Background

Female genital mutilation (commonly known as FGM) is a traditional, deeply rooted practice that has consistently targeted women and girls in a number of countries and affected their physical and reproductive integrity, self-esteem and self-worth. It has been reported primarily in more than 28 African countries, seven in the Middle East and four in Asia, and recently in a number of Western societies in Europe, North America and Australia where migrating ethnic groups originating from southern countries continue to practice it. According to the World Health Organisation (WHO), the practice has so far affected over 114 million girls and women world-wide and it is estimated that some two million girls and women i.e., more than 3 women every minute, undertake a form or another of FGM each year (WHO, 1994).

 Definition

According to WHO, there are three primary procedures with wide variation among and even within groups. They are as follows

1. Sunna circumcision which is the excision of the prepuce with or without excision of part or all of the clitoris. This is the most widely practised.
2. Clitoridectomy, which consists of the removal of the entire clitoris, both prepuce and glans and often the removal of the adjacent labia either minora, majora or both. Sunna circumcision and clitoridectomy affect 85 % of the women who have undergone FGM (WHO, 1994).
3. Infibulation which is the excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening. Referred to as pharaonic, this practice is the most extreme procedure and affects the remaining 15% of the concerned women.

 Health Consequences and Complications

The consequences of the practice are many and range from immediate and long-term health complications to serious psychosexual and social effects on girls and women (Gilbert 1993).

The short-term complications can include infection such as tetanus and risk of HIV transmission, septicemia, hemorrhage, injuries to adjacent tissues, urinary retention, shock and death (WHO, 1994). These are usually exacerbated by the poor sanitary conditions in which women live and give birth, and lack of access to a basic health care and decent reproductive health services.

The long-term effects include delayed menarche, kidney infection, infection of the uterus leading to sterility, chronic pelvic complications, loss of sexual sensitivity and sexual frigidity due to painful intercourse and obstructed labour. The procedure also usually leaves areas of tough scar tissue in place of the sensitive genitalia thus creating permanent damage and dysfunction (Howson et al., 1996). The psychological effects are equally serious and include a lasting mark on the life and the mind of the circumcised woman, trauma, possible behaviour disturbance, feelings of incompleteness, anxiety, and depression.

Apart from being a health hazard, FGM encourages early marriages and dropping out of schools by young girls. It also makes women generally subservient and, therefore, dependent on men for their social and economic survival (Toskin, 1997).

While the physical consequences of mutilation can be severe, women rarely connect their current health problems with the procedure. Therefore, circumcised women and the in-laws are strong supporters of the practice in many traditional communities. In addition, psychological problems are usually circumscribed by intense social support in these traditional cultures (Robison, 1994).

 Arguments, History, Reasons for Undertaking FGM

The practice predates the founding of both Christianity and Islam. Although it has been reported primarily in predominantly Muslim countries, it has been practised among different ethnic and cultural groups including Christians, Muslims, Jews (Falashas) and followers of indigenous African religions (Webb, Hartley, 1994).

Many reasons have been advanced to explain the continuation of the practice. In many parts of Africa, FGM has always been considered a rite of passage from girlhood to womanhood or an intrinsic part of the transition to adulthood. In Chad for instance, FGM and the accompanying ritual are designed to educate girls to become more responsible community members, venerate their ancestors and respect group traditions (Leonard, 1996). The practice is also supposed to reduce the level of women’s sexual sensation and curb their sexual urge. At the same time it has also been used to affirm the value of women in male-dominated communities and to ensure that they will be acceptable brides (Kiragu, 1995). In Sudan for instance, FGM is part of a continuation of a patriarchal repression of female sexuality. Generally, there has been a belief that excision of the clitoris protects a woman from her sexuality by keeping her from temptation and above suspicion, and is a requisite of female chastity for marriage (African Population Newsletter, 1995).

 The Overall Response to FGM

Obviously, one of the ways to deal with FGM is to ban it. However, examples of legislation against FGM abound and most of them led to little or no success. Many legal attempts have resulted in a backlash and produced the opposite effect (Muigana, 1994; Aslam, 1996). The question that has remained is ‘how to enforce laws if the law-enforcement agents are the ones who seek the practice for their daughters?’

There has been no evidence to suggest that the practice has any religious justification either in Christianity or in Islam. Yet, the religious and cultural roots of the practice are much deeper than previously thought (Khalifa, 1994). In 1994, the Grand Mufti of Egypt, Sheikh Mohammed Sayed Tantawi endorsed the International Conference on Population and Development’s call to end the practice (Kirberger et al., 1995, 10-7). In 1996, however, due to increased pressure from Muslim conservative groups in Egypt, when he became Grand Sheikh of Al Azhar, a leading scholarly institution of Sunni Islam, he reversed his position on FGM arguing that while FGM is not a duty for women, it is a tradition which ensures cleanliness if used moderately and is useful to both women and men (Aslam, 1996). A strong anti-FGM movement has been present in Egypt since at least the 1930s (Kirberger et al., 1995). Today, however, some mothers who were not circumcised themselves are mutilating their daughters, indicating that the practice is increasing.

The predominantly Muslim countries of Djibouti, Mali, Somalia and northern Sudan include 70-90 percent of women who had the operation. Some Muslim population in Indonesia and Malaysia also practice FGM (Black and Debelle, 1996). The procedure is identified as the Sunna procedure, which means according to the acts and traditions of the Prophet.

Fifty percent of women in Togo are estimated to have undergone FGM. A Togolese woman was recently granted asylum in the United States because she is a member of a particular social group, the uncircumcised women of the Tchamba-Kunsuntu tribe who oppose FGM (Reproductive Freedom News, 1996).

 Mobilisation Against the Practice

A number of advocacy groups, UN agencies, human rights organisations and women’s organizations have attempted to fight the practice through legal and human rights instruments. The African Platform for Action adopted by the Dakar Regional Conference in 1994 considered FGM a form of violence against women. WHO even opposed moves toward medicalisation of the procedure when performed in milder forms by health professionals under controlled hygienic conditions. In 1994, the United Nations 47th World Health Assembly adopted a resolution requesting all countries to establish national policies and programmes that will effectively, and with legal instruments, abolish female genital mutilation and harmful practices affecting the health of women and children (WHO, 1994). However, given the deeply rooted character of the practice little success, if at all, has been achieved. No decree or act of parliament as such has so far succeeded in stopping the practice. In Kenya and Sudan where FGM has been banned for years, 79 percent of the respondents in a recent survey favoured continuation of the procedure (Muigana, 1994).

The deep-rootedness of the practice led a number of scholars to consider the cultural relativism and moral universalism in dealing with FGM and to suggest that those at the forefront of the debate on FGM must learn to work respectfully with, instead of independently of, local resources for cultural self-examination and change (Lane and Rubenstein, 1996). The practice has been strongly associated with identity, tradition, culture and religion which are very difficult to address through legislation and human rights instruments. The recent example of Egypt backing away from its pledge to eliminate the practice is a clear indication that the legal approach has limitations (Reproductive Freedom News, 1996). Even in Western societies which have passed legislation forbidding medical personnel from performing FGM (such as France, Britain, Sweden and Switzerland, Canada), more than 30,000 girls are still at risk every year (Black, Debelle, 1995; Gallard, 1995). Forbidden from circumcising their daughters in these host countries, many parents have continued bringing their daughters to their country of origin to have them undergo a form or another of FGM.

 FGM in Uganda

In Uganda FGM is practised by the Sabiny community in the Kapchorwa district in eastern Uganda. The district is fairly underdeveloped. The mountainous nature of the district makes transport and communications with other districts very difficult and contributes to its isolation. This has sustained the perpetuation of some harmful practices including FGM. Kapchorwa has an estimated population of 135,000 (estimates for 1996). The majority lives in the rural areas. Ethnically, the people of Kapchorwa belong to the Kalenjin sub-groups of the Hilo-Hamites. They are separated from their kin the Sabout (Elgon Masai) who live in Mt. Elgon and Trans Nzoia districts of Kenya by the Kenyan Ugandan border.

The practice commonly takes place in December of even years. It is of type two according to the WHO classification and involves cutting the clitoris and labia minora of girls and women falling in the 15-25 age group. Some girls, however, undertake the practice before 15 if they are "brave" and psychologically ready to face the knife. Some delay the ritual as a strategy of evasion, but eventually submit to it due to taboos, social pressure and intimidation (Bananura, 1994).

The district is divided into three counties and eleven sub-counties. Until late 1995, research showed that up to 46%, 45% and 29% of girls aged 11-18 wanted to undertake the practice in the three counties of Kween, Kongasis and Tingey respectively, whereas 22%, 19% and 6.5% were already circumcised in the same counties. A large section of the community supported the practice (63%) because it is part of their culture and 36% because they fear mockery and harassment by the community. To some Sabiny, an uncircumcised full-grown girl or woman is regarded as deviant (Chekweko, 1994). According to Chekweko, a majority of Sabiny youth support the practice due to peer and parental influence, social pressure, cultural identity and ignorance of its short- and long-term complications.

The Sabiny have made national and regional headlines over the years for their strict adherence to the tradition of FGM as a rite of passage into womanhood. In the late 1980s, attempts by government and other NGOs to enforce compliance with international health and human rights norms and instruments nearly provoked cultural indignation and resistance. Other attempts to ban or eradicate the practice in the early 1990s had serious negative effects and caused the number of circumcised girls and women to rise sharply (Elijah, 1996).

 Typical Case of Kapchorwa’s FGM

FGM in Kapchorwa is construed as an initiation ritual that aims at sanctioning the passage of adolescents from girlhood to womanhood. While the initiation goal and the accompanying rituals (such as singing, dancing, feasting) raise no controversy, the cutting itself is a serious health hazard and should be singled out as the component to be addressed. The novelty of the REACH programme is to operate a distinction between perpetuating culture through the initiation rituals (even reassuring the community about protecting and promoting the positive aspects of their culture) and discarding the cutting practice itself or perhaps replacing it with symbolic methods or rituals.

The practice in Kapchorwa is wrapped up with much sacredness and taboos. Over the years, male-dominated communities have developed three complementary strategies to perpetuate and maintain the practice (Farah, 1996):

1. Casting a sense of sacredness on the practice in terms of rituals, taboos, witchcraft and others. The practice should be undertaken at dawn, facing east, in December of even years, after mysterious and superstitious rituals, by socially sanctioned circumcisors and guardians, etc;
2. Devising a range of institutional, social and economic regulators and "agencies" such as the circumcisors, the guardians, the tutors, the singing, dancing, feasting, etc.; and
3. Marginalising those who decide not to be part of the group by exerting social pressure and sanctions such as denying recognition to or stigmatising uncircumcised women, showing disrespect for men whose wives are not circumcised, not allowing uncircumcised women to milk a cow, fetch water, pick food from the granary, serve in public, etc.²

 The REACH Concept

The United Nations Population Fund (UNFPA) Kampala Office, spearheaded in 1995-1996 an innovative, culturally sensitive programme aimed at supporting the efforts of the community to discard the practice. The Project is called Reproductive, Educative And Community Health (REACH). The REACH concept is based on a number of premises which combine to suggest that cultural values are immutable andthat they reflect the identity of the group. Therefore, any attempt to temper with culture from this perspective is bound to be rejected by the community. The community cannot question itself or its identity. Values, however, are often expressed through practices which very much depend on the stage of knowledge, technology and exposure of the community. The rationale is that if separated from values, traditional harmful practices can be questioned by the community without causing any collective identity crisis³. Hence, in order for a socially acceptable change to take place and to sustain itself, emphasis should be put on cultural practices as opposed to cultural values, while creating a conducive environment for indigenous groups to spearhead the change (Farah, 1996).

Another assumption is that for any programme intervention to succeed, communities should be allowed to determine and steer the change at their own pace and through their own dynamics. Such interventions should encourage societies to operate within codes and rules that are acceptable to, and reproduced by their own key value-reproducing institutions such as the family, the school, the peers, the market place, clan structures, political, religious and cultural institutions. A corollary of this assumption is that such interventions should be non-prescriptive, non-incriminative and non-judgmental (Farah, 1996). In fact, REACH suggested the use of the concept of Female Genital Cutting (FGC) to describe excision/clitoridectomy in Kapchorwa. FGC singles out the actual practice or act that should be eventually abandoned. While female genital mutilation was thought to be judgmental and insensitive towards the women who have undergone the practice, female circumcision was thought to imply acceptance of excision or condoning the practice and was, therefore, rejected.

A third assumption is that a minimum bottom-up social legitimacy is require before any top-down legality or legislation is possible to ban or to enforce the ban on the practice. This involves a process of breaking the taboo on the practice, encouraging a public and open debate on its harmful aspects, digesting those harmful aspects by key change agents and eventually shifting the social norm from support for the practice to discarding it.

It is in this above context that the REACH programme attempted to detach the practice of cutting the genitals of girls and women from the cultural value of initiation. It did so through a consultative and persuasive process with key change agents in the community (such as political, clan and religious leaders, elders, women’s and youth representatives). The aim was to persuade them to recognise and appreciate the serious health risks associated with the practice for women and the community at present and in the future, while reassuring them of the support of the Programme for enhancing and promoting the community’s distinct culture. In addition, REACH invested heavily in sensitising school-going and out-of-school adolescents on the harmful aspects of the practice using peer educators among the youth. It also situated FGC in the broader problems of reproductive health in the community so that it can be tackled at the same time as other reproductive health concerns are being addressed. REACH also provided training for health workers (such as TBAs and nursing aides) in maternal and sexual health and family planning and equipped them with appropriate skills. The following is an illustration of the REACH concept.

 Operationalisation of the REACH Concept

A number of activities were implemented before the Programme started. They consisted of:

1. Carrying out a state-of-the-art review on the practice in general, and in Kapchorwa in particular, and documenting the failure of previous attempts (May 1995);
2. Bringing together clan and community leaders, elders and women’s and youth groups in a preliminary workshop to initiate an open debate on the practice (July 1995);
3. Identifying potential programme managers and consultants in the community and writing the draft project document and sharing the project document with the Ministry of Health and the Population Secretariat (August-November, 1995);
4. Securing a consensus in the community by discussing the draft project document at a second workshop with the same participants and endorsing the proposed objectives and strategies (January 1996); and
5. Launching the programme activities (January 1996).

The workshop involved presentation of papers on the harmful practices affecting maternal and child health and the historical background and available research findings on FGC in Kapchorwa. It recognised the poor reproductive health conditions in the district, discussed their causes and implications and made the following recommendations:

• Adopt the FGC concept for being less judgmental of the community;
• Sensitise the community and, in particular, the elders, women’s and youth groups on the harmful aspects of FGC;
• Promote girls’ education in the district and add a component on harmful aspects of FGC in the school health education curriculum (SHEP) of upper primary and secondary schools;
• Resolve that even symbolic initiation of girls should not be done below the age of 18 years and without their informed consent;
• Discourage licensing of circumcisors and encourage them to engage in other income-generating activities;
• Involve religious institutions, district’s heads of departments and the Elders’ Association in the sensitisation programme through seminars and workshops to be held at the district and village levels;
• Carry out more research on the views of parents, elders, youth and surgeons and use the results to develop IEC messages to discourage families from resorting to the practice; and
• Improve and expand reproductive health services in the community.

The second workshop brought together the same participants. They discussed the draft project document, and debated the proposed objectives and strategies. They also discussed and devised feasible advocacy strategies to keep the debate on the practice open in the community. The idea again was to avoid any confrontational approach but rather to cultivate and resort to persuasive methods.

The Programme was launched in January 1996 to run for one year on a pilot basis. An independent evaluation of REACH was carried out in March 1997 to ascertain the progress made and the effect of the Programme. The breakthrough could not have been more obvious.

 Objectives of the Project

The long-term objective of REACH is to improve the reproductive health conditions in the district and to discard the harmful practice of FGC while promoting the cultural values of the community.

The specific or short-term objectives to be achieved by the end of 1996 include:

1. To have actively sensitised at least 30% of the target groups about the harmful aspects of FGC in the district;
2. To have sensitised at least 50% of the TBAs in the district on the harmful aspects of FGC, while enhancing their basic delivery skills and performance;
3. To have improved the quality reproductive health care and FP services in four sub-county health units (delivery points) and in the maternity wing of the district hospital; and
4. To have established a district population structure in Kapchorwa to ensure coordination and planning of population and reproductive health activities.

REACH devised six complementary strategies to achieve the proposed objectives:

1. Organising awareness creation seminars and carrying out advocacy activities aimed at conservative groups such as Elders and Clan Leaders, and potential change agents such as peer educators, health workers and women’s groups. This involved developing FGC-specific IEC materials⁵ and using existing ones; building coalitions between project management and the Sabiny Elders’ Association; and, networking among education institutions, religious groups, politicians, health institutions and community leaders. This was meant to build partnership with key groups in the community to rally their support, legitimise the purpose of the programme and create a conducive environment for change;
2. Targeting and mobilising the young people in particular (age bracket 12-24, in schools and within the community), equipping them with information and facts about the harmful aspects of FGC, and supporting them in questioning and challenging the practice. Two groups of youth mobilisers were called upon: community-based agents (CBAs) and sub-county contact persons (SCPs) at the community level and peer educators (PEs) to reach out to school-going adolescents and youth;
3. Training of health workers and TBAs to enhance their reproductive health technical skills and to increase their awareness about the associated risks of the practice;
4. Renovating four health units and the maternity wing of the district hospital and equipping them with basic MCH/FP kits. This contribution was meant to strengthen the RH services given the poor conditions of the maternity wing and the lack of basic MCH/FP kits;
5. Proposing and supporting the organization of a Cultural Day for the district. The Cultural Day was meant as a) a reassurance the community about their cultural values; b) as an advocacy strategy to strengthen the sense within the community that positive cultural values can be promoted while negative cultural practices can be changed or replaced; and c) as a socially sanctioned demonstration event that would convince the community to discard genital cutting per se and to replace it with more symbolic rituals – such as giving the girl a cow, goats or bracelets after the rituals of feasting and dancing - to mark the passage from girlhood to womanhood. The date was proposed to be November 30 of each year with the aim of eventually replacing the formal opening of the circumcision season which takes place on December 1.
6. Supporting the district in setting up a population coordination structure to ensure integration of population issues in the district’s development planning and to ensure sustainability of the programme in the medium to the long run.

A Steering Committee was established to oversee the overall implementation of the programme. The rationale was to be as inclusive as possible, to impart a strong sense of ownership and to enable members of the community to identify with the purpose of the programme. The Committee included 15 members and was chaired by the Chairman of the Sabiny Elders’ Association. Members included two Elders’ Representatives, two women’s representatives, a youth representative, four District officers (medical, education, population and community development), the medical superintendent of the district hospital, and one representative each from the Ministry of Health, the Population Secretariat and UNFPA. A lean and functional management was put in place with a project manager, one Assistant, a provision for one consultant, and one secretary. The project manager was also secretary to the Steering Committee. The Committee meets quarterly to ascertain progress and advise on implementation.

 Independent Evaluation and Impact

REACH was implemented on a pilot basis from January to December 1996, concentrating its activities in the most accessible sub-counties of the district. Knowing that December was the "circumcision season," efforts were made to ensure that the project would reach as many target groups as possible during the pilot phase. It is a practice in the district that girls who undergo circumcision register with the District Local Council. The project had devised a simple one-page questionnaire to be filled by girls who were due for circumcision in 1996. After each youth sensitisation seminar, participants were requested to fill in the questionnaires and indicate whether they were still interested in undertaking the practice. Up to the end of November, just before the season was formally opened, more than 350 girls who were due for circumcision that year had indicated their wish and decision to skip the practice. In January 1997, REACH collected information on the number of girls and women who were circumcised in December 1996. It compared the figure with those of the previous years. The difference was already quite telling. Across the district, female genital mutilation dropped by 36% in 1996 from the 1994 figure. (For more details about the FGC incidence in Kapchorwa and about the REACH impact in 1996, please see Appendix II from the REACH evaluation report, Kiirya, 1997).

An independent evaluation was commissioned in February 1997 to assess the programme’s performance, evaluate the impact and assess the relevance, suitability and replicability of the REACH concept as a model (see Terms of Reference of the Evaluation in Appendix I).

The evaluation used qualitative and quantitative methods to ascertain the performance and the impact of the programme. It concluded that the project had made a significant impact and brought about a positive change in FGC perceptions. Project impact, the evaluation concluded, was considerable in the sub-counties of Kaserem, Kabai, Sipi, Swam and Binyiny where the programme was intensively operating (see Figure 4 below).

 Note: The drop rate of 25% for Kapchorwa Town Council area (shown in Figure 4 above) represents an increase in incidence from four cases in 1994 to 5 cases in 1996 (Source: Kiirya, 1997).

The evaluation documented the effect of project interventions during 1996. The project attracted the active participation and support of important partners including political, government, traditional and community leaders in the district. Their efforts have yielded considerable gains in terms of mobilising the community against the practice. FGC, which used to be a taboo question in Kapchorwa (community members were particularly suspicious and enraged if the issue was taken by non-Sabiny or "outsiders" and even worse by "a white person or a foreigner"), was now being discussed openly and had become an issue of public debate involving elders, clan leaders and a range of community members. This made it possible for parents, adolescents, health workers, even circumcisors themselves to digest the harmful aspects of the practice, question its relevance to the culture and, in the process, change their perception and attitude as to whether it was not time for them to abandon it.

Members of Parliament in the district have set up an advisory board on reproductive health and other development issues to enhance the process of change. For "politicians and other opinion leaders in the district, to have begun associating with the project and claimed credit for its success demonstrates a positive impact on their perceptions about the practice and the social change" (Kiirya, 1997). Members of the conservative Sabiny Elders’ Association had been won over and were at the forefront of those who were campaigning against the practice. In an interview with the British Television Trust for the Environment in August 1996, the Chairman of the Elders’ Association clearly stated that "at the beginning I was one of the strong supporters of the practice..., now I have changed." The involvement of elders and clan leaders in the sensitisation activities has also increased their knowledge about the health risks associated with the practice and the need to discard it. "For elders to have dramatically turned around to work towards discarding the practice which they have cherished and legitimised for long means that the programme has made a difference" (Kiirya, 1997). The achievement of the Elder’s Association has earned it the 1998 United Nations Population Award, of the highest accolades that UNFPA bestows.

As for the surgeons who used to move from village to village cutting female genitals, their perception and behaviour have significantly changed too. A 65-year old circumcisor, who attended the programme seminars, when asked about her experience during the last circumcision season responded "I did not go out to look for women/girls to circumcise this time. I was like a doctor... I was requested for assistance so I had to circumcise them... but they were few this time" (Kiirya, 1997).

On the other hand, the project has increased the knowledge among adolescents (particularly secondary school-going girls and boys) about the risks pertaining to the practice and has brought about a significant change in their perceptions. The evaluation compared the findings with those discussed in previous studies (Chekweko, 1994 ; Kakuba and Kanesathasan, 1995) and concluded that the project "had certainly caused a positive change" among school adolescents and teenagers. In addition, parents seemed to have appreciated the role of peer educators as change agents and supported them in their sensitisation efforts. The evaluation concluded that both men’s and women’s attitude and perception towards the practice have changed significantly and "it is the view of the evaluation that the project interventions are responsible for that change" (Kiirya, 1997). In addition, the training of TBAs and equipping them with TBA kits have improved their service delivery skills and performance. Their improved performance was recorded by the evaluation team as well as attested by a significant increase in overall awareness about the need to improve reproductive health conditions in the district.

The impact, however, was less obvious on out-of-school adolescents and drop-outs, mainly because they were not directly targeted during the pilot phase. In fact, in those geographic areas and sub-counties where the project was not actively operational, a number of married women had given in and had undergone the practice due to heavy social pressure from their in-laws, relatives and close members of their communities. The evaluation also suggested areas of consolidation of the REACH Project and strongly recommended its extension.

 Replicability of the REACH Model

The independent evaluation also looked into the replicability of the REACH model. It suggested that the concept and the approach were based on universal assumptions that were common to many communities and valid in many social and cultural contexts. Replicating the REACH model is therefore, not only possible and feasible, but is also likely to produce a positive outcome in a reasonably short period of time on such a sensitive issue. Devising a similar programme in other countries, however, should first and foremost reassure the community of the integrity of their cultural identity, and separate the practice from the culture per se so that the practice can be singled out for questioning. Again, questioning any harmful practice that is deeply rooted in tradition, should originate from within the community, through their institutions that are considered having authority on values and should not be perceived asa prescription or a recipe "handed-down" to them from a "better culture." In fact, one of the premises of the REACH concept is that there is no such thing as better cultures. Cultures vary depending on the state of knowledge, development and technology. Yet they are all equally valuable to their members (Farah, 1997). Disseminating the REACH model and the process of project initiation and development would also help other countries and communities replicate this successful experience of structurally discarding FGM and other practices harmful to reproductive health.

Three films have so far been produced to document REACH’s innovative approach and concrete impact. The Television Trust for the Environment (TVE, England) produced in August 1996 (four months before "the season") an 11-minute film as part of a six-film series on Not the Numbers Game. The film was broadcast on the BBC World TV on October 2,3,5 and 6, 1996. In turn, the BBC World TV produced a film in early December to document the real context in which FGM is practised. The film was broadcast several times on the BBC World TV between March 13 and 17, 1997.

In addition, a South African TV producer made a film in April 1997, four months after the FGM season. The film was broadcast on June 8, 1997 on M-NET TV Cable in a programme called Carte Blanche (M-NET covers 28 African countries). Later, a crew was again in Kapchorwa to document the success of the programme for the CNN World Report.⁶

Extension of the Project

REACH has been extended for another year and will be supported for the next four years by the new Government of Uganda/UNFPA Fourth Country Programme 1997-2000. The extension incorporated the recommendations of the evaluation, and actively expanded implementation of REACH to all the sub-counties in the district. It increased the number of peer educators and TBAs to be trained between now andthe year 2000 from 30 to 138 and from 56 to 508, respectively. It also strengthened the community based component of reaching to out-of school adolescents and teenagers, and expanded the sensitisation seminars from the sub-county level to the village level.

It is the strong view of the author that Uganda is now one of very few countries that are in a position to set up a realistic and achievable time table for a full eradication of FGC by the year 2000 or 2002. REACH is committed to achieving this objective with support from UNFPA.

The REACH programme addresses Female Genital Cutting which is practised in Kapchorwa, and attempts, through various strategies, to discourage the harmful practice while enhancing the accompanying social/cultural values. The above project was implemented for 10 months from February to December 1996. Since the project was implemented in the 3rd cycle, and now that the 4th cycle is expected to commence in 1997, a consultant will be hired to evaluate the project in order to assess its performance and impact. In addition, the evaluation report will be used as input into the formulation of a successor project to be implemented in the 4th cycle of the GOU/UNFPA country programme. This project is being evaluated for the first time. The work plan for the evaluation will be drawn with the identified consultant, who will be expected to meet with and brief the UNFPA country office at least once during the evaluation, and once more at the end of the evaluation.

Specifically the consultant will:

1. Assess programme performance by reviewing the management process, institutional framework including the relevance and role of the Steering Committee, technical input from various sources, and the monitoring mechanisms. Identify weaknesses and strengths with the view to make recommendations on how best the weaknesses can be eliminated/minimised in the second phase.
2. Assess project impact by examining the process of social change of attitudes vis-a-vis FGC, among the different target groups of the project.
3. Assess the relevance, suitability, and replicability of the REACH process as a model with the view to piloting the same initiative in countries and communities where the practice continues to be prevalent.
4. Submit a satisfactory report within four weeks after commencement of the evaluation. The report will be prepared in two parts: a) a general summary report of findings and conclusions in a commonly comprehensible form, and b) a more detailed technical report.

Qualifications

A degree at masters level in any of the following fields: population studies, demography, public health, social sciences, psychology. Several years’ experience in the evaluation of population programmes, analytical skills, good command of English language. An understanding of the local language in Kapchorwa is desirable.