It’s Time for New Ways of Asking for Donations on the Streets

Written by: Danielle Agnello (catch her at Twitter (@DannyAgnello_GH) or on LinkedIn)

Edited by: Line Bager (@lbager87) & Sinéad O’Ferrall (@SineadOFGH)

Chuggers - effective or not?
Chuggers – effective or not?

If you are from any major city, or have just spent any time walking on a pedestrian shopping street, then you have no doubt had a close encounter with someone asking for your generous donation to GREENPEACE, Amnesty International, or any other non-profit organization that relies on donations from civil society. Unfortunately, it is not the most popular way to obtain funds for an organization. Many people fear that they may be victims of a scam, or just don’t want to be bullied by Chuggers (Charity Muggers) into giving funds to an organization they may have never heard of. As a 33-year-old Copenhagen resident puts it, “fundraising on the street is annoying, aggressive, and makes me think poorly of any organization that uses it.”

Therefore, I decided to try walking in the shoes of these so called Chuggers, by applying to be a promoter for The United Nations Children’s Emergency Fund (UNICEF), Denmark, a position which is advertised as being a way to “engage people on the streets and inspire them through awareness of UNICEF’s work,” using existing tools such as “School in a box”, “Plumby Nuts”, andVirtual Reality Glasses”. After applying, I underwent a short phone interview, followed by a test, where I went to Strøget, the main shopping street in Copenhagen, to attempt to get my fellow residents to complete a survey about their opinions on street fundraising.

Prior to the test, I was told that UNICEF would focus on my attitude and energy, the number of people stopped or approached, and my ability to inspire people to complete the questionnaire. In return, I would get an opportunity to experience how they work and what they value. Therefore, my approach was simple, I would smile, wave, and politely ask if my target person was willing to “share their opinions about street fundraising,” or “want to fill out a 30 second survey about street fundraising.” I was nervous, but also excited to gain insight into how everyone felt about this notorious method, whilst experiencing what it was like to be the one holding the clipboard.


I sure did learn what UNICEF’s face-to-face fundraisers value! Upon arrival, I was not given any background information about UNICEF, what they value as an organization, and on top of that, I was told that they were concerned about the quantity, not the quality, in my approaches to people; there was no need to note their responses to the survey. I was told that the ‘champion’ of this test was a girl who forcefully followed people, asking them their name, age, and postal code. Hearing this made me realize that this was going to be an experience I would never forget.

Throughout my hour-long test, I was instructed to be “loud”, “to pretend I was their best friend and walk directly at people,” and when I exclaimed that I was a courteous person, I was told, “this job is not meant for polite people.” Consequently, after being pushed by the team leader to be insistent and brash to those who passed me on the street, I left  feeling shocked about how UNICEF was representing itself to the public. When I inquired about their interactive tools, such as the Virtual Reality Glasses, the team leader was surprised that I even knew about them and exclaimed they were only rarely used for events. In my opinion, that is a big mistake!

Even though it was a bit distressing, I found my attempt at being a promoter to be really fulfilling, as I was able to see what type of instructions street fundraisers are given. They are trained to hit a target, to aim for as many sign-ups as possible, rather than learning to create a fulfilling experience that raises awareness about the non-profit they are representing. Additionally, I was surprised that UNICEF did not provide any welcome packs, or even show any photographs, or supportive information about where the donor’s money was going, and what each cent actually provided, as UNHCR is doing for its donors. Isn’t financially supporting a non-profit organization supposed to be a positive experience that allows civil society members the ability to make a difference in the world?


I believe that this Chugger approach to fundraising may work some of the time, perhaps for those donors who are not affected by the aggressive nature of it. As 27-year-old Seattle resident, and past Children International fundraiser states, “I understand it. It jolts people out of their day-to-day.” However, what about the many that feel threatened by this approach? What about the potential donors that care about where their money goes? As a 38-year-old Copenhagen resident declares, “you know that a big part of your donation goes to pay the person pestering you.”

With many non-profits gaining a quarter of their total income from face-to-face fundraising, this type of fundraising is valuable, and obviously financially important. Therefore I think it is time to throw out the aggressive, fake, and annoying method that puts off a vast percentage of donors, and create approaches that allow the donor to feel fond of the organization they are financially supporting, and a valuable part of the process. We need to use these face-to-face interactions to help the public learn something about the lives of children, women, and people living in a situation completely different from their own.


If you want to share your opinion about street fundraising, you can fill out this short online survey, which UNICEF provided for my test day. I will happily pass along your anonymous responses to UNICEF, so maybe they can see that recording the responses and considering the opinions of their target group is valuable, and hopefully rethink their current approach.

Let us not forget whom these funds are for!


Why Gender Equality and Abortion are Two Sides of the Same Coin

Ireland has a long and complicated history when it comes to pregnancies and women’s rights. So much ground has been in made in Ireland in terms of human rights. Most recently and most notably the public voting in of equal marriage.

But unfortunately there is one taboo subject the Irish  government and Irish society are still too nervous to openly discuss. Abortion. Often debates descend into emotional accusations of murder and shaming. When an objective discussion on a critical issue that effects the health – both physical and emotional- of woman every day is what needed.

Ireland has just announced it’s next governmental election and abortion should be a key issue for both politicians and voters. But often abortion is viewed to much a divided and heated topic so politicians steer clear of it, and the voters are to uninformed and misinformed on the topic to know what questions to ask, and who to ask.

As the election talks and promises kicks off, it will be interesting to see how abortion is talked about. One perspective is it is a gender rights issue as discussed by Maebh Butler, an Irish student.

Her blog is re-blogged here with permission and original post was posted here.

Why Gender Equality and Abortion are Two Sides of the Same Coin – A Blog by Meabh [sic] Butler

Abortion is a word which has a lot of baggage attached to it. Decision, choice, necessity. Murder, shame, expenses. Stigma, boats, aeroplanes. Criminal. Human right. Whatever name you give it, it is something that will continue to effect women worldwide. There is a whisper going through Irish media at the moment that is slowly beginning to rise in volume. Whether through a letter to the editor of The Irish Times, a debate on the television or a simple sharing of a post on Facebook, the conversation on abortion is happening in Ireland, and it is time that we all start listening.

There is a problem with the abortion debate in Ireland, and it is that the government are refusing to take a clear position on the matter. As someone who actively engages with the radio, newspapers and social media, the only person in government I have heard take a side on abortion, is Tánaiste Joan Burton. I am sure, or at least I would hope, that there are certainly many other members of government who have an opinion on abortion. Yet, to an average member of the public, this does not seem to be the case. There has been a deafening silence from all other parties.

Why is it, then, the political parties, that were so quick to celebrate and to encourage the people of Ireland to accept marriage equality, are shying away from the abortion discussion? This is where the issue of gender equality in Ireland comes right to the forefront of Irish politics, without our even realising it. There has been a spate of changes in the last 25 years or so in Ireland that has seen the country make leaps and bounds into a more liberal and accepting society: the change in Family Planning Laws in 1979, the law recognising marital rape in 1990, the divorce referendum in 1995, the marriage equality referendum in 2015. Many argue the changes reflect the separation between state and church in Ireland. The same can be said about abortion, but what differs with this issue is that it is solely to do with women.

Abortion is not at the forefront of Irish politics, because it is not deemed a ‘serious’ issue. The debate is not worth the political risk. Abortion, in its simplest terms, is about a woman’s ownership of her body. As it stands in Ireland, a woman’s body is no more than the property of the state. In a government which has consisted of an overwhelming majority of men since its establishment, it is no wonder that abortion is not considered an urgent matter.

In her introduction to Politics and Feminism, Anne Phillips (1998) makes note of the fact that, although we are moving forward globally in terms of equality between the sexes, this is not conveyed within the world of politics. Politics is, as she says, “business as usual”. Fiona Buckley (2013) also points out the harsh reality of gender inequality in her articleWomen and Politics in Ireland: The Road to Sex Quotas. She highlights that since the Irish government was established in 1922, only 92 women have ever been elected to Dáil Éireann. In 2013, a mere 26 women accounted for the make-up of Teachtaí Dála. Politically in Ireland, there has not been equal representation of women.

Without representation, it is incredibly difficult for anyone to feel equal within their society. If we look at our political representatives, it would appear that Ireland is only inhabited by middle-class, suit wearing, white males. The Dáil depicts an environment that is hostile towards women. It is undoubtedly a male sphere, an ‘old boys’ club’. We only have to think of two infamous incidents which epitomise how the Dáil engages with issues of what should be of utmost concern. The ‘LapGate’ incident in 2013, in which TD Tom Barry pulled Aine Collins onto his lap during a late night debate on abortion is one such example. Not only was this inappropriate, but Barry admitted to having been under the influence of alcohol. The matter of having a bar in the Dáil is a concern for another day, but the sheer light-heartedness and inappropriateness of the situation speaks miles about the government’s priorities.

Another example of the trivialisation of women’s issues occurred in 2011, when Sinn Féin TD Dessie Ellis proposed the question of how gender quotas would be appropriated to Independents. He was answered by an uproar of laughter, proving gender equality is clearly not taken seriously by the Irish government. In October 2015 Speaking on an abortion debate on Tonight With Vincent Browne, TD Ruth Coppinger made the point that our incredibly restrictive and harmful abortion laws correlate with our male dominated government. We must ask ourselves in earnest, if the debate was over what men could do with their bodies, would we really be having the same discussion?

Coppinger’s point is an important one to take note of. Ireland is not viewing abortion as what it is- a woman’s right and choice to do what she wants with her own body. Meryl Kenny (2007) makes the point that by viewing political institutions, such as the Dáil, through a gendered lens, it opens up the opportunity to see how gender norms are considered in these institutions, and makes way for an understanding as to why the government makes the decisions that it does. By understanding this, we can realise that gender is an important aspect that needs to be taken into account in all aspects of regulations, legislations, budgets and laws.

It is clear that there is a relationship between gender equality and the issue of abortion in Ireland. The fact of the matter, though, is that, despite being considered anything but urgent, Irish women are demonstrating their sheer desperation over the fact that they cannot access safe abortion methods. The silence within the media from the politicians, is being taken over by ordinary and everyday women who are sharing their ‘coming-out’ abortion stories. Something which they should not have to feel the need to do, but sadly find themselves with no other choice.

The recent attention surrounding the Abortion Pill buses only emphasises this. There has been much criticism from the Pro-Life Campaign, and Cora Sherlock, the deputy chairwoman of the Pro Life Campaign, was quoted as calling them “dangerous” and “inappropriate” (Kelleher, 2015). Whether these pills are dangerous or safe, is beside the point in this debate. Women are crying out for their right to their bodies. This only adds to the reason why the government need to repeal the eight amendment, and at the same time, why they are so terrified to do so. The constant shaming of ‘murderer’ and ‘criminal’ weigh a lot heavier on one’s conscience than words such as ‘choice’ and ‘right’. Alongside the fact that the issue of women’s bodies is not top of the list on Dáil priorities, it is no surprise why no one is dealing with this issue.

The Irish Family Planning Association state on their website (ifpa, 2014) that in 2014, 3,735 women were said to have left Ireland to have an abortion in the United Kingdom. Quite terrifyingly, 21 of these women were under 16 and so are legally considered children. These women and children are your friends, family, neighbours, doctors, shop assistants, dentists, girlfriends. In Ireland, these women and children are criminals. We need to bring them back from the periphery of society where the abortion shaming and stigma has pushed them. We need to allow them the right to a safe abortion, whatever their circumstances. So, in the words of The Simpsons’ Helen Lovejoy, “Won’t somebody please think of the children?” How on earth can we convince ourselves as a country that it is okay to call a 15 year old girl, the victim of rape or incest, a criminal and a murderer because she does not want to become a mother in this horrible, horrible circumstance. The argument of ‘protecting the life of the unborn child’ seems petty and futile in this circumstance especially when the person herself is only a child.

Let’s not, however, strip away the rights of Irish women with the arguments of specific circumstances, because at the end of the day, a woman’s body belongs to only her. No one else should be in charge of it. It is one of the most precious things she owns. There is a fault with the ‘Pro-Life’ argument simply in the name alone. Being ‘Pro-Life’ should mean wanting to protect and respect all life, including the life of the woman who is pregnant, the woman who has an established life for herself already, and who is fully capable of deciding whether she is ready to be a mother or not. Do not dictate her right on the basis of the possibility of life. Repealing the eight amendment will not affect you in anyway if you do not wish to have an abortion, something which will continue to happen whether you agree with it or not. We cannot continue to ignore our country’s issues by sending them on to England in the hope that it will go away. It will be one step further in viewing women as equal in Irish society. But how can this be achieved, when women are nowhere to be seen in Ireland’s political forefront? Until the Irish people are represented equally by their government, an issue such as abortion, will never be dealt with adequately. Do not take away the choice. Let’s give Irish women back their bodies.

About the author: Maebh Butler

I am a final year student from Dublin, studying English in UCD. Although writing and reading have always been at the heart of my interests, my time in college has helped me to become more aware of social issues of inequality and injustice. This is an area I hope to become more involved with after my degree.


Buckley, F. (2013) Women and Politics in Ireland: The Road to Sex Quotas, Irish Political Studies. Available at: [Downloaded: 01 September 2015].

Irish Family Planning Association (2014). Abortion in Ireland: Statistics. Available at: [Accessed 7 November 2015].

Kelleher, O. (2015) ‘Abortion pill bus greeted with ‘abortion is murder’ placards in Cork’,The Irish Times, 25 Oct. Available at: [07 Nov 2015].

Kenny, M. (2007) ‘Gender Institutions and Power’, The Author Journal Compilation Politics: 27(2), pp. 91-100.

Phillips, A. (1998) Feminism and Politics. New York: Oxford University Press.


Written by Ashley Monet Stamps- Lafont

Edited by Sinead O’Ferrall & Helen Myrr

We, the students of Global Health have published several blogs covering reproductive health services in low and middle-income countries. Now, it’s time to shed some light on a terse situation happening in, arguably, the most ‘free’ land in the world. The United States’ coverage of women’s health, reproductive health services in particular, has been thrust into the global spotlight in light of the upcoming 2016 Presidential election.

First on the docket lies the funding of the controversial health care service center, Planned Parenthood. Since it’s founding in 1916 by the late suffragette Margaret Sanger, the organization has touted itself as being a non-profit devoted to better health and better rights for women. Over the course of the years, Planned Parenthood has advocated for many causes in the U.S., including the legalization of abortion, the funding of breast cancer screening programs and better sexual education of adolescents.


Given the numerous services Planned Parenthood has provided to women in the US over the course of almost a century, the continued funding and support of the organization is an unlikely point of contention. However, Planned Parenthood has been plagued with scandal this year, based upon a viral video that insinuates the fetal tissue resulting from abortions is sold for profit to research centers.

Why is this an issue? There are a few reasons:

  • A non-profit organization is just that – not for profit. Selling any goods or wares for profit would revoke non-profit status and the organization would have to be assessed as a business entity.
  • Fetal tissue resulting from abortions are human remains, setting off a wide variety of moral and ethical debates about the proper disposal of remains.
  • Conservatives and pro-life activists in the United States have a tense history with Planned Parenthood based on it’s abortion services, and are known to protest Planned Parenthood based upon its status as a legal provider of abortions in many U.S. states.

Republicans who have entered the 2016 U.S. Presidential race have debated the topic and all 11 top-ranked candidates have voiced their support for defunding Planned Parenthood. This sentiment was cemented by a vote by the U.S. House of Representatives on Sept. 30 2015 to defund the organization. The U.S. Congress later voted to continue funding the org, but only through Dec. 11 of this year.

When did women’s health become victim to political sentiment?

My personal opinion is that women’s bodies should absolutely not be policed, and the defunding of Planned Parenthood is only a thinly-veiled attempt to reopen national discussions concerning abortion. Since when did we start defunding organizations when not a single investigation has revealed truth to the speculation? Planned Parenthood was there for me during my college years when I was truly under-insured and needed guidance not just for sexual health, but for physical exams that were required by my university.

What happens if Planned Parenthood is defunded, indefinitely?

Planned Parenthood has been a beacon for low-income people to receive medical care. 10% of Americans are uninsured, and left to abandon when accessing health care services. The speculation surrounding the fetal tissue sales has done nothing more than provide the ammunition conservatives required to pass legislation that will disproportionately affect a population who, arguably, needs access to reproductive health services the most. 

We’ve covered women’s health to a certain degree in low and middle-income countries but cannot turn our backs on the status quo in some high income countries. Planned Parenthood’s future is not certain, but whatever outcome there may be, women’s health and proper access to healthcare is an issue that deserves attention.


The following blog is re-edited with permission from a FGM series published on ‘Inside the intern’s life’.  

Written by Sinéad O’Ferrall (Original and Rewrite) @SineadOFGH

Edited by Line Bager & Helen Myrr

As part of my MSc in Global Health program, I got an opportunity to intern with the UNFPA in the Uganda country office. I have been here nearly 4 weeks already and we have just finished working a big marathon event. Partnering with the Church of Uganda in the Kapchowra district, a marathon was organised to accelerate the end of FGM in that region.

And they are off........
And they are off…….. Photo credit: Sinéad O’Ferrall

It was an impressive day where FGM was highlighted as practice only fit for the history books.The race was organised chaos but we managed to get the runners where they need to be, the t-shirts on said runners and all staff to their locations. With flag offs at the 21km, 12km, 8km, 5km, 2km and children’s sprint everyone could get involved. Between the heat, the hills and the altitude I am so impressed with anyone who ran. There were a few local celebrities such as Stephen Kiprotich and Moses Kipsiro both gold medal runners, Stephen is the current Olympic gold medalist for marathon running.

Once the race was over, there was speeches and dramas from various members of the Church of Uganda, UNFPA and local organisations, all speaking on the harmful practice of FGM and encouraging people to say “No to FGM”.
This girl should never be cut!


What is FGM?

FGM stands for female genital mutilation. It is not circumcision. Not cutting or surgery. Mutilation. It is permanently, needlessly and traumatically changing the female body, specifically the genitals.

FGM is defined by WHO as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical purposes.”

FGM is classified into 4 categories depending on how exactly the mutilation takes place, but all of them have short and long term consequences on the physical and mental health of the girls and women being cut.

Type What is involved:
1 – Clitoridectomy Partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and/or in very rare cases only, the prepuce (the fold of skin surrounding the clitoris).
2 – Excision Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina).
3 – Infibulation Narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.
4 – Other All other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Ref: WHO-FGM report 2012

Who performs FGM and why?

Though it is not performed performed everywhere,, it is deeply rooted in certain cultures and communities.. For example in Uganda FGM has a national prevalence of  1.4% while in the Pokot population, a tribe within Uganda, it is  95% . In Tanzania, again the national prevalence is 14.6%, within certain communities such as the Maasai tribes, FGM has a prevalence of 100%.  This demonstrates how statistics can misrepresent the scale of the problem, and how one shouldn’t take them at face value, which can lead to an issue being diluted and lost in the mix.

It is practiced across Africa, and has been seen in Asia as well as in Europe, America and Australia. With the increase in global movement and immigration, it is not surprising that these “localised” practices are popping up all over the world.

Within the cultures that practice FGM, there are various beliefs as to why it is done. But the general theme is, it is a rite of passage for the girl to become a woman and eligible therefore for marriage. It is also used as a means to control a girl’s sexuality pre-marriage to ensure virginity, and, during marriage to ensure loyalty.

There are also many other misled beliefs that it can help in labour, increase sexual pleasure or that it is beneficial to a woman in some way or another.

Should these girls face FGM?


Just how much of a problem is this?

Aside from the immediate consequences of extreme emotional and physical trauma and pain, high risk of infections including Sexually Transmitted Infections (STIs), HIV and sepsis, haemorrhage, and death, there are long lasting consequences also.

The mutilation is known to heal slowly or not at all which presents continuing risk of infection and pain, Urinary Tract Infection (UTIs) and leads to many complications relating to pregnancy and labour. These can include obstructed and prolonged labour, obstetric fistula, low birth weight and death to mother and/or infant. Also, difficulty having intercourse, pain during the act and reduced libido are often experienced.

But FGM does not only affect your health. It has negative effect on many social aspects of a girl’s life. FGM is often viewed as rite of passage into womanhood, and once a girl is cut she is suitable for marriage. Girls are often married to older polygamous men and encouraged to have children straight away. On top of all of that, they are often unable to attend school and complete their education. This further limits their future opportunities and ability to contribute to society, so the society as whole suffers.

FGM – life long consequences


How do we stop it?

There are three broad approaches tha all need to work simultaneously to make an impact – 1. Education and awareness, 2. having a legal framework and enforcing it and 3. support and counselling.

Girls should be educated not cut!


  1. Education and Awareness

Education: this perhaps is the most important tool we have at our hands to make a lasting change in people’s attitudes towards FGM.

FGM, like most harmful practice survives because of secrecy, myths and uncertainties! People believe it is beneficial or essential and they don’t hear of an alternative point of view, unless we inform them of other options.

UNFPA is heavily involved in supporting education and awareness programs and they work with many partner organisations such as the Church of Uganda who organised this marathon to reach communities that need to hear this message. Check out links 1 & 2 to see some stories from the field.

2. Legal framework and enforcing the law

Uganda made FGM illegal in 2009 which was a huge step forward, however enforcing the law has met major obstacles. Since the practice is performed often in secret, in communities that respect the duty to perform FGM over the law, to report perpetrators would be seen as “betraying” their communities and traditions. Some believe FGM is vital to their community and this is why education is so important, so people are given the tools and information to say no to FGM.

While the law, in its isolation, has not been effective, it has been useful as a tool for organisations campaigning to ⋕EndFGM, as it gives a legal framework to work in.

3. Support and counselling

This is both to help the already mutilated woman, to treat the medical side effects and to counsel communities that want to say no to FGM. It is so important not to just convince communities it is wrong and then leave. We need to give them the tools they need to stand up to harmful traditions of their tribe and overcome the greater cultural pressures.

Support can be in many forms. Some examples include finding alternative incomes and roles for cutters such as enlisting them as advocates for the ⋕EndFGM campaign or offering incentives to cutters to hand over their cutting tool. It can also be providing materials and tools to support events such as the marathon against FGM.

This is just a brief overview of a very complicated and culturally rooted practice. If you want more details please check the full blog series on Inside the intern’s life and you can read the blog entry that talks about the day of marathon here.
It is a horrendous and traumatic practice that needs to end, but thankfully communities are mobilising to say ‘No to FGM’ and it is so important we support them in any way we can.

Cultural sensitivity or an excuse for inaction? Field work reflection– Tanzania, post scriptum:

Writen by: Line Bager (@lbager87)

Edited by: Sinéad O’Ferrall (@sineadOFGH) & Helen Jane Myrr

Five weeks of fieldwork in Tanzania has concluded and we have returned back to our “comfort zones”. Reflecting on the challenges we faced during our time in the field is inevitable. This blog follows on from “To give or not to give? That is the question”. by Sinéad O’Ferrall (03/06/2015). Here I would like to focus on how we acted, and were perceived as a group, when we visited various health institutions. In these situations, whilst we were curious and naturally inquisitive, we were also concerned about the nature of the questions. It is essential to remain as sensitive as possible meaning I would rarely ask the difficult questions. However, one of my fellow students rightly raised the question: at what point does cultural sensitivity become an excuse for inaction?

Credit: Julia Manzerova (
Credit: Julia Manzerova (

Female genital mutilation – a universal wrong?

Who decides if a practice falls under the definition of cultural or harmful? Or can we define a practice as both? We had only been in Tanzania a few days before this question was raised. At a visit to a reproductive health clinic we learned that women who have been mutilated suffer from many complications and that the staff regularly encountered such cases. Many students were from a ‘western’ perspective, horrified and there was a broad consensus that such practice should not be written off as acceptable because of its cultural roots. Female genital mutilation (FGM) is an example of a practice, which we, as outsiders to the culture, consider as clearly violating human rights of girls and women. This is why I believe we, as students largely educated in northern Europe and America, did not quite appreciate the sensitive nature of this topic as we asked many critical questions about the continuing practice of FGM, despite it being delegalised in Tanzania. Our local teacher was clearly on the defence straight away, maybe surprised at the direct nature of the questions, which naturally led us to stop asking once we realised this. But does the apparent discomfort of our teacher mean we shouldn’t have asked these questions at all?

Striking the balance:

I’m tempted to ask if we sometimes hide behind a principle of cultural relativism to avoid stepping up when we see something as wrong? To what extent is it okay to ask sensitive questions and keep on probing when the answer is being refused or avoided? On more than one occasion, when visiting various health clinics, there was a discomfort among some due to the constant probing and lack of sensitivity in the questions and comments. After asking the same question several times, and being refused an answer, maybe it should be accepted that either the question is not understood, or is being deliberately avoided. Despite our pre-departure training we were still unable to appreciate that cultural differences needs to be respected. Some students felt that not asking these difficult questions would be to silently condone the practice and that we are obliged to ask the difficult questions – maybe that is one of the reasons we are here. But it must be done in a way so we do not disregard the cultural differences – there is rarely a right or wrong, rather many grey areas. As a famous scholar within development studies emphasised; going in to the field requires unlearning what you already know – otherwise you are pre-determined to see things in a certain light.

Who decides?

So what are we left with? Does everything fall in absolute categories of right or wrong? Or are all cultural practices and beliefs a matter of perspective? Who decides where the line is drawn between what differences should be accommodated and which should not? Personally I find it difficult to believe in absolute values. Even the idea of Human Rights is a paradigm that some parts of the world subscribe to more than others. It is hard for me to see concepts that are ‘culture free’ and if that is the case then it also true that our background will influence the way we approach an issue. Unlearning what you already know is near impossible. Even if you succeed you end up acquiring another relative perspective – it is simply not possible to ‘stay neutral’. Nevertheless, the attitude of unlearning might be the best way to stay open-minded and avoid snap judgements. This fieldtrip has shown us just how difficult it can be to study and critically consider what we are seeing while remaining culturally respectful.

From Local Whispers to Global Discussion

How the Taboo of FGM Became a Global Challenge

By Renée Bouhuijs and Magdalena Uerlich

“The body is not like a suit of clothes, to be hemmed and stitched to the style of the times.”

Dr. Paul McHugh, Johns Hopkins University

Photograph by Renée Bouhuijs

On November 11th 2014, the international conference on Female Genital Mutilation / Cutting (FGM/C) was held in Copenhagen. During this day, it became very clear that the issue of FGM/C is closely related to the health of many women, and importantly from a global health perspective, that it should be acted upon through a global movement and through stimulating community development in general. This comes in relation to the announcement of a global media campaign of the UN and The Guardian to end FGM/C within a generation.

UNICEF refers to FGM/C as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons”.

Four types of the practice can be distinguished:article-2320665-19A8CFEB000005DC-573_306x423

Type 1: Excision of the prepuce, with or without excision of part or all of the clitoris.

Type 2: Excision of clitoris with partial or total excision of the labia minora.

Type 3: Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation).

Type 4: Pricking, piercing or incising of the clitoris and/or labia. Stretching the clitoris and/or labia. Cauterization by burning of the clitoris and surrounding tissue. Scraping of tissue surrounding the vaginal orifice (anguriya cuts) or cutting of the vagina (gishiri cuts). Introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it. Any other procedures that fall under the above definition.

The reasons for practicing FGM/C, however, are diverse. Some mention the control over women’s sexuality, where “FGM, in particular infibulation, is defended in this context as it is assumed to reduce a woman’s sexual desire and lessen temptations to have extramarital sex thereby preserving a girl’s virginity”, as well as hygiene, as uncut women are seen as dirty. Moreover, gender based factors are often mentioned. FGM might also be practiced as to enhance a girl’s femininity, which may be synonymous to docility and obedience. The link to religion is often made, although religious writings do not mention FGM/C.

Present situation

The estimated prevalence of women between the ages of 15 and 49, affected by FGM type 1, 2 or 3, is still extremely high in some African countries. Somalia has the highest estimated prevalence with 97.9 % (2006), followed by Guinea with 95.6% (2005) and Sierra Leone with 94% (2006).


In terms of globalisation related to health, we think it is interesting and relevant to address what will happen to prevalence rates and the situation in general if people start migrating and moreover, what the global response is to this issue which still affects millions of girls and women.


Looking at the European level, according to the European Commission, there is a lack of reliable and comparable data on the prevalence of FGM at EU level due to under-reporting and incompleteness. It is estimated, however, that hundreds of thousands of women living in Europe have been subjected to genital mutilation and thousands of girls are at risk. The largest groups of women and girls originating from countries in which the practice of FGM/C is widespread live in the following EU countries: Austria, Belgium, Denmark, Germany, Spain, Finland, France, Ireland, Italy, the Netherlands, Portugal, Sweden and the United Kingdom.

In relation to migration, changes can already be seen in the perspective towards FGM/C practices in the first generation of migrants. It is essential to realise that these changing perspectives are not merely an issue of a sudden change after migration; countries or areas of origin might have a history of campaigning against FGM/C. Transitioning to a new area or country may strengthen and encourage feelings that had been developed already. For instance, a study in Britain found that a majority of young Somali women who came to London at a young age, seemt to be uncut.

Risks of FGM/C are likely to get lower once people can withdraw from social pressure. However, some new fears may come in place such as that family members, in the home country, still want to circumcise daughters. Also, transitioning from cut to uncut generates new behaviour among girls, which might be a concern. Some of the EU countries have implemented laws to eliminate FGM practices, including making practices punishable even if conducted in another country.


Work being done to fight FGM/C

We are familiar with a number of initiatives that address the issue of FGM/C and, furthermore, during the international FGM/C conference it became clear what the current global movement to abandon these practices within one generation entails. In general, over the last few decades multiple campaigns have been developed to address the issue of FGM/C. The Orchid project, the Waris Dirie Foundation, UNICEF and Amnesty International are just a few organisations that work together with local NGOs on educating communities and lobbying for national laws against FGM. As Molly Melching of the organisation Tostan emphasised at the FGM/C conference, it is essential to regard the development of communities as a greater good, which will have its influence on abandoning FGM/C practices. With the development and strengthening of communities come the focus on governance, democracy and human rights. Merely educating communities will not be sufficient however, men need to get involved actively and might want to be used as role models in the process of abandoning FGM/C. This is what it takes to get a broader outreach, as pointed out by Jensen, the Danish minister for Trade and Development Cooperation during Copenhagen’s international FGM/C conference. Besides, as stressed by Nafissatou Diop (coordinator for the UNFPA/UNICEF joint programme on FGM/C), in order to stop the so called medicalisation of FGM/C – the execution of it in medical centres or clinics – it will be vital to work towards a better integration of prevention within health services and greater visibility of the communities that have succeeded in actually changing.

Remarkable in aforementioned discussion is the call for more pressure on the political environments of the countries that are greatly affected by FGM/C, while these countries were not represented at all during the international conference. This raises an essential point in tackling issues like FGM/C and one could argue that this is one of the aspects that should be considered most when discussing FGM/C practices.

Updates from the field – spotlight on sexual & reproductive health

Putting the focus on Family Planning in Tanzania

By: Sophie Lauridsen

In 2013, 289,000 women died from pregnancy and childbirth related complications, a 45% reduction in levels since 1990. As we near the conclusion of the Millennium Development Goals, it can be safely acknowledged that the targets of reducing the maternal mortality ratio by three quarters between 1990-2015, as well as guaranteeing universal access to reproductive health for the improvement of maternal health (MDG 5) will not be achieved. In Tanzania as it is, maternal death and disability remains a leading contributor to healthy life years lost for women of reproductive age. According to the 2010 Global Burden of Disease study, for women 15-49 years of age, maternal disorders are the second major cause of deaths, just behind HIV/AIDS, and the fourth major contributor to disability-adjusted life-years.

Despite the acknowledgment that men play an essential role in maternal health and that recommendations exist to encourage male participation from the 1994 International Conference on Population and Development, many sexual and reproductive health interventions remain focused towards other challenges that revolve directly around the female counterpart.

One major component for the reduction of maternal deaths is the practice of Family Planning. Nevertheless, 222 million women in the world remain with unmet family planning needs. While there is a 60% demand for family planning among married women in Tanzania, 25% of them have an unmet need. Prenatal care is of major importance for the positive outcome of a pregnancy, especially in primagravida. Under normal circumstances, WHO recommends that a pregnant woman has at least four anti natal care (ANC) visits to provide sufficient care. Ninety six percent of pregnant women make at least one ANC visit in Tanzania, but only 43% have the recommended four ANC visits. During the ANC visits the woman will be presented to family planning. The utilisation of family planning services and methods is limited.

The levels of maternal mortality and morbidity have improved in the past decade and a half, but new strategies and evidence-based interventions need to be brought forward simultaneously. In Tanzania, the number of married women using family planning has remained relatively unchanged compared to the number of unmarried women, which has been seen to increase. Together with the figures of unmet need for family planning, it can be understood that cultural and gender related factors are strong barriers towards the utilisation of family planning.

Sex Education: Time for a change Poland?!

By: Cathrine SN, Elisa Odds and Nathalie S.

Addressing sexual education and issues surrounding this topic in a modern Central-European country was not as easy as one could have thought. The fact is that Poland has had a massive transformation the last years, going from a communist state to a modern “westernized” society. Poland has done a very good job in many areas, but there are still issues in need of improvement.

Sexual education in schools, or “Preparation for Family Life” as they like to call it here in Poland, must be said to be quite lacking. The NGO Ponton has stated in one of their reports that the level of adolescents’ knowledge on puberty, reproduction and contraception is “frighteningly low”.

As a student, quoted in the report, said: “In my school Preparation for Family Life was for girls only and the teacher made it look as if she was doing us a favour that she was teaching us. We were stunned when she said that a girl can have her period at the age of 16 at the earliest and if she had it sooner it means she’s sick. The classes were hopeless”.

Pic 1

Another student said: “In secondary school there was a woman who came from nowhere and told us about the rhythm method and said that condoms are not effective because they may constrict the base of the penis cutting the blood flow, which may in turn cause permanent impotence (…)”.

Why is it like this in 2014? According to Ponton, the situation is a result of taboos concerning sex related topics as well as the religious influence in society.

The Catholic Church has a strong position in Poland and its influence can be seen in many ways. Abortion is not allowed, unless the foetus has some serious and life threatening malformations (and hence it is not viable), the woman’s life is at risk because of the pregnancy or if the pregnancy is a result of a criminal act. Estimates from a Polish NGO in the field, shown to us during class, placed the number of illegal abortions performed around 80.000-190.000 annually.

While staying here in Poland, we have had the chance to look into different perspectives and issues related to sexual education. We conclude that it is clear that young people in Poland still do not have proper access to information and knowledge regarding sexuality, reproduction, contraception use and STIs.

Thanks for reading. 

In Bed With The Penal Code

By Anne Gotfredsen

In October 2013, a Swedish man, formerly sentenced to one year in prison, was freed from charges of inciting harm to other. He was charged because he had unprotected sex with four women without revealing his positive HIV-status. None of the women were infected.

The latest ruling was based on medical input that the transmission risk was in reality almost zero, since the man was in stable treatment. The verdict represents a shift in Swedish interpretation of existing laws regulating exposure to HIV. According to the Communicable Disease Act, a carrier of HIV must communicate his or her status (Disclosure Act) to the person(s) he or she will engage in sexual activities with. The key issue is not if transmission occurs, but whether or not there is a risk of transmission and if the person has acted intentionally or negligently. Around 40 persons have been convicted and about 100 forced into isolation since the late 1980s according to RFSU (the National Council for Sexual Education), the sentence mainly being aggravated assault. Half of those 40 convictions happened between 2004 and 2010. According to UNAIDS, Sweden has one of the most active law enforcements in the world in relation to its HIV-infected population, with a top ten ranking in convictions.

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International legislation
With the recent verdict in Sweden it seems a much-needed change is about to come. In many countries, including Sweden, HIV is no longer classified as a deadly disease, which should be reflected in the legislation. Nevertheless, without access to HIV testing and accurate treatment the HIV/AIDS is still a highly fatal disease, a grim reality for millions of people globally. Around 60 countries have specific HIV legislation that criminalizes HIV transmission or exposure, and many more have related legislation that present obstacles to prevention or treatment. These laws are often specifically targeted at subgroups in the population that are deemed as “risky” (for example men who have sex with men, sex workers and injecting drug users). The history of HIV and the national responses to it is complex and multi-layered, intersecting with other forms of discrimination since many of the infected, are members of already vulnerable and/or impoverished populations and communities. What could then be the way forward?

The United Nations and various NGO’s around the world are arguing for a limitation of contain- and-control-strategies since they increase stigma and discrimination, are often randomly enforced – and, introduced and interpreted without evidence. However, it is important to include available evidence in the human rights argument, evidence that shows how these kind of measures do more harm than good to the general public’s health. Control of “risky” individuals is not the answer and several other strategies show better results; communication and empowerment of sex workers, needle and syringe exchange, and active inclusion of the groups involved to outline prevention programs. Still, if criminalization prevails, there are ways to make it safer; Crown Prosecution Service for England and Wales has for example introduced a guidance that sets out a number of factors that should be considered when deciding whether to prosecute someone for transmitting HIV, as a way to limit wrongly or random convictions.

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Shared responsibility and brave politicians
Most transmissions occur when we are unaware of our HIV- status, which indicates that policies should promote testing and early treatment, instead of criminalization that might discourage people from taking the test in the first place. To isolate the causal relationship between stigma and delayed testing is difficult, since many of the groups at risk already face heavy discrimination. Yet, this is not a convincing argument for keeping barriers that indirectly contribute to negative health outcomes for the population as a whole. Anyone can be HIV-positive and criminalization, through disclosure acts, might lead to a false sense of security. There is a shared responsibility for one’s sexual health but the current Swedish legislation forces the responsibility on only one part. To argue for decriminalization is complex, and policy-makers have to be brave. The burden of proof lies on the promoter and it is a complicated matter to prove that the abolishment of a law is less harmful than keeping it. Research is also very time-consuming and costly, but indeed necessary. A law that regulates intimacy and our sexual life has to be well argued for and evaluated both in terms of moral and scientific evidence.

Anne 3

Global Health Issue: FGM

By Nathalie S

It has been estimated that up to 125 million girls and women alive today have undergone procedures known as Female Genital Mutilation (FGM). Furthermore, it has been assessed that up to three million girls are at risk of the procedure every year. As it yields no medical benefits, it has been strongly condemned by international organisations and many national governments. Yet, with the staggering numbers of people affected, it is clear that the issue still constitutes a serious global health problem. Advocacy to end FGM has increased in the past decade, resulting in the issue gaining momentum on the international policy agenda. This article will provide an overview of the topic.


An Overview

FGM is an umbrella term referring to all procedures causing damage to the external female genitalia for non-medical reasons. The damage caused ranges from injuries to the tissue to total or partial removal. In its most severe form – also called infibulation – the external genitalia is completely removed and the vaginal opening closed surgically, only to be opened after marriage and at childbirth.

There are no known medical benefits of FGM. In fact, it’s downright harmful. The procedure often causes severe physical and psychological trauma, which those that have undergone it have to endure for the rest of their lives.

A majority of FGM is performed by traditional practitioners, who usually hold respected and central positions in their communities. The conditions where the cutting is performed do usually not meet modern standards of hygiene and sterility, increasing the already-high risks involved in the procedure. Although the number of cases has decreased in recent years, an alarming trend of medicalisation has emerged. Out of all the procedures taking place, an increasing number is performed by professional health workers.

Some of the immediate consequences of FGM include severe hemorrhage, infection, and urine retention (the inability to empty the bladder). The severe pain and shock involved also renders cutting as a traumatic, horrifying experience. This is especially so as many girls are cut after infancy, when they are more capable of understanding the reality of the procedure and form a lasting memory of it. Severe bleeding and infections also result in mortality, although the exact figures are not known. Some estimates from Sudan suggest that up to one third of those undergoing the procedure die. This is, however, a rate that is increased by antibiotics not being readily available.

The long-term consequences are in many ways even more severe, and make living with FGM so unbearable for many women. At worst, having undergone it causes reoccurring cysts, bladder and urine tract infections, and infertility. It has also been linked to an increased risk of neonatal mortality and difficulties during birth. Another consequence is also that those who have undergone FGM usually find intercourse and menstruation extremely painful, which can severely decrease the general quality of life and wellbeing of the individual. In many cases significant improvement could be achieved through reconstructive surgery, although they are inaccessible to many women due to the lack of economic resources, and local social norms.

FGM is mainly practiced in the western, eastern and north-eastern Africa and in some countries the Middle-East and Asia. Migrants from these areas have also brought the practice to areas where it wouldn’t otherwise occur, such as many developed western nations with significant immigrant populations from these regions.

The highest percentages of girls and women affected by FGM occur in Sub-Saharan countries, such as Guinea, Djibouti, Eritrea and Sudan, where rates range from 88-96%. Perhaps surprisingly, the rate in Egypt is also high, at 91%. Thus, the adverse health effects of FGM disproportionately affect many of the world’s poorest countries, which are simultaneously struggling with many other development issues, such as weak health systems, lack of resources, corruption and high prevalences of many challenging diseases, such as Malaria and HIV/AIDS, that place a heavy strain on local health systems.

From a human rights perspective, FGM violates the right to health, physical integrity and freedom from discrimination, violence, torture and cruel, inhuman or degrading treatment. When causing mortality, it also violated the right to life.

 Causes of FGM

It can be said that FGM is deeply rooted in social, cultural and religious norms and understandings of female sexuality. Dating back to at least the fifth century B.C., it has established a position of a social convention in many communities. Many see it as way to control the female libido, and consequently as a reassurance against unwanted sexual activity taking place outside of marriage. In many places having undergone the procedure is understood as the removal of unwanted, impure body parts and considered the proper way to raise girls.

Rally in Kenya against FGM: Say NO - UNiTE
Rally in Kenya against FGM: Say NO – UNiTE

In some communities in Kenya, for example, FGM is performed to ensure that the girls in the family can get married and that a proper bride-price can be agreed on from the groom’s family. It’s also the only livelihood of some practitioners, some earning up to 30 USD per girl. This is an aspect that is often overlooked by the responses combatting FGM, which tend to be focused on educational and attitude change campaigns.

The supporters of FGM use arguments of tradition and religion to argue for the continuation of the practice. However, no religious text is known to actually describe the practice.

It’s known that FGM is facilitated by the wide acceptance it has in some communities both within the families of girls and among men, who demand it from their brides-to-be. As marriage is a key economic event in many communities, FGM essentially becomes a bargaining chip and an investment in the future economic welfare of the family. Considering this, international organisations and local movements advocating against FGM could benefit greatly from including strategies that help families and practitioners economically, instead of focusing only on educational campaigns.

Thank you for reading

Abortion and Conviction

By Katrine Kildemo

Since 1979, women in Norway have had the opportunity to choose abortion in the first 12 weeks of pregnancy. The law on abortion finally gave women the right to make decision regarding their own body, and this was an important step towards female rights and gender equality.

v                                           Figure 1: Illusatration by Nora Hjelmbrekke

After a recent shift in the Norwegian government from a socialistic party to a more liberal party, it has been suggested to change the liberal law of abortion. According to the Ministry Health and Care Service, the change proposes that the general practitioner (GP), acting as a gatekeeper, can guard himself against a referral and treatment related to abortion due to conflicts of conscience and personal ethics. The GP will be obligated to inform and refer patients to a colleague who will give a referral for the abortion. This has subsequently raised a debate between the left and right wing.

At first thought this may not seem to be a serious issue. One can just book a new appointment at the doctor next door. But Norway is an outstretched country with great distances and a population size of only 5 million inhabitants. Therefore, distances between the inhabitants are vast. The majority of the population is situated in the southern part, which makes municipalities in the north big in size but low in inhabitants. The proposal will therefore mostly affect women living in municipalities with few GPs. “How will the proposal be carried out when the only GP in the municipality refuses to make a referral for the abortion?” asks Marianne Bremnes, the mayor from the many municipalities with limited GPs. The distances between municipalities are extensive, so ‘just’ traveling to a different municipality is not always a convenient choice. There should be an equal opportunity for every woman in Norway to access a GP willing to perform an abortion, but with the distance this is not possible. Hence, there is an obvious disadvantage for women living in remote areas with fewer GPs.

In a time when help and support is absolute, the woman must feel quite neglected and perceive a lack of understanding, when meeting a GP who will not refer her to an abortion. Abortion is for many women a difficult process and can be a traumatic experience. Women who choose abortion because they do not want children or the time is not suited, can have difficultly talking about it. Abortion is one of the most tabooed topics for a woman in the Western world. Yet by introducing this law, women who are already in a vulnerable situation will be even more negatively affected if the GP’s bad guilt and conviction refuses to refer her to an abortion. It should, as it has for the last 30 years, be the woman’s rights and feelings that is the focal point, and not the GP’s guilt and conviction.

One of the important arguments from GPs in favour of the proposed reform is “the respect for life as a doctor and an ethical thinking human being” as the GP Harald Ramm Salbu says. Furthermore, he argues that it is a fight about democratic fundamental principles.

He concludes that if the reform does not become enforced, he will not be continuing as a doctor as it goes against his respect for life and ethical principles. In the Norwegian Medical Association one can find the ethical rules for doctors and in section 1, sub- section 2 it says: “The doctor shall serve the patients interest and integrity.” Does it not go against his ethical principle by acting on self- interest and bad guilt? Shouldn’t a doctor treat and behave objectively?

If this reform gets approved, why should only doctors have this right to guard themselves due to ethical reasons? What if other health personnel start guarding themselves from booking abortion appointment? And what if it does not stop at abortion but continues to prevention? There will be serious problems in the future if considerations will be given to the doctor and other health personnel rather than the patient.

Finally, another perspective of this discussion could be a comparison to a related controversy. Recently a debate started in Norway about whether or not people who reject a job offer due to religious beliefs can expect to get unemployment benefits. So in terms of the doctor’s ethical or religious beliefs, is it more accepted that a GP can make a similar choice without any repercussions?