Health Breaking News: Link 255

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 255


Global health: Still hope for it yet 

WHO’s Draft Concept Note: Treating the Symptoms, Not the Causes?  

Review: Textbook of Global Health Fourth Edition, Oxford University Press 2017 

Measuring Progress towards Health SDGs: Great Effort, More Needed 

UN Technology Bank To Build IP Infrastructure In LDCs; Private Sector Funds Needed 

Public-Private Partnerships as the Answer . . . What was the Question? 

Unitaid Official Explains How ‘Breakthrough’ HIV Medicine Pricing Deal Brings Best To The Neediest 

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects 

Use Competition Law For Wider Access To Cheap Medicines? 

[Report] A Fair Shot for Vaccine Affordability: Understanding and addressing the effects of patents on access to newer vaccines 

Evaluating a decade of Australia’s efforts to combat pandemics in Asia and the Pacific: are health systems stronger? 

Countries agree next steps to combat global health threat MERS-CoV 

Democratic Republic of Congo: MSF treats 17,000 people in one of the largest national cholera outbreaks 

India rolls out new TB diagnosis aimed at catching child cases 

New lab will boost UN efforts to keep harmful insects at bay 

Zoonoses focus for World Rabies Day: Infectious Diseases Hub 

World Hunger Haunts the U.N. Festivities 

Ending rural hunger: Learning from a decade of Canada’s aid efforts to support global food security 

The Urbanization of Malnutrition 

Weeks left to save East Africa’s starving children: World Vision  

The Parliament of Benin adopts a new Tobacco Control law 

ICTSD at the WTO Public Forum 2017 

Human Rights Reader 423 

Fighting For Breath: Access To Oxygen Therapy Should Not Be A Matter Of Location Or Luck 

Family Planning in the Context of Latin America’s Universal Health Coverage Agenda 

Cities must lead the clean energy drive, says report 

Climate science: getting African researchers involved 

Food safety advocates speak out as MEP attacks acrylamide regulation 

Increased drugs’ use threatens aquatic environment, report says 

Environment and Health in the Anthropocene

The idea of the 'Anthropocene' as an epoch with unprecedented scale, scope and interactions of multiple human impacts on the biosphere, can serve as a 'window' into crucial issues related to the connections among climate change, environment and health. In such contexts, integration of the fields of environmental ethics, public health ethics and bio(medical) ethics is needed

By Ted Schrecker

Professor of Global Health Policy, Newcastle University, UK

Co-editor, Journal of Public Health

Environment and Health in the Anthropocene

Towards Holistic Understandings and Policy Responses



It is now widely argued that humanity has entered a new geological epoch – the Anthropocene – characterised by the unprecedented scale, scope and interactions of multiple human impacts on the biosphereClimate change is the most familiar of these impacts, but it is far from the only one, and understandings of what the concept of the Anthropocene means for health policy and public health practice are still at an early stage.  The idea of the Anthropocene can also serve as a ‘window’ into broader issues related to the connections between environment and health, in such contexts as the health consequences of urban air pollution and the health implications of how cities are designed and managed.

In 2013, the normally cautious International Agency for Research on Cancer designated ambient air pollution as a Group 1 carcinogen, the category for which evidence of carcinogenicity from multiple research designs is strongest.  As Eugene Milne and I point out in the Autumn, 2017 issue of the Journal of Public Health (of which we are joint editors), this was probably the most under-reported public health story of 2013.  According to the World Health Organization, most of the millions of premature deaths attributable to ambient air pollution occur in low- and middle-income countries, but air pollution’s health impacts are not confined to far-away places.  Exposure to particulates and nitrogen dioxide in outdoor air pollution probably accounts for around 40,000 deaths per year in the UK, and they are unequally distributed.  ‘Residents of leafy suburbs’, we wrote, ‘do not face the same exposures as those living, working and walking in traffic-intensive urban settings; indeed that leafiness itself is to some degree protective’.

A special section on environment and health in the new issue of the Journal foregrounds the findings of a massive effort by Annette Prüss-Ustün and colleagues to update WHO estimates of the global burden of disease attributable to environmental determinants of health.  They conclude that just under one-quarter of global deaths and disability-adjusted life years (DALYs) were attributable to environmental exposures in 2012 – although ambient air pollution exposures were only one contributor.  Especially critical from a policy and equity perspective is their observation that:  ‘The lower people’s socioeconomic status the more likely they are to be exposed to environmental risks … Poor people and communities are therefore likely to benefit most from environmental interventions as they are disproportionally affected by adverse environments’.

The environmental justice movement in the United States has been making this point for quite a long time.  The importance of making the connection between unequal environmental exposures and broader socioeconomic factors is underscored by situations like the poisoning of residents of once-prosperous Flint, Michigan.  There, a one-two punch of deindustrialisation and cost-cutting in public services led to a situation in which residents, now predominantly African-American, were exposed to toxic levels of lead and other contaminants decades after all the scientific evidence was in place.  (A more extensive list of references on the Flint situation is available from the author.)

In our editorial, we also argued that technical fixes like policies supporting or subsidising a shift to electric vehicles may be inadequate responses to the equity issues raised by how societies design transport systems and urban infrastructure more generally, revisiting the question asked in a 2011 Journal article: ‘Are cars the new tobacco?’  The authors concluded that they are.  The UK’s Sustainable Development Commission, now unfortunately disbanded, took an even more holistic and thoughtful view in a report on Fairness in a Car-Dependent Society that is still available online.  Like the broader idea of the Anthropocene, these perspectives direct our attention to the functional and ethical inadequacy of incremental solutions.

These issues are in no way confined to the United Kingdom.  The illustration shows the realities of simultaneous exposure to risk of traffic injury and high levels of pollution in a low-income area where I used to work in downtown Ottawa, Canada’s national capital.  Think of the multiple exposures of the wheelchair user in the picture, and contrast them with the ‘epidemiological world’ of the occupants of air-conditioned vehicles just feet away.  Above and beyond such failures of humane planning, high-income countries continue to subsidise fossil fuel consumption in a variety of ways.  For instance, in 2014 the OECD pointed out that good, green Germany subsidised company cars through its tax system to the tune of almost €2,500 per car per year.  This is grotesque on both environmental and equity grounds.  Outside the high-income world, transport policy in many countries prioritises convenience and speed for a car-owning domestic minority and foreign investors and tourists who demand ‘world-class’ infrastructure – a global health equity issue that deserves far more attention than it has received.

Encouragingly, at least in the academic world more attention is being paid to such questions.  A lead article in the September issue of The American Journal of Bioethics calls for integration of the fields of environmental ethics, public health ethics and bio(medical)ethics.  Today, despite shared values and overlapping concerns, people and institutions concerned with these areas often don’t talk to one another.  Coincidentally – well, not really – the new issue of the Journal of Public Health also includes a call for contributions to a special section on public health ethics, which will appear in 2018.


All views expressed are exclusively those of the author.

Brazil Crippled by Corruption

Brazil is paralyzed by corruption. The fight against it is expensive and the Country doesn’t seem able to win the battle since many political exponents are involved in corruption. Bribery is at all levels and in all areas, but is particularly damaging the health sector. The anti-corruption program is a valuable instrument but the effects on health are conflicting

By Pietro Dionisio

EU health project manager at Medea SRL, Florence, Italy

 Degree in Political Science, International Relations Cesare Alfieri School, University of Florence, Italy

Brazil Crippled by Corruption


For the last few years, the Brazilian society has been voicing their collective dissatisfaction with continual cases of endemic corruption, especially the ones emanating from the political bodies. After finally ascending to power in the early 2000’s, the Labor Party was expected to bring a higher level of ethics to the way government (at all levels; federal, state, municipal, etc.) conducts itself. Unfortunately, too many cases of alleged corruption followed many of the politicians who had vowed to clean up the Brazilian political process. To that effect, a significant percentage of the population felt betrayed by the Labor Party and their allies, since the expectation was for a modern, transparent, ethical government as the party waved in political campaigns. The political opposition to the labor party obviously exploits the public cases of corruption to their benefit. This was the case of the “Brazilian Democratic Movement Party” leaded by Michel Temer. But corruption still is damaging the Country.

It is just a few weeks since Luis Inacio Lula da Silva, the former Brazilian president has been condemned to nine years and six months for bribery in one of the “Lava Jato” investigations, the scandal of the Petrobras black oil giant – in which he was accused.

The investigation into corruption at the state-controlled oil company Petrobras has led to more than 100 convictions over the past three years and among the condemned are some of the country’s most influential businessmen, Temer included (the current Brazilian president). As an effect, owing to Petrobras’ role as the country’s biggest investor, Brazil’s spending policies, including for health, shrank dramatically. In December 2015, one year after the scandal outbreak, the industrial production of instruments and materials for medical and dentistry, as well as optical supplies, decreased by 14.9%, as compared to the previous year, even as the number of workers employed in the sector showed a 2.2% drop from January to December 2015.

Much like Petrobras scandal, the “Fatura Exposta”, a bribery and money laundering case, has severely impacted the country. As the Authorities allege, bribes were demanded from companies seeking to sell medical equipment (including x-ray machines, prosthetics and CT scanners) to the national healthcare system. Purportedly, between 2006 and 2017 the offenders appropriated 10 percent of the total value of all contracts (some 300 million reals, or $95 millions). As such, while the system was on the verge of collapse in 2015 and 2016, a state of financial emergency was declared, whereby even funds to pay employees were lacking.

Owing to these circumstances, it comes as no surprise that on 13 December 2016, the Senate of Brazil passed a constitutional amendment, the so called “ Death Amendment”, that caps public spending for the next two decades. If implemented, the funding cuts will impact millions of Brazilians actually relying on its Unified National Health System. In a nutshell, as investments drop, barriers to the already limited right to health in Brazil are expected to increase in a vicious circle thwarting the much needed control of health threats like Dengue fever, Zika virus, HIV/AIDS, while restricting access to preventive services.

The Petrobras scandal and the current situation in Brazil are a lesson of how corruption can affect the public health sector, mining its foundations in terms of investment, quality of services and services supply.

The Brazilian system has some elements that favor corruption and moral hazard. As for the health sector, local bureaucracy employees, who are responsible for a wide range of activities (including, just for example, contracting hospital reforms, purchasing vaccines, and paying public servants’ wages, among other things), actually have several ways to embezzle public funds, while managing millions of dollars every year.

To address the problem, in 2003, the federal government introduced the Brazilian anti-corruption program that randomly draws municipalities to be audited concerning their use of federal funds. Auditors analyze municipalities’ accounts and documentation, and physically inspect public works and service delivery, to assess whether earmarked federal transfers are effectively spent according to their guidelines. Additionally, a set of anti-corruption laws were enacted. Among these, the “Brazilian Clean Company Act” of 2014 holds companies responsible for the corrupt practices of their employees and introduces strict liability for those offences, meaning a company can be liable without a finding of fault.

All these efforts have brought positive results. In fact, the anti-corruption program substantially reduced corruption within health transfers, while decreasing occurrences of over-invoicing, off-the-record payments, and of procurement irregularities such as participation of ghost firms or tailored terms of references to specific vendors. Disappointingly, according to a study by the Harvard University, the anti-corruption program has also produced some imbalances, including by making health indicators significantly worse. Relevantly, it reduced per capita hospital beds, immunization coverage, and the share of households with access to piped water, connected to the sewage network or with septic tanks. As a result, municipality budgets have substantially lost their federal transfers (between half to all transfers loss in a cross-sectional comparison over the baseline period, amongst low-procurement-intensity transfers).

This strange outcome could be in accordance with Huntington’s claim that local bureaucracies have more accurate information about the local demand for public goods and the quality of local suppliers. On the flip-side, the anti-corruption program has produced a slowing down of money circulation. When corruption works, money flows faster since there is no competition among different players and money allocation is extremely focused. When an anti-corruption program is implemented, the criminal action is cut at its root.

As such, it is likely that in the short run, the return to a competitive market would reduce the quality and quantity of goods available, though in the long run, this issue should recover due to the competition among different players.

In my opinion, the Brazilian puzzle should be solved now that the country is expected to exit recession by the end of current year. In this regard, the optimal design of capacity-building interventions to disseminate best practices among local procurement staff, and the analysis of the extent to which those interventions can improve public service delivery, are to be pursued as relevant strategies to limit the problem in the future.




Health Breaking News: Link 254

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 254


40 million slaves in the world, finds new report 

Red flags raised over governance of EU Trust Fund projects  

WHO: Together on the road to universal health coverage 

Health workers race to contain cholera outbreak in northeast Nigeria 

Malaria Control: A Critical Investment for Saving Lives in Africa 

Unitaid and government of Mozambique launch TIPTOP project to prevent malaria in pregnancy 

Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data  

DNDi welcomes Malaysia’s move to secure access to more affordable treatments for hepatitis C 

Malaysia Grants Compulsory Licence For Generic Sofosbuvir Despite Gilead Licence 

New antibody attacks 99% of HIV strains 

Dormant leishmaniasis parasites: threat to control 

MSF statement at the 67th session of the WHO Regional Committee for Europe 

WHO Issues Alarming Report On Coming Shortage Of Antibiotics 

One year after promising to tackle Anti-Biotic Resistance, the UN assesses its progress 

Prestigious Research Awards Put the Spotlight on Women’s Health 

Pregnant and breastfeeding women: A priority population for HIV viral load monitoring  

Access To Generic Reproductive Health Supplies Decades Behind Medicines? 

Wait, What? Tobacco Giant Backs Foundation to End Smoking 

‘Window of opportunity’ closing on non-communicable diseases, warns UN health agency 

How to Create Comprehensive Care for Non-Communicable Diseases  

6 Early Lessons on Long-Term Climate Strategies 

Don’t ignore the one group that can make climate action happen 

Theresa May takes swipe at Trump’s climate stance in UN speech 

Richard Branson slams Donald Trump after hurricanes: ‘Whole world knows climate change is real’ 

EU auditors to assess anti-pollution efforts by testing Brussels air 

World Hunger on the Rise Again 

Nigeria: Famine averted but millions still at risk, stresses top UN relief official 

The Gates Foundation Is Still Making Grants to Reinvent the Toilet 

Barack Obama on how to convince a nation that development is a bargain 

Unravelling Tied Aid  

First Asia Pacific Conference on Integrated Care 6-8 November 2017 Brisbane (Australia) 

Nicaragua: Teenage Pregnancy

Nicaragua currently lags behind other countries in the LAC region as for the decline of teenage pregnancies, and although the adolescent fertility rate fell sharply between 1990 and 2000, the decline has slowed considerably

By Clara Affun-Adegbulu*

Intern and Research Assistant at Institute of Tropical Medicine in Antwerp (ITM)

Teenage Pregnancy in Nicaragua

Towards Achieving the Sustainable Development Goals (SDGs)


Nicaragua is doing well economically. In spite of the recent slowing of the global economy, the country has managed to maintain an above average level of growth within the Latin American and Caribbean region (LAC), cut poverty rates and make progress with achieving the SGDs (The World Bank 2017). This success story is however in danger of unravelling because of the stall in the decline of teenage pregnancies. Nicaragua currently lags behind other countries in the region, and although the adolescent fertility rate fell sharply between 1990 and 2000, the decline has slowed considerably.


Adolescent fertility rates in the LAC region, 20151


Nicaraguan adolescent fertility rate, 1990-20151


According to La Federación Coordinadora Nicaragüense de ONG que trabajan con la Niñez y la Adolescencia (CODENI 2013)2 :

  • Births among adolescents follows social gradient. For instance, adolescent fertility is 75% higher in rural areas, and 46% of uneducated teenagers are mothers.
  • Sexual violence and a lack of access to appropriate sexual and reproductive health (SRH) information and services are the main causes of adolescent pregnancy.
  • Pregnancy poses risks to the reproductive health of the adolescent mother and exposes her child to issues such as increased risks of perinatal mortality and delayed development.
  • Adolescent mothers are more likely to stop their education early, be single mothers, have more children at shorter intervals and live in poverty.

Possible Public Policy Interventions

  1. Improve access to SRH information and services: Sex education should be offered as early as possible in schools, with a similar service provided in extra-curricular settings for children who are not in the school system. Vulnerable groups e.g. girls (and boys) in rural areas, should be targeted with tailored information.
  1. Reduce sexual violence: The prosecution of rapists should be prioritised, girls and their families should be educated about their rights, and the process of reporting crimes should be simplified and decentralised.
  1. Increase school enrolment: Primary and secondary school enrolment has been stalling in the last few years. Increasing school enrolment would have the double benefit of reducing adolescent pregnancy and preparing girls for future employment.
  1. Reintegrate adolescent mothers into the education system: teenage mothers are often excluded from the education system and later become unemployable because of their lack of skills. Providing these girls with ways of finishing their education would mean that they could break the cycle of poverty.
  1. Offer early social and medical intervention: Children of teenage mothers are at risk of poor health and social outcomes. Early intervention would mitigate this risk and reduce the inequalities and inequities that these children face.

The problem is multifaceted, however, and Nicaragua must resolve it if it is to continue its developmental trajectory unhampered and achieve SDGs such as:

  • Goal 1: No poverty
  • Goal 3: Good health and well-being
  • Goal 4: Quality education
  • Goal 5: Gender equality
  • Goal 8: Decent work and economic growth
  • Goal 10: Reduce inequalities



  1. The United Nations (UN). 2015. Transforming our world: the 2030 Agenda for Sustainable Development. United Nations Official Document: Resolution A/RES/70/1 adopted by the General Assembly on 25 September 2015. Accessed June 1, 2017.
  2. Unidad Técnica del Observatorio de Derechos Humanos de Niñas, Niños y Adolescentes de la Federación Coordinadora Nicaragüense de ONG que trabajan con la Niñez y la Adolescencia (CODENI). 2013. “Las niñas, niños y adolescentes cuentan.” Observatorio sobre derechos humanos de la niñez y la adolescencia nicaragüense. Boletín No. 5, Año 2, mayo 2013.
  3. The World Bank. 2016. LAC Equity Lab: Gender – Health. LAC Equity Lab tabulations   using WDI – World Development Indicators and Health Nutrition and Population Statistics. Accessed May 30, 2017.
  4. The World Bank. 2017. Nicaragua: Country at a glance. Last Updated April 10, 2017.



* Nurse and Public Health Masters student at the Medical University and University of Vienna. She is currently interning as a research assistant at the International Health Policy unit of the Institute of Tropical Medicine, Antwerp, working on a literature review project on health systems strengthening. Clara is particularly interested in global health and development policy

Health Breaking News: Link 253

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 253


In Defense of Global Health 

114 Nations Seek Support to Implement UN’s 2030 Development Agenda 

UN science report to guide countries on the SDGs 

Taking Stock of SDG Actions on UN’s Development Agenda  

WHO’s online consultation: Safeguarding against possible conflicts of interest in nutrition programmes: “Approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level” 

WHO: public health round-up 

WHO guardian of health 

Why Medicaid Is The Platform Best Suited For Addressing Both Health Care And Social Needs 

Evaluating the impact of Affordable Care Act repeal on America’s opioid epidemic 

A Stocktake Review of DFID’s Work on HIV and AIDS – Executive Summary 

In desperate need 

British diplomat lobbied on behalf of big tobacco 

Mercury convention raises heat on producers 

Antimicrobial resistance: The complex challenge of measurement to inform policy and the public 

New Study Looks At IP And The Rise Of Mega-Regional Agreements 

How to Protect a Drug Patent? Sell it to a Native American Tribe 

This Shield of Patents Protects the World’s Best-Selling Drug 

The Cancer Patient Taking On High Drug Prices 

A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money 

A Much-Needed Corrective on Drug Development Costs 

PATH points to power of $120M core boost with new vaccine initiative 

Ten electorates contain 600 threatened species – but will MPs fight to save them? 

Land ruling threatens Brazil’s indigenous peoples ― and its climate commitments 

Third of Earth’s soil is acutely degraded due to agriculture  

Human Rights Reader 422 


Looking Upstream: A Funder Collaborative Goes Local to Address the Roots of Health 

Misplaced Trust: diverting EU aid to stop migration. The EU Emergency Trust Fund for Africa 

Libya’s migration crisis is about more than just security 

Providing family planning services to women in Africa 

Promoting evidence-based health care in Africa 

A Philanthropic Fellowship Where Research Meets Environmental Crisis

Health Breaking News: Link 252

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 252


TDR at Global Evidence Summit in Cape Town 13-16 September 2017 

The Role of the Private Sector in Global Health Security, Chatham House, London, 28 September 2017 

UK slips out of top 10 most generous nations as giving surges in developing countries 

Interview: BRICS to boost South-South cooperation, world development: UN official  

Combating Climate Change Impacts 

Air pollution in Europe: Countries struggle to meet emission limits due to emissions from agriculture and transport 

As flood waters rise, is urban sprawl as much to blame as climate change?  

Healthy Animals and the Future of a Continent: Behind Giving for Livestock in Africa 

China partners WFP to fight hunger in Zimbabwe 

Is China Really Helping Africa? 

What’s This Leading Tech Funder Up To in Africa? 

Scaling up Development Finance 

A development finance glossary 

Is India’s Expedited Examination Of Patents A Big Deal? 

Medicine movers: what it takes to reach every patient 

Now online: first independent framework for assessing pharma company action on AMR 

DNDi: More than EUR 56 million raised to fund initiative to fight antibiotic resistance 

WHO Prequalifies key treatment for children with TB 

Unitaid Board approves new grants to prevent tuberculosis in high-risk populations and increase TB diagnosis in children 

Hookworm, a disease of extreme poverty, is thriving in the US south. Why? 

WHO and HRP celebrate World Sexual Health Day 

Estimated economic impact of vaccinations in 73 low- and middleincome countries, 2001–2020 

MSF takes next steps to lower vaccine prices: Launch of innovative tool to help countries negotiate lower pneumonia vaccine prices 

Kymriah, the Novartis $475,000 CAR T treatment, received 50 percent Orphan Drug tax credit on trials 

Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study  

Researchers develop innovative methodology for evaluating benefits of new medicines 

Donor funding health policy and systems research in low- and middle-income countries: how much, from where and to whom 

UNPO Newsletter: July-August 2017 edition 

South Sudan: “Many people have known war and displacement for their entire life” 

Addressing vulnerability of pregnant refugees 

Human Rights Reader 421 

Tapping Bollywood to improve sanitation in India 


Zero Tolerance for FGM

Over 200 million girls and women living across 30 countries mainly in Africa as well as Middle-East and Asia share a common misery called genital mutilation / excision also known as female circumcision or Female Genital Mutilation (FGM). An additional 30 million girls are on the verge of submitting themselves into this practice in the coming decade.....The true extent of the abuse against children beginning as young as 7 and 9 years is much more than what we see in the numbers

By Jitendra Panda*

Country Director at Health Poverty Action

Universitat Oberta de Catalunya, Somalia

Zero Tolerance for Female Genital Mutilation

Legalizing Menstrual Leave for Working Women Living with FGM


Women and children demand and deserve more than what our governments and civil societies are currently doing to stop FGM. Over 200 million girls and women living across 30 countries mainly in Africa as well as Middle-East and Asia share a common misery called genital mutilation / excision also known as female circumcision or Female Genital Mutilation (FGM). An additional 30 million girls are on the verge of submitting themselves into this practice in the coming decade. International migration of populations to developed countries such as UK, Germany, France, Italy or USA from conflict and war torn countries such as Somalia, Ethiopia, and South Sudan has caused the migration of FGM practice which has further exacerbated the problem in other countries.  A report on unrecorded female genital mutilation (FGM) in Germany, estimated that there are 58,000 women in the country who have been victims of female circumcision. An estimation figure of FGM by the Government of UK shows that more than 180,000 women and girls are living with FGM and a further 65,000 girls under the age of 13 are at risk of FGM.

Over the last three decades national and international efforts to reduce or stop FGM have only resulted into some significant reduction in a few countries. For example, FGM prevalence rates among girls aged 15 to 19 declined by 41 percentage points in Liberia, 31 in Burkina Faso, 30 in Kenya and 27 in Egypt. Sadly however, for many other countries like Somalia, Guinea and Djibouti, FGM practices continue unabated. FGM is banned by law in several countries in Africa and Europe. These numbers do not make many senses unless there are efforts to look into the lives behind these numbers. The true extent of the abuse against children beginning as young as 7 and 9 years is much more than what we see in the numbers.

In particular, the Zero Tolerance campaign castigates the tendency to equate the benefits of FGM to male circumcision, contending that in reality FGM unlocks severe consequences! The United Nations and many developed nations recognize female genital mutilation / cutting (FGM/C) as an illegal practice as well as violation of human rights as it unleashes both short-term and long-term negative effects on both the psychological and physical health of girls and women through its procedures which involve the rudimentary and painful partial or total removal of external female genitalia that always cause other form of injuries to the female organs and critically and terminally impairs a woman’s sexual and reproductive functions including the ability for normal passage of both urine and menstrual blood. Indeed many young girls die during the act of genital mutilation or circumcision due to excessive bleeding and many who are so lucky to survive into womanhood still face death during births because of FGM related complications.

In Somalia where I work, for example, above 90 per cent girls and women aged 15 to 49 are victims of FGM with the multitude of supporters and practitioners claiming that this adherence to the local socio-cultural norms is a healthy source of female chastity, hygiene and breeds family respect. The general believe in many people is that the practice maintains women’s virginity and reduces excessive desire for sex and so circumcised girls are likely to be considered as faithful and improve the chances of marriage and fertility. Just like many protagonist societies, the FGM practice in Somalia enjoys very strong moral, social protection and support from religious leaders, elders, family heads and even extended family/clan lineages. Among the Somali population, these very deeply-rooted cultural and social beliefs existing in the defense of FGM continue to dominate and defeat major efforts by any liberal government, civil society and/or non-governmental advocacy groups to discourage or criminalize the various forms of FGM practices leading to the lack of consent to develop laws and policies to stop FGM.

The controversies surrounding FGM or how to stop it has thus been a never ending struggle for Somali governments and civil societies as well. While the majority of faith-based groups and leaders are in favor of some sort of relaxation in the current practice, many governments’ institutions have made attempts to have it banned (zero tolerance). This so far has largely remained unconvincing for many key leaders and lawmakers. The advocacy for minor forms of FGM (type 1 or 2) expressed by some religious and traditional leaders is nowhere near to the ongoing efforts toward the zero tolerance.

The Zero Tolerance campaign  believes that medicalization of FGM will go against the Stop FGM movement as people will find ways to continue this practices at public and private medical institutions. Together with international agencies, civil societies and national governments, every citizen should continue to convince the decision-makers, whether government or religious institutions, to adopt strong political, legal and social measures to discourage FGM practices. I believe that the political leadership, support of religious institutions and coordination among international and the local civil society need to be harnessed to silence this practice and classify FGM as an offense.

As part of this global campaign, one of the many initiatives that we should add to the campaign is to advocate for one day leave in the beginning of monthly menstrual period for all female employees in non-profit, private and public sectors. The leave is given at the beginning of each menstrual cycle as commemoration of their self-reawakening and awareness of the detriments of FGM and their individual commitment as victims to our global Zero Tolerance campaign. It is not only an effort to help relieve their physical and mental pain (dysmenorrhea) in the beginning of monthly menstrual cycle but also to slow our solidarity and support to their fight against FGM.

We should encourage members of all global movement and all well-wishers to join particularly our mothers, women and young sisters in celebrating the beginning of each menstrual cycle for every female as a cherished sign of womanhood. At the same time we commit ourselves to fight against the practice for our future generation free from FGM. We want to envision every FGM-free and painless monthly menstrual period for every woman as special, free from daily chores and with the highest level of personal hygiene and physical rest possible for all. Our hope is that other institutions as well as our society will recognize this effort and work towards achieving a FGM-free society.

We are hopeful that as we stand side by side in this struggle, this day will not only continue to remind us all of the painful experiences women go through each day, but also challenge us to the collective resolve for Zero Tolerance to FGM across the globe.


*Disclaimer: The views and opinions present in this article are my own and do not necessarily reflect the official position of my organization or institutions that I work for or associated with.