1. Ahoua Koné, JD, MPH Health Alliance International February 2011

2. FGC or FGM: what is it? Ancestral Practice ~ 2000 B.C. Moral outrage? Rite of passage? Health hazard?

3. Classification (by outsiders) (4 types: 0-III or I-IV) Type 0: Symbolic act Type I (Sunna) : Clitoridectomy - Partial or complete removal of clitoris Type II (Excision): Removal of clitoris + inner labia Type III (Infibulation): Removal of clitoris + both inner & outer labia + stitching

4. Reasons for practicing FGC? Culture? Right of passage? Increase chances for marriage? Religion? Preserve of female virginity? Control /enhance sexuality? Esthetic / beautify the girl or woman? Cleanliness? Unknown?

5. FGC by Country and Age Prevalence Among Younger and Older Women Percent Source: DHS STATcompiler: accessed online at www.measuredhs.com/statcompiler on July 21, 2004.www.measuredhs.com/statcompiler

6. Health Consequences Short term –Severe pain, hemorrhage, infection, urine retention Long term – varies greatly according to type – UTI, obstetric complications, sexual dysfunction, psychological problems, death

7. FGM/C: Trends over Generations 1950s1960s1990s2000s Age10–15 years8-12 years1 year < SiteSacred place Outside the home At a home At home # GirlsA cohort from different villages (10+ pers.) From several families within same village (2-6 pers.) A single family or single child A single family or single child Duration2-4 weeks7-10 daysHours FestivitiesCommunity level Family levelNone CuttingYes

8. How to address FGC? Medicalization? Criminalization? Eradication Policy development? Health Education? Advocacy? General Female Education? Cross-Cultural Interventions?