Here is an example of a Plan-assisted healthcare project in Mali, Africa.

In Mali, 94 per cent of girls are circumcised, but a campaign that focuses on the health risks is slowly changing attitudes.

Since 1995 Plan has been working in Mali with local organisations and the Malian government to reduce the incidence of girls who undergo female genital mutilation. Plan's approach focuses on the health risks.

Female Genital Mutilation is when the clitoris is cut off, usually with a penknife and without anaesthetic. It is performed on girls aged from a few days old to their early teens for cultural and religious reasons. The World Health Organisation estimates that up to 140 million girls in 28 countries, mostly in North and West Africa and the Middle East, have undergone female genital mutilation, and each year a further two million girls are at risk.

With infibulation, the cruellest form of genital mutilation, the clitoris and all external genitalia are removed. The bleeding edges are stitched together leaving a tiny opening for urination. The girl’s legs are then tied for several weeks to allow a scar to form.

In Mali, the main reason infibulation is performed is to protect a girl’s virginity thus increasing her bride price. Complications from the procedure include loss of blood, shock and infection – all can be fatal. Other serious health problems include kidney damage due to restricted urination; infertility and scarring which obstructs childbirth and can result in the death of both mother and baby if the scar is not cut open.

Plan as part of its Reproductive Health project has funded the training of hospital health staff to deal with complications in girls, teenagers and women transferred from the rural areas.

Plan's prevention and support strategies involve group discussions, home visits, advocacy through radio and TV programs and lobbying opinion leaders to promote public discussion on ending the practice. General healthcare and psychological support are also offered to girls and women affected.

By working with local NGOs, Plan can also speak with community and religious leaders, village elders and the excision practitioners themselves.

While female genital mutilation is not illegal, the Ministry of Health, through lobbying by Plan, has now forbidden the practice to be performed in a hospital or by hospital staff. Three villages have also officially abandoned the practice and two public forums organised with Muslim associations have been held.

As an ongoing process, Plan also continues to lobby for a law banning the practice. But changing attitudes is a slow process and thousands of little girls every day continue to have their genitals forcibly and brutally mutilated.

"But at least now people talk about the practice. Some years ago there was no debate about it. Now there is a lot of public discussion," says a Plan Mali spokesperson.

As well as reducing the incidence of female genital mutilation and healthcare of girls and women who have undergone the practice, Plan Mali.s Reproductive Health project also focuses on HIV/AIDS care and education about safe sex for the prevention of HIV and STDs; and family planning. Plan runs these projects through 19 local NGOs, local health centres and youth associations.

One of Plan’s most encouraging partnerships is with the Foundation for Children – a new partnership that has recently seen the introduction of antiretroviral treatment for 250 children living with HIV/AID. This project is a source of hope for children living with HIV/AIDS, their families and communities.

Other health projects carried out by Plan Mali include child immunization, reducing child deaths from malaria, the treatment of diarrhoea in children and reducing malnutrition among children under five.

Healthcare programs such as Plan Mali’s Reproductive Health project and other child healthcare projects are funded by donations and child sponsorships.