Gender &
Reproductive Health
Gender &
Reproductive Health
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By Charity Koronya Mailutha, Stephen Mucheke, George Kaggwa |
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Introduction Female genital mutilation (FGM), also commonly known as female circumcision (FC), has been widely practised for a long time by different communities in Kenya for social, cultural and economic reasons. Although it is a deliberate procedure to initiate the girls into adulthood, the practice has both adverse health and socio-economic effects on the girl-child and woman (Family Planning Association of Kenya, 1994). In its strategic plan for the period 1994-2000, Family Planning Association of Kenya (FPAK) identified women’s empowerment as a goal. To achieve this goal, one of the issues being addressed is eradication of female genital mutilation (FGM) in Nyambene district.* The project seeks to actively work for the establishment of equal rights for women to enable them to exercise control over their own reproductive and sexual health choices. International Planned Parenthood Federation and Plan International (Meru) fund this project which started in 1991 on a pilot basis. Since 1991, the project was being implemented in 5 pilot locations. In late 1995, with funds from Plan International (Meru), the project has been expanded to 11 more locations. Socio-economic Context According to the 1989 population census, Nyambene district had a total population of about 580,000. It is subdivided into 11 locations (smaller administrative units) with an average of 53,000 inhabitants per location. Female genital mutilation (FGM) is deeply entrenched cultural practices in Nyambene district as well as in other parts of Kenya. This practice violates women’s rights, suppresses their sexuality, ensures their subjugation and controls their reproductive health functions. FGM is associated with initiations, coming of age rites, education in family life, special feasting, bestowal of status and rare opportunities to celebrate - important activities that women fear they will lose with the eradication of FGM. Myths Associated with FGM In Nyambene district of the Meru community, the following myths are associated with FGM: • Circumcision makes childbirth easier. • Circumcision preserves virginity. • Female circumcision enhances recognition in the community. • Female circumcision prevents promiscuity. • Uncircumcised girls cannot mature physically and mentally. • Circumcised girls make better wives. Objectives As mentioned earlier, the project aims to advocate for gender equity and enhancement of socio-economic status of women to enable them to exercise control over their reproductive health. The specific objective of the project was to eliminate or at least to minimise the incidence of female genital mutilation in Nyambene district. Other associated objectives are: Strategy and Activities The project utilises a community approach with the following strategies: information, education and communication (IEC), advocacy, research, and training. So far, the following activities have been undertaken:
To make an impact in the project sites, community participation was mandatory. This was necessary because FGM is a very sensitive cultural practice that is strongly embedded in people’s way of life. Project Advisory Committee A PAC composed of influential and respected community opinion leaders was formed at each of the project sites. The PAC members included representatives of council of elders, clan and family elders, religious leaders, women and youth group leaders, headmen, chiefs and their assistants, education officers, adult education officers and representatives of various development committees in the project sites. Orientation workshops were held to sensitize the PAC members on their role, the dangers and consequences of female circumcision and the need to eradicate the practice, importance of family planning, methods of family planning, and sexually transmitted infections including HIV/AIDS. During the workshop, participants also discussed and recommended the following advocacy strategies: The formation of PACs and their orientation towards elimination of FGM has made FPAK’s work easier. PAC members spoke with authority on the dangers and consequences of FGM to the community members. They were not seen as strangers who were condemning FGM. Community members identified with them and felt challenged to start abandoning the practice which has outlived its purpose. To enhance community involvement, community members also participate in developing IEC materials and culturally sensitive strategies and activities. Sensitisation Seminars for the Community Sensitisation seminars have been held for a cross section of community members. The target audience is segmented so as to reach each segment effectively with appropriate messages on the dangers and consequences of FGM, the need to eradicate the practice and the importance of girls’ education. The sensitisation seminars focus on young girls and boys, parents, opinion leaders, young male adults (future husbands), female circumcisers and traditional birth attendants. Research as a Basis for Programming Qualitative Research on Female Circumcision A study conducted in the district by the Family Planning Association (FPAK) found that:
Volunteer Community Gender Educators (VCGEs) The VCGEs are the focal point at the community level. They are the link between community members and FPAK, and they mobilise and educate community members. VCGEs were identified, recruited and trained for two weeks to carry out IEC and advocacy activities in the project sites. Those recruited included clan leaders, women and youth group leaders, adult education teachers and choirmasters. The training covered reproductive health problems associated with female circumcision, advocacy, communication skills, community mobilization and empowerment skills among others. The VCGEs from the old sites are also refreshed on record keeping, report writing, advocacy, project monitoring and community mobilisation. The project currently has 16 VCGEs; five of them are paid some honorarium while the other 11 are purely voluntary. With support from the provincial administration, the PAC and other community leaders, the VCGEs have continued with advocacy activities on eradication of female circumcision in Nyambene district. A total of 7,590 community members in Nyambene were reached through formal and informal discussions, public meetings, seminars, lectures and group talks with the messages on the dangers of female circumcision, importance of girls education, family planning and HIV/AIDS. IEC Materials IEC is a major component of the project. Community members were actively involved in the production of IEC material through workshops. The VCGEs and the PAC members play key roles of distributing the IEC materials. For instance, 2,300 posters and 1,800 brochures with the messages on dangers of female circumcision and early marriages were distributed in the project sites in 1996. The materials are in English and are also translated in local languages to enhance use by a wide audience in the community. An IEC Workshop In 1996, a five-day workshop to develop IEC materials on the dangers of female circumcision produced posters targeting girls, youth and community members; wallchart for leaders; and a booklet for youths. Participants for the workshop were drawn from collaborating organizations such as Africa Medical Research Foundation (AMREF), Family Planning Private Sector (FPPS), Kenya Association of Professional Counsellors, National Council of Churches of Kenya (NCCK), Ministry of Health, UNICEF, Ministry of Information, Action AID, Ministry of Education, National Council for Population and Development (NCPD) in the office of the Vice President and Ministry of Planning and National Development. The materials were pre-tested with the target audience and finalized during 1996 and printed during 1997. Folk Media Female circumcision is a rite accompanied by pomp and pageantry – songs, dances and funfair. FPAK adapted the existing traditional activities of song and dance to educate community members on the drawbacks and dangers posed by FGM. Women groups in the project sites have been sensitized and have composed songs, dramas, poems and skits with messages to eradicate FGM. The Role of Video Shows Video shows have played very important roles in the project. A videocassette covering the launch and with relevant messages on the dangers of female circumcision was produced and will be used for advocacy activities. During the training and orientation seminars and workshops, participants are shown a video show depicting actual female circumcision and other blood-letting, harmful, traditional practices. Homogeneous groups in terms of age and or sex watch the same video show. This allows the participants to come to grips with what really happens during female circumcision. Discussions from the video shows reveal the lack of knowledge on the subject. Many women, even those who are circumcised, cannot reconstruct the circumcision event. They may not even realise which part of their reproductive anatomy is missing or has been tampered with. Pictures of a model of the female anatomy and the effects of FC are also available during the workshops and seminars. The video shows and the pictures of the model inform the community members on FGM and help them to realise the harm, pain and trauma caused by FGM. Voices of the Young: Peer Clubs Almost all the victims of FGM are young girls. The decision on if and when FC should be done in most cases comes from the relatives. Research findings (FPAK, 1994) reveal that 89 percent of the girls interviewed stated that other people (relatives and parents) decided that they be circumcised. A more recent study (FPAK, 1997) showed that it was mainly the mother or both parents who decide on the girl’s circumcision. Young girls who decide not to be circumcised have therefore found themselves at loggerheads with parents in particular and the community in general. In a number of families, parents have ended up expelling their daughters who decide against circumcision. A mother was quoted saying, "to avoid public shame, I will circumcise my daughter even if she climbs on top of the tree.... I will cut the tree down and have her circumcised." According to a study conducted by FPAK in the district’s ten locations in 1997, it was found that the decision not to get circumcised came mainly from the girls themselves. The girls in the district therefore felt that in order to sustain these decisions, they need to come together as a group and work together in an effort to overcome these problems. One of the girls was quoted saying, "I have never had an interest in the rite. I don’t like it. It is not important to me and I do not see any good in it." Another one came out strongly: "I made the irreversible decision not to undergo the rite... I am a Christian and I value all parts of my body." FPAK has encouraged the girls to organize themselves into peer clubs. This constitutes an advocacy outlet. These girls have also served as strong role models in community to influence the community and specifically other girls to abandon FGM. They meet during the club sessions to assist each other, particularly those who have not undergone FGM or those under parental pressure to undergo FGM, to cope and to form strategies. The youth/girls are counselled on how to handle rejection from the peers and community in general or being looked down upon when they say "no" to FC. These clubs have helped girls who were disowned by their parents to get support from the provincial administration, the church and other organizations to continue with their education. They have also composed plays, poems and songs with the themes of eradicating female circumcision. To date, three peer clubs have been formed in Kabachi, Ntunene, and Akirangondo locations in the district. The clubs have a total of 36 members who meet periodically to assist each other. "Transforming" Female Circumcisers The circumcisers are normally very old women – aged around 80 years – who inherit their work from their mothers. They start training when they are about 50 years old. During the training they begin by assisting with holding the initiates and observing how the procedure is done. There is an average of between two to three circumcisers in each location. However, one location has up to 10 circumcisers, some of whom are hired to work in neighbouring locations. The circumcisers hardly have any other source of income; they rely exclusively on female circumcision for their livelihood. It also gives them social status and class. The project has approached female circumcisers with education seminars and meetings. Female circumcisers are very crucial in the campaign to eradicate FGM. The VCGEs have arranged to have monthly meetings with the female circumcisers. The meetings have been successful though initially there was a lot of resistance from the circumcisers. These constant and frequent meetings have reformed four female circumcisers into strong advocates for the eradication of FGM. Many of the female circumcisers have "inherited" the practice from their parents and it forms an important way of raising income. It also gives them social status and class. Having reached them with the relevant IEC messages, a new cadre of reformed female circumcisers are now emerging in the project area. The project has succeeded in winning them over by using education and persuasion methods rather than force, as the provincial administrators had done in the past, which resulted in most of them going underground as was the case before the project was initiated. Results Achieved FPAK’s effort to advocate
for the eradication of FGM in the 16 pilot locations of Nyambene district
has been successful. Although it is too early to show the total impact,
a preliminary review of the project shows some success in changing attitude
and behaviour towards female circumcision. Some of the specific achievements
are: 2. A number of girls in Nyambene have been empowered to report attempted circumcision to the relevant authorities such as the chiefs and division officers, while others sought refuge in churches and some have written to FPAK asking for assistance. For instance, in 1996, two girls who had been chased from home by their parents for refusing to be circumcised were counselled and rehabilitated. Both girls are back in school, but one of them is still living with Christian families because her parents have refused to accept her back at home. 3. Change in behaviour towards female circumcision is being achieved. There are willing role models from the community who have been active in advocating for the eradication of these practices. Circumcised women have given several live testimonies in public on the effects of female circumcision on their sexual life and have stated their willingness and commitment not to circumcise their daughters. 4. The Project Advisory Committee members have taken initiative to persuade some girls not to undergo circumcision. Community members have formed locational and sub-locational committees to address FGM. 5. Four reformed female circumcisers have publicly denounced the practice and shown their commitment to "down their tools" and to be strong advocates for eradication of FGM. No one has approached them to perform circumcision, for fear of being reported to the authorities. A number of meetings have been held between VCGEs and other female circumcisers with the aim of reforming them. 6. Two area chiefs have shown the commitment to invoke the Chiefs Act to ban FGM in their locations. The arrest of four female circumcisers by the chiefs and 55 parents by the District Officer for circumcising their daughters are further proof of the success of the project. 7. Youths have formed peer clubs to support the eradication of FGM. Some male youths have challenged their parents to stop "misusing" their future wives. There have been resolutions and commitment by male youths to continue advocating for eradication of this harmful practice. The youths have also formed drama clubs to portray the dangers of FGM and used slogans in favour of uncircumcised girls by young adults. Uncircumcised girls are now being referred to as manyanga (youthful) and mambo yote (the best of all) and those circumcised are called mitumba, meaning "second hand goods." 8. Community support in eradicating FGM is very significant in that community members have been offering community facilities free for seminars. They are also involved in developing advocacy strategies and have used positive slogans to praise the uncircumcised girls. The community leaders have provided support to the project by organising and facilitating sensitization and education activities. The community has written to request for more IEC materials and to encourage FPAK to continue with the good work of educating people on the dangers of this harmful practice. The sensitised teachers and leaders have composed debates, themes, songs and dramas with messages on the need to eradicate FGM. Thus there is active community participation in local committees, advisory panels, folk media groups as well as willingness and enthusiasm to serve as volunteer community gender educators. 9. The Methodist and Catholic Churches have shown their support in the community by publicly burning the female circumcisers’ tools. There have been requests from the Catholic Church for seminars in their churches to educate their members on the dangers of the harmful practice. 10. A number of uncircumcised women in Nyambene have reported cases of insult on the basis of being uncircumcised to the police, something which had never happened before the project’s intervention. Uncircumcised women are now willing to come out openly in public, declare their "status" and be proud of the fact that they are uncircumcised. 11. The demand for IEC
materials on FGM is rising. Parents are referring their daughters
to VCGEs to be counselled and educated on the dangers of FGM. Both
parents and girls have provided testimonies and served as role models
against female circumcision to encourage others. Project Management The project is managed by FPAK and operates from the headquarters. The Programme Manager is in charge of the overall implementation of the project and is assisted by a Programme Officer. At the district level, the FPAK Regional Manager is responsible for the management of the project activities in the project site and is assisted by the PAC. In each location, a part-time VCGE carries out the day-to-day educational and advocacy activities of the project with the support of the PAC. Project forms committees at the project sites to advance advocacy activities on the eradication of female circumcision. The committees are composed of opinion leaders in the community who include clan elders, religious leaders, village elders, women groups leaders and land committee officials. Project review meetings are held regularly. During the meetings, the VCGEs and PAC review the project implementation and how to improve the project performance. In addition, they discuss further strategies to address female circumcision and report on the achievement and constraints encountered on the course of project implementation. Lessons Learnt During the project implementation, the following lessons have been learnt: Targeting the young girls who are the victims of female circumcision is very effective. The few who have been reached with the appropriate educational campaigns have been empowered to stand up against the pressure from the community including their parents. In addition, they have been found to be assertive enough to report forced circumcision to the provincial administration, seek refuge in churches and even written letters to FPAK seeking for assistance for their ostracism from the community. There is need to create a support system in the community to assist the girls who run away from their homes or are chased away by parents for resisting this harmful practice. Most opinion leaders and community gatekeepers do not consider or recognise FGM as a reproductive health priority issue. Those who recognize it do not have an idea of the negative effects of the practice nor the courage to initiate interventions. A few of them at the project sites preferred not to publicly condemn the practice for fear of being cursed. Since female circumcision is embedded in the culturally dreaded topic of human sexuality, there is need to broach the subject and to transmit the broader body of knowledge on human sexuality. This will enable people to discuss the problems such as those touching on the loss of women’s capacity for experiencing sexual pleasure posed by FC. The use of role models and life testimonies during sensitization activities has had a lot of impact and multiplier effects. There is need to have uncircumcised leading personalities as the role models on anti-FC campaigns. Collaboration and networking with other agencies including churches help to reach more people with minimum or no funds. There is need for lobbying and advocacy to churches and organizations currently not coming up strongly on opposing FC. Community involvement in project implementation has borne a lot of fruits. However, it is important to avoid direct confrontation between the circumcised and the uncircumcised women. This can cause a counter-productive backlash to the advances already made. There is therefore need to win without making losers. There is a need to educate and moderate the overenthusiastic administrators. In "persecuting" female circumcisers, these individuals may create cultural resistance and make the practice go underground. It will be almost impossible to tackle FC when it goes underground. The Future: Problems and Challenges Despite the successes recorded so far, a number of challenges have been identified. So far, the anti-FC campaign has covered limited ground; there remain large unreached areas. There is a need, therefore, for more funds for anti-FC campaigns. Although a few of the community members in the project sites have abandoned the practice, there is the danger of the practice being reintroduced from neighboring locations which have not been reached by the project activities. This calls for more resources to expand the project coverage and intensify IEC and advocacy activities. Networking among agencies in FC education will ameliorate the situation. Much still remain to be done and the project faces many challenges: Since changing FGM takes a long time just like many other cultural practices, the following plans have been suggested to help ensure future project sustainability:
Footnotes *Another issue FPAK addressed is early marriage in Kilifi district, using an approach similiar to that used in Nyambene district to eradicate FGM |