Marianne Sidibe N'Diaye

Female genital mutilation (FGM) is a common practice in West Africa that often causes serious physical and psychological complications. Marianne Sidibe reforms Senegalese health care and creates new systems of support to meet the needs of girls and women who have undergone this destructive procedure.

Marianne organizes a national network of midwives and nurses to identify women who have experienced genital mutilation and refer them to appropriate help in the form of counseling, affordable surgery, or support groups. She works to change the standard of training programs for midwives, nurses, and doctors so that health professionals are equipped to respond to the particular needs of women who have undergone mutilation. Further, she has formed the first support center for circumcised girls and women, which she plans to replicate across the country. Marianne positions her specific efforts on FGM to broadly advance the rights and health of women in her country and lead the way for improvements in prevention and care throughout the West African region.

Although female genital mutilation has been illegal in Senegal since 1999, the practice remains common in the nation and in the whole of West Africa. About one in every five Senegalese girls experience some form of circumcision during their youth, either as infants, in childhood, or as a rite of passage during the teenage years. The practice is less prevalent in Senegal than in neighboring countries like Mali, where an estimated 80 percent of girls are circumcised and where no legal protections exist to guard against the practice.
Usually performed by elder village women, circumcisions can result in severe injury or even bleeding to death. For those who survive, the procedure often causes complications later in life that make daily routines intensely problematic, let alone childbearing and normal sexual function. Post-mutilation girls and women are prone to infection and many are incontinent, leaking urine throughout the day and night. Husbands tend to see women with this condition as unclean, often casting them out of the house. Tens of thousands of women in West Africa experience this particular complication, and hundreds of these have committed suicide.
To date, much of the attention given to this issue has focused on prevention, and very little on helping circumcised girls and women to forge rewarding lives. The health care system in Senegal isn’t organized to meet women’s health concerns, especially relating to mutilation. Poor referral systems and geographic isolation keep women who have experienced circumcision from getting needed help. Even when they can travel to a hospital or clinic, women find that midwives, doctors, and nurses lack the training and coordination to serve their needs. The results of this systemic flaw are thousands of unnecessary injuries and hundreds of preventable deaths.

With support from her organization COSEPRAT, Marianne helps women who have experienced female genital mutilation through three main efforts. First, she works to change training programs for health care providers, helping these providers learn about mutilation—and join the movement to end it—early in their careers. Second, she forms support and counseling centers, partnering with midwives in rural areas to identify and serve affected women. Finally, she leads preventative efforts throughout Western Africa, designing creative interventions and public education campaigns to protect women from genital mutilation.
To prepare midwives and nurses to deal effectively with survivors of FGM, Marianne founded a two-year training program running parallel to traditional certification programs. Her first class of 30 midwives and 13 nurses from around the country met in 2003. The program has since reached a significant portion of the midwives in Senegal; in fact, it has doubled the number of midwives being trained in the country. Marianne also works with the head of the State Hospital in Dakar, training doctors to perform minor surgeries that can completely change the lives of women who are severely affected by mutilation. The trainings are entirely self-supporting, drawing the salaries of its lecturers from minimal school fees.
The true innovation of these trainings lies in their content and the roles they encourage students to take on. For aspiring midwives and nurses, Marianne has inserted a new module into the standard curriculum, devoted entirely to FGM education and taught by a team of physicians and psychologists. The module has two main advantages over the standard curriculum: it ensures that new nurses and midwives learn about the particular needs of post-mutilation girls and women; and it enlists trainees as participants in the campaign to end the practice of female circumcision in Senegal. Trainees re-envision their role as health professionals, learning that they are not merely technicians, but scouts and rights advocates as well.
For the faculty of the training programs, Marianne draws together teachers who address complementary aspects of reproductive health and FGM. The group of urologists, surgeons, epidemiologists, midwives, pathologists, and psychologists she has assembled form a cooperative team that puts FGM in full context. Drawing from their diverse fields of expertise, teachers help trainees to understand the social, medical, and psychological dimensions of FGM, and to find out about affordable surgical advances that can help some circumcised women and girls to lead normal lives. Through their experience with Marianne’s program, the lecturers learn about the realities of village-level health care, particularly as it relates to FGM and reproductive health. As they return to their home clinics and hospitals, this knowledge drives them to ensure better care.
In addition to training, Marianne lays the foundation for a national system of support centers serving girls and women affected by mutilation. The first center is attached to the Dakar Hospital, sharing office space with COSEPRAT. The center interviews each patient and refers them to surgery or intensive counseling according to their need. It offers the first comprehensive program in Senegal specifically devoted to the survivors of mutilation. To ensure that women in need actually use the centers, Marianne and her team build networks of midwives, nurses, and women’s organizations throughout the country, encouraging them to refer patients and help spread information.
The 1999 national law banning female circumcision has made only a nominal impact on the practice. Marianne has initiated a “lay down your knives” campaign to push toward the end of FGM, seeking through education to convert circumcisers into reformers. The campaign brings together circumcisers and circumcised, and encourages understanding on both sides. To cover the cases in which this supportive approach fails, Marianne encourages midwives to report instances of mutilation, allowing police to apprehend circumcisers. She and her colleagues then visit the arrested women, helping them to connect with government-run training programs and find alternative lines of work.
Marianne backs up her campaign with media-based public education, enabled by contributions of air time from local and national radio stations. She also taps journalists from international organizations to spread information on FGM throughout West Africa. Media programs allow Marianne and her colleagues to reach audiences beyond Senegal with in-depth analysis of FGM, and to spread awareness of COSEPRAT strategies to help circumcised girls and women.

Marianne enrolled in a midwifery program in her late teens, graduating from both basic and advanced courses of study. After finishing her formal training, she climbed the professional ranks, eventually becoming president of Senegal’s national association of midwives. During her ten-year tenure in this role, she transformed her profession piece by piece through improvements in midwife training curricula and a professional code of conduct that standardized a coherent system of ethics.
As a practicing midwife, Marianne saw hundreds of West African women whose lives were torn apart by circumcision. Many found sexual intercourse so severely painful that they avoided it at all costs. Others developed severe urinary tract infections or continually leaked urine, making daily routines next to impossible and causing repeated humiliation. Marianne recalls meeting two sisters in 1995, one of whom had been circumcised. This young woman endured chronic pain and lived in constant fear that her husband might demand a second child. Yet she refused a gynecological exam, apprehensive that she would be exposed to her family. At the urging of her sister, she eventually agreed to the exam, which led to a minor surgical procedure that corrected the problem and restored her to a somewhat normal and healthy life.
This experience cemented Marianne’s decision to commit her life to the issue of female genital mutilation. If medical advances could improve the lives of FGM survivors so easily, she realized, then the suffering of thousands of women could be prevented with relatively little effort. She had already worked on the prevention of FGM through education. Now she has designed a comprehensive support system for survivors of FGM and founded COSEPRAT to put that system into action.