FOTO

:

Co-funded by the Rights, Equality and Citizenship (REC)

Programme of the European Union

Asterempowering women

The fight against female genital mutilation in Italy

An analysis of national policies and services in Milan and Rome

Research (in alphabetical order): Giulia D’Aguanno, Vittoria Pugliese, Rossana Scaricabarozzi

Contributions: Beatrice Costa

Supervision: Luca De Fraia

Graphic layout: Tadzio Malvezzi

Pictures: ActionAid

This report has been produced in the framework of the AFTER, Against FGM/C through empowerment and rejection projec, rco-funded by the Rights, Equality and Citizenship Program (REC) of the European Union.

The AFTER project is coordinated by ActionAid International Italia Onlus and is implemented in cooperation with the following partners: ActionAid Sweden, ActionAid Ireland, Fundación Simetrias, Respect for change, Universidad de Castilla-La Mancha. The realization of the research products, including this report, has been coordinated by Universidad de Castilla-La Mancha. We thank all professionals, institutional representatives and social and healthcare operators interviewed in Milan and in Rome for their availability and useful recommendations.sanitarie intervistati a Milano e Roma per la disponibilità e per le preziosi indicazioni.

The contents of this document are the sole responsibility of ActionAid Italy and project partners and can in no way be taken to reflect the views of the European Commission.

Output 2 WS1 “Mapping and Gapping Assessment” - Italy, project JUST/2014/RDAP/AG/HARM/8001

Co-funded by the Rights, Equality and Citizenship (REC)

Programme of the European UnionAster

empowering women

Associate Partner

INTRODUCTION 04

POLICIES AND SERVICES TO PREVENT AND FIGHT FEMALE GENITAL MUTILATION IN ITALY 05

Population living in Italy originating from countries where FGM/C is practiced 05

FGM/C in Italy: prevalence and risk 09

Legislative framework against female genital mutilation in Italy and in Milan and Rome 09

Policies and programmes against FGM/C in Italy and in Milan and Rome 11

Services available in Milan and Rome 13

CONCLUSIONS AND RECOMMENDATIONS 14

INDEX

4

This report analyses the interventions carried out in Italy to prevent and fight female genital mutilation (FGM/C), in particular in Milan and Rome. The analysis has a double objective: to map available actions and services and to present recommendations which could improve future interventions. In order to better understand what has been done locally, analysis of the national context have been added relating to policies and estimates of the problem. The research has been elaborated in the framework of the AFTER project – Against FGM/C through Empowerment and rejection 1, co-financed by the European Union and implemented in five countries: Italy, Spain, Ireland, Belgium, Sweden. The project aims to contribute to prevent and combat female genital mutilation through the empowerment and mobilisation of migrant women and the sensitisation of affected communities, as well as through producing recommendations for European, national and local institutions to improve the effectiveness of interventions. ActionAid is also committed to prevent and combat FGM/C through a multi-country program implemented in 10 African countries. Fighting FGM/C is an integral part of our wider strategy to fight any form of violence against women and promote women and girls’ control over their bodies. With the AFTER project, ActionAid wants to expand its action by focusing on the specificities of the FGM/C problem in Europe, with interventions built on the experience and knowledge gained through programmes implemented in Africa.

In the framework of the present analysis, the definition of female genital mutilation is in line with the one made by the World Health Organization (WHO)2, according to which FGM/C includes all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. FGM are classified into four main types:

» Type I: partial or total removal of the clitoris and/or the prepuce (clitoridectomy);

» Type II or excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora;

» Type III or infibulation: narrowing of the vaginal orifice with creation of a covering seal by cutting

1 For more information on the topic www.afterwomen.eu/project2 World Health Organization, 2007 www.who.int/reproductivehealth/topics/fgm/overview/en/

and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris;

» Type IV: all other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping and cauterization.

According to the latest data published by UNICEF and UNFPA, in the world today at least 200 million girls and women in 30 countries have undergone some forms of FGM/C3. Such practices are considered by the United Nations as a form of violence against women and girls and a violation of their fundamental rights. In December 2012, the United Nations General Assembly adopted a resolution against female genital mutilation4 and the fight against the FGM/C was also included among the targets of the fifth Sustainable Development Goal, dedicated to gender equality, of the Agenda 20305. The 30 countries6 to which reference is made are, however, not to be considered the only ones in which FGM/C is practiced, but those for which data on the phenomenon are available. With migration flows, FGM/C has also become an issue for Europe too, broadening the spectrum of forms of gender-based violence which institutions need to take into account: it is estimated that in 2011 in the European Union, Norway and Switzerland about 550,000 first-generation immigrants lived with female genital mutilation7.

3 UNICEF, Female Genital Mutilation/Cutting: A global concern, 2016: www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf 4 UN General Assembly, Intensifying global efforts for the elimination of female genital mutilation, A/RES/67/146: www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/67/146 5 United Nations. Sustainable Development Goals. 17 goals to transform our word, 2015: www.un.org/sustainabledevelopment/gender- equality/ 6 Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Ivory Coast, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Djibouti, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda, Indonesia, Iraq and Yemen.7 Luk Van Baelen, Livia Ortensi & Els Leye, Estimates of first-generation women and girls with female genital mutilation in the European Union, Norway and Switzerland, in The European Journal of contraception and reproductive health care, 2016

INTRODUCTION

5

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CHART 1 Number of women and men living in Italy belonging to the 10 communities with highest female population, 2016

(Source: Istat, Stranieri residenti al 1° gennaio 2016)

Population living in Italy originating from countries where FGM/C is practiced The data presented in this section are related to the foreign population officially resident in Italy, as it is not possible to accurately estimate the population living in Italy without a residence permit. For this reason, data are to be considered an underestimate of the actual number of people present on the national and local territory. According to the latest data published by ISTAT8, 8 National Institute for Statistics, Stranieri residenti al 1° gennaio 2016. http://dati.istat.it

foreigners originating from countries where FGM/C9 is practiced and living in Italy on 1st January 2016 were approximately 492,500, of which 164,500 female and 328,000 male. The largest communities come from Egypt (23%), Senegal (21%) and Nigeria (18%) - accounting for 61% of the population from countries where FGM/C is practiced - followed by Ghana (10%), Ivory Coast (5%), Mali (3%), Burkina Faso (3%), Gambia (3%) and Cameroon (3%).

9 The 30 countries for which data are available according to UNICEF’s report Female Genital Mutilation / Cutting: A global concern, 2016

POLICIES AND SERVICES TO PREVENT AND COMBAT FEMALE GENITAL MUTILATION IN ITALY

6

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CHART 2 Female population living in Italy originating from 30 practising countries, 2016

(Source: Istat, Stranieri residenti al 1° gennaio 2016)

0

100000

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20162015201420132012201120102009200820072006

CHART. 3 Population living in Italy originating from 30 practising countries, 2006-2016

(SOURCE: Istat, Stranieri residenti al 1° gennaio 2016)

n Womenn Mann Total

Between 2006 and 2016, the number of residents from these countries has grown steadily, with the exception of 2012, when we have a significant decrease.

The female population comes mainly from Nigeria (23%), Egypt (22%), Senegal (16%) and Ghana (11%), Ivory Coast (6%), Cameroon (4%), Burkina Faso (3%), Ethiopia (3%) and Eritrea (3%).

7

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CHART. 4 Population living in the Municipality of Milan originating from 30 practising countries, 2016

(Source: Istat, Stranieri residenti al 1° gennaio 2016)

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CHART. 5 Population living in the Municipality of Roma originating from 30 practising countries, 2016

(Fonte: Istat, Stranieri residenti al 1° gennaio 2016)

8

Other countriesIndonesiaKenyaSomaliaIvory CoastCameroonNigeriaEthiopiaSenegalEritreaEgypt

Roma

Milano

CHART. 6 Population living in the Municipalities of Milan and Rome, percentage, 2016

(Source: Istat, Stranieri residenti al 1° gennaio 2016)

79%

28%

7%

11%

3%

4%

3%

14%

3%

18%

0,6% 0,6% 0,6% 0,6% 0,6%

2%

3% 2% 3% 3% 4% 10%

Ethiopian (7%) and the Malian (5%). The female population accounts for 32% and comes mainly from Egypt (28%), Nigeria (18%), Ethiopia (14%), Eritrea (11%), Indonesia (4%) and Senegal (4%).

In the Municipality of Milan, 95% of the female population originating from the 30 countries analyzed comes from 5 countries (Egypt, Eritrea, Senegal, Ethiopia and Nigeria), with a predominant Egyptian component. The Municipality of Rome has a more varied group: 90% consists of women and girls from 10 countries (Egypt, Nigeria, Ethiopia, Eritrea, Indonesia, Senegal, Somalia, Cameroon, Kenya and Ivory Coast).

In Lombardy Region there are 162,500 people from 30 countries where FGM/C is practiced. 27% are present in the Municipality of Milan (43,600 people), where the most numerous communities are the Egyptian (82%), the Senegalese (6%) and the Eritrean (4%). The female population accounted for 29% of the total and comes mainly from Egypt (79%), Eritrea (7%), Senegal (3%), Ethiopia (3%) and Nigeria (3%).

In Lazio Region the resident population originating from these 30 countries is much lower than in Lombardy and is about 48,250. More than 70% live in the City of Rome (33,700), where the most numerous communities are the Egyptian (33%), the Nigerian (13%), the Eritrean (9%), the

9

FGM/C in Italy: prevalence and riskThe first and unique official estimate of the prevalence of FGM/C in Italy done by the Italian government was published in 2009 and data refer to 200810. The estimate was calculated on the basis of the prevalence in the countries of origin, according to WHO data, and the population resident in Italy from practising countries. According to these data, 35,000 women with FGM/C lived in Italy and 1,100 girls under the age of 17 were at risk of being subjected to it. However, this methodology does not allow a real estimate of the problem, this is why European Institutions are developing a new and common data collection system for Member States to allow more realistic estimates11.

In Italy, recent efforts have led to far more high estimates compared to the 2009 government study: according to a research conducted in the framework of the Daphne Mgf-Prev project coordinated for Italy by the University of Milan - Bicocca, currently women in Italy who were subjected to FGM/C during childhood would be between 61,000 and 80,00012. The most affected group is the Nigerian one, that together with the Egyptian community constitutes more than half of the total number of women with FGM/C. Data published in November 2016 by the University of Milan - Bicocca also allowed estimate the prevalence within individual communities: women from Somalia have a higher prevalence (83,5%), followed by Nigeria (79,4%), Burkina Faso (71,6%), Egypt (60,6%) and Eritrea (52,1%)13. The methodology used also takes into account the selective process of migration - for example, according to geographical area of the country of origin or the social extraction - which may lead to a different prevalence rate than the one estimated for the country of origin.

Legislative framework against FGM/C in Italy and in Milan and Rome

National level Italy has ratified several international conventions condemning FGM/C, including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence14. It has also been actively engaged in the process leading to a universal ban on FGM/C, in particular by supporting the adoption of the above mentioned Resolution of the United Nations General Assembly against the practice in 2012. The fight against the FGMs has been among the priorities of the Italian

10 Department for Equal Opportunities, Analisi quantitativa e qualitativa sulla mutilazione genitale femminile in Italia, 200911 European Institute for gender equality, Estimation of girls at risk of female genital mutilation in the European Union, 201512 Patrizia Farina, Livia Ortensi, Mutilazioni genitali femminili: una nuova stima per l’Italia, 2 maggio 201713 Preliminary results of the survey were published by the University of Milan - Bicocca in February 201714 Texts available on the website: www.un.org/womenwatch/daw/cedaw/ and https://www.coe.int/en/web/istanbul-%20convention/home?desktop=true

development cooperation over the years, within programmes and projects against gender-based violence.

In 2006, the Italian Government introduced a specific law against FGM/C: Law 7/2006 Provisions for the Prevention and Prohibition of Female Genital Mutilation15. The Law includes three axes of intervention: prosecution, prevention and protection. It also stipulates that the Department for Equal Opportunities of the Italian Government coordinates the activities of all relevant Ministries (in particular Health, Education, Foreign and Internal Affairs).

The law envisaged amendments to the Penal Code by introducing FGM/C as a crime through two new articles: 583 bis and 583 b. The punishment envisaged is from 4 to 12 years in prison16. In case the person in charge is a doctor, the penalty is the disqualification from the profession from 3 to 10 years. The principle of extraterritoriality is applicable by making FGM/C punishable even if committed abroad.

Article 3 of the Law envisages public awareness-raising measures through information campaigns and awareness-raising initiatives. Training courses are also envisaged to provide information to pregnant women, training for school teachers and the monitoring of cases detected in local healthcare facilities.

Article 4 commits the Ministry of Health to issue guidelines for health professionals and other professionals in contact with communities from countries where FGM/C17 is practiced in order to implement prevention, care and rehabilitation interventions for women and girls subjected to FGM/C. The Guidelines have been drafted by the Ministry of Health as a tool for Regions to activate initiatives to train healthcare staff to prevent FGM/C and to respond adequately to the demand of a specific group of female immigrant population.

The Law introduces a helpline (Article 5) under the responsibility of the Ministry of the Interior aimed at receiving reports and providing information on services and associations active in the territory.

The Law also dedicates an article to international cooperation programmes to fight FGM/C at global level (Article 7).

Law 7/2006 specifies the annual budget allocated for the implementation of certain measures, for a total of € 5 million per year:

15 Law 7/2006 Disposizioni concernenti la prevenzione e il divieto delle pratiche di mutilazione genitale femminile: www.camera.it/parlam/leggi/06007l.htm 16 Article 6 of Law 7/2006. The article also specifies that those who cause lesions, which are different from genital mutilations in order to misuse the woman’s sexual functions are subject to a penalty of 3 to 7 years. The penalty may be reduced by 2/3 for minor injuries or increased by 1/3 if the victim is a minor or if the act is committed for profit17 Ministry of Health, Linee guida destinate alle figure professionali sanitarie nonché ad altre figure professionali che operano con le comunità di immigrati provenienti da Paesi dove sono effettuate le pratiche di mutilazione genitale femminile: www.salute.gov.it/imgs/C_17_pubblicazioni_769_allegato.pdf

10

» Art. 3: Information and awareness campaigns: € 2 million / year

» Art. 4: Training of healthcare workers (Article 4): 2.5 million euro / year

» Article 5: Helpline (Article 5): 0.5 million euro/year

In addition to the Law on FGM/C, in the area of prevention and the fight against gender-based violence, Law 119/201318 Urgent provisions on security and the fight against gender violence introduces the possibility of granting a residence permit to foreign women who have been subjected to domestic violence and includes FGM/C among the forms of violence for which the residence permit can be issued. Women who have suffered FGM/C can also be guaranteed free legal support regardless of their income.

Regarding the protection of minors who have suffered or are at risk of undergoing FGM/C, the general provisions of the Civil Code - in particular Articles 330 and 333 – are applied. The articles provide for the loss of parental authority in case of violation or neglect of duties of parents and preventative actions in the event of prejudicial behavior of parents towards the child. In addition, with Italy’s ratification in 2012 of the Council of Europe Convention for the Protection of Children against Sexual Exploitation and Sexual Abuse19 (Lanzarote Convention) the penal code has been modified. Now it foresees the loss of parental responsibility in cases of FGM/C20.

For the right of asylum, Article 7 of Decree 251/200721 relating to persecuting acts includes serious violations of human rights, physical, psychological and sexual violence and acts against a specific gender or a minor as factors to be taken into account when it comes to assessing the recognition of the refugee status. FGM/C can therefore fall within this category. Decree 142/201522 includes people who underwent FGM/C among the groups that need special attention in reception policies (Article 17).

18 Legge 119/2013, Disposizioni urgenti in materia di sicurezza e per il contrasto alla violenza di genere, per la protezione civile e l’amministrazione obbligatoria delle province: www.gazzettaufficiale.it/eli/id/2013/10/15/13A08425/sg 19 Modification provided by art. 4 of Law 172/201220 Art. 583-bis of the Penal Code21 Decree 251/2007, Implementazione della Direttiva 2004/83/CE, recante norme minime sull’attribuzione, a cittadini di Paesi terzi o apolidi, della qualifica del rifugiato o di persona altrimenti bisognosa di protezione internazionale, nonché norme minime sul contenuto della protezione riconosciuta: www.gazzettaufficiale.it/eli/id/2008/01/04/007G0259/sg 22 Decree 142/2015: www.gazzettaufficiale.it/eli/id/2015/09/15/15G00158/sg. Il Decreto implementa la Direttiva 2013/33/EU22 per stabilire gli standard per la ricezione dei richiedenti protezione internazionale e la Direttiva 2013/32/EU22 sulle procedure comuni sulla protezione internazionale

Local level In Italy the legislative competence at the local level is in the hands of the Regions. This is why for the analysis relating to Milan and Rome reference is made to Lombardy and Lazio Regions.

The Lombardy Region in 2012 adopted a Law against gender-based violence: Law No. 11 of 3 July 2012 condemning all forms of violence against women, including female genital mutilation (Article 1)23. However, the Law does not foresee dedicated activities and budget allocations for preventing and combating FGM/C. The Lazio Region also has a law against violence against women, Regional Law 4/201424, which does not include references to FGM/C. Article 1, however, specifies that the Lazio Region implements measures aimed at preventing and combating all forms of violence against women in the public and private spheres. Regional Law No. 11 of 10 August 2016, which regulates social policies promoted by the Lazio Region, devotes an article to interventions targeted at women who are subjected to violence, pregnant women and vulnerable women (Article 15). There is specific mention to measures to prevent and counter FGM/C through information and training activities and the monitoring of implemented actions25.

23 Regional law 11/2012: Interventi di prevenzione, contrasto e sostegno a favore di donne vittime di violenza: http://normelombardia.consiglio.regione.lombardia.it/NormeLombardia/Accessibile/main.aspx?view=showdoc&iddoc=lr00201207030001 24 Regional law n° 4 of 19 March 2014: www.socialelazio.it/binary/prtl_socialelazio/tbl_normativa/legge_4_2014.pdf 25 Regional law n° 11 of 10 August 2016: www.socialelazio.it/binary/prtl_socialelazio/tbl_normativa/LR_11_2016.pdf

11

Policies and programs against FGM/C in Italy and in Rome and Milan

National level

Since the adoption of Law 7/2006, the Italian Government’s Department for Equal Opportunities has adopted two Strategic Plans. The first in 200726 allocated 4 million Euros for the implementation of article 3 (related to sensitization and information campaigns). Through a call for proposals, 21 projects27 were selected, 7 for each of the following 3 categories:

» Research-action

» Sensitization and information campaign

» Education.

The projects were implemented by local authorities, associations and hospitals.

The second Plan28 was adopted in 2011/2012 and foresaw the allocation of 3 million Euros shared among Regions and autonomous provinces through an agreement approved by the Conference of State and Regions.

The Department for Equal Opportunities didn’t publish on its website a report detailing the interventions and the results achieved through the two Strategic Plans.

For the implementation of Article 4 of Law 7/2006, the Ministry of Health from 2005 to 2016 transferred to the regions a total of € 14,625,768.86 for training activities, less than € 2,5 million per year provided by the Law: since 2009 resources reserved to the implementation of Article 4 have been reduced and currently reach approximately 177,000 euros per year29. The already mentioned Law 119/2013 Urgent provisions on security and the fight against gender violence led to the adoption of a three-year action plan against violence against women30. The Plan makes reference to FGM/C only in one of the annexes, the one related to the training of professionals in contact with women suffering from violence.

26 Department for Equal Opportunities, Avviso Pubblico n° 1 del 13 agosto 2007, Avviso per il finanziamento di progetti volti alla prevenzione e al contrasto delle pratiche di mutilazione genitale femminile, 2007, pubblicato in Gazzetta Ufficiale n° 187, agosto 2007: www.gazzettaufficiale.it/eli/gu/2007/08/13/187/sg/pdf 27 Department for Equal Opportunities, Projects to Prevent and Combat Female Mutilation Practices 27 Admitted to the Financing As per Public Announcement no. 1 of 13 August 2007.28 State-Region Conference, Accordo per la promozione di interventi contro la mutilazione genitale femminile, 2012: www.pariopportunita.gov.it/media/2746/intesaconferenza_mgf.pdf 29 State-Regions Conference Agreement for the Promotion of Actions against Female Genital Mutilation, 2012: www.pariopportunita.gov.it/media/2746/intesaconferenza_mgf.pdf 30 Data provided in March 2016 to Parliament by the Ministry of Health in response to Senator Donella Mattesini’s parliamentary question: http://www.senato.it/japp/bgt/showdoc/frame.jsp?t ipodoc=SommComm&leg=17&id=00966822&par t=doc_dc-sedet i t_pi-%20inter vento_catalfom5s&parse=si&stampa=si&toc=no

Local level

Milan Since 2008, the Lombardy Region has implemented several actions related to the prevention and elimination of FGM/C through the funds provided by the Department for Equal Opportunities and the Ministry of Health through Law 7/2006.

In 2008, a Regional Coordination Board was set up to launch a programme of awareness raising, information and training31. The project Knowing cultural differences and growing through integration was also been implemented and it was entrusted by the General Direction of Health of the Lombardy Region to Éupolis Lombardia (Upper Institute for Research, Statistics and Training of the of the Lombardy Region) 32. Within the project, training activities were carried out involving more than 1,300 professionals

- healthcare professionals, school staff, operators and social workers - and awareness-raising activities, providing information leaflets in 6 languages, informative videos and a Vademecum33 on FGM/C for to professionals in the social and health sectors. The Vademecum includes the main contents of the Guidelines produced by the Ministry of Health to prevent FGM/C and respond to the needs of women who have undergone it.

In 2010, the City of Milan implemented the Campaign “Insieme per dire mai +”34, which foresaw the production of informative materials including informational leaflets and posters. The campaign was held from 6 February until 8 March 2010. After the adoption from the Italian government of the second Strategic Plan against FGM/C in 2011/2012, the Lombardy Region received 1.202.907,14 euros. Through Deliberation nº X/133335 of 7th February 2014, a programme was launched which included three areas of action:

1. Provision of innovative and experimental intervention models - 652,000 euros. This area of intervention envisaged the creation of a multidisciplinary reference center for the prevention, fight and care of FGM/C to be established at the Health and Listening Center for foreign women and their children based in the San Carlo Borromeo and San Paolo of Milan hospitals.

2. Training - 190,000 euros. Eupolis Lombardia has been entrusted with training courses addressed to various professional figures including healthcare professionals, social workers, school workers, reception centers for migrants and asylum seekers, local police.

31 The information is provided in the text of Resolution No. X / 1333 of 07/02/2014, page 27 www.regione.lombardia.it/amministrazione_aperta/71683508 32 Information available at: www.eupolis.regione.lombardia.it 33 Éupolis Lombardia, Female genital mutilation: vademecum for health, social and healthcare professionals: www.eupolis.regione.lombardia.it/shared/ccurl/923/286/VADEMECUM%20MGF%20PER%20OPERATORI%202.pdf 34 Information available at the link www.comune.milano.it/wps/portal/ist/it/news/primopiano/archivio_2007- 2011/salute/salute_infibulazione-campagna 35 Resolution n° X / 1333 of 07/02/2014: www.regione.lombardia.it/amministrazione_aperta/71683508

12

3. Information and sensitization activities - 360,000 euros. This area of intervention, under the responsibility of IULM University, envisaged the promotion of the Multidisciplinary Center, the creation of an online platform, e-learning activities, the update of information material and the production of a Vademecum addressed to different professional figures.

In 2016, due to a delay of the start of the activities, the available budget was reduced from € 1,202,907.14 to € 580,80036. The resulting remodeling of the activities envisaged:

» € 260.800 for the realization of innovative intervention models for the integration of women and girls who have undergone FGM/C or are at risk of being subjected to it

» €320.000 for the training activities entrusted to Éupolis.

The conclusion of the activities was set at the end of 2016. At the time of publication of this report, no information was available on the activities implemented and the results achieved.

Rome Through the resources allocated in 2007 under the First Strategic Plan of the Italian Government’s Department for Equal Opportunities, several projects were approved and implemented in the area of Rome, including:

1. STOP FGM (under the category Research-Action) led by Parsec Association and implemented by a consortium of public and private partners including the San Camillo Forlanini Hospital in Rome, the Health

36 Lombardy Region, Resolution n° 0000295 of 16 March 2016 www.sancarlo.mi.it/sites/default/files/DEL-2016-0000295.pdf

Department of Lazio Region RPPS-CNR and NODI Association. The project included research, training and communication activities. Interviews to health care professionals, teachers, cultural mediators were carried out in order to identify the training needs as well as the magnitude of the FGM/C problem in the regional territory.

2. Aware bodies, FGM/C and integration through the law (under the category awareness raising campaigns) implemented by the ISTISS (Institute for Social Services Studies) in cooperation with public and private partners, envisaged awareness raising activities, among which the production of a video-documentary in order to provide health professionals with tools to prevent and respond to FGM/C.

3. Training for preventing and combating FGM/C (under the category Training) targeting social professionals and implemented by INMP – National Institute for the promotion of health of the migrant population and the fight against poverty.

With the second Strategic Plan of the Italian government, in 2011-2012 216,589.81 euros were allocated to Lazio Region. Through these resources a research-action project was financed titled “Preventing and combating FGM/C – Lazio Region” 37 implemented in 2014-2015 by a partnership composed of: Lazio Sanità – Agenzia di Sanità Pubblica, ASL Roma A, L’Albero della Vita Foundation, Association Nosotras, Hospital San Camillo. The project aimed at implementing innovative intervention models in order to foster the social integration of women and minors survivors or at risk of undergoing FGM/C, train specific professionals and promote informative and awareness raising activities.

37 Lazio Region, Determination B01146, March 2013

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Services available: Milan and RomeMilan

» Health and listening center for foreign women and their children: the Center is a service of the Hospital Santi Paolo and Carlo and is run in collaboration with the Cooperative Crinali, which deals with training and research activities and promotes and cooperation between women. The service provides support to migrant women in their reproductive pathway - pregnancy, voluntary interruption of pregnancy, sterility, gynecological problems - and children up to the first year of life. There are linguisticcultural mediators from different countries.

» SVSeD, sexual and domestic violence emergency service: since 1996, the Mangiagalli Clinic has set up an antiviolence center for sexual and domestic violence, providing health care, legal and psychological and social support for women survivors of sexual and domestic violence. The center cooperates with the Health and listening center for foreign women and their children on cases of FGM/C.

Rome

» Regional centre for the assistance and surgical treatment of health complications due to female genital mutilations - Women and child health Department of San Camillo - Forlanini Hospital: the centre offers assistance to women who suffer from diseases connected to reproductive health, obstetric problems during pregnancy and delivery and sexual and relational diseases due to FGM/C.

» SaMiFo: the center promotes health protection of forced migrants. SaMiFo offers medical assistance to asylum seekers and refugees. Basic and specific assistance can be granted in psychiatry, psychology, gynecology, orthopedics and forensic medicine clinics.

» INMP, National Institute for the promotion of health of the migrant population and fight against diseases and poverty: It is a public body, part of a national network responding to health problems relating to migration and poverty.

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CONCLUSIONS AND RECOMMENDATIONS

Efforts have been made by the Italian Government to prevent and fight FGM/C, particularly since the adoption of National Law 7/2006. Moreover, at international level, Italy has contributed to promote the adoption by the UN General Assembly of a Resolution against FGM/C and included the fight against the FGM/C among the priorities of its development cooperation interventions aimed at the promotion of gender equality. However, there is a need to rethink policies and interventions at national level, in particular to strengthen prevention and protection activities and services, also in view of the growing presence of migrant communities in Italy from practising countries. In particular, special attention was given to prosecution measures, through the introduction of FGM/C as a crime, rather than prevention measures. We believe that prosecution measures not accompanied by systematic preventive measures are scarcely effective in combating FGM/C, because they risk to stigmatize communities from countries where it is practiced, to preclude the raising of cases and to hinder the intercultural dialogue on violence against women. Moreover, since the adoption of Law 7/2006 there is only one sentence of conviction for FGM/C and before the law was adopted at least three other cases had come to the attention of our courts.38

The prosecution measures foreseen by the law were not accompanied by systematic prevention activities, which were instead mostly relegated to short-term interventions, despite the annual resources provided for this specific purpose by the law itself. The analysis has also revealed how the resources effectively spent on preventing and combating FGM/C are in fact far below the provisions of Law 7/2006. At regional level, the example of Lombardy also shows the existence of cases where some of the resources made available by the National Government to combat FGMs have not been spent and it is unclear how they have been used. FGM/C are a complex issue, which has ancient and deep socio-cultural origins, untied from any religion. As such, they require not only prosecution measures, but also, and above all, preventive interventions over time to be included in broader strategies to combat all forms of gender-based violence and to promote and protect the sexual and reproductive rights of women and girls.

38 Fabio Basile, University of Milan, Il reato di “pratiche di mutilazione degli organi genitali femminili” alla prova della giurisprudenza: un commento alla prima (e finora unica) applicazione giurisprudenziale dell’art. 583 bis c.p., July 2013: http://riviste.unimi.it/index.php/statoechiese/article/download/3098/3294

A fundamental aspect to ensure the effectiveness of future actions is the involvement of communities from practising countries, both in design and in the implementation of interventions. In this sense it will be important to value existing experiences and services that already implement prevention actions with this approach, also with the support of cultural mediators. Until now, awareness and information actions have mainly targeted health professionals, while women and more generally migrant communities have been considered more as an ultimate target of the activities and only to a lesser extent as protagonists in the definition and implementation of the interventions. Although training health operators is important, it is essential to address the issue of FGM/C especially in its socio-cultural aspects, to ensure effective prevention interventions.

Equally important will be the strengthening of existing specialised services, including those dedicated to the promotion and protection of women’s sexual and reproductive rights, ensuring the construction of local networks able to properly respond to women’s needs. Services should also ensure the presence of cultural mediators in order to meet the needs of migrant women.

In order to inform future strategies, it will also be essential to evaluate the interventions implemented so far in the whole national territory, in order to build on the experience gained. To this end, public administrators at all levels must ensure transparency on the actions taken with the resources made available through Law 7/2006. The Department for Equal Opportunities will have to be responsible for collecting and systematizing information on activities implemented across the country, publishing them online along with centrally promoted actions.

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In particular, we address the following recommendations to the relevant institutions:

To the European Union:

» Promote with the Member States an estimate of the prevalence of FGM/C by taking into account the selective migration process, enhancing existing experiences in this field.

» Promote preventive actions in the member states involving the communities from countries with excise tradition in planning services and policies.

To the Department for Equal Opportunities:

» Integrate in the next Action plan against violence against women, actions for the prevention and fight of FGM/C, and value in particular the involvement of communities originating from practicing countries in the design and the implementation of activities.

» Ensure that the free-toll national number 1522 – a 24h information service for survivors of violence

– delivers information on specialised services responding to FGM/C.

» Ensure that future actions aimed to prevent and combat FGM/C enhance and increase the experience gained over the years by services and associations active in the country.

» Ensure, in coordination with the Ministry of Health and the Ministry of Education, that training activities are directed not only to professionals in the health field but also in the social and educational fields.

» Map and publish online information on specialised services available in the country.

» Publish online complete information on all activities that have been implemented at national and regional levels the Regions and Autonomous Provinces and impact achieved so far in order to inform future strategies.

To the Ministry of Health:

» Publish online full information on activities carried out in the Regions and Autonomous Provinces through the funding provided by art. 4 of Law 7/2006 for the training of health professionals and other relevant professional figures.

» Clarify how art. 4 of Law 7/2006 will be implemented in the coming years, specifying intervention priorities in the light of the substantial reduction of resources in the last years.

» Ensure that future interventions are aimed at strengthening existing specialised social and health services, including family counselling services, also by ensuring the presence of linguistic and cultural mediators.

» Contribute to the mapping of available services in the territory for preventing and combating FGM in coordination with the Department for Equal Opportunities.

To the Lombardy and Lazio Regions:

» Make online information available on the interventions realised with the funds provided by Law 7/2006 since its introduction, detailing how the available resources have been spent.

» Ensure that future regional programmes for preventing FGM/C involve women and, more generally, communities from practising countries, in the design of activities.

» Ensure that future interventions are aimed at strengthening existing specialised social and health services, as well as family counselling services as sites for the promotion and protection of women’s sexual and reproductive rights, including by ensuring the presence of linguistic and cultural mediators.

» Integrate the fight to FGM/C within a wider strategy for combating all forms of violence against women. Health and listening center for foreign women and their children on cases of FGM/C.

ActionAid ItaliaVia Alserio n. 22 - 20159 MilanoTel. +39 02 74200276EUProjects.ita@actionaid.orgwww.afterwomen.eu