Female genital mutilation is not just a women's issue. The cultural practice is the partial or total removal of the external female genitals for non-medical reasons by process of cutting. Approximately 3,780 women and girls have experienced FGM in Ireland since 2011. It is estimated that over 200 million girls have been subjected to the harmful practice across the globe. It is internationally recognised as a violation of human rights, a form of gender based violence that the United Nations has dubbed "catastrophic." But FGM is not just a women's issue. It is a problem that both women and men across many communities have a role in addressing - and eradicating. AkiDwA, or Akina Dada Wa Africa, was one of the first organisations that addressed FGM in Ireland. Directly translating to 'sisterhood' in Swahili, the group is a national network working to highlight the issues faced by migrant African women across the country.   Dr Caroline Munyi has been involved in AkiDwA's work for the past decade. As the NGO's current Migrant Women's Health Coordinator, she was raising awareness of FGM before a lot of people had even heard of it.

“AkiDwA was one of the very first organisations in Ireland that addressed FGM, which made it difficult because it is a very hidden issue," she says.

"It’s a part of the anatomy that is affected by serious forms of cutting, so it’s not like other issues that might be affecting certain communities.

"A lot of the time, you can’t just go out there and talk about it. You have to find specific language to broach the subject."

AkiDwA first began raising awareness of FGM in Ireland back in 2001. They began campaigning for legislation to protect girls against the practice, eventually partnering with the Irish Family Planning Association (IFPA) in 2005 to consult with women from communities affected by FGM. Dr Munyi says that it took years for FGM to be recognised as an issue that is indeed relevant to Ireland, and the women and girls living here.

“The problem wasn’t just at a community level, it was also with service providers like counsellors and others in the health profession," she says.

"At that time, FGM was almost new to Ireland, so people didn’t know what it was. It was a huge conundrum we faced.

"We needed to start at a point of education - teaching why it happens, where it happens, and why it shouldn’t happen."

  In 2012, the Criminal Justice (Female Genital Mutilation) Act was signed into law. The legislation made it illegal for a person to carry out, or try to carry out, FGM on a woman or girl in Ireland. It also made it illegal for a person to remove a girl or woman from the country with the intention of carrying out FGM. Earlier this year, Ireland saw its first FGM conviction - a father and mother who were sentenced to five and a half years and four years and nine months respectively for subjecting their infant daughter to the practice. The conviction was an historical first - so much so that the judge was forced to look to the UK to determine a fair sentencing. The only problem was that the UK case concerned FGM Type 2 and the Irish case concerned FGM Type 1. Although all FGM practices involve the deliberate cutting of the genitals, not all types of FGM are the same. According to the NHS, Type 1 involves removing or partially removing part of the clitoris, while Type 2 involves removing part or all of the clitoris as well as the inner labia. Type 3 involves infibulation, the narrowing of the vaginal opening by cutting and repositioning the labia. Type 4 involves all other harmful procedures to the genitals including piercing, scraping, or burning. Director of Communications for World Vision Ireland Fiona O'Malley says that although Irish law "makes it clear that FGM will not be tolerated," there are still many misconceptions that exist - within both practising and non-practising communities. The charity works primarily in the developing world with women and girls who are at risk of FGM, educating and raising awareness - while also creating legislation to best protect them. O'Malley says that one of the best ways to tackle the issue is to inform communities of the negative health implications that come with the practice. "The cultural significance of FGM is historical, it's intergenerational," she says. "It goes back thousands of years, and because FGM is shrouded in secrecy and stigma and shame, it makes it quite a complicated machine to dismantle." O'Malley says that one of the most common misconceptions about FGM is that it carries any health benefits. It does not. "There are no health benefits," she says. "In fact, it's quite the opposite. "Aside from the psychological implications which include trauma and shock (...) there can be cysts, infections, problems in childbirth, bleeding, haemorrhaging, scarring, urinary tract infections, and sometimes death." "It's a violation of a woman's rights - her right to health, to safety, the right to be free from cruel and inhumane or degrading treatment... and the right to life when FGM results in death."   In rural Sierra Leone, the vast majority of girls will undergo FGM. The harmful practice is seen as a crucial part of an initiation into an all-female society called Bondo, allowing girls to become women and prepare them for marriage. Teenager Isha* was just 12 years old when she was forced to undergo FGM. A native of Sierra Leone's northern territory, she was one of the estimated 94 percent of women and girls who have experienced the practice, which is seen as a custom and tradition. She later provided her survivor testimony to NGO Plan International, saying that she "didn't really know anything about FGM" before she was cut. "As soon as I went inside someone blindfolded me so I couldn’t see, and then it happened," she says. "After my initiation, my parents gave me a gift so that I would appreciate the effort they had gone to, but I didn’t see what they had done as an effort at all." *Isha refused to be married young, and so she was rejected from her family and thrown out of her home. Now a member of Plan's Girl Power Group, she lives in a school that supports young people who have endured difficulties at home. There, she educates girls about FGM, and the support they can get if they ever find themselves in a similar situation. "It wasn’t until I came here that I fully learnt what FGM is," she says. "And when I heard the explanation of what it involves – that they removed my clitoris – it was a horrible realisation. I lost part of my body because of that and I won’t ever get it back."   Since the early 1990s, there has been a significant drop in the rates of young girls being subjected to FGM across Africa. A BMJ study from two years ago showed that in East Africa, rates of FGM had dropped from 71.4 percent in 1995 to just 8 percent in 2016. Not dissimilarly in West Africa, rates declined from 73.6 percent in 1996 to 25.4 percent in 2017, with North Africa seeing a decrease from 57.7 percent in 1990 to 14.1 percent in 2015. Researchers posited that making FGM illegal had probably contributed to the reduced rates, but also that further education around the practice - and the harm it causes - most likely played a part too. But education isn't just a necessity for those living in countries with FGM affected communities - it's also crucial here in Ireland. Since 2011, AkiDwA's community health ambassadors have been working to raise awareness of FGM in Irish communities, informing people about the dangers associated with the cultural practice and why it should never be carried out. Dr Munyi says that engaging with the community is a crucial part of the day to day work that they do. However, it isn't just the community that needs to be informed about FGM - it's wider society. One of the most prevalent myths about FGM in Ireland is that it doesn't happen here. In actual fact, new data shows that 1,600 girls are currently at risk of FGM in this country right now. Dr Munyi says that AkiDwA are constantly working to debunk myths like this - as well as other misconceptions that continue to spread about FGM.

"One of the most common myths is that FGM is only performed by poorer people," she says.

"This isn't true. Now that we have better education, we know that even wealthy people in suburban areas are performing it.

"Another misconception is that many people, even health professionals, still refer to FGM as ‘barbaric.’ When we talk like that, we are not doing any justice to the survivors because we are saying that FGM doesn’t come here.

"We are saying that FGM is being performed by people who we can’t imagine."

  FGM is not just a women's issue, but it is not strictly a class issue either. The presumption that FGM only occurs in communities that are undereducated and socially disadvantaged further stigmatises those affected by the practice. Although a lot of the time, rates of FGM may be higher in rural areas, it does happen across many different cultural and socio-economic groups.

"When we don't think about it this way, it marginalises people," says Dr Munyi. "You can’t just look at someone and say that they would or wouldn’t subject their child to FGM.

"We have this notion that for someone to reach a certain level of awareness or education in the modern world that they wouldn’t do this, but seeing the statistics, it is shocking. It makes us rethink how to approach the issue.”

Since 2005, the IFPA have been offering free counselling and treatment services for survivors of FGM. Women living in Ireland who have experienced the practice can drop into a clinic with an appointment for counselling, information about pregnancy and FGM, or for help with pain and infection. The IFPA also offers information on surgery, should a survivor require it to relieve their symptoms. This surgery is offered free of charge. But despite the services offered by certain groups, a lack of awareness around FGM - and its consequences for women and girls - remains.

“There is not enough support given to survivors of FGM," says Dr Munyi. "We have seen cases where women have been in hospitals and health professionals don't know what to do.

"We want medics, midwives, and students in nursing to be trained on how to deal with FGM. But we also want to engage with women in the community and find a way to talk about FGM comfortably.

"What we are hoping is that through our work these cases can become fewer and fewer." You can find out more about IFPA's FGM free treatment service here.  *Names have been changed to protect the identity of survivors.