that ... and we did the trends across Africa, but those reports then get into the hands of activists.

So for example activists working in Egypt recognizing the enormously high prevalence rates in Egypt, in the 80 percent range. And about 80 percent of that 80 percent are done by medical practitioners, and yet almost no medical malpractice cases ... a couple of slaps on the wrist ... 

And so these activists are working with parliamentarians to try and strengthen their legislation and what's the resource that they use, but our report on the legislation in Egypt plus our report on medicalized FGM ... and it's available to them in English and in Arabic. 

That kind of ... where you've engaging with policymakers and with activists who really close down the practice and shift the dialogue is absolutely critical. 

Marshall: Maybe it would be good if you could describe a little bit where 28 Too Many came from and what it does? Then I want afterwards make sure that we don't neglect the interesting religious dimensions of all of this. I think if you just introduce the organization a little bit that would be helpful. 

Callaghan: Doctor Ann-Marie Wilson, she worked for Medair and other organizations like that about 10 to 15 years ago, and she tells the story of working with Medair in a Sudanese refugee camp and having a patient come in and losing this patient in pregnancy to her FGM. 

Having never seen this in her life before ... what is this about? Then torn up and went on a journey of going back to college and doing a master’s degree in exploring FGM, and then learning to be a midwife in order to understand that and spending time in Pakistan and Nigeria and so on, and just trying to understand the practice. 

And what she realized in order for this is that there's quite a lot of effort going on, but a complete lack of information. A complete lack of data. There's data in 100 places if you're clever enough to know that the DHS exists and you can go and trawl through their reports. You might be able to find something and if you know how to do statistics you might be able to compare some things to some things; then if you look on the UN site you might. 

So she set up the organization to take all of that and do this secondary research compilation process of really understanding, presenting the picture at the national level, in each of the 28 countries. 

As we've ... we've been working on that for five to six years. We're about halfway through the 28 countries and we've been working our way down the prevalence rates. The highest prevalence countries near the beginning ... 

Marshall: Which are the top five just for reference? 

Callaghan: Well, it's interesting. The highest prevalence would be Somalia, 98 percent, but the three countries that have reasonably high prevalence, but have such enormous populations that they are half the problem all combined, is: Egypt, Nigeria, and Ethiopia. 

The three of them together make up 50 percent of the problem. 

Marshall: So you're working your way down through 28 countries of Africa? 

Callaghan: So we're working our way down through 28 countries of Africa, and then at the same time ... 

Marshall: Which have significant ... 

Callaghan: Which have significant ... 

Marshall: So in other words they're a lot of countries that simply don't. 

Callaghan: There's a lot of countries ... Southern African tends to not have FGM. There's other issues, breast ironing, labia stretching, et cetera, but we try to stay within the WHO definitions of FGM. 

And then the Mediterranean countries above the desert tend not to have FGM, but it's this band across the Sahel up into the Horn and down into Tanzania. As we've worked across that we've then started to pick up that we keep coming up against the same issues, and so we've started a series of thematic reports for medicalization ... as I said before Egypt, it's a medical story in Egypt. Ninety-nine percent of medicalized FGM is happening there, but there's clearly an anthropological piece to this.

For example, do alternative rites of passage, do they end FGM or do they postpone FGM? How do you do culturally sensitive programming? Do we use the word mutilation? Do we use the word cutting? Do we use the word circumcision? And of course in the vernacular, is there a positive way of having ... is there a way of having the conversation to abandon FGM by making a positive argument for why not, rather than a negative argument for why? 

So we're just finishing off an anthropological report which is looking at these different issues and then making programming suggestions/key questions for designing program interventions. 

The law was a big one. Religion is a big one, and then of course diaspora. 

Marshall: Well, let's come to the question of religion. I think there are really two dimensions. One is how people believe that the religious requirements call for them to continue the practice, and the rationale within a theological setting. And then the second is how various religious institutions and leaders are acting to respond to this. 

Callaghan: Again what's so interesting is when you ask somebody out there "What do you know about FGM?" Once you find the people that know about it, they almost always make two big assumption mistakes. The first is that it's a practice that is about the transition into womanhood. That it's a puberty-based practice, which of course it is amongst the Maasai, but it's not amongst many of the other communities. 

And then secondly that it is somehow connected to Islam. That it's Muslim communities that practice this. And I love Nigeria as an example because it flips everything on its head. Very broadly speaking if one thinks about Nigeria, northern states are Muslim or sharia law; southern states are Christian. Boko Haram in the north, so immediately the thinking is what impact has Boko Haram had on the spread of FGM, blah, blah, blah, blah, blah. Well actually, FGM doesn't really happen in the north. It happens in the south. 

It happens in the Christian states, and so it's happening in the big Pentecostal churches, not in the mosques in Nigeria, which of course it's exactly the opposite in Somalia where clearly it is tied up within Islam, or in Bohra, in India, or in Yemen. 

So what we know about the origins of FGM is still pretty shrouded in mystery, but it definitely predates Islam and it predates Christianity. It does seem to have its genesis somewhere in the Horn of Africa, Egypt, Sudan kind of space, and so clearly FGM can't be a religious requirement because it existed before those two religions. 

The one community that seems to have made the most wholesale progress on ending FGM is the Ethiopian Jews. When they returned to Israel almost seemed to have abandoned it wholesale in the 1950s after the return. 

So again faith doesn't really ... it's not about the faith, it's about the culture, and it's about how faiths around the world have embraced certain cultural aspects in order to further the aims of the religion. Clearly ... in some communities like Maasai FGM, where it is a big public ceremonial process, often the faith leaders are involved in that ceremony or process.

In Nigeria where it's attached to the naming ceremony, almost the christening of the child, faith leaders would again be involved in the process there. In other places where it's much more hidden, much more personal, Egypt for example, it's much less of a faith leader engagement in the practice. 

I think both Christianity and in Islam patriarchal structures, patriarchal theology gets used to continue the subjugation of women, and FGM very much has to be seen as part of the bigger gender justice narrative. It's very often linked to marriage and often to child marriage. It's linked to virginity and chastity, and promiscuity/purity narratives within both Islam and Christianity. 

Marshall: What about the roles that religious communities are playing, and what can we say is positive, in other words, in ending this? Do you see centers of action? Are their particular communities that have been seized by the issue and have shown leadership? Others that have been more reticent? 

Callaghan: I think it was the Scottish Presbyterians that started the anti-FGM process in Kenya during the colonial era, and there's some amazing theological texts by Islamic scholars from Egypt, from Iraq, from Kenya, Somalia speaking out against it, but equally there's strong evidence to suggest that the reason why Mali doesn't have a law against FGM is because the faith leaders have said, “You won't go there.” And the political system is tied so much to the endorsement of the faith leaders that they just don't go there. 

My sense is churches and mosques have provided and do provide places of safety, but I'm not sure that that's necessarily a good strategy. It's a bit like the soup kitchen and food bank. It's great because it means people don't starve, but we have to ask the question why people are starving in the first place. The church and the mosque seem to be quite reticent to engage in the systemic issues because it challenges male headship so much, because once you go down this track from FGM, [it leads to] child marriage, widows’ inheritance, land rights, property ownership, women can work, women can be in leadership, women can lead churches. That whole thing. Domestic violence. it starts to erode at the male headship reality of so many of our religious institutions that they're not obvious allies. 

Marshall: That's a telling statement: “Not obvious allies.” 

Callaghan: Yeah. 

Marshall: I think we should move on, though we could discuss this all day, but are there any elements or thoughts either on the diaspora side which we started talking about or on the broader, really African side, or even on the way the issues are presented in India or in Indonesia, which have really come onto the map more recently? 

Callaghan: Well, there's a researcher at Leicester University in the U.K. doing some really interesting work at the moment on, I think he's a [inaudible 00:36:33]. So, he's doing predictive modeling of trends around FGM, and what he's seeing is the headline number is coming down slowly in most countries. Once you dig inside the data and you get into by age group breakdown, in most countries it's quite a sharp turn down, but what he's seeing is that mostly once you get down to the village level, the trend graph coming down actually is a step down graph, so it really is that this village does FGM until this village doesn't do FGM. It's 100 percent to zero percent at the village level, and it's because FGM is so tied to belonging to identity, to marriageability, that the gatekeepers, whether they're the grandmothers or the elders or whoever it is, are making a decision that in our village we're not doing this anymore. 

Yes, there are the odd stories of the one family and the girl who didn't get cut, but they are so few and far between and so ostracized by that, that you can't imagine that 98 percent of the village are doing it this year and then next year it's 72 percent. It really doesn't work like that. It might look like that in a country, but the real work is how do you get an entire community to abandon it. This is where the faith leaders can play an incredibly important role, because if a faith leader, who often at the village level is one of the loudest opinion leader voices, makes the argument that in order to be a faithful member of this community, we should not do this, that has the potential to end it in that community and then it's the next community and it's the next community. That, I think is again, why I come all the way back to the grassroots activists. 

That's the conversations that they're really having. Ninety percent of FGM is happening in Africa, so yes, it is happening in the Middle East and we keep finding new communities; certainly across Yemen, but up in Iraq, [inaudible 00:39:40], over in Iran, Pakistan, India, Indonesia, Malaysia. We keep discovering. Columbia, Latin America, that it's a practice that as it becomes more known it pops up. The Bohra community in India is an interesting one because you almost ... It's so recent that the activism has started that you can go back to the woman who realized what had happened to her, having got into the global conversation and then going, "Oh, hang on. This happened to me, what happens to all of us," and you can see the genesis of the beginning of the unraveling. I wonder how many other communities it'll pop up in. We hear the stories of something very similar happening in the southern states of America, in the Bible Belt in the last hundred years.

Marshall: You mean 100 years ago.

Callaghan: Yeah. 

Marshall: You're in the United States and you're giving a presentation at George Washington University tomorrow that's focused on the diaspora - in other words, the U.S. situation. There are at least two currents that I'm aware of in the United States. The first is the judge who threw out the case last week and then there's a case of an imam at a mosque who generated a controversy essentially by supporting the practice, so I'm curious as to how you will respond to those two very U.S. circumstances.

Callaghan: Yeah, what's interesting about the case that was thrown out, it was Bohra Indian community and that's really not, as I see it, much on the radar in the U.K.

Marshall: What? The Bohra community?

Callaghan: The Bohra community. I picked up on it because I've looked at more broadly what's happening around the world and then bumped into the activists at various UN events, but the fact that, that was a focal point for the conversation here was somewhat interesting. I guess for me, what I'm always looking for is what is the pattern in the data? What's the pattern in the data telling us? That original research that was done by CDC or whoever it was 2013 and mapped out the 513,000 people; they identified the hot spots. They identified the states that had the highest prevalence. I took the IOM data and it marked out the cities in those same states. What I'm looking at inside the IOM data is what are the ethnic mix of those communities. 

For example, Minneapolis/St. Paul is one of the key hot spots in the country, but it's a Somali/Ethiopian mix. Well, that tells me it's probably type three. It tells me it's happening somewhere around five, six, seven, eight, nine. That's very different to Washington or Seattle, which might be a different mix of communities. Maybe Egyptian or Nigerian and so on. Once you can understand what's going on in Minneapolis and I think if we dig inside the data, we're bound to get down to which zip codes and therefore, which primary schools and which clinics and which mosques and so on. Once you get down into that level of the detail, that would need to shape a whole bunch of things. It would need to shape service provision for anti-fistula clinics for women who have probably had type three and who are going to have serious birth difficulties. 

It's going to have to shape fistula support, which really, I don't know if anyone in the U.S. thinks about things like fistula because that's not really a U.S. centric issue. That's the support after the fact. Also, obviously marriage counseling and sexual health and those kinds of conversations, but then you think about the prevention strategy and what age groups are kids most at risk within their community. I can't believe that everybody or mostly everybody is going back to Somalia or going back to Ethiopia to be cut because I just don't know that people who are refugeed or whatever have the financial capacity to go back or the passport capacity to go back, so that has to mean it's happening here. Who are the cutters? Are they flying in? Are they already here? Where is it happening? When is it happening? Is it happening in front rooms or is it happening in clinics? Is it happening at community ceremonies? 

You can start ... It starts to inform the intelligence gathering process and the prevention and the education process. Then, on the prosecution side of things on this court case that was thrown out two weeks ago, it's essentially saying that a federal law is unconstitutional, so it needs to be a state law. [We’re] looking at those states with high prevalence and no laws. We're looking at the states with high prevalence and very weak laws and cross border, state-to-state, and so on. We identify communities like Washington or Pennsylvania or Massachusetts that don't have laws but have significant populations, or states like California and Minnesota, Tennessee, and Illinois who have significant populations and have some laws, but they really need strengthening. That creates an advocacy agenda with when is the next round of voting taking place, and can we get referendums onto those bills, and can we mobilize either community-wide votes to look at laws like that, or can we mobilize advocacy to get state legislators to start passing laws? 

What does a good law look like? That's a chunk of work, but at least by looking at the data, we know where to target it, and I'm one of those people that says if we can target two things and that knocks over half the problem, and then you have to target 50 other things and knock out the other half of the problem, let's just go for the two, your big ones. The data suggests the big ones and it suggest the interventions. Also, tomorrow I'm meeting not only with this workshop in the morning, but in the afternoon I'm meeting with the research department at State that is providing the research for the desk officers who have-

Marshall: At the State Department?

Callaghan: Yeah, at UCI, whatever it's called. The immigration department that handles the research to provide the desk officers for refugee and asylum seeker cases.

Marshall: I see.

Callaghan: We had a phone call a couple of weeks ago and I'm sitting with them tomorrow, and one of the questions they said is if I'm gonna tell my desk officers anything, my case officers anything, what are the two or three key questions I need to be asking if the asylum case is about FGM? Being able to say, well think about age. Think about geography. Don't ask the question “Is there a law back in their home country?” because the law is going to be ineffective anyway, so that's not the right question, but that's often the question that gets asked. What is the risk profile of this person and therefore, do they qualify for asylum based on that risk profile? Equally, I'm talking with them. Equally, I'm talking with lawyers who handle asylum cases all the time. 

They're coming to us and saying help me fight this asylum case. I need to convince the government, blah, blah, blah, blah, and so what I like about that is everybody's working from the same set of data and then the case gets fought on the strength of the case, not on the misperception of you're not Muslim, so you're not a risk, or the classic Nigeria thing of you come from the north, so you must be at risk. If you come from the south, it'll be fine. It's like, well, no. If you could move to the city, you'd be okay. Again, not necessarily. In fact, probably not in Nigeria. Yeah, so I just think being able to provide the data that enables better decisions is what's absolutely critical.

Marshall: Good. Well, thank you so much Sean. This has been a fascinating discussion. I look forward to finding ways to follow up.

Callaghan: Wonderful. Thank you.