An evaluation of the Female Genital Mutilation (FGM) project and improvements through Microfinance


By Nida Jafrani, Barsha Mishra, RJ Shea, Mary Sprouse, and

Katie Yonover

(See full project report here)

Utilizing a March 2014 health assessment, Northwestern Access to Health Project (NAHP) identified a need to address female genital mutilation (FGM) in Douentza, Mali. To accomplish its goals, NAHP partnered with the Near East Foundation (NEF), a local NGO in Mali, to help implement and carry out the project in September 2014. In 2014, the NAHP initiated two health interventions in Douentza, Mali. The first project, as discussed in the NAHP blog post “Promoting Public Health Through Music in Mali”, was the production of an educational music album to increase local residents’ knowledge of common diseases and available treatment options. The second project is an ongoing FGM abandonment intervention that aims to reduce the practice through microcredit and education. This blog post provides a discussion of the second project and contains proposals for continued success of the project.

IMG_0039FGM is a traditional practice that is deeply rooted in multiple communities among twenty-eight countries in Africa and additional countries in Asia and the Middle East. In Douentza, 75% of females have undergone some form of FGM. In Mali, that percentage increases to 89% of females. To reduce FGM throughout the world, most NGOs traditionally focus on educating communities about the harmful consequences of FGM. In other words, most organizations focus on reducing the demand for the practice through anti-FGM education.

Unlike typical FGM projects, NAHP’s second intervention took an entrepreneurial approach by addressing the economics of FGM and supporting FGM education and sensitization in Douentza. Because FGM provides financial benefits for the cutters, this project focused on reducing the supply of cutters through the creation of alternative livelihoods. With the help of the NAHP team in Mali including NEF and project manager Laya Ongoiba, NAHP learned that the traditional “cutters,” the women who perform FGM, would give up their livelihoods if they had the opportunity and tools to sustain an alternative career. In Douentza, FGM is a livelihood that is passed down from mother to daughter; therefore, if the mothers participating in the project cease the practice of FGM, the concern of new cutters entering the market is low.

IMG_0040The NAHP in Mali identified the cutters in the region and reasonable alternative careers that each woman wanted to pursue. Ten cutters participated in the project; nine chose “embouche” (sheep/goat raising) and one chose to sell ice cream in the local market. These careers should provide about the same amount of income each woman earned from her livelihood as a cutter.

Each woman participated in a FGM training, a small animal training, and swore on the Koran that she would comply with the terms of her contract. The contract includes a commitment to stop performing FGM and to educate women who seek their services about the dangers of FGM.

After these steps were completed, Ongoiba helped the women open accounts with a local, woman-owned and managed microfinance institution, NEF Nayral (“Nayral”). Through each account, the women received the start-up capital for their chosen alternative careers. The goal of the project is that the women will eventually become self-sustaining in their respective businesses.

IMG_0063In March 2015, our group evaluated the success of the FGM project since its implementation in September 2014. We qualitatively and quantitatively assessed the project’s effectiveness for reducing the practice of FGM in the region and we evaluated the sustainability of the microfinance aspect of the project. After completing the evaluation, we made proposals for improving the existing project in Douentza and scaling the project.

Project Manager Laya Ongoiba qualitatively evaluated the project based on her relationships with the traditional cutters and the Douentza communities. She concluded that community members are still approaching the cutters to perform FGM, but the traditional cutters refuse and educate those community members on the harmful effects of the practice (Ongoiba Report Sept. 2014). Local health officials including Doctor Yacouba, director of the Douentza Community Health Center (“CSCOM”) and Doctor Baboucar Traoré, Chief Doctor of the referral health center in Douentza, provided information about FGM-related complications and general attitudes about FGM in the community. Doctor Yacouba strongly believes that attitudes about FGM are slowly changing; however, he did not have conclusive data on FGM-related complications. Both doctors explained that the reason this data does not exist is because FGM is done in secret and families will not bring their child to see a doctor unless a complication becomes so severe that intervention is necessary. Doctor Baboucar Traoré and Doctor Yacouba emphasized the need for continued education on FGM in the community.

From this information we learned that while attitudes are changing about FGM, some members of the community continue to support the practice. For example, while the younger generation is generally open to change, older women are more resistant to change and often pressure younger women to carry on the tradition of FGM. In order to assure continued community buy-in for the project, attitudes towards cutting must shift so that the practice is no longer in demand.

To help support this shift, we proposed the implementation of a community education outreach plan. The outreach plan targets three specific groups: 1) older women, 2) men, and 3) young people. Ongoiba and each cutter in her respective village should meet with each of the three target groups to provide education and sensitization on FGM. These efforts should also include the support of community leaders like young advocates, local Imams and Village Chiefs. We believe that the proposed outreach plan coupled with the project’s current approach of targeting the supply of FGM in Douentza is necessary for long-term success of the project.

To ensure the project’s sustainability within Douentza, our evaluation of the microfinance aspect of the project illuminated two important areas for improvement: financial literacy and sheep/goat raising.

Financial literacy sets a foundation for the sustainability of the project. Financial illiteracy increases exposure to emergencies, theft and fiscal mismanagement. A major change that many of the cutters have experienced is learning how to smooth their income over a six-month period before selling each set of animals. In their old careers after each FGM, the cutters saw immediate monetary results. To address this challenge, we proposed the implementation of a small business training which would help improve financial literacy. Small business training would explain how much each woman should expect to make from selling her animals, how much money each woman needs to buy for the next batch of sheep/goats, how to manage profits, and how to begin saving.

Additionally, the cutters are new entrants into the field of sheep/goat raising. To ensure maximum efficiency in these new livelihoods, additional trainings on sheep raising should be incorporated into the project. Our research identified four areas of focus: 1) housing arrangements, 2) feeding techniques, 3) biosecurity, and 4) administrative practices. We determined that increased training in these areas could significantly increase the women’s effectiveness and productivity, which in turn increases the project’s sustainability.

Finally, if the project is scaled out to other communities within Mali, our team concluded that two of the most important variables that must be addressed from the onset are the demand for the practice and the importance of strong, local leadership. Although the project in Douentza began by focusing heavily on the supply-side of the practice, it may not be feasible in other communities to effectively cut off supply in the same way; for example, if those communities are better connected to larger cities. In addition, Laya Ongoiba has been a vital part of the health intervention in Douentza, and has been described as a key player in its successes. Therefore, locating a leader who is invested in the project and widely-respected in the community is a significant variable to consider when scaling the project horizontally to other communities in Mali and could considerably enhance its success.

28 Too Many FGM…let’s end it. Country Profile: FGM in Mali. 2014. (accessed March 21, 2015).

Guindo, Yacouba. 2015. Interview by NAHP team during March 2015 Site Visit. March 2015, Northwestern University School of Law.

Laya Ongoiba, e-mail message to Juliet Sorensen, December 23, 2014.

Laya Ongoiba, e-mail message to Juliet Sorensen, February 25, 2015.

Near East Foundation. 2010. Women’s Microfinance. (accessed February 2, 2015).

Sorensen, Juliet. Women’s e-News. Genital Mutilation. August 26, 2014. VACtt5Uo7GI (accessed March 1, 2015).

Traoré, Baboucar. 2015. Interview by NAHP team during March 2015 Site Visit. March 2015, Northwestern University School of Law.

WHO Progress Report, An update on WHO’s work on female genital mutilation (FGM). 2011.
UNDP, UNFPA, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO/RHR/11.18, (accessed March 21, 2015).

About the Contributors:
Katie Yonover: Katie Yonover is a third year law student at Northwestern University. Katie graduated from the University of Illinois with a B.A. in Global Studies and Spanish. She is particularly interested in international law and development. Katie had the opportunity to travel to Mali with the NAHP team in March 2015.

Mary Sprouse : Mary Sprouse is a second year law student in Northwestern University’s Accelerated JD program. She has a B.S. from Kansas State University in Mechanical Engineering, and she is interested in pursuing energy law after law school.

Nida Jafrani: Nida J received her J.D. from Northwestern in 2015. She has a B.A. in International Affairs from The George Washington University, and prior to law school she worked at the Carnegie Endowment for International Peace. She is excited to pursue a career in international law and will begin as an associate at White & Case, LLP in October.

R.J Shea: will enter his third year at Northwestern University’s School of Law in the Fall of 2015. R.J. graduated from the University of Wisconsin-Madison in 2012, earning a B.S. in Microbiology and English while maintaining a social life that would make Leonardo DiCaprio envious. R.J.’s legal interests include litigation, international human rights, and public service.

About NPHR Blog (339 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

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