Alternative rite of passage (ARP) scale-up project in Kenya and Tanzania by Plan Nederland

ALTERNATIVE RITE OF PASSAGE (ARP) SCALE-UP PROJECT IN KENYA AND TANZANIA

ARP Baseline Survey Final Report Submitted to Amref Health Africa in Kenya / Tanzania By Paul Kiage, Dr. Elizabeth Onyango, David Odhiambo with Moses Okelo and Stephen Sifuna 6th July, 2014

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2 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

TABLE OF CONTENTS TABLE OF CONTENTS ..................................................................................................................................... 3 LIST OF TABLES ................................................................................................................................................ 6 LIST OF FIGURES .............................................................................................................................................. 7 ACRONYMS......................................................................................................................................................... 8 ACKNOWLEDGEMENTS ............................................................................................................................... 10 EXECUTIVE SUMMARY ................................................................................................................................ 11 1

SECTION ONE: INTRODUCTION AND METHODOLOGY ........................................................... 19 1.1

BACKGROUND INFORMATION ................................................................................................................. 19

1.2

PURPOSE OF THE BASELINE SURVEY ....................................................................................................... 19

1.3

BASELINE STUDY OBJECTIVES ................................................................................................................ 20

1.4

STUDY METHODOLOGY .......................................................................................................................... 20

1.4.1

Survey Design ............................................................................................................................... 20

1.4.2

Study Sites ..................................................................................................................................... 21

1.4.3

Data Collection ............................................................................................................................. 21

1.4.4

Household Survey ......................................................................................................................... 22

1.4.5

Key Informant Interviews (KIIs) ................................................................................................... 22

1.4.6

Focused Group Discussions (FGDs) ............................................................................................ 22

1.4.7

Data Processing and Analysis ...................................................................................................... 22

SECTION TWO: ARP BASELINE SAMPLE CHARACTERISTICS ............................................... 24 2.1

HOUSEHOLD AND DEMOGRAPHIC PROFILE OF RESPONDENTS ................................................................. 24

3 SECTION THREE: KNOWLEDGE, ATTITUDES AND PRACTICE OF FEMALE GENITAL CUTTING ........................................................................................................................................................... 26 3.1

INTRODUCTION ....................................................................................................................................... 26

3.2

KNOWLEDGE OF FEMALE GENITAL CUTTING (FGC)............................................................................... 26

3.3

PREVALENCE OF FEMALE GENITAL CUTTING IN THE PROJECT AREAS .................................................... 27

3.4 ATTITUDES AND PRACTICE OF FEMALE GENITAL CUTTING: THE CULTURAL MEANING AND REASONS FOR PRACTICING OF FGC ........................................................................................................................................ 29

3 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

3.5

AGE AT CIRCUMCISION ........................................................................................................................... 30

3.6

WHO DECIDES ON THE CUT..................................................................................................................... 32

3.7

WHO PERFORMS THE PROCEDURE .......................................................................................................... 33

3.8

WHERE AND WHEN THE PROCEDURE IS PERFORMED .............................................................................. 34

3.9

THE TYPE OF CIRCUMCISION PRACTICED BY THE COMMUNITIES ............................................................ 36

3.10

INSTRUMENTS USED FOR THE CUT ...................................................................................................... 37

3.11

EFFECTS OF FEMALE CIRCUMCISION .................................................................................................. 37

3.12

ATTITUDES TOWARDS FEMALE CIRCUMCISION (CONTINUED/STOPPED) ............................................ 39

4 SECTION FOUR: SOCIAL CULTURAL BARRIERS IN DENOUNCING FEMALE CIRCUMCISION ............................................................................................................................................... 42

4.1

CULTURAL ACCEPTANCE, IDENTITY, BLESSINGS AND STATUS ............................................................... 42

4.2

GIVES WOMEN THE CERTIFICATE TO MARRY, HAVE SEX AND PROCREATE ............................................... 43

4.3

FEMALE CIRCUMCISION CONFERS BETTER MARRIAGE PROSPECTS IN GIRLS ............................................ 43

4.4

THE MYTHS OF FGC BELIEVED TO CONTROL WOMEN SEXUALITY / DESIRES ........................................... 44

4.5

FGC CONFERS CLEANLINESS IN WOMEN ................................................................................................. 45

4.6

FGC MAKES BIRTH EASY ......................................................................................................................... 45

4.7

IN-DEPTH ANALYSIS OF FGC IN THE TARGET COMMUNITIES .................................................................. 46

SECTION FIVE: ALTERNATIVE RITE OF PASSAGE - THE SOCIO-CULTURAL ENABLERS 47 5.1

AWARENESS OF MESSAGES AGAINST FEMALE CIRCUMCISION ................................................................ 47

5.2

AWARENESS ON THE ALTERNATIVE RITE OF PASSAGE (ARP) ................................................................ 48

5.3

ALTERNATIVE RITE OF PASSAGE (ARP) MESSAGES AND COMMUNITY ACCEPTABILITY ........................ 49

5.4

THE DESCRIPTION OF IDEAL MARRIAGE PARTNERS BY THE MORANS .................................................... 53

5.5

BEST CULTURAL RITUAL FOR GIRLS NOT CIRCUMCISED ........................................................................ 54

5.6

KEY SOCIO-CULTURAL ENABLERS ON WHICH TO ANCHOR ARP ............................................................. 55

SECTION SIX: CAPACITY AND READINESS OF LOCAL COMMUNITY STRUCTURES ...... 57 6.1

COMMUNITY STRUCTURES AND TRADITIONAL GOVERNANCE OF THE MAASAI COMMUNITIES .............. 57

6.2

COMMUNITY STRUCTURES AND TRADITIONAL GOVERNANCE OF THE SAMBURU ................................... 58

6.3

LOCAL ADMINISTRATION ........................................................................................................................ 60

4 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

6.4 7

CIVIL SOCIETY ORGANIZATIONS ............................................................................................................. 60

SECTION SEVEN: CONCLUSIONS AND RECOMMENDATIONS ................................................ 67 7.1

CONCLUSIONS ......................................................................................................................................... 67

7.2

RECOMMENDATIONS ............................................................................................................................... 69

REFERENCES .......................................................................................................................................... 72

5 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

LIST OF TABLES TABLE 1: SUMMARY OF ALTERNATIVE RITE OF PASSAGE (ARP) BASELINE INDICATORS ........................................................... 13 TABLE 2: DISTRIBUTION OF THE BASELINE SAMPLE BY PROJECT AREA ..................................................................................... 21 TABLE 3: CHARACTERISTICS OF ARP ADULT AND YOUNG RESPONDENTS.................................................................................. 25 TABLE 4: KNOWLEDGE OF FEMALE CIRCUMCISION .................................................................................................................... 26 TABLE 5: PREVALENCE OF FEMALE CIRCUMCISION AMONG WOMEN AND GIRLS ........................................................................ 27 TABLE 6: PREVALENCE OF FEMALE CIRCUMCISION AMONG YOUNG GIRLS BY PROJECT AREA ................................................... 28 TABLE 7: PREVALENCE OF FEMALE CIRCUMCISION BY AGE ....................................................................................................... 29 TABLE 8: PERCENTAGE OF MOTHERS REPORTING WHO PERFORMED CIRCUMCISION AMONG THEMSELVES AND DAUGHTERS BY PROJECT AREA ................................................................................................................................................................ 33 TABLE 9: PERCENTAGE OF WOMEN AND PLACE WHERE FGC WAS PERFORMED .......................................................................... 34 TABLE 10: COMMUNITY ATTITUDES TOWARDS FEMALE CIRCUMCISION ..................................................................................... 40 TABLE 11: PERCENTAGE OF POPULATION REPORTING HAVING HEARD OF MESSAGES AGAINST FEMALE CIRCUMCISION ................ 47 TABLE 12: PERCENTAGE OF RESPONDENTS REPORTING THAT ARP WOULD BE ACCEPTED BY THE COMMUNITY .......................... 52 TABLE 13: ASSESSMENT OF THE CIVIL SOCIETY ORGANIZATIONS IN THE ARP PROJECT AREAS ........................................ 62

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LIST OF FIGURES FIGURE 1: MEDIAN AGE AT CIRCUMCISION FOR MOTHERS AND DAUGHTERS ....................................................... 31 FIGURE 2: PROPORTION OF COMMUNITY MEMBERS REPORTING KNOWING EFFECTS OF FEMALE CIRCUMCISION 38 FIGURE 3: ATTITUDES TOWARDS FEMALE CIRCUMCISION BY GENDER ................................................................. 40 FIGURE 4: SOURCES OF INFORMATION AGAINST FEMALE CIRCUMCISION .............................................................. 48 FIGURE 5: KIND OF MESSAGES REACHING THE TARGET ARP SITES (%) .............................................................. 50 FIGURE 6: PROPORTIONS OF MORANS DESCRIBING THEIR IDEAL MARRIAGE / POTENTIAL PARTNERS.................. 53 FIGURE 7: PROPORTION OF ADULT POPULATION AND YOUNG GIRLS PREFERENCES FOR CULTURAL RITUAL FOR THE UNCIRCUMCISED TO BE ACCEPTED BY THE COMMUNITY ....................................................................... 54

7 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

ACRONYMS AIDS

Acquired Immune Deficiency Syndrome

AMREF

African Medical and Research Foundation

ARP

Alternative Rite of Passage

FGC

Female Genital Cutting

FGDs

Focus Group Discussions

FGM

Female Genital Mutilation

HIV

Human immunodeficiency Virus

IEC

Information Education and Communication

KAPB

Knowledge, Attitude, Perception and Behaviour

KII

Key Informant Interviews

KCO

Kenya Country Office

KDHS

Kenya Demographic and Health Survey

MYWO

Maendeleo Ya Wanawake Organization

MOH

Ministry of Health

N/A

Not Available

NGOs

Non-Governmental Organizations

Research Assistants

Reproductive Health

STDs

Sexually Transmitted Diseases

STIs

Sexually Transmitted Infections

TDHS

Tanzania Demographic Health Survey

PSU

Primary Sampling Unit

PPPS

Probability Proportional to Population Size

Reproductive Health

SPSS

Statistical Package for Social Sciences

SSP

Sampling Start Point

TBA

Traditional Birth Attendant

UNAIDS

United Nations Joint AIDS Programme

UNDP

United Nations Development Programme 8

ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

UNICEF

United Nations Childrenâ&#x20AC;&#x2122;s Fund

USAID

United States Agency for International Development

WHO

World Health Organization

9 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

ACKNOWLEDGEMENTS The â&#x20AC;&#x153;Baseline Survey for the Alternative Rite of Passage (ARP) Scale-Up Project in Kenya and Tanzaniaâ&#x20AC;? is a joint project of Amref health Africa in Kenya and Tanzania with funding from the Dutch Postcode Lottery through Amref Health Africa in Netherlands. The research team would like to particularly thank all the survey respondents: mothers, young girls and men drawn from the project areas of Loitoktok (Kenya), Magadi (Kenya), Samburu (Kenya) and Kilindi (Tanzania). Special thanks also goes to the key informants, cultural elders, community leaders, local administrators, Ministry of Education officials and teachers who created time within the tight school calendars to allow the in-school youths to participate in the study. We are also grateful to the Ministry of Health officials both in Tanzania and Kenya for their involvement in the supervision and tireless efforts in ensuring that the survey was conducted professionally. We also wish to acknowledge the Research Assistants (RAs) and Supervisors in the four project areas for their contribution and hard work during the data collection. Finally, the team is grateful to the Amref health Africa in Kenya and Tanzania Country Offices Management for the logistical support and project field officers for their guidance during the data collection.

10 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

EXECUTIVE SUMMARY This report presents the baseline findings of the Alternative Rite of Passage (ARP) scale-Up project being implemented by Amref Health Africa in Kenya and Tanzania with funding from the Dutch Postcode Lottery through Amref Health Africa in Netherlands. The ARP scale-up project focuses on contributing to the abandonment of Female Genital Cutting (FGC) in Magadi, Loitokitok, Samburu and Kilindi by 2015. The main objective of the survey was to establish the benchmark indicators on which the project activities to be implemented and monitored over the next 3 years. Methodology The baseline assessed the prevailing levels of knowledge, attitude and practices (including socio cultural aspects such as who decides on the cut, when it is done, by whom and why?) within the community with regard to female genital cut (FGC) and Alternative Rite of Passage (ARP) as its culturally acceptable replacement. The study used a combination of qualitative and quantitative data collection approaches in carrying out the ARP baseline. The baseline data was obtained through household interviews with 1,327 respondents consisting of 494 married women aged (15-49) years, 344 adult men aged 18 years and above and 489 young girls (10-24 years). The household data was obtained through random selection of households from both clusters where ARP work had commenced in Loitokitok and Magadi including a few other clusters where ARP advocacy work were yet to be rolled out. To enhance validity and reliability of the ARP baseline study findings, quantitative data were triangulated with qualitative data generated through FGDs and in-depth interviews with key informants spread across the four project areas of Magadi (Kenya), Loitokitok (Kenya), Samburu (Kenya) and Kilindi (Tanzania). Key Findings The key findings of the Alternative Rite of Passage (ARP) baseline is that FGC is still widely practised among the nomadic pastoralist communities largely due to an entire range of cultural reasons that include giving identity and be socially accepted in the community “FGC is done for cultural acceptance, confer a sense of belonging and preserve the community’s culture”. The main reasons for continuation of FGC in the ARP project areas are that it is part of the community’s culture; it gives the women the certificate to have sex, marry and procreate. Further, FGC is considered as a rite of passage from girlhood to womanhood and makes young girls have better marriage prospects in the community. FGC is also perpetuated as a means of ‘supposedly’ reducing sexual desires of young girls and women thereby curbing sexual activity before and infidelity within marriage. False perceptions and beliefs that FGC makes women earn respect (honour) confer cleanliness and makes child birth easy. The practice was established to be on the decline as married women were twice as likely (85.7%) to have been circumcised compared to younger unmarried girls (45.2%). The age at circumcision also varies across the ARP project areas with the median age for circumcision being 14 years but is considerably lower in Kilindi where girls as young as 5 years are 11 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

considered ready for the cut. The baseline point to a trend to circumcise girls at younger ages especially in Kilindi before the girls are able to make a choice to accept or refuse the cut. The summary of survey indicators is provided in Table 1.

12 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Table 1: Summary of Alternative Rite of Passage (ARP) Baseline Indicators National1 (%) Kenya

Indicators

Loitokitok (%)

Magadi (%)

Samburu (%)

Kilindi (%)

National2 (%) Tz

99.2%

99.1%

99.2%

98.3%

% of girls (10-24 years) reporting knowledge of FGC

99.2%

97.5%

84.1%

94.9%

% of the population reporting knowledge of female circumcision

99.1%

99.5%

99.0%

94.0%

97.8%

96.2%

93.8%

96.7%

56.5%

39.5%

63.3%

50.9%

28.0%

45.2%

Median age of circumcision among mothers (15-49 years)

Median age of circumcision among young girls (10-24 years)

14.25

% of women (15-49 years) reporting knowledge of female circumcision

% of married women (15-49 years) reporting having been circumcised

96%

27%

% of unmarried young girls (10-24 years) who have undergone female genital cut

Proportion of community members who know at least three effects of FGC

82%

Aggregate (%)

15%

98.9%

85.7%

The effects of FGC mentioned by respondents 22.1%

20.2%

19.4%

19.1%

20.2%

56.6%

77.5%,

65.7%

49.3%

61.9%

Effect 2: Difficulty in giving birth

3.2%

15.0%

22.9%

28.8%

17.4%

Effect 3: Prevents sexual satisfaction

7.3%

9.5%

21.4%

17.7%

13.9%

Effect 4: has lost its significance

22.8%

9.0%

9.3%

12.7%

Effect 5: Donâ&#x20AC;&#x2122;t know

14.2%

5.0%

14.4%

12.6%

11.6%

Effect 6: Limits education rights of girls

21.0%

13.5%

2.0%

2.8%

9.9%

Effect 6: Psychological trauma / painful experience

32.0%

57.0%

49.8%

22.8%

39.9%

Effect 7: May lead to infertility

1.8%

0.0%

0.5%

3.7%

1.6%

Percentage of the population who know at least three effects of FGC Effect 1: Excessive bleeding

% of the population favourable to the continuation of FGC

24.1%

36.5%

28.6%

8.8%

23.7%

% of ever- married women favourable to discontinuation of FGC (stopped)

82%

66.7%

58.8%

65.3%

80.3%

92%

68.0%

80.2%

74.2%

68.3%

80.0%

% of uncircumcised girls favourable to discontinuation of FGC (stopped)

1 2

Kenya Demographic and Health Survey 2008/9; Tanzania Demographic Health Survey (TDHS) 2010

13 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

75.7%

% of self-efficacy by uncircumcised girls to refuse pressure to perform FGC Attitudes towards FGC % of population with perceived social support by girls (and women?) for FGC discontinuation

82%

65.5%

61.0%

64.6%

81.5%

92%

68.3%

% of population reporting FGC to be continued

24.1%

36.5%

26.8%

8.8%

23.7%

% of population reporting abandonment of FGC is conditional (depends/unsure)

9.1%

2.5%

4.5%

5.6%

5.5%

40.1%

3.5%

25.5%

14.2%

4.2%

15.4%

17.2%

49.7%

66.4%

19.3%

17.9%

5.6%

3.5%

20.0%

20.1%

84.5%

94.5%

84.1%

94.0%

87.0%

N/A

35.5%

23%

64.4%

52%

Boys

56.8%

49%

Girls

<=48.7%

< =48.7%

<= 49%

Boys

49.3%

43%

Proportion of morans describing their ideal marriage (potential) partner as educated Proportion of morans describing their ideal marriage (potential) partner as not circumcised Proportion of morans describing their ideal marriage (potential) partner as circumcised The number of morans describing their ideal potential partner as economically stable % of population reporting having heard of messages against female circumcision Proportion of CSOs/FBOs with ARP as common and permanent agenda Number of role models and change agents actively promoting ARP and are recognized by their community leaders % school dropout rate among girls3

Loitokitok & Magadi sites to -

% Primary school completion rate

20.9% 13.5% 38.1% 12.2%

Primary school retention rate disaggregated by gender (enrolment in primary schools)

School transition rate from primary to secondary disaggregated by gender

The figures for the school dropout rate, completion rate, retention rate and transition rate in the project areas were obtained from the respective County Development Profiles published by the Ministry of Devolution and Planning (2013). These figures across the four (4) ARP project areas do not add up to 100% because they are drawn from different Counties / Districts.

14 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Girls

<=49.3%

<= 43%

Number of CSOs actively engaged in Anti FGC campaign

N/A

No of community leaders actively engaged in anti FGC campaign

N/A

% of County Annual budgetary allocation for ARP

None

N/A

County by-laws enacted outlawing all forms of FGC % of schools adopting ARP %

Yes Loitokitok & Magadi sites

15 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Yes

N/A

Recommendations FGC is a multi-faceted problem and therefore should be approached by encouraging participation of all community members through project / area advisory council: The ARP scale up project should target young boys in schools (11-14 years), especially the morans (1130 years), unmarried girls, circumcisers, parents â&#x20AC;&#x201C; both the mothers and fathers, cultural elders, community leaders, local and religious leaders, government officials and political leaders are involved in program design and implementation. While time-consuming, ensuring participation of all from the outset encourages a sense of involvement and ownership at the community level, which can in turn result in the much needed political support at the SubCounty, County and National levels. This can be achieved through the formation of project advisory council both at the Sub-County and County level with representation of young girls the morans and school boys, women, community leaders, religious leaders, political leaders and government officials. The District Advisory Council (Tanzania) and Area Advisory Councils (Kenya) at the County, Sub-County and district, divisional and locational levels will help in the prosecution of child abuse cases. The use of legislative force especially through community child protection systems, such as Area Advisory Councils will help ensure that gender violence cases including FGC are prosecuted, serving as a deterrent force against would be circumcisers at the local level. The ARP Project to develop ARP follow-up and reporting mechanisms on a quarterly basis. The project needs to put in place interventions that will help ARP girls cope with the social pressure that may force such girls submit to FGC practice. Once a girl has graduated through the ARP, there will be need to conduct regular follow-up of ARP-girls, refresher training and counselling on a quarterly basis to keep the fire of ARP burning in such girls until they reach an age where peer pressure doesnâ&#x20AC;&#x2122;t mean much. There is therefore the need for constant follow-up to counsel ARP graduates to cope with ridicule, stigma and discrimination they are likely to face from their peers and the community in general by ensuring that they do not succumb to female circumcision. The suggested follow-up platforms may include ARP girls clubs in schools and churches. Focus on High Impact Community Advocacy campaigns targeting the Morans (18-30 years) and young girls (11-17 years). Changing community cultural attitudes and beliefs on FGC is a resource-intensive, long-term process that may take time before impact is created through continued education and awareness programs. This will require uninterrupted contact with communities to ensure community trust and continued success is sustained. There is therefore the need to develop high impact advocacy interventions targeting the Morans (1830 years) and young girls (11-17 years) as these two groups will ensure real and meaningful change is achieved. Such highly focused social mobilization/campaign strategy should aim at breaking the silence surrounding FGC by producing unified anti-FGC messages that will help change the attitude of morans and young girls towards ARP and marriages to the uncircumcised girls. The project should also develop targeted advocacy plan around the anti FGC activities that will be periodically monitored and reported. The ARP project should therefore advocate for increased community mobilization and advocacy on the negative health and social effects of FGC and its legality. The ARP project should engage the whole community, including the cultural elders, the morans, community leaders (religious leaders, village chiefs, and elders), teachers, womenâ&#x20AC;&#x2122;s groups, peer educators, women, men, boys and girls; local administrators, teachers, church leaders, traditional circumcisers and health professionals to address the retrogressive cultural practices including early marriages and 16 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

moranism. The advocacy component should in addition target the County Governments / District leaders to strengthen the enforcement of the anti-FGC and early marriage laws through arrest, prosecution and punishment of perpetrators. This is because many cases of FGC and early marriages go unreported and many grass root leaders / administrative ignore or sometimes collude in the parents to perpetuate the practice of FGC and early marriages.

Use comprehensive approaches including Creating and strengthening partnerships with local stakeholders, administrators and other actors: FGC is a complex tradition that cannot be successfully addressed in isolation from its socio-cultural, economic, and political implications. Integrated strategies must be designed in collaboration with other agencies including CSOs, FBOs and NGOs with a focus on FGC in order to incorporate reproductive health and sexual rights information, community-based strategies to address poverty and development issues while creating linkages with top policymakers and womenâ&#x20AC;&#x2122;s equity and human rights organizations. Under this component, the project will need to enhance its engagement with the local administrators that include chiefs and their assistants, clan elders who are very influential in the Maasai and Samburu communities. Also to be targeted are the Members of the County Assembly (MCAs), Members of Parliament and other County leaders to publicly denounce the FGC practice within the targeted project areas. Promote Gender Equality and Empower Women and Girls: Such strategies should take the form of awareness creation among the target communities to enhance girl child education, introduction of sanitary program to maintain girls in schools, advocacy for representation of women in leadership, decision making and targeted educational programs on the effects of FGC in a classroom environment. Girls and Boys Education is critical in anti FGC programs: Schools provide an excellent avenue to address the effects of FGC and creating a pool of women who can pass appropriate knowledge / information to their children. Such programs will also encourage young girls and boys including the Morans to reject the practice as they will be exposed to relevant information on the effects of FGC. It is therefore recommended that the Amref health Africa led ARP project should consider working more closely with schools, teachers, school committees, school boards, churches, Morans and building the capacity of teachers to help them overcome social inhibitions to address the negative effects of FGC and early marriages within the school environment and places of worship. This component of the project can be 17 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

enhanced by working with school PTA committees and school board members in addition to offering sponsorship for the needy girls as a way of ensuring the girls remain in school. This is important as a good number of parents may be yet to be convinced that it pays to spend money on girlâ&#x20AC;&#x2122;s education. The use of health risk approach in addressing FGC: Amref health Africa has been working with communities in a number of health programs such as maternal and child health as well as water, sanitation and hygiene. This holistic development approach is strength for bringing behavioural change on FGC to the communities by focusing on interventions using a health risk approach and addressing health complications of FGC. Such programs should target men and young boys specifically through social forums since the men strongly believe in marrying circumcised women/girls. They men should equally be educated on the dangers of the cut and its long term effects on the young girls and women in general. Therefore, there is need to mainstream FGC as a cross-cutting issue in all Amref health Africa programmes in the project areas. Re-orient Traditional Circumcisers to new roles including training to be champions of ARP and anti FGC crusaders: in order to boost the living standards of the community and improve their access to essential commodities such as food and clothing, it is recommended that the social development component of this project focuses on training of traditional circumcisers on attitude change in addition to economic empowerment and integrate them with community action, e.g. in women and prayer groups. This should be done in collaboration with other relevant Government departments. In addition, Amref health Africa should focus the training of traditional circumcisers on attitudinal change in addition to economic empowerment and integrate them with community action, e.g. in women groups. Amref health Africa need to engage with other anti-FGC stakeholders e.g. World Vision, PATH and UNICEF etc and discuss which approaches and methods are found to be most efficient when â&#x20AC;&#x2DC;convertingâ&#x20AC;&#x2122; circumcisers. Use culture specific community entry and advocacy approaches including the use of known community role models. These could be successful, Samburu and Maasai women and girls who have denounced the practice and help convince other young girls to say no to the practice. Also to be encouraged is the use of community radio stations in passing crucial anti FGC messages / campaigns.

18 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION ONE: INTRODUCTION AND METHODOLOGY

1.1 Background Information The Alternative Rite of Passage (ARP) scale-Up project is a three year regional project which commenced from July 2013 and is to end by to June 2016 and is being implemented in Magadi, Loitokitok, and Samburu in Kenya and Kilindi in Tanzania. .The project is funded by the Dutch Postcode Lottery through Amref Health Africa in the Netherlands. The goal of the ARP scale-up project to contribute to the abandonment of Female Genital Cutting (FGC) in Magadi, Loitokitok, Samburu and Kilindi by 2015. Female genital cutting is “the partial or total removal of the female external genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons.”4 It is estimated that more than 130 million girls and women alive today have undergone FGM/C, primarily in Africa and, to a lesser extent, in some countries in the Middle East. Amref health Africa in Kenya working with the Maasai community in Magadi and Loitokitok in Kenya, have succeeded in developing an alternative rite of passage (ARP) to female circumcision that is accepted by the community. It is the reason that Amref Health Africa calls it community-led alternative rite of passage. The ARP is a ceremony that retains the culturally meaningful rituals and eliminates the harmful cut from a girl’s initiation ceremony to adulthood. This ensures that a girl can make the transition to womanhood in good health and is at the same time accepted by the community. The project approach starts with discussion with the cultural elders, since they make the decisions in the pastoralist communities, they must first be convinced of the advantages of eliminating female circumcision. Through this initiative, girls participate in three-day long workshops and go through sexual and reproductive health and rights and life skills education. At the same time elderly women are also train them on important cultural values of womanhood ‘how to handle the husband’. This is very important and promotes their feelings of self-worth, in view of their lower status compared to boys. In addition, much attention focuses on going to school and finishing a programme. The elders, fathers and mothers are encouraged to invest in the girls. The alternative ceremony, therefore, not only fights circumcision but also school dropout and early marriage.

1.2 Purpose of the Baseline Survey The main objective of the survey is to establish the benchmarks on the key outcome indicators of the project. The baseline report is to further provide additional insights into the existing socio cultural, economic and religious contexts promoting the practice of FGC in Magadi, Loitokitok, Samburu and Kilindi.

WHO, UNICEF and UNFPA, Female Genital Mutilation: A joint WHO/UNICEF/UNFPA statement, World Health Organization, Geneva, 2007, pp. 1–2.

19 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

1.3 Baseline Study Objectives The objectives of the ARP baseline study were: 1. Establish the prevailing levels of knowledge, attitude and practices (including socio cultural aspects such as who decides on the cut, when it is done, by whom and why?) within the community with regard to female genital cutting (FGC) and Alternative Rite of Passage (ARP) as its culturally acceptable replacement. 2. Identify the key social cultural barriers (myths, beliefs, norms) that stand in the way of the community and girls in denouncing FGC. 3. Identify the key social cultural enablers on which ARP or anti-FGC campaign would be successfully hinged without unnecessarily antagonizing the culture. 4. Establish the capacity and readiness of local community structures including traditional governance structures, community based organizations, faith based organizations, school health committees and boards to support and promote ARP.

1.4 Study Methodology A combination of qualitative and quantitative data collection approaches were applied in carrying out the ARP baseline. The baseline data was obtained through household interviews with 1,327 respondents consisting of 489 married women aged (15-49) years, 344 men aged 18 years (both morans and adult men) and 489 young girls (10-24 years). The household data was obtained through random selection of households from the sampled clusters. To enhance validity and reliability of the ARP baseline study findings, quantitative data were triangulated with qualitative data generated through FGDs and in-depth interviews with key informants spread across the four project areas of Magadi, Loitokitok, Samburu and Kilindi. 1.4.1 Survey Design Central to the methodology was the cross-sectional cluster survey involving random selection of households across the four project areas of Magadi, Loitokitok, Samburu (all in Kenya) and Kilindi in Tanzania. The study therefore used a sample design that included both ARP clusters and areas where ARP activities were yet to be rolled out. The reason for including clusters was to eliminate biases in the ARP baseline findings. The survey collected data among women of reproductive age groups (15-49 years), young girls (10-24 years) and men aged 18 years and above (consisting of both the morans and adult men). Families with at least one daughter aged between 10 and 24 years were eligible for the baseline because of the extreme young and older ages at which girls get circumcised. The survey sample was drawn from the ARP project areas of Magadi, Loitokitok as areas where ARP had been implemented with a mix of sites where ARP advocacy work were yet to be rolled out. The sampled sites in Samburu and Kilindi project sites were relatively new and therefore needed no differentiation. A total of 1,327 respondents consisting of 494 adult women (15-49 years) in marital unions, 344 men aged 18 years drawn from the households

20 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

while the 489 young unmarried girls aged between 10-24 years were drawn from both the households and schools within the project areas. 1.4.2 Study Sites The Alternative Rite of Passage (ARP) is being implemented in Magadi, Loitokitok, Samburu and Kilindi. The study sites were therefore drawn from Magadi, Loitokitok, Samburu (all in Kenya) and Kilindi District in Tanzania. The distribution of the ARP baseline sample target is summarized in Table 2. Table 2: Distribution of the Baseline Sample by Project Area 5 Project Area Female (15-49 Young Girls Men (18 Total Sample years) (10-24 years) years+) Loitokitok

132

121

341

Magadi

114

122

322

Samburu

121

120

322

Kilindi

127

126

342

Total

494

489

344

1327

1.4.3 Data Collection Data was collected from all study sites through a combination of qualitative and quantitative methods. The data collection for the ARP scale up baseline took place between the 12th to 20th May 2014. Altogether, 34 focus group discussions (FGDs) were held with homogeneous groups of community leaders, elders, adolescent girls and boys (morans), male adults and women in active reproductive ages. In-depth interviews were held with 43 key informants that included community leaders, religious leaders, women leaders, teachers, provincial administrators that included chiefs and their assistants; children officers, police amongst others. In Loitokitok and Magadi project sites, a questionnaire survey was carried out among the clusters where Alternative Rite of Passage (ARP) activities were already being implemented and clusters where ARP were yet to roll-out. The ARP clusters were identified from the locations where Amref health Africa Kenya has already started implementing ARP activities. In total, 508 households were drawn from ARP clusters while 329 households were from clusters in Loitokitok and Magadi that were yet to be reached. For each area, randomly selected, individual confidential interviews were held with: one female (15-49 years) or

The sampled Sites included 1. Samburu: South Horr, Sirata and Suguta; 2. Kilindi: Kibirashi, Kisangasa, Saunyi and Mkindi; 3. Loitokitok: Rombo, Olugulului, Nomayamat; Elangata Engima, Ilntilal, Lenkism and 4. Magadi: Shompole, Ilparakuo, Entasopia, Daraja, Oloika, Entaamo OlKaramatian

21 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

males aged 18 years (morans 18-30 years and adult men 18 years +) were interviewed interchangeably in the sampled households and with one girl aged 10â&#x20AC;&#x201C;24 years where available within the household. This sampling plan resulted in a total of 1,327 individual interviews as illustrated in Table 2. The reason for the unbalanced number of males and females included in the study is that among the pastoralist communities, men are always out in the field or shopping centers leaving their women to be in charge of the homes. Therefore, more mothers were interviewed during the study with eligible girls (10-24 years) drawn from the households and schools. 1.4.4 Household Survey The research team collected primary data using household survey instruments that mirrored the DHS tools FGC section. Household data collection was executed by research assistants recruited from within the four (4) project areas after receiving 2-3 days training in field research ethics, field data collection procedures and questionnaire completion. The questionnaire was administered through face-to-face interviews with 494 eligible women in active reproductive ages (15-49), with 489 young / adolescent girls (between 10-24 years) and 344 adult men aged 18 years and above on FGC related issues in the community. 1.4.5 Key Informant Interviews (KIIs) The consultants carried out interviews with 10 key informants from each project area who possessed vital information on the subject matter. Key informants consisted of CHMT members drawn from MOH staff working in target project areas as well as local opinion leaders that included teachers, women leaders, religious leaders, CBO/NGO officials operating within the project areas, provincial administrators mainly the chiefs and their assistants; children officers, police amongst others. 1.4.6 Focused Group Discussions (FGDs) Thirty four (34) Focus Group Discussions (FGDs) were conducted among the local community members: women, men, youth and adolescents girls and boys on the topical issue of female genital cutting. The participants were chosen purposively and the groups were largely homogeneous in nature. 1.4.7

Data Processing and Analysis

The data collected from households from survey target groups of women (15-49 years), young / adolescent girls (10-24 years) and young and adult men (aged 18 years and above) formed the critical pillars of the ARP Baseline study. As a matter of procedure, other methods of quality checks such as repeat interviews, spot checks, accompanied interviews, retraining and questionnaire editing was done in the field by the supervisors and Research Assistants. The supervisors further checked the questionnaires and validated the data in the field by randomly sampling 20 per cent of the filled questionnaires. After the questionnaires were received from the field, the lead consultants edited all the questionnaires before accepting the team returns. All questionnaires were processed through initial coding of open22 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

ended questions. Thereafter, the data was captured using EPI Info through a data entry screen specially created with checks to ensure accuracy during data entry. All questionnaires were double entered to ensure data quality. Erroneous entries and potential outliers were then verified and corrected appropriately. A total of 5 data entry personnel were engaged during the exercise. The captured data were then exported to Statistical Package for Social Sciences (SPSS) version 20 for cleaning and analysis. The cleaned data was then analysed based on frequency runs and cross-tabulations which assisted in comparing grouped project areas, age characteristics, education and socio-economic variables. The qualitative data were captured and analysed using content analysis. The information gathered through key informant interviews and FGDs were triangulated with household data.

23 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION TWO: ARP BASELINE SAMPLE CHARACTERISTICS

The ARP scale-up project baseline survey on knowledge, attitudes, practices on female circumcision cutting (FGC) and alternative rites of passage (ARP) study report is presented along thematic areas of interest to the project. Under knowledge, attitudes and practices, the areas covered are: knowledge of the female genital cutting, prevalence of the female genital cutting, age at circumcision, attitudes towards circumcision, who performs the cut, who decides on the cut and types of the cut in the communities etc. Also discussed are the key socio-cultural barriers (myths, beliefs, norms) that stand in the way of the community and girls in denouncing FGC.

2.1 Household and Demographic Profile of Respondents Table 3 presents the demographic characteristics of married women respondents (15-49 years), adult men (18 years +) and young girls (10-24 years) not in marital unions. From the table, it is evident that the baseline survey adult respondents were mainly of Maasai (55.9%), Samburu (24.6%), Nguu (9.2%) and Zingua (7.0%) ethnic origins with high levels of illiteracy; none level of education (60.1%, primary level of education 28.6%) among adults and mainly in self-employment (66.9%). The adult respondents ascribed to protestant religion (48.4%), Catholics (28.4%), Muslim (18.6%) and traditional religion (4.5%). Most of the adult respondents (67.4%) were in monogamous unions compared to 25.8% who were in polygamous marriages with 4.4% reporting that they were widowed and divorced/ separated (2.4%). The unmarried young girls (10-24 years) are reported to have only managed primary level of education (42.5%) with another 15.2% reporting to have acquired secondary education. Over half (50.7%) were still at school at the time of the baseline.

24 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Table 3: Characteristics of ARP Adult and Young Respondents Adult Respondents Number of Respondents (Women and men)

n= 837

Project Area

Marital Status

Monogamous marriage

564 (67.4) 216 (25.8%)

Loitokitok

220 (26.3%)

Polygamous marriage

Magadi

200 (23.9%)

Widowed

37 (4.4%)

Samburu

201 (24.0%)

Divorced/ Separated

20 (2.4%)

Kilindi

216 (25.8%)

Gender

Age Grouping

Male

343 (41.0%)

15-19

Female

494 (59.0%)

20-24

111(13.3%)

25-29

153 (18.3%)

Religion

38 (4.6%)

Catholic

238 (28.4%)

30-34

142 (17.0%)

Protestant

405 (48.4%)

35-39

120 (14.4%)

Muslim

156 (18.6%)

40-44

80 (9.6%)

38 (4.5%)

45-49

99 (11.9%)

50+

92 (11.0%)

Traditional/others Education None Pre-Primary Primary

503 (60.1%) 71 (8.5%) 168 (20.1%)

Ethnic Group Maasai

468 (55.9%)

Samburu

206 (24.6%)

Secondary

77 (9.2%)

Nguu

77 (9.2%)

University

10 (1.2%)

Zingua

59 (7.0%)

Others

8 (1.0%)

Sambaa

9 (1.1%)

Kamba

4 (0.5%)

Pare

3 (0.4%)

Main Economic Activity Unemployed

184 (22.0%)

Employed

78 (9.3%)

Kikuyu

2 (0.2%)

Self Employed

560 (66.9)

Others

9 (1.1%)

Young unmarried girls (10-24 years) n=489 Project Area

Age Grouping

Loitokitok

121 (24.7%)

10-14

180 (36.8%)

Magadi

122 (24.9%)

15-19

217(44.4%)

Samburu

120(24.5%)

20-24

92 (18.8%)

Kilindi

126 (25.8%)

Education None

Occupation 9 (2.4%)

Unemployed

97 (20.1%)

Primary

159 (42.5%)

Self employed

89 (18.4%)

Secondary

57 (15.2%)

Farmer

32 (6.6%)

Tertiary / vocational

1(0.3%)

Student

245 (50.7%)

University

6 (1.6%)

Others

20 (4.1%)

Others

142 (38.0%)

25 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION THREE: KNOWLEDGE, ATTITUDES AND PRACTICE OF FEMALE GENITAL CUTTING

3.1 Introduction Female genital cutting (FGC), also known as female circumcision is a common practice in many communities in Africa, Kenya and Tanzania included. In a few societies, the procedure is carried out when a girl is a few weeks or months old (e.g. Eretria, Yemen), while in most others, it occurs later in childhood or at adolescence. In the case of Kenya and Tanzania, FGC is typically part of a community ritual initiation into a womanhood that includes a period of seclusion and education about the rights and duties of a wife.

3.2 Knowledge of Female Genital Cutting (FGC) All the survey respondents: women aged 15-49 and were married, young girls (10-24 years) and adult men (18 years +) were asked about their knowledge on FGC. Overall, the study established that virtually all (97.8%) women aged 15-49 years and adult men 18 years + had heard about FGC. The ARP baseline further reveals that survey respondents irrespective of their gender had heard of female circumcision with higher number of men (98.8%) compared to women (97.8%) reported having heard of this cultural practice compared to 94.9% among young unmarried girls (10-24 years). Table 4 presents survey respondents (general population, women 15-49 years and young girls 10-24 years) knowledge of female circumcision across the four ARP project areas. Table 4: Knowledge of Female Circumcision Ever heard of female circumcision General population (Adult men and women) n=828

Yes

Women (1549 years)

Yes

n = 486 Young girls (10-24 years) n=489

No Yes No

Project Area Loitokitok

Magadi

Samburu

Total Kilindi

218

199

203

819

99.1%

99.5%

99.0%

94.0%

97.8%

0.9%

0.5%

1.0%

6.0%

2.2%

131

113

120

116

480

99.2%

99.1%

99.2%

98.3%

98.9%

0.8%

0.9%

0.8%

1.7%

2.8%

120

121

117

106

464

99.2%

97.5%

84.1%

94.9%

0.8%

0.5%

2.5%

15.9%

5.1%

(KDHS 2009, knowledge of FGC among women 15-49 years= 96%

TDHS 2010, knowledge of FGC among women 15-49 years = 82%)

26 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Across the 4 project areas, knowledge of FGC ranks high in Magadi (99.5%) among adults and 99.2% among adolescents and young girls (10-24 years) followed by Loitokitok (adult men and women 99.1% and young girls 99.2%), Samburu (adult men / women 99.0% and young girls, 97.5%) and Kilindi (adult men/women, 94.0% and young girls, 84.1%).

3.3 Prevalence of Female Genital Cutting in the Project Areas Women and young girls and who reported to have heard of female circumcision were further asked if they had been circumcised. The baseline data reveals that the practice of FGC by individual project area is more prevalent among adult married women in Samburu (96.7%) followed by Loitokitok (96.2%), Magadi (93.8%) and Kilindi (56.5%) while among the young girls 15-24 years are less likely to have been circumcised. The practice of FGC has been established to be more predominant in the Kenya project areas namely Magadi (63.3%), followed by Samburu (50.9%), Loitokitok (39.5%) and least practised in Kilindi of Tanzania at (28.0%). Table 5: Prevalence of Female Circumcision among Women and Girls Ever circumcised

been

Married women (15-49 years)

Yes

Loitokitok

n = 485 Young girls (10-24 years) n = 480

Project Area

Yes No

Magadi

Samburu

Total Kilindi

127

105

116

418

96.2%

93.8%

96.7%

56.5%

85.7%

3.8%

6.3%

3.3%

43.5%

14.3%

217

39.5%

63.3%

50.9%

28.0%

45.2%

263

36.7%

49.1%

72.0%

54.8%

60.5% (KDHS National prevalence of FGC =27%

TDHS National prevalence of FGC =15%)

Overall, Table 5 presents the prevalence of FGC among women in the project areas. It shows that the prevalence of female circumcision in older women 15-49 years (85.7%) is nearly twice as high when compared to the practice of FGC among young unmarried girls 10-24 years (45.2%) in the project areas.

27 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

The study also analysed the prevalence of FGC among the young girls by age category and project area. Table 6 shows that the proportion of young girls circumcised increases with age 10-14 years (20.8%), 15-19 years (59.0%) and 20-24 years (60.7%). Table 6: Prevalence of Female Circumcision among Young Girls by Project Area Ever circumcised 10-14 years

been Loitokitok Yes No

15-19 years

Yes No

20-24 years)

Project Area

Yes No

Total

Magadi

Samburu

Kilindi

15.1%

38.9%

19.6%

14.0%

20.8%

141

84.9%

61.1%

80.4%

86.0%

79.2%

125

55.8%

79.6%

64.2%

35.8%

59.0%

44.2%

20.4%

35.8%

64.2%

41.0%

69.2%

63.3%

94.1%

34.5%

60.7%

30.8%

36.7%

5.9%

65.5%

39.3%

The high prevalence of FGC in the project areas were confirmed by a number of KIIs. According to the Chief of Lenkism Location in Loitokitok, “there is high prevalence of FGC in Lenkism area especially girls aged 9-13 years. He goes ahead and states that about 95% of households still circumcise their girls with the most common type being cliteridectomy”. The KII reported that FGC is performed by traditional circumcisers and particularly done in secret in an enclosed household because the community fears the law. “The public ceremonies conducted in the past are no longer there but when there is a traditional wedding or male circumcision, the community members tend to hide and combine such occasions with circumcisions for girls too”. In Kilindi, the District Education Officer confirmed the high levels of FGC in the community. “FGC is widespread in the district especially among the pastoral communities; it is actually a condition for a girl to get married. Parents and the community at large are responsible for the decision and determine when the rite is to be done and to who. The practice is done secretly and they use knives and razor blades”. In Samburu, the high prevalence of FGC was confirmed by health care providers (HCP) working within the facilities. One such health worker observed “I would say that the prevalence of FGC is about 90% for the older mothers but for the younger ages 8-24, it may be a little bit lower because some of them have not reached the age of marriage. But nowadays they are doing it even before they get a marriage proposal. I see that from the many teenage pregnancies I attend to at the facility. A girl cannot give birth before she is cut. It is totally unacceptable among the Samburu community”. Cross analysis of the ever circumcised by age indicate that FGC is quite high in higher age groups (married women) compared to younger ages (see Table 7). This is good news for the 28 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

ARP project as this cultural practice is becoming less common / is on the decline among younger women from the project areas. The probable reasons for the actual decline in the practice could be due to a number of reasons ranging from the ARP advocacy work already being implemented in Loitokitok and Magadi or due to the fact that the FGC practice is prohibited by law in the two countries (Tanzanian Special Provision Act of 1998 amendment to the penal code, specifically prohibits FGC, NBL 1998 while in Kenya, the Children’s Act of 2001 outlaws FGC). Table 7: Prevalence of Female Circumcision by Age Ever been circumcised by age Married women (1549 years)

Years 10-14

20-24

25-29

83.3%

85.7%

88.9%

83.3%

79.7%

84.8%

93.4%

16.7%

14.3%

11.1%

16.7%

20.3%

15.2%

6.6%

125

20.8%

59.0%

60.7%

141

79.2%

41.0%

39.3%

Yes No

n = 485 Young girls (10-24 years) n = 480

Yes No

15-19

Total

30-34

35-39

40-44

45-49 417 85.7% 69 14.3% 217 45.2% 263 54.8%

Table 7 shows that FGC prevalence is high among married women and increases with age as evident in comparing data among young girls and married women in the ARP project areas. When asked whether they felt the practice was still prevalent in their respective communities, participants in the focus group discussions and key informant interviews indicated the converse revealing that FGC is still widespread within the project areas with the practice being done very early in the life of young girls when they cannot protest and also to conceal the practice from law enforcers. FGD participant with young boys (18-24 years) in Elarai, Kilindi revealed that “Girls in this community must be circumcised. Some are circumcised at early ages 10-15 and immediately after the cut are considered ready for marriage if they are not at school”. A similar situation was reported among the Maasai interviewed in Magadi and Loitokitok where it was reported that FGC is still prevalent but done secretly especially during school holidays deep in the bushes or across the border in Tanzania.

3.4 Attitudes and Practice of Female Genital Cutting: The cultural meaning and Reasons for Practicing of FGC There are striking similarities and differences in the meaning and importance attached to the practice of FGC among the different ethnic communities represented in the ARP baseline. The ARP focus group discussions, key informants and survey respondents gave a multiplicity of reasons why FGC is practised in their communities and their personal views regarding the practice. Analysis of survey responses indicates differences between women, and men; community and religion; the old and young girls and boys, and some differences between ethnic groups. 29 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

When asked whether the practice is required by their communities, 39.2% of the adult respondents (women 40.0%, men 38.1% and young girls 22.2%) believe that the practice is required by their communities while 58.2% reported to the contrary with another 2.4% who reported lacking knowledge of why the FGC practice within the community. By ARP project area, Magadi (52.0%), the Samburu (48.5%), Loitokitok (35.9%) and communities in Kilindi (22.2%) were of the opinion that the FGC practice is required by their communities. The adult respondents who mentioned that the practice is required and should be continued indicated that FGC is for preservation of their cultural practice / tradition: Loitokitok (96.1%), Magadi (92.9%), Samburu (92.3%) and Kilindi (88.9%). According to a cultural elder from Elanga’ta in Loitokitok “female circumcision is tradition among the Maasai that is done because we found it and it is part of our culture, in addition, socially for the girl to get ready for marriage so that the family could get wealth and culturally to get cows. It makes young girls feel like an adult. For religious reasons, he believed that those brave girls should make a sound/cry so that they could save boys / their brothers from death”. The baseline reveals that the target communities are still locked in this enduring practice due to deeply held cultural, social and at times, political significance. The cultural significance of FGC is the most important reason why girls and women get circumcised followed by its ability to improve marriage prospects among girls across all the four targeted project areas. Limiting a woman’s sexual desire, prevents immorality and observed as a rite into adulthood were also mentioned, but by only small proportions of respondents, suggesting that these reasons are not predominant in their cultures. There are significant differences between the four project areas. Preservation of custom and tradition is particularly strong among the Maasai in Loitokitok, Magadi and among the Samburu communities while in Kilindi, it is only among the pastoral Maasai that continue to put much emphasis on FGC as a prerequisite for marriage or as a rite of passage. The Maasai groups appear to be more concerned with circumcising a girl to make her eligible for marriage.

3.5 Age at Circumcision Figure 1 indicates that there is a slight variation at the median ages at which circumcision is performed in the ARP project areas. The ages at which the mothers in the project areas underwent through circumcision are as follows Loitokitok 14 years, Samburu and Kilindi (15 years each) and Magadi (16 years). Compared to their daughters, there is a slight variation as depicted by the trend lines across the four project sites with the baseline data indicating that there has been a significant drop in ages of circumcision in Kilindi from 15 years to 10 while it has increased in Magadi from 16 years for the mothers to 18 years for their daughters. The data further reveals that the age for circumcision in Magadi area ranges from 13 to 18 years while the age at circumcision in Loitokitok and Samburu has remained the same for mothers and daughters at 14 and 15 years respectively. The reasons given for the early age of cutting for girls in Kilindi was best captured by KII working for Ereeto Maasai Youth. He observed 30 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

“the cut is done early at childhood by about age 5 years. At this age, the young girls cannot protest against the cut and law enforcers are unable to detect its occurrence when done early and also the child cannot report. This is done early with only the knowledge of the mother” Most KIIs indicated that once a girl has attained puberty (9-13 years), their communities would see such girls as being permissible to start sexual life and therefore ready for marriage. The median age of circumcision is 5 years lower in Kilindi compared to aggregate project areas median age of circumcision (15 years). The baseline data therefore point to very younger ages of circumcision and by implication ages of marriage and risky sexual behaviours these young girls are exposed to as FGC is a precursor for early and forced marriages in the targeted communities. In these communities, adulthood is not only determined by biological age but by the rites of passage from childhood to adulthood, which from a community perspective automatically translate into marriage, irrespective of the biological age of the girl. The risky situation for these girls is made worse by the morans who upon beading the young innocent girls are culturally accepted to have unprotected sex with the young girls in a special hut called singira as is the case Samburu as summarized by a young Samburu girl in school during FGD “Beading of the girls is done by the Moraans where the beaded girls are required to sexually service the Moraans at any time without getting pregnant. Promotion of these sexual activities is usually encouraged with the girls of the same clan and different clans. Mothers also encourage the girl by constructing for them a different hut called singira.” Figure 1: Median Age at Circumcision for Mothers and Daughters

According to FGD respondents in Kilindi, “Girls in the community are circumcised early at age 5 years with only the knowledge of the mother and yet circumcision ceremony is done at a later date, at age 9-13 years. The girls could be attending ARP ceremonies but are already

31 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

circumcised. Some women get circumcised at delivery. A sheep is then slaughtered and lady is given oil from the sheep as medicine. This fat stops pain, bleeding and enhances healing.

3.6 Who Decides on the Cut When asked to mention, who decides on the cut, the ARP baseline qualitative data indicate that there are some important differences in decision-making between the sites. Among the Maasai in Loitokitok and Magadi, it is clearly a decision made by the parents mainly the mothers in consultation with the fathers but in some cases the girls too would initiate the process for the cut. In both Loitokitok and Magadi “It is the mother who decides when a girl should be circumcised but she has to discuss this with the father of the girl. Cultural elders may only influence by attending and ensuring that the steps are followed carefully”. Cultural Elders FGD participant in Loitokitok. This was further confirmed by respondents in Magadi who stated that “In a number of cases, the prospective candidates (young girl) would prompt her parents with the request to be circumcised when they realize that their age mates are getting initiated. Through ordinary social interactions, the girls are normally prepared psychologically to expect the ritual when they come of age. In most cases however, it is the parents who initiate the process. Even in cases where the girls request for the cut, they would ordinarily discuss it with their mothers first, who would in turn carry the agenda forward to the father”. KII, from Entasopia in Magadi with another KII from the same locality reporting that “generally, the decision to make is “when” and not “if” the cut is to be procured as it is already part of the culture. Since it is already stuck in the minds of the community that FGC signifies a transition to maturity, it is not uncommon to find the girls themselves seeking to be operated”. Among the Samburu it became apparent from the focus group discussions and KIIs among the Samburu, it is a decision made mainly by the fathers. “Usually the person who decides when it is done is the father. The mother’s activity regarding the circumcision is only to prepare the requirements like the skin, calling the circumciser and rebuilding the home to fit the bed and also the ceremonial event” KII, the Assistant Chief, Sirata in Samburu. “There are two possibilities, maybe a man can be interested in a girl and approaches the parents and usually the first thing they ask is whether she is circumcised or not. They will then discuss the dowry and arrange for the circumcision because we believe that the girl cannot be a complete wife without circumcision. The other possibility is that the girl will become big or older without being married and the parents fear that she may get pregnant any time so they decide to have the cut done because it is a curse to be pregnant without being circumcised and the final word rests with the Mzee, father of the girl”. Observed the Assistant Chief of South Horr. Further, among the Samburu the girls may also bow to peer pressure and opt to be cut “Some girls opt for it for fear of intimidation and peer pressure especially those in the rural areas”. Among the Samburu, the Moraans and young girls are culturally accepted to have sex upon beading. “Among the Samburu community, having multiple sexual partners among the non-married and married people is a common practice. A married woman with extra-marital affair is referred as sintani and sex between morans and young girls is just something accepted so it is not a big deal but the young girls are not expected to get pregnant and for them to avoid getting a curse, they therefore opt for circumcision”, observed KII working with SAIDIA in Lesirkan. This signifies the social contradictions that allow young men to have sex and yet condemns pre-marital pregnancies. Among the pastoralist communities in Kilindi, it is the parents and elders who make the decision on the cut.

32 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

In Kilindi, it is mainly the mothers who decide on the cut. FGD with mothers (30-49 years) in Kibirashi revealed that “FGC has to be practised because it is part of our culture of the Nguu, Zigua and Maasai. Mothers are the key decision makers on the cut. We believe that if one is not circumcised, the parents can die. Girls who are not circumcised are referred as Kigoli – a child and men are discouraged from marrying such girls. If a girl passes the age, then the community put pressure on such girls to be circumcised. If one goes ahead and marry such women, they are told to return the child to the parents”. The person who decides on the circumcision in Kilindi were further confirmed during an FGD with young men in Mkindi, “Mama ndiye anayefanya maamuzi ya kukeketa binti baada ya kuona binti amevunja ungo – the mother of young girl makes the decision on when to cut the girl upon attain appropriate age” Young Male FGD participant, Mkindi

3.7 Who Performs the Procedure Across all four ARP project sites groups, nearly all the mothers (97.8%) who had been cut reported that a traditional circumciser had performed the rite with a similar percentage (98%) reporting that their daughters had been circumcised by the traditional circumcisers.

Table 8: Percentage of Mothers Reporting who Performed Circumcision among themselves and daughters by Project Area Who performed the circumcision Traditional circumciser

Mothers Daughters

ARP Project area Loitokitok

Magadi

Total

Samburu

Kilindi

123

104

115

409

97.6%

98.1%

96.6%

100%

97.8%

205

100.0%

96.2%

98.1%

100.0%

98.3%

Among the Samburu, circumcision is normally done by an expert woman whom they call the ‘Nkakitori’. “This woman is old and has reached the age of not giving birth anymore i.e. menopause. This woman must come from a poor family and hence this is why there is a tradition of giving her some items in return” KII, Assistant Chief, Sirata, Samburu. In Magadi, it emerged that the circumcisers are not any ordinary women, but a select few who acquire the skills through natural endowment. In Kilindi, FGC is normally done by the traditional circumcisers at a fee of Tshs. 2000. “A traditional circumciser is paid for this act after she has circumcised the girls, usually in the afternoon.” Male FGD participant in Mkindi, Kilindi It is only in a few cases where mothers indicated (2.1%) being circumcised by trained medical staff or their daughters circumcised by medical staff (1.7%) confirming to a small extent the medicalization of the practice as reported by mothers during FGDs who indicated that there are cases where uncircumcised women seeking delivery services within the health facilities have been circumcised by the medical staff just before birth. This was particularly the case in Loitokitok, Magadi and Samburu project areas.

33 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

3.8 Where and When the Procedure is performed The place for circumcision varied slightly by project site for both mothers and daughters but the majority of the mothers and young girls in Loitokitok (mothers, 97.6% and girls 97.8%), Magadi ( mothers, 98.1%, 97.3%), Samburu (mothers, 100%, girls 98.3%) and Kilindi (mothers, 87.1% and girls, 87.9%) were cut within their homestead (household) with a significant proportion (12.9%) of the mothers in Kilindi indicated that they were cut in “secluded places in the bush” possibly to avoid confrontation with law enforcers since the practice is illegal in both Tanzania and Kenya. Young girls in Kilindi (12.1%) also reported to have been cut in the bush. “FGC is done in the bush where parents decide on the time and date of circumcision, usually during the time of harvest in August to October”. Young girl discussant, Kilindi. In Loitokitok, to avoid being arrested, a few parents were reported to prefer taking their young daughters across the border in Tanzania for circumcision.

Table 9: Percentage of Women and Place where FGC was performed Where the circumcision procedure performed (married women) Place Individual homestead Secluded place bush Health facility Total Young girls (10-24) Individual homestead Secluded place - bush Health facility Across the border (Tz/Ke) Total

Loitokitok

ARP Project area Magadi Samburu

Total Kilindi

122 97.6% 1 0.8%

104 98.1% 0 0.0%

119 100.0% 0 0.0%

61 87.6% 9 12.9%

406 96.7% 10 2.4%

2 1.6% 125 100.0%

2 1.9% 106 100.0%

0 0.0% 119 100.0%

0 0.0% 70 100.0%

4 1.0% 420 100.0%

45 97.8% 0 0.0% 0 0.0% 1 2.2% 46 100.0%

72 97.3% 0 0.0% 2 2.7% 0 0.0% 74 100.0%

58 98.3% 1 1.7% 0 0.0% 0 0.0% 59 100.0%

29 87.9% 4 12.1% 0 0.0% 0 0.0% 33 100.0%

204 96.2% 5 2.4% 2 0.9% 1 0.5% 212 100.0

The ARP baseline reveals that circumcision among the Maasai is largely done within the household “Circumcision in this community is done inside individual household within the homestead or near the door of the house within the Boma. During circumcision period, the circumcisers are given fats of the slaughtered sheep or goats or at times given sheep or goat to make them happy of the activity performed. The circumcised girls are also given gifts by their parents and friends if they do not shout during the cutting of their genitals”. FGD with young mothers, Maa Community – Loitokitok.

34 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

KII within Magadi project area gave a narrative account of where and when the FGC procedure is performed. “Each parent has a role to play in ensuring their daughters are circumcised. Since the ritual is also associated with cost implications, it is the duty of the father to mobilize the necessary resources. The mother also fulfils her part of the arrangements such as preparing the candidate and identifying a woman circumciser. An appointment is fixed only when all preparatory arrangements are complete. The initiates are operated separately (not in a group) in their parents’ homestead, and specifically in the same hut that they use for sleeping. This is because they get physically immobilized after the procedure and must be close to their bed. For girls, there are no specific seasons for initiation. Initially, circumcisers used to operate with a single tool which they used at different times on different candidates. The tool was a copper metal which was sharpened in a very special way. With the emergence of contagious infections such as HIV, circumcisers have resorted to using a different blade for each candidate. With the criminalization of the practice through the Children’s Act of 2001, it is speculated that some ardent parents make secret plans to procure the cut in discrete locations. In Kilindi young girls in Elaria detailed the procedure of the practice. “FGC is done within the girls’ home where traditional circumciser is invited to conduct the procedure which is done in the morning hours (9-10am). Previously, the procedure was done inside the house but currently done outside the house. During such occasion, a bull or a sheep is slaughtered and part of it is given to the circumciser ‘Ngariba’. In addition, members of the community are invited for the celebrations which involve dance, singing and eating. The practices involve the cutting of the genital part of the girl and mainly a razor blade is used”. According to the Assistant Chief of Pakaase Sub-Location, in Magadi “the procedure is conducted by traditional circumcisers within the homestead of the girls’ parents. The circumcisers must be women of a respectable age, usually 40+ years. In the distant past, the cut took the form of scooping a sizable chunk of flesh from the girl’s genital organ. This has gradually become unpopular, and majority of initiates now go for just a small cut”.

From both qualitative and quantitative data, it is evident that to a small extent in Loitokitok, Magadi and Samburu, circumcision at times take place within the health facilities. This clearly demonstrates that the procedure is not only being practised at health facilities contrary to Ministry of Health policy, but also that health staff are privately providing this service at families’ homes. For the Samburu, the circumcision procedure is always performed at home. It is done at dawn in front of the mother’s house or the left/right side of the house depending on the clan. KII, Sirata Samburu. “Sometimes when the daughter is small she sleeps in the mother’s house but when they reach a certain age, and they begin being courted “beaded” by the Moraans, then the mother constructs for her a special house called “singira” where she can sleep and have unprotected sex with the Moraans. Once a girl has been beaded and the mother built her the singira which is just a few meters away from her manyatta, the Morans can then sneak in anytime at night for unprotected sex with the young girl”. KII Lesirkan, Samburu. “The circumcision procedure is usually done within the homestead and the mother’s house may be modified or a new house may be built in the homestead with a special bed. And they put some

35 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

twigs and the intestines of the slaughtered goat on the roof of the house to show that there is a ceremony going on there”. KII, Religious leader, South Horr, Samburu In Kilindi, it was reported that old women and or traditional circumcisers / birth attendants perform the procedure at the home of the girl or within their own homes. “The procedure is performed among young girls between the ages of 13-15. The practice is designed to correspond with the beginning of the menstrual cycle in girls”. Women leader, Jitegemee Women Group, Kilindi. In Kilindi, to prepare young girls for circumcision it was reported that such girls would stay in doors for seven days. “A girl would stay inside the house for seven days in readiness for circumcision followed by a traditional ceremony where women would cook food, feast, sing and dance to the tune of drums. During this period, the girl would be given gifts and also taught on how to live with a man” KII Kilindi

3.9 The Type of Circumcision Practiced by the Communities The World Health Organization (WHO) groups FGC into four types6: 1. Excision of the prepuce (the fold of skin surrounding the clitoris), with or without excision of part or the entire clitoris. 2. Excision of the clitoris with partial or total excision of the labia minora [the smaller inner folds of the vulva 3. Excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening (infibulation). 4. Unclassified, which includes pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the opening of the vagina (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or to tighten or narrow the vagina; and any other procedure that can be included in the definition of female genital mutilation There is no denying it: cutting away the clitoris and labia in young girls and stitching up a large part of the vagina is simply traumatic. Not only is it very painful but it can also unnecessarily cause death of a mother and a child during delivery. Genital mutilation of girls is prohibited by law in practically all countries - Kenya and Tanzania included. Nevertheless, FGC it is still part of the rites of passage from girl to woman in nomadic communities. Asked what form of female circumcision they faced, majority (95.6%) of the women in the ARP project areas reported that they had flesh removed from the genital area with only 4.4% reporting otherwise. Of the 4.4% who indicated that flesh was not removed, 37.3% indicated

WHO website hhp://www.who.int/topic/female_genital_mutilation/en/

36 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

that the genital area was just nicked with another 62.7% reporting that they don’t know what was done. In Samburu, the baseline established that circumcision type practised in the area is type 2. “The one they do here is the one referred as type 2. The one that many try to do nowadays is just cutting a bit, the one they called suna”. KII, Children’s Officer, Baragoi, Samburu. Another KII in Samburu observed “They go to the extent of cutting the labia and this causes a lot of birth complications. They just want to hide behind the culture and they do not bring the girl to hospital if there is a problem. Even if the girl is an outsider, she must undergo the cut when she goes to give birth at the TBA. It is just a practice that is engrained in the culture”. Observed the KII, District Officer, Samburu Central. A small proportion (4.5%) of women in the project area reported that they faced the worst invasive form of the operation in which “the labia is removed and sewn closed as practised among the Muslim women” Observed KII, Muslim Religious leader in Kilindi but according to the Medical Officer of Health in Kilindi, FGC is still prevalent in the community. “Two types of FGC are practiced in the community, one involves the removal of the clitoris and the labia minora and the other is clitoridectomy. Women especially old women perform the operation on the girls. The practice is carried out in secret places with the use of two common tools, razor blades and knives”. The ARP baseline established that the type of circumcision could be changing in the communities: “Of late, some families have opted for the partial type, only removing the clitoris while in rural areas they still do the old harmful way of cutting everything i.e. removal of the clitoris together with part or all of the labia minora”. Observed woman KII in Loosuk, Samburu. Another KII observed: “Nowadays they cut very little, just the clitoris because the law changed and they have been educated a little on the effect of FGC. And they do it to the girls at the age of 12 or 14. It is done because this is Samburu culture and it is done in a rush to prevent pregnancy before the cut”.

3.10 Instruments used for the cut Among the mothers, for whom nearly 9 in 10 have been cut in Loitokitok, Magadi and Samburu and 5 in 10 in Kilindi by a traditional circumciser, most of them were cut with a special sharp Maasai knife known as an “Ormurunya”. Until recently among the Maasai in Loitokitok, Magadi and Kilindi, all young girls of ages 10-15 would undergo through the procedure using the same sharp instrument / knife known as an “Ormurunya”, after which a paste made from cow dung and milk fat is to be applied to stop bleeding. Among the Samburu, “a sharp knife called ‘Mpaiyi’ but currently they purchase a razor blades for the procedure”. This finding gives further evidence of a trend towards looking for safer ways of performing the procedure.

3.11 Effects of Female Circumcision Generally, the risks and complications associated with Types I, II and III of FGC are similar, but they tend to be significantly more severe and prevalent the more extensive the procedure is. The Immediate consequences include severe pain and psychological trauma, bleeding, shock, infections, and in some instances death. The long-term consequences can include 37 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

chronic pain, infections, keloid scarring, cyst formation, clitoral neuroma, decreased sexual enjoyment, and psychological consequences like posttraumatic stress disorder. A key informant in Samburu who had undergone summed the effects of FGC as follows “Those who have not undergone the cut are physically stronger and can do more strenuous work. You are prone to back ache and weakness all the time. Like myself I had to be rushed to hospital because of over bleeding.” ARP baseline respondents were also asked the health, psychological and social problems / effects of female circumcision. Overall, the proportion of community members who reported knowing at least three effects of FGC by project areas were 20.2% distributed as follows: Loitokitok (22.1%), Magadi (20.2%), Samburu (19.4%) and Kilindi (19.1%). At individual level, the effects of FGC were mentioned as follows; excessive bleeding 61.9%, painful personal experiences (39.9%), death (30.1%), difficulty in giving birth (17.4%), prevents sexual satisfaction (13.9%), has lost its significance (12.7%), don’t know (11.6%), limits education rights of girls (9.9%), psychological trauma (9.7%), against the religion (6.3%), against human rights and dignity for women (4.2%), stigma and discrimination / ridicule by peers (3.8%) and may lead to infertility (1.6%). Figure 2: Proportion of Community Members Reporting Knowing Effects of Female Circumcision

By project area, the ARP baseline findings were as follows: excessive bleeding (Magadi, 77.5%, Samburu 65.7%, Loitokitok 56.6% and Kilindi 49.3%), painful personal experiences (Magadi, 57.0%, Samburu, 49.8%, Loitokitok and 32%, Kilindi, 22.8%), death (Kilindi, 42.8%, Loitokitok 36.1%, Magadi, 22.5% and Samburu, 17.4%), difficulty in giving birth (Kilindi, 28.8%, Samburu, 22.9%, Magadi, 15% and Loitokitok, 3.2%), prevents sexual satisfaction (Samburu, 21.4%, Kilindi, 17.7%, Magadi, 9.5% and Loitokitok 7.3%), has lost its significance in the community (Loitokitok 22.8%, Samburu, Kilindi and Magadi all at 9%) and those reporting lack of knowledge in FGC effects (Samburu, 14.4%, Loitokitok, 14.2%, 38 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Kilindi, 12.6% and Magadi, 5.0%). Other significance findings on the effect is the proportion of FGC is the low proportions of community members reporting that the cut limits girls education (Kilindi, 2.8% and Samburu, 2.0%) compared to Loitokitok and Magadi at 21% and 13.5% respectively. Most of the key informants who were involved in the study from the four ARP project areas confirmed that FGC is a bad tradition. They have never heard of any sound justification for it. The Kilindi MoH reported that “FGC is a bad tradition because of all its adverse effects on the girl, these include: physical pain and psychological trauma, infection and difficulty during delivery, third degree tear of the perineum and fistula”. The KII (MOH, Kilindi) summarized the effects of FGC as follows;  risk of birth complications  urinary tract infections  chronic lower back pain  risk of infection  Can lead to death  disruption of school programme / school drop out  premature engagement in sex  premature marriages  the risk of rapture during birth  reduced sexual pleasure  danger of infection  unnecessary costs  unjustifiable suffering during the procedure and the healing period “Young girls are often traumatised after undergoing FGC, but many tend to remain silent because it is a cultural taboo for one to speak about sexual issues in the community,” explains KII, Teacher who is also a counsellor in Kilindi.

3.12 Attitudes towards Female Circumcision (Continued/Stopped) Women and men sampled in the baseline who had heard of female circumcision were asked if they thought the practice should be continued or discontinued. Surprisingly, majority of respondents 68.3% want FGC discontinued compared to a quarter of the respondents (23.7%) who want the practice to be continued with 5.5% who expressed conditional approval (depends / not sure) with another 2.4% who were unsure (don’t know) of their opinion (Table 10)7. The ARP Baseline findings were also compared with the latest Demographic and Health Survey (DHS) in both Kenya and Tanzania. In Tanzania, the TDHS 2010 indicates that

It is worth noting that FGC is illegal in both Tanzania and Kenya. The two Governments position on FGC could have influenced the respondents’ attitudes towards the discontinuation / abandonment of FGC. When compared to KDHS (2008-09) and TDHS (2010) the Baseline findings summarized above on the practice of FGC to be continued, stopped or unsure are therefore considered to represent the same trend as in the latest KDHS and TDHS reports.

39 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

among the Tanzanian women who had heard of female circumcision, 92% think that the practice should be discontinued. Only a small minority (6%), believe the practice should be continued, and 2% of women expressed conditional approval or were unsure of their opinion. The situation is not any different in Kenya. More than 4 in 5 women believe that female circumcision should be stopped (82%); only 9% feel it should be continued and 4% are unsure. Table 10: Community Attitudes towards Female Circumcision Should FGC be stopped or continued Continued Stopped Depends Donâ&#x20AC;&#x2122;t Know Total

ARP Project area Loitokitok

Magadi

Total

Samburu

Kilindi

198

24.1%

36.5%

28.6%

8.8%

23.7%

144

122

128

176

570

65.5%

61.0%

64.6%

81.5%

68.3%

9.1%

2.5%

4.5%

5.6%

5.5%

1.4%

0.0%

4.0%

4.2%

2.4%

220

200

199

219

838

100.0%

The proportion of the respondents who say that female circumcision should continue are mainly those in Magadi (36.5%), Samburu (28.6%) and Loitokitok (24.1%) and those in the older ages from 40+ years and those who advocates for the discontinuation of are mainly in Kilindi and Loitokitok at 81.5% and 65.5% respectively and those in the lower age groups 15-19 years (76.3%) compared to the older ages 45+ (58%). Interestingly, there is no significant variation in the proportion of community members who want this practice stopped by gender, male (68.8%) and female (68%) and those reporting to be continued by gender male (23.9%) and female (23.6%) as summarized Figure 3. Figure 3: Attitudes towards Female Circumcision by Gender

40 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

For discontinuation of FGC, a cultural elder from Loitokitok recommended for leaders support and stakeholders partnership including chiefs, religious leaders, NGOs to sensitize people on anti-FGC and ARP. He also mentioned the important role played by political leaders such as MCAs, area MP, elders, Governor in sensitizing the community using their forums because he believes they have an impact to the people. Finally, he says, the entry point to end FGC should be through the community leaders and elders since the practice is mainly cultural, women, the morans, young boys and religious leaders, hence the need first for advocacy and sensitization of harmful effects of FGC and be made aware that FGC contravenes several basic rights of women and girls, including right to liberty and the right to be free from inhuman degrading treatment. The political leaders in the project areas should advocate for elimination of harmful traditional practices such as FGC.

41 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION FOUR: SOCIAL CULTURAL BARRIERS IN DENOUNCING FEMALE CIRCUMCISION

This section of the report discusses the key social cultural barriers (myths, beliefs, norms) that stand in the way of the community and girls in denouncing FGC. The practice of FGC derives from varied and complex belief systems and rituals surrounding women’s fertility and control of their sexuality in traditional male dominated societies. The reasons given by communities that practise FGC vary widely but a common reason given for the practice is its cultural significance. An in-depth analysis of the key informant interviews (KIIs) and focus group discussions (FGDs) by the consultants provides a more in-depth understanding of the cultural meaning and significance (myths, beliefs and norms) of FGC among communities in the ARP project areas. These include;

4.1 Cultural Acceptance, Identity, Blessings and Status Cultural Acceptance, Identity, Status and blessings to young girls: Circumcision was and still continues to be a requirement for a girl to be considered a woman by members of the ethnic groups mainly by the Samburu and the Maasai both in Kenya and Tanzania. “It is done for cultural acceptance, confer a sense of belonging and preserve the community’s culture”. This view is particularly strong among the Samburu and Maasai who hold that circumcision is a mark that distinguishes a girl from a woman. Therefore to be uncircumcised among the Samburu and Maasai is a shame and the uncircumcised girls are subjected to ridicule and abuse. “You cannot get married if you have not been circumcised and you cannot make a good wife if you don’t get the cut. Moraans will laugh at one who has married an uncircumcised girl! The Morans refers to the uncircumcised women as outcast which is abusive. If you are circumcised your husband will have a voice in the community and the uncircumcised women and their husbands remain voiceless” observed the District Officer, Samburu Central. Among the Maasai, “during circumcision, the cultural elders give their blessings to the circumcised girls. The elders will encourage their sons to marry the circumcised girls and to stop marrying from other tribes who are uncircumcised”. FGD by Cultural Elders, Loitokitok FGC confers social status in women where they are given blessings after undergoing the cut and their families honoured. Across the four project areas, “Some of the social reasons for promoting this practice have deep roots in the culture. The Samburu community believes that they must maintain their culture by practising FGC and the family believes that they must complete the needed cultural practice in order to receive communal blessings” observed women leader, Loosuk, Maralaal, Samburu.

42 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Another KII is Samburu observed that FGC is “a rite of passage and marks the graduation from childhood to adulthood. It also enabled them to get husbands and be accepted in the community” Samburu Cultural Elders, Nomanyana.

Among the Samburu, “the Moraans, don’t want to marry an uncircumcised girl and those who move to other places and get married, when they come back even if it is after 10 years with children and the wife is not circumcised then she must undergo the cut for her to be accepted and allowed to enter the home”. AIC Religious leader, South Horr Samburu.

4.2 Gives women the certificate to marry, have sex and procreate Female genital mutilation / cutting (FGC) is viewed by communities in the ARP project areas as a rite of passage from girlhood to womanhood. It is seen as critical and positive component in preparing the female for marriage, sex and childbearing as well as giving important recognition among one’s peers and community members. The adult status gained through undergoing FGC allows young women to participate in adult privileges, duties, and responsibilities such as marriage, sex and procreation. Both the Samburu and Maasai ethnic groups traditionally follow the cutting with a period of seclusion during which a girl recovering from FGC is taught communal knowledge on sexuality, procreation, and how to relate with and treat a husband and his peers. In addition, the shedding of the blood has spiritual implications that make it right for a girl to conceive and procreate. Traditionally, the Maasai had a belief that an uncircumcised girl has unclean blood, which needs to be removed through the cutting of part of the genitalia. Still among the Maasai, a child born of or conceived by an uncircumcised girl is considered to be ritually unclean or outcast and cannot participate in some cultural events. Such children are stigmatised throughout their life and treated as outcasts even within their own families. Among the Samburu, babies conceived by uncircumcised young girls are considered “unwanted” or outcasts because they are born by children (uncircumcised girls). To avoid the bad omen, such babies are thrown into the forests to be mauled by wild animals while their uncircumcised mothers are forced to perform abortions. “We have rescued many babies born of uncircumcised girls because the culture here is that such a baby cannot live. They either squeeze the ladies stomach until it comes out (abortion) and if it survives they force tobacco in the mouth…they don’t allow it to live!” Children’s Officer Samburu

4.3 Female Circumcision confers better marriage prospects in girls Among the pastoralist communities, it is believed that FGC confers better marriage prospects in girls: The FGC practice enhances a girls marriage prospects. Across all the four ARP project sites, the baseline established that FGC is considered a prerequisite for marriage in. The ‘bride price’ paid in kind in the form of cattle is part of the marriage transaction in the local communities and is generally paid by the groom’s family to the family of the bride. This may not be paid if the bride has not undergone FGC or the number of animals paid in kind would just be too few. Moreover, family ‘honour’ is ruined in two communities if the bride has not undergone FGC. “What I know is that once the girl is circumcised there will be a 43 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

marriage and the father will be receiving dowry. So it is like an investment and you must make the investment marketable”. Teacher Moi Girls’ Samburu

4.4 The myths of FGC believed to control women sexuality / desires According to Maasai myth which was narrated to the consultants during the baseline, a Maasai girl called Napei once had intercourse with an enemy of her family. To punish her and suppress the desires that lead her to commit such a crime in the first place, Napei was subjected to female genital mutilation. Since then, every Maasai girl reaching adolescence has undergone FGC, which has been used ostensibly to curb sexual desire and promiscuity amongst girls. By undergoing FGC, girls bring honour to both themselves and their families. As a result, the Maasai have held on to the custom in spite of massive criticism by wider Kenyan society. Across the four ARP project areas; there exists a belief that the clitoris makes a woman easily sexually excited. It is believed that FGC limits a woman’s sexual desire or prevents immorality. Therefore, it is practised to control a woman’s sexual desires and to prevent immoral behaviour. Control of sexual desire is a definition of true womanhood in these communities. As one Maasai woman respondent put it: “A man can seduce a Maasai girl for over 5 years and she will never give in but for someone who is not circumcised, they easily get sexual desires”. Culturally, “not giving in” to sexual advances is considered honourable for a woman. Women Leader, Kilindi District. Based on a story given by the deputy leader of age set in Magadi, “Female genital cutting is a cultural rite of passage that has been practiced by the Maasai for generations. There are no clear records to explain its origin, and although the practice is deeply entrenched in the community, I have not come across any convincing explanation to justify its existence other than the mere claim that it is one of the core cultural rituals which define the community’s identity”. “Through inquiries that I have made courtesy of my position as a Deputy Leader (“NKOPIRR”) of the “ILMEMIRRI”age set, I have gathered that the practice is likely to have originated during the days of resistance wars against the white man’s occupation of Maasai territory. The most plausible story goes that female circumcision started out of a conspiracy by young Maasai warriors who got deeply humiliated and enraged when they returned from the battle field only to find that some of their spouses and unmarried sisters had been made pregnant by the same white men they had gone to chase out of their territory. This resulted in the birth of illegitimate white children, much to their chagrin. The men reportedly reacted by holding secret strategy meetings where it was decreed that all warriors preparing to go to the battlefield would henceforth circumcise their spouses to leave them in situations which would make them practically unavailable for sex. With time, this practice gained prominence and evolved into a cultural rite of passage for girls”. From the story, it would appear that the cut was originally meant to target young married women and older girls. However, it is a fact that the age bracket progressively widened afterwards to include even girl children as young as 10 years in some cases. 44 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Other myths associated with female circumcision among the Maasai community are summarized hereunder;      

that uncircumcised girls would not get married children born of uncircumcised girls are associated with bad luck Uncircumcised girls are considered as children reduced parental respect being considered minors by their peers and the general community a reduced marriage prospects

However, the girls themselves have started realizing the folly of these myths. A number of uncircumcised girls have still ended up getting married after all

4.5 FGC confers cleanliness in women Confers Cleanliness in Women: In addition to gaining social acceptance, circumcision is believed to make a girl physically clean among the Maasai and Samburu. During focus group discussions in all the four project sites, particularly with groups that support FGC in particular the morans, it was reported that uncircumcised girls are unclean and their genitals produce a bad smell. A possible explanation for this is the belief among morans that circumcised girls are different from uncircumcised girls in many ways. The local communities were found to believe that uncircumcised women are physically dirty and therefore may be barred from engaging in daily activities as cooking or drawing water from the rivers or water sources. Among the Maasai and Samburu, the uncircumcised women are viewed as children and even though adult are banned from key social functions such as leadership and deprived access to resources. This status was summarized by a Samburu cultural elder ‘Ipayiany’ “For instance if a girl gets a husband or if she grows old in the father’s home until the age of 25, the father and mother would decide to circumcise her to remain in the home as a clean young woman called Siemolei” In Kilindi, the baseline established that the uncircumcised women are considered dirty and are often rebuked and stigmatized by the community. “They are called ‘Kigoli’ and must be circumcised at delivery to remove the dirt. This is done secretly without drumming or dancing’. Female FGD participants, Kibirashi in Kilindi

4.6 FGC makes birth easy There is widespread false belief that FGC makes birth easy: In all four project sites, circumcision is falsely believed to make child birth easier. Among the Maasai, for example, it was believed that if the clitoris was not cut then it was believed that it could grow long and obstructs the birth of a baby during delivery. In Kilindi it was reported that “FGC is compulsory because it helps during delivery. It makes a baby come out easily as the part which is removed can act as a barrier to child birth. “We cannot do without FGC as it is very important to the community and we have not experienced any problem with the practice. If the issue is bleeding,

45 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

even if you cut your finger, you will bleed, why then should one be afraid of blood? A girl who skips the practice must be cut at delivery”. Young Girl FGD participant in Elerai, Kilindi.

4.7 In-depth Analysis of FGC in the target communities Feedback from the FGDs and KIIs with both women and men shows how complex the FGC practise is. Some of the barriers to female circumcision and effects are captured in Figure 4. From figure 4 it is evident that FGC is often a precursor of early and forced marriage in the communities practising FGC. In the four targeted communities, adulthood is not only determined by biological age but also by the rites of passage from childhood to adulthood, which from Samburu and Maasai communities perspective automatically translate into marriage, irrespective of the biological age of the girl. In the targeted communities, girls as young as the age of nine can be withdrawn from school to undergo FGC and subsequently to be married off to old suitors. The lack of education among these girls exacerbates their economic dependency on their husbands. Coupled with their lack of negotiation skills because of their younger ages and status in the society, the girls become more vulnerable to sexual abuse by morans who beads them. Similarly, difficulties in negotiating sexual relations can also increase their vulnerability to unwanted pregnancies, HIV transmission, unsafe abortions perpetuated by the community (as is done among the Samburu) in the name of removing the ‘cursed’ child.

46 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION FIVE: ALTERNATIVE RITE OF PASSAGE - THE SOCIO-CULTURAL ENABLERS

This section of the report discusses the alternative rites of passage (ARP) to female circumcision that is accepted by the nomads: a ceremony that ensures that a girl can make the transition to womanhood in good health and well prepared. The project approach starts with discussion with the elders, since they make the decisions in the nomadic tribes, they must first be convinced of the advantages of eliminating female circumcision. Amref health in Africa envisages a rite of passage that excludes genital cutting, but which is still relevant to the cultural beliefs and behaviours of targeted communities.

5.1 Awareness of Messages against Female Circumcision The respondents in both qualitative and quantitative components of the ARP baseline were asked if they had heard of messages against female circumcision. Majority of the mothers (87%) sampled in the survey reported to have heard of messages against female circumcision compared to only 13% who indicated otherwise. Table 11: Percentage of Population Reporting having heard of messages against female circumcision Ever heard of messages against FGC Adult men and women

Yes No

Total

Project Area Loitokitok

Magadi

Samburu

Total Kilindi

186

189

169

184

728

84.5%

94.5%

84.1%

94.0%

87.0%

109

15.5%

5.5%

15.9%

14.8%

13.0%

220

200

201

216

837

100.0%

The project areas with highest knowledge of messages against female circumcision is Magadi (94.5%) followed by Kilindi (94.0%), Loitokitok (84.5%) and Samburu (84.1%). The respondents in the ARP baseline were further asked if they had heard of or seen messages on against FGC. The baseline data shows that the main sources of messages against FGC were Government officials / District Officers, chiefs, assistant chiefs (36.3%), community leaders (34.1%), health workers (30.3%), religious leaders (29.9%), radio (29.2%) and NGOs that includes Amref Health Africa, PATH, Maendeleo ya Wanawake, World Vision etc and local CBOs (24.4%) and relatives (9.7%).

47 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Figure 4: Sources of Information against female circumcision

5.2 Awareness on the Alternative Rite of Passage (ARP) Alternative rites-of-passage (ARP) are used as tools to discourage the practice of female circumcision. In such ceremonies, girls do not have their genitalia cut but they still receive education on their roles as women in society, as well as lessons on sexual and reproductive health, and the importance of formal education. The respondents in both qualitative and quantitative components of the ARP baseline were asked if they had heard of the Alternative Rite of Passage (ARP). Majority of the mothers (72.4%) sampled in the survey reported NOT to have heard of the alternative rites of passage compared to only 27.6% who indicated to have heard of the different types of alternative rite of passages. Majority (95.2%) of those who had heard of the ARP messages consider them to be positive compared to only 4.8% who see them to be against their long held tradition of FGC. The KIIs in the ARP project areas confirmed being aware of a number of initiatives. According to the Chief of Lenkism Location, Loitokitok, â&#x20AC;&#x153;there have been a few activities in the past especially through peer educators who sensitized on life skills in schools and behaviour change and inform children on how to help each otherâ&#x20AC;?. He feels like according to the culture, girls do not have ARP trainings where they are secluded in the bush for some times before being cut unlike the boys where they receive training from elders and peers. In addition, he believes that uncircumcised girls bring bad omen to the family especially male children will either not prosper or die. He was also aware of AMREF Kenyaâ&#x20AC;&#x2122;s contribution through the Nomadic Youth Reproductive Health project in the past which trained peer 48 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

educators in the area, community health workers, life skills and sexuality in general; however, there is need for follow-up of the girls as they face stigmatization from the community. In Magadi, the KII, who is the chairman of the ARP committee, reported that “this particular area is an ARP site. The programme is spearheaded by AMREF, and complimented by the church. However, the AMREF programme appears to be experiencing some challenges as its acceptability is being questioned”. Through the alternative rites of passage, the young girls not only escape the pain of the knife, but also the risk of contracting HIV through sharing a blade, and life-threatening complications such as bleeding to death. The outcome of ARP were captured by young girls as well as community members including community elders who have since joined the campaign to end unnecessary bloodshed and help Maa girls make more of their lives. “In the Maasai community, FGC is an old-age tradition that has been hard to fight. Previously, an uncircumcised woman from my community would not find a suitor. Even after the outlawing of the vice, it continues in secret in some areas, I consider myself lucky to be among the girls who have a choice provided through the alternative rite of passage”. ARP graduate FGD participant. According to the FGD and KII respondents, “Facing the knife is an option for Maasai girls as elders and morans are now willing to embrace change. This is a major break from traditional Maa culture, where teenage, and sometimes younger, girls were circumcised and married off immediately. Puberty is no longer welcomed by a cut that endangers the lives of young girls and thereafter married off sometimes to strangers. They are now free to mature, pursue their education, and choose their own husbands”. KII, Kimana, Loitokitok “I now do not have to worry about circumcision; all I am required to do is to continue working hard in school so as to have a bright future. The elders have blessed us and accepted us as adults in the community,” In-school young girl FGD participant in ARP area

5.3 Alternative Rite of Passage (ARP) Messages and Community Acceptability The respondents were asked the kind of ARP messages they have heard and what they thought of the alternative rites of passages. The baseline data indicate that the communities in the project area had heard that one can bleed to death due to FGC (59.0%), FGC can promote infection (49.3%), limits girls education (42.1%), it is a violation of human rights (12.4%), that a girl can still get husband without undergoing through the cut (10.0%) and the existence of the other forms of alternative rites of passage (1.9%).

49 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Figure 5: Kind of Messages Reaching the Target ARP Sites (%)

Asked about the Alternative Rite of Passage, interestingly, majority of the parents both mothers and fathers (91.9%) reported that they would allow ARP if it were to be organized in their areas compared to 8.1% who would not opt for ARP. “The most important thing for the success of ARP is that there must be a celebration where everyone is invited. In fact it is the ARP that has led to the slight drop in the FGC. We have noted that without graduation and celebration ARP cannot succeed”. KII woman leader Loitokitok Women both in Magadi and Loitokitok were in agreement that with proper sensitization, ARP will largely succeed as captured in the FGDs “If they can perform normal ceremonies with the blessings of the elders but with no cutting done, we shall embrace the practice. Women say that there should be intensive sensitization to educate everybody on Alternative Rite of Passage in the community. Once the elders accept the practice, ARP will succeed”. In Samburu, a religious leader observed that “the most important people to be involved for the success of ARP are the cultural elders as the wazee are the ones who give the blessings. The Moraans should also be made to realize that they can marry a woman who has not undergone the cut”. Another KII in Samburu recommended for ARP messages to target mainly the man. He observed “It’s the men who have a voice in this community. Even if you were to ask them “ni nani ako kwa manyatta? Who is in the manyatta” they will answer you “hakuna mtu mzima, ni bibi na watoto tu! No one” the wife is not considered to be a person. Even where men are sitting under a tree, women are not allowed there, no talking there or sitting there. And once the man has said he has said. Man is like the law itself. And even the eldest son tries to oppose their decisions, he will be given a thorough undressing…he is undressed! And he is cursed. In fact we have had many cases of the elder brothers of some girls coming to report that the procedure will be done to them but they tell us to (gestures with his hand zipping the lips). They say that if the father knows they reported, they will be in big problems because they will be cursed. And they do believe that the curses 'zinashika'. I am telling you there is a lot you can learn from this tradition. And this traditions they come from the Maasai but if you go to the Maasai a lot of advocacy has been able to change them but for here, if you just go behind this forest there is a place called Anata Nanyuki, if you see how things are done there…. If light comes to that area then even vision 2030 will even be impossible. In such places even a child to reach class 6 is just impossible. We have about 2-3 50 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

locations in South Horr, you get that there are so many children in ECD, class I-IV but onwards is just boys very few girls. We tell them that they are killing the community and they are claiming that Nairobi 'wametutupa'. Even the MCAs don’t want to talk about it because they tell us that “nikiongea hiyo kura yangu imeisha”. The story captured in the Standard Newspaper of 5th June 2014 summarizes the worries of Members of the County Assembly in Kenya being roughed up by female supporters of FGC in Sajiloni shopping centre, Kajiado County,

Since the first demonstration, there has been increased pro-FGC activism in Kajiado Central. A second and a bigger demonstration with over 2500 women occurred even when the political leaders had done their best to stop it. A bigger demonstration is now planned for the 51 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

26th June 2014. The cause of the current situation of unrest point to the arrest of a cultural chief following the death of a young girl who died during the month of April 2014 after undergoing FGC. Kajiado central leaders have strongly condemned the pro-FGC activism and committed to support the anti-FGC campaigns and laws. In Kilindi, the District Commissioner reported that for ARP to succeed “Influential people in society should be involved in the anti FGC efforts to promote goodwill among the community members. Such people include the traditional birth attendants, traditional circumcisers, traditional elders and religious leaders. All the players should make a point of playing their allocated roles, for instance, the government should ensure the implementation of the Children's Act while community sensitization should be carried out extensively”. The Kilindi MoH reported that “FGC should be stopped through education of the community members about the effects of this practice and enforcement of laws against the practice”. According to the MOH, “Elders are the most important decision makers in the community”. The 27.6% of the respondents ARP who indicated that they had heard of ARP were further asked if they believe ARP is acceptable by their respective communities, 88.1% of these respondents confirmed that such practices would be accepted by their communities. By gender, more men who are the decision makers reported that ARP will be accepted by their communities (90.1%) compared to 86.7 for the women respondents. By ARP project area, the acceptability of ARP is as summarized in Table 12.

Table 12: Percentage of Respondents Reporting that ARP would be accepted by the Community Believe ARP would be accepted by the community Adult men and women n=227 Total

Yes No/DK

Project Area Loitokitok

Total

Magadi

Samburu

Kilindi

199

97.3%

91.4%

68.4%

83.7%

88.1%

2.7%

8.6%

31.6%

16.3%

11.9%

226

100.0%

The high levels of community acceptability Loitokitok (97.3%) and Magadi (91.4%) may be a pointer to the successes of the Amref health Africa in Kenya’s on going ARP advocacy activities and is also indicative to the program of the kind of resistance to expect in Samburu (31.6%) and Kilindi (16.3%). It is therefore important for the project officers in the latter two project areas to learn from the successes in Loitokitok and Magadi in preparation of their role out of ARP strategies.

52 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

5.4 The Description of Ideal Marriage Partners by the Morans As defined elsewhere in the document, age-sets among the nomadic and semi-nomadic pastoralist societies, are constituted as a result of the circumcision and initiation of teenage boys into adulthood (Spencer 1965, 1998; Jennings 2005). Twice every year, boys aged between 11 to 15 years are circumcised in public ceremonies. All cohorts of boys circumcised over a period of 5-8 years are grouped into age-sets, which pass through stages of adulthood together, from warriors to junior elders to senior elders. The moran phase, the warrior stage in the life of the youth (under 30) among the Maasai and Samburu men, provides a strategic position both economically and militarily, and is still desired to date. To assess what the morans would consider to be their ideal marriage partners, the baseline assessed the feelings of young men between ages (18-30 years). Figure 6 shows that the morans prefer circumcised (38.1%) marriage partners, educated (20.9%), others (15.2%), not circumcised 13.5% and economically stable partners (12.2%).

Figure 6: Proportions of Morans Describing their Ideal Marriage / Potential Partners

Cross analysis by ARP project areas shows that the proportion of morans describing their ideal / potential partners being circumcised was quite high in Magadi (66.4%) compared to Loitokitok (49.7%), Samburu (19.3%) and Kilindi (17.9%). Interestingly, the Kilindi and Samburu morans were for economically stable partners at 20.1% and 20.0%. The finding that only 1 in 10 morans reporting they would uncircumcised girls (13.5%), shows how it will be an uphill task to change the mindset of the moraans to marry the girls who have successfully undergo through ARP.

53 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

5.5 Best Cultural Ritual for Girls Not Circumcised All the baseline respondents were asked what would be the best cultural ritual that would help a girl who is not circumcised or who undergoes ARP feel she is fully accepted by the community as a woman; among the adult (married women and adult men 18 years), about a third (27%) recommended them to be or have been educated (go to school), need to be blessed by cultural elders (23.4%), be blessed by parents (15.8%), hold a community ARP ceremony where such girls who opts for ARP attend (10.0%), blessed by religious leaders (6.1%),others / donâ&#x20AC;&#x2122;t know (15.5%) and be given an ARP graduation certificate (2.2%). On the other hand, a significantly higher proportions of young unmarried girls (10-24 years) preferred going to school (25%), blessings by cultural elders (21.5%), blessings by parents (15.8%), holding of a community ARP ceremony where the girls who undergo ARP are acknowledged (8.9%), be blessed by religious leaders (5.1%), obtain an ARP certificate upon graduation (4.0%) and others / donâ&#x20AC;&#x2122;t know (19.9%). Figure 7: Proportion of Adult Population and Young Girls Preferences for Cultural Ritual for the Uncircumcised to be accepted by the Community

54 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

5.6 Key Socio-cultural Enablers on which to Anchor ARP Asked what they would consider to be some of the socio-cultural enablers on which ARP would be successfully hinged without unnecessarily antagonizing the local cultures, the baseline established that for ARP to succeed, 48.0% of the respondents reported that such programs must encourage participation at all levels through intensive community mobilization and education in behaviour change. Such ARP advocacy activities must ensure parents (mothers and fathers), the youth especially the morans and young girls, traditional circumcisers, local and religious leaders and government officials that includes the chiefs and their assistants all play roles in the program design, implementation and follow-up. In particular, 36% of the respondents recommended that ARP initiatives must promote the training and sensitization of the elders who are the key decision makers on the cultural rites. While this may be time consuming, another 34.5% recommended for the participation of community members in the ARP to enhance the transition from an attitudinal change to a behavioural change. In particular the elders from the onset encourages a sense of belonging and investments in the project outcomes at the community level, which can in turn result in the needed political support at the local, district, regional and national level. From the KIIs and FGDs, it emerged that FGC is a complex tradition that cannot be successfully addressed in isolation of its cultural, economic and political implications. Such integrated approaches must be designed in collaboration with the local communities in order to incorporate reproductive health and sexual rights at the local level and links to policy makers and womenâ&#x20AC;&#x2122;s equity including human rights. In addition, the quantitative as well as the qualitative component of the ARP baseline recommended for promotion of public ceremony associated with the rite of passage (34%) marking the alternative rite of passage and constant follow-up of the girls who have adopted ARP. The KIIs recommended for a public ceremony need to accompany the period of seclusion. During the seclusion period, an Alternative Rite of Passage (ARP), which allows the girls to undergo training and graduate into womanhood without the actual cut is to be introduced to the initiates. This ceremony will act as the substitute to the traditional process of FGC. But due to enormous pressure that they will face upon their return to the villages, the ARP project need to make constant follow-up to ensure such initiates do not succumb to peer pressure to undergo the cut or and early forced marriage. Such girls would require constant follow-up and counselling by the project. Further, baseline respondents recommended promoting good understanding of the role of public (as opposed to familial) ceremonies in that culture (27.5%). Among the Maasai of Kajiado and the Samburu, the end of a girlâ&#x20AC;&#x2122;s seclusion period after undergoing female circumcision is not a public ceremony but instead the parents organize a feast at home. The amref health in Africa led ARP project must therefore embrace the public ceremony component in their alternative rituals. Religion: Some of the KIIs recommended for strong involvement of the church in implementing ARP. One of the factors which have contributed to change is the churches campaigns against FGC in the region. There FGC as reported by individual families that have begun to oppose the practice out of religious conviction: â&#x20AC;&#x153;I would support a very strong involvement of the church. It is noteworthy that majority of the church population are women. 55 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

This is quite good for the ARP campaigns because women happen to be better listeners than men. Besides, although key decisions affecting culture are taken by men, the women are credited for their quiet diplomacy which is a powerful strategy for influencing the decisions taken by the men” KII, Assistant Chief in Magadi Education: The importance of education was a common theme, in terms of the importance of education about the health risks of FGC, the differences in behaviour and focus of circumcised and uncircumcised girls at school. School dropout among girls is reported to be higher among those who have undergone female circumcision. This is considered to be due to the belief by circumcised girls that they are mature women and are no longer girls, hence they are more difficult to teach and more easily lose interest in learning to be married off to old suitors or are forced into marriages: Using the school as the entry point for ARP implementation by sensitizing the teachers. The project needs to capitalize on the existing opportunity created by the female population among the students. “Since part of the pressure for FGC come from young men who are potential suitors to the girls, the schools component would equally achieve the combined effect of roping in the boys”. KII, Magadi

Local administration: Both the Kenyan and Tanzanian governments have imposed a ban on the practice. “I believe as an individual and as a servant of government that the practice is bad and we already involved in implementing the law. FGC is sometimes a source of family conflict. I have handled cases of disagreements between mothers and their daughters arising from the feeling by the girls that once they have been circumcised this signal their graduation to the category of “a woman” hence the mothers are their equals and cannot push them around. KII Magadi The chiefs and their assistant chiefs would come in handy as potential mobilizers of the women for sensitization meetings through women’s organizations and enforcers of the law because FGC is against the law. “Women in this locality are fairly responsive to summons by the chiefs. But it is important to identify and train the local women so that the sensitization is conducted by people who understand the local priorities, language and culture”. KII Loitokitok In summary, the key informants recommended that for ARP to succeed there is need for structured engagement with the community leaders that includes leaders of the age sets, community leaders, group ranches, the religious leaders / the church, primary/secondary schools and the government through the provincial administrators, chiefs and their assistants. In addition, there is need to identify role models from the Maasai community to implement anti FGC programmes. In this way, the locals would not see the idea as foreign thing being pushed down their throat by outsiders.

56 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION SIX: CAPACITY AND READINESS OF LOCAL COMMUNITY STRUCTURES

One of the objectives of the ARP baseline was to establish the capacity and readiness of local community structures including traditional governance structures, community based organizations, faith based organizations school health committees and boards to support and promote ARP.

6.1 Community Structures and Traditional Governance of the Maasai Communities The Maasai are a semi-nomadic community located in Rift Valley and Central areas of Kenya and Northern Tanzania stretching all the way to Kilindi in Tanga Tanzania, where they move around in search of pasture and water for their animals. There is no doubt that the Maa community is one of the most homogenous communities both in Kenya and Tanzania. The community’s lifestyle is guided by distinct structures with very strong social codes. In particular, the males are segmented into age cohorts each with distinct roles and a wellregarded leadership to coordinate the communication with other age sets. Key decisions affecting the population’s common welfare are taken by specific organs whose authorities vary upwards in a graduating chain of command. The decisions are disseminated across age and gender barriers using standard communication channels. In this kind of setup, there is very little room for individual autonomy particularly with regard to decisions which bear the prospect of a significant threat of cultural infringement. As for women, they were found to have very marginal levels of autonomy as captured by KII in Magadi “When a Maasai male greets a fellow man and proceeds to enquire about the ‘children’, he actually means the real children and their mother”. The implication is that culturally, most decisions affecting the life of Maasai women are made in a men’s forum. This leaves very limited room for women to exert a major influence even on aspects of the Maasai culture which undermine their own dignity and rights including female circumcision. At the community level, the Maasai are a very united tribe. A Maasai stranger from as far as Narok or Voi would be very easily welcomed into any homestead around as long as he states who his parents are and which age set he and his father belong to. The community’s social codes even define the nature of guest entertainment for such a stranger depending on the identity particulars which will reveal his/the father’s social rank and category of relationship to the host, however distant. Secondly, the community’s way of life is guided by traditions which are crafted by specific governance structures. For generations, community members have been socialized to respect and abide religiously with decisions taken by the substantive structures. Over the years, the Maasai have been known to cherish and protect their culture so much that they have literally traversed the habitable areas of Kenya all the way from Northern Rift Valley stretching to Narok, Kajiado, Central Kenya to Arusha, and Kilimanjaro to Kilindini 57 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

partly to avoid infiltration by other cultures, which they feared would dilute their culture. As a result, community members learnt to highly value their cultural practices to the extent that those who skip the rituals carry a permanent guilt of being regarded second class members. With such an ingrained sense of culture and tradition, it can be very difficult to persuade Maasai people to let go of traditional practices like FGC.

6.2 Community Structures and Traditional Governance of the Samburu Closely related to but distinct from the Maasai, the Samburu are seminomadic pastoralists who live in Northern half of the Rift Valley region within Samburu County, Kenya. According to the 2009 Population and Housing Census, the population of Samburu County was 223,947. With a population growth rate of 4.45% per annum as opposed to the national growth rate of 3%, the county population is expected to have risen to 255,931 persons in 2012 comprising of 128,004 females and 127,927 males. The population is projected to increase to 292,484 in 2015 and 319,708 in 2017. The Samburu people keep herds of cattle, sheep, goats and camels. They are part of the ‘Maa’ speaking people as are the Maasai. The people of Samburu are known for their cultural riches which they continue to exploit to this date. Although threatened by changes in people’s lifestyles, the indigenous knowledge systems continue to help community cope with and adapt to the environment. About 95% of the words of both languages are the same. The name ‘Samburu’ is also of Maasai origin and is derived from the word ‘Samburr’ which is a leather bag used by the Samburu to carry a variety of things. Like the Masai, the Samburu have held on to their traditions, from their food (maizemeal, fermented milk, meat and blood), to their homes (mud huts called manyattas) to their clothing. Despite the powerful forces of modernity, the Samburu take pride in their culture and keeping their rich traditions alive. As recently as the 1990s, wearing pants was considered by most Samburu people to be a rather unmanly abandonment of cultural traditions. Through the government efforts and increased education and interaction with non-Samburu there has been little change in their mode of “traditional” dressing which is still the norm among the Samburu. Men wear a cloth which is often pink or black and is wrapped around their waist in a manner; they adorn themselves with necklaces, bracelets and anklets, like the Maasai. Women wear two pieces of blue or purple cloth, one piece wrapped around the waist, the second wrapped over the chest. Women keep their hair shaved and wear numerous necklaces of beads and bracelets.

Among the Samburu, kinship and age-sets constitute the primary horizontal governance institutions that motivate decentralized norm enforcement, collective action, and local public goods provision in the region. Kinship is one of the most important dimensions around which exchange, cooperation, and reciprocity take place. Several important factors characterize kinship networks that exist in the area. There are 9 clans in the region; all are patrilineal, meaning that individuals become a member of their father’s clan at birth. Given this automatic membership, clans constitute a natural primary group for many important social and economic decisions are made including the socialization and care of children and the 58 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

movement of cattle in search of pasture. Despite the importance of intra-clan relationships, most individuals also maintain close relationships with cousins, uncles, and aunts in their motherâ&#x20AC;&#x2122;s families. Networks centered on age-sets serve as an additional horizontal governance institution. Age-sets among the Samburu communities, as in many other nomadic and semi-nomadic pastoralist societies, are constituted as a result of the circumcision and initiation of teenage boys into adulthood (Spencer 1965, 1998; Jennings 2005). All cohorts of boys circumcised over a period of 5-8 years are grouped into age-sets, which pass through stages of adulthood together, from warriors to junior elders to senior elders. The institution of age-sets constitutes a horizontal governance institution in this region by creating dense, reciprocal ties between young men of approximately the same age who go through circumcision and initiation rituals together. As part of these smaller circumcision groups and the larger age-set groups, young men spend their early adult years providing security against cattle raids and migrating with herds of cattle so that communal grazing lands will not become depleted during the dry season. These networks are also crucial for motivating forms of collective decision making, management of pasture and security. A good example among the Samburu is the a lorora which is a huge amalgamation of about 200 manyattas that are built for political reasons like security and also cultural ones like circumcision of boys and also transition of other age sets. In this lorora most elders will be found together in one place which is rare owing to the vastness of Samburu. Elders make all the decisions in Samburu communities. Decision is made at the village level, clan level and district level depending on the scale of the issue or the types of resources involved. For example, decisions about areas to be used for grazing are taken by elders of the villages that share the grazing areas. This means that decisions relating to a common resource such as the red Maasai sheep would be taken by elders from the different clans across the Sub counties of Samburu Central, Samburu East and Samburu North. According to the Samburu customary law and governance structure, the elders must first be consulted before any decisions are taken and any newcomer to Samburu community must first establish a meeting with the local elders to explain what and who they intend to engage with and to answer any questions put to them. The committee of the respective group ranch questions put to them. The committee of respective elders will either take a decision, or if it is about a common resource, may seek wider counsel from other elders. It is very important to realize that the elders vary in level of influence and respect owing to their clan of origin. Those who are from around Mt. Nyiro are the most powerful clan and whatever they say goes in the whole community with little or No resistance at all. Their decisions are paramount. They also decide on major activities like building Lororas, transitioning of age sets, raids and others and are considered to be the custodians of the Samburu culture in addition to being the repository for knowledge about the Samburu culture, beliefs and history. Below the community elders are the morans. The moran phase, the warrior stage in the life of the youth (under 30) Samburu men, provides a strategic position both economically and militarily, and is still desired to date. Because the Samburu moran has the duty to defend the community and the livestock, the moran-hood promotes values as self-respect, perseverance, courage and fellowship, giving the young men popular attention, glamour and a sense of freedom, but also a strong sense of responsibility. The moran-hood remains the basis 59 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

of Samburu pride, building a bridge between the present and their heroic past while the elders in local networks make decisions to prevent bad omen and enforce norms and laws of the Samburu community. It is also important to note that the Moraans cannot go against what the elders have said otherwise he can be undressed publicly and also given a curse which they believe in. Thus you cannot elicit change from morans without first going through the elders.

6.3 Local Administration Across the four project areas both in Kenya and Tanzania, there exists local administration consisting of chiefs and their assistants. The local administrators ensure harmonized planning and implementation of development projects / interventions between the government and the local community. These leaders form the channel of communication between the government and the community. These community actors would act as the entry point of engagement between the ARP project and the targeted communities as well as the enforcers of the law since FGC is an illegal in both Kenya and Tanzania.

6.4 Civil Society Organizations The concept of civil society organizations (CSOs) has gained ascendancy during the last two decades all over the world. In this study the use of the concept civil society organization (CSO) covers a wide range of actors from informal activists groups and well established registered organizations to civil movements and their networks. In four ARP project areas namely Magadi, Loitokitok, Samburu (all in Kenya) and Kilindi in Tanzania, the CSOs occupy diverse roles and pursue a variety of activities ranging from education and health care service delivery to advocating for the marginalized groups and lobbying on top of the traditional area of service delivery. This baseline identified many types of CSOs that included Community based organizations (CBOs), Faith Based Organizations (FBOs), Women groups, self-help groups, and youth groups social welfare groups. However, in Magadi and Samburu the baseline was faced with a number of challenges from insecurity to the existence of noncredible CBOs that could not be included in the survey. The baseline assessed existing community structures and organizational capacity of the CBOs, FBOs operating in the project areas to determine their capacity, gaps and priorities. The objective was to establish the capacity and readiness of local community structures including traditional governance structures, community based organizations, faith based organizations school health committees and boards to support and promote ARP activities within the respective project areas. The assessment, the baseline used 7 evaluation criteria that examined the capacity of the civil society organization (CSO). The objective was to determine the CSOs that already have minimum competencies and only need some capacity building in order to support advocacy work towards abandonment of FGC. The seven major evaluation points included:

60 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

 

    

Governance structure and credibility: the presence of a management committee, constitution and registration status. Knowledge base and capacity to monitor and evaluate projects and trainings in M&E and its implementation, data collection techniques used including the analytical capabilities. Organization’s activities: current activities being implemented and whether appropriate records are kept. Financial management system including accountability and transparency in the management of their financial management system (FMS) Collaborators and any existing partnerships that have been established, history of proposal application, successful funding or declination etc Technical capacity in the girl child including the presence of advocacy materials on FGC. General perception from other stakeholders on the CSO performance and its ARP activities on the ground.

61 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Table 13: Assessment of the Civil Society Organizations in the ARP Project Areas CSO Enduet Women Group – Loitokitok (Ke)

Observations  The organisation is dully registered and has a management committee with written policies. The roles and function of the management commit.ee are clearly spelt out with each office bearer being allocated specific roles. The office bearers are elected every three years.  Members are able to participate in decision making. The management keeps proper records for accountability purposes.  The organisation has a bank account and operates table banking. It’s however, not represented at the annual budgeting and planning meetings at the village level, in the local authorities or even at the county level. The support for ARP is mobilized from local sources. The organisation writes project proposals on ARP and is also aware of existing sources of funding but the accessibility of the same is not possible.  The organization is only for women hence men and youth are not represented and consequently tasks cannot be allocated to them. All members are encouraged to give their views and are listened to irrespective of age and ethnicity especially during meetings.  The organisation works with the government departments in eradicating FGC by providing baseline information. It participates in local development activities such as: Njaa Marafuku, Pesa ya Wamama and Ukulima bora. The organisation is known and at the same time knows and works with other development agencies in the area such as Amref Health Africa and MAA AIDS Association. The community knows and respects the organisation for its activities in empowering the girl child; it thus experiences a lot of support from the community. Being women, they are supported by their husbands and some people even contact the organisation to intervene in cases of FGC. There is no community policy as well as elements of gender policy strategy. The organisation has an external stakeholder namely Amref Health Africa and occasionally does external relationship management. The organisation operates from a Manyatta with no HR systems/policies, equipment e.g. rescue homes, annual budget and financing for ARP activities and oversight stewardship.

Observations on ARP activities  Sensitize women on ARPs  Has network of members who monitor FGC activities in the manyattas/villages  Support education of the uncircumcised girls facing stigma and discrimination from the community  The organisation has 27 trained staff and has reached over 1000 girls through its activities, 80 of whom have finished high school.  Organized for graduation of over 200 girls through ARP

62 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

Assessment outcome  Recommended for partnership / networking



Osutua Enduet Self Help Group – Loitokitok (Ke)

Rise and Shine Youth Group

     

Rescue services are available although limited because of the increasing numbers. The organisation has a plan to mobilise more women but without clear targets. The organisation has savings in the bank account. It also has plans for the community without external support; these plans include resource mobilisation through investments. The organisation is aware of local opportunities and threats to ARP activities and applies dialogue, identification and implementation of emerging community needs. Registered by Ministry of Social Services, has a committee and constitution with elections done every 2 years. The organizations works with local administrators including chiefs and law enforcement agencies – the police Promotes education and sensitize the community Registered by Ministry of Social Services, Has an active committee and constitution Has resource centre



No records available on ARP related activities



Lacks capacity to implement large project



Mobilized role models who campaigned against FGC Work with girl child forums in schools to support ARP Has been able to reach over 2000 girls within the catchment area Has not implemented ARP activities Newly registered



Recommended networking partnership



Not recommended

 

Muungano –Kilindi (Tz)



 

Registered in 2012, has a constitution and office bearers whose roles are clearly spelt out and who elected every three years. Meetings are held every Thursday and the members are the main decision makers. The organisation has no resource mobilization and management structure. It is not represented at annual budgeting and planning meetings at the local authorities’ level, village level and district level. The organisation does not mobilize ARP support from local sources neither does it write project proposals on ARP. It is, however, aware of existing sources of funding. The organisation is a women group mainly made up of older women. The organisation does not work with any government departments, neither does it participate in local development activities nor is it known by development agencies. The organisations are aware of anti-FGC organisations and works with a local development agency known as Tupendane. The local community knows respects and actively supports the organisation. The organisation has no gender and community

 

63 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

for and



World Handeni, (Tz)

VisionKilindi



policy, no external stakeholders, external relationship management HR system, physical structures, annual budget, oversight and stewardship and rescue services. The organisation does not have any plans and savings whatsoever. It is aware of local opportunities and threats to ARP activities. Registered in 1981. It has a national board and a project committee at project level. There are appropriate policies and the roles of the management committee as well as the office bearers are clearly spelt out. Elections are held every three years. The members views are taken into consideration and the same members are engaged in decision making, the leadership is also accountable to the members. The organisation has sound finance resource mobilization and management structure and is represented at the annual budgeting and planning meetings at the district level. The organisation mobilizes ARP support from local resources and donors, it writes project proposals on ARP and is aware of the available sources of funding. There is a fair representation of men, women and youth in the organisation. Tasks are allocated in a gender sensitive manner and all members are encouraged to give their views and are listened to irrespective of gender, age or ethnicity. The organisation works with government departments in eradicating FGC and participates in local development activities. Is knows development agencies in the area, is known by the same and works together with them. The local community knows, respects and supports the organisation fully. The organisation has a child protection policy, elements of gender policy strategy which are implemented, external partners, external relationship management, physical structures in very good status, HR systems, annual budget and financing for ARP activities, oversight and stewardship, rescue services but no equipment such as rescue homes, The organisation has annual plans derived from strategic plans. It relies on donors entirely hence no plans for its own continuity without external support. It has savings, undertakes investments and is aware of local opportunities and threats to ARP activities. There is continuous dialogue, identification and implementation of emerging community needs and

      



The organization is renowned for its ARP work both in Tanzania and Kenya Has an established organisational culture of transparency and accountability Has a wide network Involved in the sensitization and awareness creation on the effects of FGC Has experiences and lessons learnt from working on ARP Its holistic approach to development is strength for working with behavioural changes against FGC. The organisation’s Christian values and relationship with churches are comparative advantages as opposed to many civil society or human rights organisations Members include the youth, women, and elders act as important role models standing up against FGC

64 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014



Recommended networking partnership

for and

Ereto Maasai Youth (EMAYO) - Kilindi (Tz)



 



Hanga



projects. Registered in 2006 and is managed by a board of 8 officials. Appropriate management policies are in existence. The roles of the management committee and official are clearly stipulated. Elections are held every three years. The leadership listens to members’ views and involves them in decision making; it is also accountable to the members. The organisation has a sound finance resource mobilization and management structure. It is represented in annual budgeting and planning meetings at the local authorities and district level. The organisation is aware of existing sources of funding and also writes project proposals on ARP. The organisation has six men and two women. The roles are allocated in a gender sensitive manner and all members are encouraged to give their views without discrimination. The organisation works with the community and education departments of government; it also participates in local development activities. It is known by development agencies and it also knows some such as Amref Health Africa and World Vision which it works with. The community at large knows, respects and supports the organisation. The organisation has a community and gender policy which is implemented. It has external stakeholders and relationship management, physical structures, HR systems, oversight and stewardship. The organisation has a five year strategic plan and keeps a reserve to cushion it in case of funding shortfall. It engages the community to support the projects as a plan for its continuity without external support. It rents out the office space as an investment and is aware of local opportunities and threats to ARP activities. There is continuous dialogue, identification and implementation of emerging community needs and projects. The number of staff trained in the organisation is two and the number of people reached by the organisation is two thousand. The organisation is registered with the relevant authorities. It has the appropriate management structure but whose roles are not spelt out clearly. The leadership consults the members on key decision and is accountable to those members. The organisation does not have a finance resource

 

Work with Education department Has reached about 2000 people



Need to be capacity built before structured engagement and networking



Has reached about 150 people



Not recommended

65 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

ď&#x201A;ˇ

mobilization and management structure; it is not represented in annual budgeting and planning at any level. It does not mobilize support for ARP activities, writes no project proposals for the same and is not aware of sources of funding. There is fair representation of men, women and youth who are allocated roles without gender bias. The members are encouraged to give their views regardless of age, gender or ethnicity. The organisation works with government departments by participating in workshops, it knows other development agencies such as EMAYO, Amref Health Africa and World Vision and works with them. There is support and goodwill from the community. I9t has one external stakeholder, World Vision. The organisation has some savings and has trained 2 of its staff and reached 150 people.

66 ARP Baseline Final Report for Amref Health Africa in Kenya and Tanzania July 2014

SECTION SEVEN: CONCLUSIONS AND RECOMMENDATIONS

7.1 Conclusions The ARP baseline has established that FGC is a highly ritualized and deeply entrenched in practicing societies, and is best understood as a range of procedures that are linked to communal identity, cultural beliefs, and social norms. The procedure is often viewed as empowering young girls during their transition to womanhood. FGC is to date still widely practised based on entire range of cultural reasons that include; confers social status and family honour, cultural identity, control sexuality / promiscuity, better marriage prospects, makes birth easier and as a rite of passage / transition to adulthood. Comparison of adult mother and the young girls point to a declining trend in the practice of FGC among the target communities. The ARP baseline study shows that, despite stiff cultural resistance in the four project sites, progress towards abandonment of female circumcision can be achieved through well-focused, incremental interventions that involves all community members: cultural elders, community leaders (religious leaders, village chiefs, elders), ‘circumcisers’, teachers, women’s groups, peer educators, women, men, boys and girls; local administrators, teachers, church leaders, and traditional circumcisers and health professionals. This study also provides some insights into the factors which contribute to the continuation of FGC among the Samburu and Maasai in Kenya and Tanzania. FGC is a highly valued cultural tradition among the Maasai and Samburu, making its total elimination difficult given that nearly all the mothers and about half (45.2%) of young girls have been circumcised. Among the Maasai, the end of a girl’s seclusion period after undergoing genital cutting is not a public ceremony but instead the parents organise a feast at home. This therefore mean to reduce the practice or total abandonment would require a combination of intensive community mobilization and sensitisation on FGC to bring about attitudinal and behavioural changes at family and community level. This study therefore concludes that community mobilization, education and sensitisation are precursors to the success of ARP and is critical for creating the conditions in which ARP can be introduced and anchored to bring about change in the communities. This can be achieved through community mobilization and education to assist in raising awareness on the harmful effects of FGC. The baseline further reveals that ARP can make a remarkable contribution towards the abandonment of the FGC but this will largely depend on the socio-cultural contexts in which FGC is practised in the targeted communities and adopting effective socio-cultural enablers on which ARP would be successfully hinged without antagonizing the local cultures. This study has confirmed that ARP cannot be introduced without a preceding or accompanying process of community involvement, mobilization and sensitization in which attitudinal change will be stressed. For the ARP approach to be replicated successfully in Samburu and Kilindi, it will require a good understanding of the role of public (as opposed to familial) ceremonies in these cultures, and a judgement as to what format for the ritual is the most appropriate means of

helping those that have decided to abandon the practice. Due to fear of being ridiculed among the peers, women and girls who are not “circumcised” still continue to be referred to as children among the Samburu and Maasai. Immediately after the public ceremony marking the “graduation” of young girls from childhood to woman hood through ARP, there will be need to constantly follow-up and counsel the girls who have gone through ARP. This is due to enormous pressure that they will face upon their return to the villages to be circumcised. Therefore, the ARP project need to make provisions for constant follow-up to ensure such initiates do not succumb to peer pressure to undergo the cut or be forced into early marriages. The role and meaning of traditional rites of passage and of female circumcision varies considerably in the project sites. While the ARP approach has been adapted in the local conditions, some of the tensions apparent in its implementation suggest that greater attention needs to be paid to the way the approach is to be introduced in different communities especially in Samburu where it is expected to meet the greatest resistance from the cultural elders. A number of challenges are envisaged in the process of implementing ARP and need to be addressed. The challenges will include;   



Culture: The Maasai and Samburu value their culture and therefore it may be difficult to discuss this deep-rooted cultural tradition, which most people find hard to abandon. Cultural sensitivities will limit appropriate entry points for community discussions especially with women. Social function: FGC serves other social functions which help to maintain the identity and cohesiveness of the community. To change such a functional cultural element is not only a challenging and daunting task but can also be one that is full of frustrations as recently witnessed in Kenya with women demanding that their girls be allowerd to undergo FGC. Peer pressure and stigmatization: For the girls who are to go through the alternative rites of passage, it is expected that they will face the challenges of peer pressure, ridicule and stigmatization from the community. High illiteracy levels among the Maasai women and girls as the community for a long time did not value female education; therefore many girls are not educated, leaving them with few opportunities besides marriage going through FGC and subsequently married off. Economic asset: The Maasai and Samburu communities see a girl-child as an economic asset and therefore a source of the family’s wealth. Parents marry off their daughters at an early age since their bride price (cows and goats) helps to reduce their poverty. Resistance to change: Despite the successes of the campaign against FGC, some members of the community are still reluctant to change. To evade the law, they perform FGC secretly, at night without ceremony. The girls are then married off, all without prior preparation. The suddenness and the speed of the situation may pose a challenge to the project. FGC has evolved to be a private family affair: The practice of FGC among the Maasai and Samburu is largely a private event; for most families, there is neither a public cutting ceremony nor public festivities and celebrations organized to mark the event. Since the practice has been outlawed in Kenya and Tanzania, the practice is highly secretive done at night or deep in the bushes. Vastness: The target areas are quite vast in coverage and lacks adequate infrastructure to reach out to the nomadic pastoralist populations.

ď&#x201A;ˇ

Insecurity: One of the project area, Samburu County is prone to banditry attacks and cattle \rustling and this may affect the project implementation activities compared to the other three sites.

7.2 Recommendations In addressing the above challenges, the ARP baseline recommends the following:

FGC is a multi-faceted problem and therefore should be approached by encouraging participation of all community members through project / area advisory council: The ARP scale up project should target young boys in schools (11-14 years), especially the morans (11-30 years), unmarried girls, circumcisers, parents â&#x20AC;&#x201C; both the mothers and fathers, cultural elders, community leaders, local and religious leaders, government officials and political leaders are involved in program design and implementation. While time-consuming, ensuring participation of all from the outset encourages a sense of involvement and ownership at the community level, which can in turn result in the much needed political support at the Sub-County, County and National levels. This can be achieved through the formation of project advisory council both at the Sub-County and County level with representation of young girls the morans and school boys, women, community leaders, religious leaders, political leaders and government officials. The District Advisory Council (Tanzania) and Area Advisory Councils (Kenya) at the County, SubCounty and district, divisional and locational levels will help in the prosecution of child abuse cases. The use of legislative force especially through community child protection systems, such as Area Advisory Councils will help ensure that gender violence cases including FGC are prosecuted, serving as a deterrent force against would be circumcisers at the local level. The ARP Project to develop ARP follow-up and reporting mechanisms on a quarterly basis. The project needs to put in place interventions that will help ARP girls cope with the social pressure that may force such girls submit to FGC practice. Once a girl has graduated through the ARP, there will be need to conduct regular follow-up of ARP-girls, refresher training and counselling on a quarterly basis to keep the fire of ARP burning in such girls until they reach an age where peer pressure doesnâ&#x20AC;&#x2122;t mean much. There is therefore the need for constant follow-up to counsel ARP graduates to cope with ridicule, stigma and discrimination they are likely to face from their peers and the community in general by ensuring that they do not succumb to female circumcision. The suggested follow-up platforms may include ARP girls clubs in schools and churches. Focus on High Impact Community Advocacy campaigns targeting the Morans (18-30 years) and young girls (11-17 years) Changing community cultural attitudes and beliefs on FGC is a resource-intensive, long-term process that may take time before impact is created through continued education and awareness programs. This will require uninterrupted contact with communities to ensure community trust and continued success is sustained. There is therefore the need to develop high impact advocacy interventions targeting the Morans (18-30 years) and young girls (11-17 years) as these two groups will ensure real and meaningful change is achieved. Such highly focused social mobilization/campaign strategy should aim at breaking the silence surrounding FGC by producing unified anti-FGC messages that will help change the attitude of morans and young girls towards ARP and marriages to the uncircumcised girls. The 69

project should also develop targeted advocacy plan around the anti FGC activities that will be periodically monitored and reported. The ARP project should therefore advocate for increased community mobilization and advocacy on the negative health and social effects of FGC and its legality. The ARP project should engage the whole community, including the cultural elders, the morans, community leaders (religious leaders, village chiefs, and elders), teachers, womenâ&#x20AC;&#x2122;s groups, peer educators, women, men, boys and girls; local administrators, teachers, church leaders, traditional circumcisers and health professionals to address the retrogressive cultural practices including early marriages and moranism. The advocacy component should in addition target the County Governments / District leaders to strengthen the enforcement of the anti-FGC and early marriage laws through arrest, prosecution and punishment of perpetrators. This is because many cases of FGC and early marriages go unreported and many grass root leaders / administrative ignore or sometimes collude in the parents to perpetuate the practice of FGC and early marriages.

ARP Communication Strategy: Amref health Africa (Tz/Ke) should hire the services of a specialist to develop an ARP communication strategy that can be used to communicate messages targeting decision makers in the community in a bid to negotiate for change of some of the traditional practices. In addition Amref health Africa (Tz/Ke) should produce an ARP training manual and encourage the use local languages and local trainers as facilitators (Samburu and Masaai). In developing such training manuals, Amref health Africa in Tanzania and Kenya should benchmark with existing manuals of other partners such as UNICEF and Population Council that have developed related materials. The project should also develop visual aids showing the human anatomy and the effects of FGC to be used by the community FGC trainers. These will be especially helpful since majority of the community members, especially women are illiterate. Use comprehensive approaches including Creating and strengthening partnerships with local stakeholders, administrators and other actors: FGC is a complex tradition that cannot be successfully addressed in isolation from its socio-cultural, economic, and political implications. Integrated strategies must be designed in collaboration with other agencies including CSOs, FBOs and NGOs with a focus on FGC in order to incorporate reproductive health and sexual rights information, community-based strategies to address poverty and development issues while creating linkages with top policymakers and womenâ&#x20AC;&#x2122;s equity and human rights organizations. Under this component, the project will need to enhance its engagement with the local administrators that include chiefs and their assistants, clan elders who are very influential in the Maasai and Samburu communities. Also to be targeted are the Members of the County Assembly (MCAs), Members of Parliament and other County leaders to publicly denounce the FGC practice within the targeted project areas. Promote Gender Equality and Empower Women and Girls: Such strategies should take the form of awareness creation among the target communities to enhance girl child education, introduction of sanitary program to maintain girls in schools, advocacy for representation of

women in leadership, decision making and targeted educational programs on the effects of FGC in a classroom environment. Girls and Boys Education is critical in anti FGC programs: Schools provide an excellent avenue to address the effects of FGC and creating a pool of women who can pass appropriate knowledge / information to their children. Such programs will also encourage young girls and boys including the Morans to reject the practice as they will be exposed to relevant information on the effects of FGC. It is therefore recommended that the Amref health Africa led ARP project should consider working more closely with schools, teachers, school committees, school boards, churches, Morans and building the capacity of teachers to help them overcome social inhibitions to address the negative effects of FGC and early marriages within the school environment and places of worship. This component of the project can be enhanced by working with school PTA committees and school board members in addition to offering sponsorship for the needy girls as a way of ensuring the girls remain in school. This is important as a good number of parents may be yet to be convinced that it pays to spend money on girl’s education. The use of health risk approach in addressing FGC: Amref health Africa has been working with communities in a number of health programs such as maternal and child health as well as water, sanitation and hygiene. This holistic development approach is strength for bringing behavioural change on FGC to the communities by focusing on interventions using a health risk approach and addressing health complications of FGC. Such programs should target men and young boys specifically through social forums since the men strongly believe in marrying circumcised women/girls. They men should equally be educated on the dangers of the cut and its long term effects on the young girls and women in general. Therefore, there is need to mainstream FGC as a cross-cutting issue in all Amref health Africa programmes in the project areas. Re-orient Traditional Circumcisers to new roles including training to be champions of ARP and anti FGC crusaders: in order to boost the living standards of the community and improve their access to essential commodities such as food and clothing, it is recommended that the social development component of this project focuses on training of traditional circumcisers on attitude change in addition to economic empowerment and integrate them with community action, e.g. in women and prayer groups. This should be done in collaboration with other relevant Government departments. In addition, Amref health Africa should focus the training of traditional circumcisers on attitudinal change in addition to economic empowerment and integrate them with community action, e.g. in women groups. Amref health Africa need to engage with other anti-FGC stakeholders e.g. World Vision, PATH and UNICEF etc and discuss which approaches and methods are found to be most efficient when ‘converting’ circumcisers. Use culture specific community entry and advocacy approaches including the use of known community role models. These could be successful, Samburu and Maasai women and girls who have denounced the practice and help convince other young girls to say no to the practice. Also to be encouraged is the use of community radio stations in passing crucial anti FGC messages / campaigns.

References

1. Project Proposal, Let Girls Become Women Without the Cut, Amref Health Africa in Kenya and Tanzania 2. Indicators Log frame Contribute to the abandonment of FGC in Magadi, Samburu, Loitokitok (Kenya) and Kilindi (Tanzania) by 2016 Amref Health Africa in Kenya and Tanzania 3. Kajiado County Development Profile (2013), Ministry of Devolution and Planning 4. Kenya Demographic and Health Survey (2008- 2009) Kenya National Bureau of Statistics 5. Tanzania Demographic and Health Survey 2010, National Bureau of Statistics, Tanzania 6. Samburu County Development Profile (2013), Ministry of Devolution and Planning 7. WHO 2008. Road map for accelerating the attainment of Millennium development goals related to maternal and new born health in Africa. WHO. Geneva, 2008.

Annex 1: School Enrolment, Retention, Drop out and Transition Data

Area Magadi

Gender Oloibortoto Primary School Entasopia Primary School Pakaase Primary School

Olorika Olorika

Retention rate

Transition

2012

2013

2014

Boys

145

182

196

190

Girls

144

159

177

185

Boys

317

318

322

337

Girls

284

289

307

305

Boys

111

122

141

143

92%

Girls

106

113

114

96%

369

386

419

425

Boys

400

454

435

517

Girls

356

395

432

435

756

849

867

952

average Kilindi

Drop out

2011

Average Loitoktok

Enrollment 2011

2012

2013

2014

2011

2012

2013

2014

2011

2012

2013

2014

99%

98%

99%

100%

99%

98%

99%

100%

33%

96%

33%

96%

33%

Ngobore Boys Girls Kwekinkwe mbe

Boys

Elerai

Boys

161

185

218

220

94%

92%

93%

99%

94%

92%

93%

99%

Girls

141

129

145

136

84%

81%

79%

93%

84%

81%

79%

93%

Kwendiswati

Boys

84%

92%

88%

98%

84%

92%

88%

98%

Girls

63%

84%

81%

94%

63%

84%

81%

94%

105

117

81%

87%

85%

96%

81%

87%

85%

96%

572

569

527

521

Girls

Average Samburu

Suguta Mar Mar Primary

Boys

School

Girls

450

448

464

475

Nkeju Emuny Primary school

Boys

188

226

207

208

Girls

140

178

194

186

Boys

226

233

229

228

Girls

186

197

200

201

Boys

154

172

185

200

Girls

121

125

154

169

Boys

315

325

330

336

Girls

266

298

293

303

246

435

454

500

Sirata Primary School Nkopelian Primary School Loosuk Primary School AIC Moi Girls Samburu

Boys Girls

Nyiro Girls Secondary

Logorate Primary School Average

94%

96%

98%

100%

74%

96%

100%

19%

22%

94%

96%

98%

100%

74%

96%

100%

19%

22%

Boys Girls

South Horr Primary school

Boys

509

542

524

571

Girls

438

479

480

553

Boys

213

203

208

241

Girls

143

177

176

182

463

515

519

550

10%

Annex 2: ARP Baseline Tools SECTION 1. HOUSEHOLD IDENTIFICATION

This section is to be completed for each household visited.

100. ARP Project Area.

1.Loitokitok

2.Magadi 3.Samburu 4.Kilindi

101. District Name

__________________________________________

102. Community Health Unit name. 103. Village / Manyatta Name.

104. Household number.

105a. Interviewer number.

106. Date of interview.

105 b. Interviewer Name: Day:

Month:

Year:

107. Time interview commenced.

108. Time interview ended.

109

H109 to H110 be filled-in after all questions for the HH have been completed Result of HH interview Completed 1 Not at home

Refused

HH not found/destroyed

Other (specify________________) 6 110

Respondent to HH Form: Name: ____________________________ (To be filled-in after completing

Line No:

Household Listing Module) Interviewers

Refer at ALL times to your survey manual for instructions. Remember to obtain consent from each household. Write answers directly in the tables for sections 1-4.

Field Check that ALL answers are recorded in each section, ensuring gaps or missing answers are Supervisors obtained BEFORE leaving the household. Please complete this part of the form Field supervisor

HH Survey Enumerator

Data entry clerk

Name Date

HOUSEHOLD SELECTION / SAMPLING INSTRUCTIONS

INTERVIEWER/ENUMERATOR: It is your job to select a random (this means any) household within the sampled CLUSTER. A household is a group of people who presently eat together from the same pot.

Start your walk from the start point that has been randomly chosen by your Field Supervisor with the guidance of Clan Elders. Team members must walk in opposite directions to each other. If A walks towards the Sun, B must walk away from the Sun; C and D must walk at right angles to A & B.

Use the Day code to determine the sampling interval. For example, on the 5th of the month, the day code and sampling interval is 5. So you choose the 5th dwelling structure on the right. On the 6th of the month, the sampling interval is six, so you choose the sixth dwelling structure on the right and so on.

If no-one is at home (i.e. premise is empty) substitute with the next household to the right. If the interviewer has refused, use the day code to select a substitute household (i.e. after a sampling interval).

When you find a household with someone at home, please introduce yourself using the following script. You must learn this introduction so that you can say it exactly as it is written below:

Good morning / afternoon. My name is ____________________. I am working with The African Medical and Research Foundation (AMREF) Kenya / Tanzania, an independent nonprofit, non-governmental organization (NGO) spearheading implementation of health programs within African region. We are conducting a survey that asks about various reproductive health issues affecting young girls and mothers in this community. Every young girl in the household aged (15-24 years) and for adults, only ONE respondent either husband (18 years +) or mothers (15-49 years) have an equal chance of being included in the study. The survey will take about 25-35 minutes to complete. Whatever information you provide will be kept confidential and will not be discussed with anyone other than members of the survey team.

Participation in this survey is voluntary, and if we should come to any question you donâ&#x20AC;&#x2122;t want to answer, just let me know and I will go to the next question; or you can stop the interview at anytime. However, we hope you will participate in this survey since your views are important.

Your household has been chosen by chance. We would like you help us choose a young girl (15-24 years) from your household. Would you help us pick one? In addition, we would also wish to talk to you or the mother of the young girl sampled within the household.

Note: the person must give his or her consent by answering positively. If participation is refused, walk away from the household and use day code to substitute the household. If consent is secured, proceed as indicated in Q201:

The questions in this survey are for Adult Men (18 YEARS +) AND MOTHERS AGED 15-49 YEARS in the sampled household. If there is more than one mother in a household, choose one mother at random to be interviewed.

SECTION 2. HOUSEHOLD CHARACTERISTICS 201.

Please tell me the names of all the members of your household who usually live here, sleep here and eat from the same pot, including yourself. Please include children, relatives or orphans, but do not count temporary visitors. First names are sufficient. This information is confidential and will not be shared with anyone. Names are only used to capture information about in the respondent and children and will not be revealed to anybody. Make a list of ALL names before asking other questions.

202. After getting the full list of family members, continue with the other questions in the table for each person in the list. 201. 202. 203. 204. 205. 206. FIRST, PLEASE TELL ME THE NAME OF EACH PERSON WHO USUALLY LIVES HERE IN THIS HOUSEHOLD, STARTING WITH THE HEAD OF THE HH?

Line No.

WHAT IS THE RELATION-SHIP OF (name) TO THE HEAD OF THE HH?

1. Head 2. Spouse 3. Child 7. Relative 8. Other

IS (name) MALE OR FEMALE?

1. Male 2. Female

AGE: HOW OLD IS (name)?

HOW OLD WAS (name) ON HIS/HER LAST BIRTHDAY? For children < 5 years write the number of months.

WHAT IS THE HIGHEST LEVEL OF SCHOOL COMPLETED?

WHAT IS THE MAIN ECONOMIC ACTIVITY OF (NAME)?

Write the number for the grade level. 0. 1. 2. 3. 4. 5. 6. Other

None/Never Pre-School Primary Secondary University Postgraduate DK

……………………..

207

208

209

210

WHAT IS YOUR INCCOME PER MONTH (Wages, Salaries and in kind)

WHAT IS YOUR ETHNIC GROUP/ TRIBE?

WHAT IS YOUR RELIGION?

MARITAL STATUS – WHAT IS YOUR MARITAL STATUS

Enter Amount (Kshs)

MAASAI

1. CATHOLIC

SAMBURU 02

2. PROTESTANT

2.MONOGAMUS

3. MUSLIM

3.POLYGAMUS

4. NO RELIGION

4. WIDOWED

1.NEVER MARRIED

KAMBA

1.Unemployed

KIKUYU

2. Employed

SOMALI

05 5. TRADITIONAL RELIGION

5. DIVORCED

3. Self –Employed

TURKANA 05

4. N/A

POKOT

6. OTHER ........................................................ 7. N/A

BORANA

(SPECIFY)

OTHER (SPECIFY)

6.SEPARATED

1 2 3 4 5 6 7 8 9 10

SECTION 3: FEMALE GENITAL CUTTING AND ALTERNATIVE RITE OF PASSAGE This section is to be completed ONLY one adult respondent (male/female) in the household (for male respondents only Q300 and Q301 are applicable then skip to Q309). Please circle the correct answer.

Yes (1) Skip to 302 300. Have you ever heard of female circumcision?

301. In some communities, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

No (2) Yes (1)

302. Have you yourself ever been circumcised?

No (2)

→ 309

Yes (1) Skip to 305

303. Now I would like to ask you what was done to you at the time. Was any flesh removed from the genital area?

No (2)

Don’t Know (98) Yes (1)

304. Was the genital area just nicked without removing any flesh?

No (2)

Don’t Know (98)

Yes (1)

No (2)

305. Was genital area sown closed?

Don’t Know (98) 306. How old were you when you were circumcised? AGE IN COMPLETED YEARS

IF RESPONDENT DOES NOT KNOW THE EXACT DATE, PROBE TO GET AN ESTIMATE

DURING INFANCY……………………………………….. 2 DON’T KNOW…………………………………………… 98

TRADITIONAL TRAD. CIRCUMCISER…………………1 TRAD. BIRTH ATTENDANT…………..2 OTHER TRAD…………………………...3

HEALTH PROFESSIONAL 307. Who performed the circumcision? DOCTOR…………………………………4 TRAINED NURSE/MIDWIFE…………5 OTHER HEALTH PROFESSIONAL…….6 SPECIFY…………………………………

Don’t know………………………………..98 1. Individual Household within Homestead

2. Secluded places in the bush 308. Where was it performed?

3. Health Facility 4. Across the border in Tanzania

Yes (1)

No (2) if No, Skip to 311

309. Are any of your daughters circumcised?

Not applicable (3)

Daughter 1 TRADITIONAL TRAD. CIRCUMCISER…………………1 TRAD. BIRTH ATTENDANT…………..2 OTHER TRAD…………………………...3

HEALTH PROFESSIONAL 310. Who Performed the circumcision and at what age?

DOCTOR…………………………………4 TRAINED NURSSE/MIDWIFE…………5 OTHER HEALTH PROFESSIONAL…….6 SPECIFY…………………………………

Don’t know………………………………..98

Age of circumcision

Daughter 2

TRADITIONAL TRAD. CIRCUMCISER…………………1 TRAD. BIRTH ATTENDANT…………..2 OTHER TRAD…………………………...3

HEALTH PROFESSIONAL DOCTOR…………………………………4 TRAINED NURSSE/MIDWIFE…………5 OTHER HEALTH PROFESSIONAL…….6 SPECIFY………………………………… Don’t know………………………………..98

Age of circumcision

Daughter 3 TRADITIONAL TRAD. CIRCUMCISER…………………1 TRAD. BIRTH ATTENDANT…………..2 OTHER TRAD…………………………...3

Age of circumcision

311. Do you believe that this practice is required by your community?

1 Yes 2 No

312. Do you believe that this practice is required by your religion?

3. Don’t Know 1 Yes 2 No 3. No Religion

313. Do you think that female circumcision should be continued, or should it be stopped?

4. Don’t Know 1 Continued 2 Stopped 3. Depends 4. Don’t Know Go to section 4.

314 Give reason for your answer in 313 above

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

SECTION 4. ALTERNATIVE RITE OF PASSAGE

400

Have you ever heard of messages against female circumcision?

1 Yes 2 No Skip to 403

401

If yes from whom?

1 Community leaders 2 Government Official

(Record all responses given)

3 Religious leaders 4 Health workers 5 Peer Educator

DO NOT READ OUT ANSWERS

6 Radio 7 Posters 8 Relatives 9 Other (specify): _______________

402

What kind of messages have you heard?

1 FGC limits girls education 2 Can still get a husband without being circumcised

(Record all responses given)

3 One can bleed to death 4 Can lead to HIV infection

DO NOT READ OUT ANSWERS

5 It is a violation of human rights 6 Existence of Alternative Rite of Passage 7 Other (specify): _________

403

1 Yes

Have you heard about the Alternative Rite of Passage?

2 No Skip to SECTION 5

404

What do you think about the Alternative Rite of Passage?

405

Would you allow/propose your daughter to undergo an Alternative Rite of Passage if it was organized in this community?

406

Do you believe that Alternative Rite of Passage (ARP) is acceptable by your community?

1 Positive 2 Negative 1. Yes 2. No 1 Yes 2 No Skip to 408

407

IF YES TO Q406, What are some of the key socio-cultural enablers on which ARP would be successfully be hinged without unnecessarily antagonizing your culture?

3. Donâ&#x20AC;&#x2122;t Know 1 Intensive community sensitization as an enabler in behaviour change process 2 Promote public ceremony associated with the rite of passage 3. Promote the training and sensitization of elders 4. Promote the participation of community members in the Alternative Rite to enhance the transition from an attitudinal change to a behavioural change 5. Promote good understanding of the role of public (as opposed to familial) ceremonies in that culture 6. Others (Specify)

408

IF NO TO Q406,what are some of the socio-cultural barriers (myths, beliefs and norms) that stand in the way of the community in girls in denouncing FGC?

409

Do you believe that ARP is acceptable by your Religion?

______________________________________________________ 1 Yes 2 No 3. No Religion 4. Donâ&#x20AC;&#x2122;t Know

SECTION 5: KNOWLEDGE, ATTITUDES AND PRACTICE TOWARDS FEMALE CIRCUMCISION

501

What are the health, psychological or social problems associated with female circumcision?

1 Excessive bleeding 2 Painful personal experience

(Circle all that are mentioned by the respondent) 3 Against rights & dignity of women 4 Prevents sexual satisfaction 5 Limited/Limits education of girls DO NOT READ OUT ANSWERS 6 Against religion

7 Might lead to infertility 8 Has lost its significance 9 Ridiculed by peers 10 Difficulty when giving birth 11 Death 12 Others (Specify): ___________________

502

How would you describe your ideal marriage partner/s (wife/husband)?

503

What would be the best cultural ritual that would help a girl who is not circumcised or who undergoes ARP feel she is fully accepted by the community to have become a woman?

13 Donâ&#x20AC;&#x2122;t know 1. Circumcised 2. Educated 3. Not circumcised 4. Economically stable 5. Other specify _______________________________

1. 2. 3. 4. 5. 6. 7.

Blessing by cultural elders Blessing by religious leaders Blessing by parents An ARP graduation certificate Holding of a community ARP ceremony where the girls who undergo ARP are publicly acknowledged Going to school Other (Specify)

Thank the Interviewee and leave for the next household. THE END

ALTERNATIVE RITE OF PASSAGE (ARP) SCALE-UP PROJECT IN KENYA AND TANZANIA Young Girls (10-24 years) IDENTIFICATION Area

Tribe

ARP Project Area ---------- Location 1. 2. 3. 4.

Loitokitok Magadi Samburu Kilindi

__________ __________ __________ ___________

Sub-Location __________ __________ __________ __________

Q05. INTERVIEWER VISIT Date Interviewer’s Name and Code Time interview start Time interview end Household Number

1. 2. 3. 4. 5. 6.

Maasai Samburu Kamba Kikuyu Somali Other Specify _________________________

……/…./…..

REMARKS__________________________________________________________________ SUPERVISED BY

CHECKED BY

ENTERED BY

…../…../…..

….../…./…..

…../……/…..

DD/MM/YY

NAME DATE

Informed Consent Good morning/afternoon. My name is _______________________________________. I am working for the African Medical and Research Foundation (AMREF Ke/Tz). We are conducting a survey about the Alternative Rite of Passage (ARP), a three year regional project being implemented in Magadi, Samburu, Loitokitok (Kenya) and Kilindi (Tanzania). The information we collect will inform AMREF and other stakeholders; the 88

community, health care providers, policy makers and the Government on specific best practices in reaching adolescents and youth with sexual and reproductive health information. The questions usually take about 25 to 35 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time. In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions? May I begin the interview now? Your household has been chosen by chance. We would like you to choose young girls between 15-24 years from your household. Would you help us pick one? Confidentiality of all the information obtained will be strictly adhered to. May I have your permission to continue with the interview? (Circle one.)

1 = Yes

2 = No (Terminate the interview) and substitute with the next household

Interviewer’s Name: ______________Signature: ______________Date: ___________

SECTION 1: DEMOGRAPHIC CHARACTERISTICS (ALL) 101 How old were you on your last birthday? Age: _______years 98 Don’t know 102

When were you born?

Date: __/__/__ 98 Don’t know

103

Have you ever attended any formal school?

1 Yes 2 No Skip to 106

104

Are you currently attending school?

1 Yes 2 No

105

What is the highest level of school you have 1No education completed? 2 Primary 3 Secondary 4 Technical/vocational school 5 University/college 6 Post-university/graduate school 7. Other Specify _____________________ 98 Donâ&#x20AC;&#x2122;t know

106

What is your occupation?

1= Full time housewife 2 = salaried job 3 = self employed 4 = casual worker 5 = farmer 6 = unemployed 7 = Student

107

8 = Other Specify _________________________ 1 = Single (Skip to 201)

What is your marital status?

2. = Single living with partner (Skip to 201)

3 = Divorced 4 = Separated 5 = Widowed 6 = Married monogamous 7 = Married (polygamous) 8 = Married (inherited) 108

How old were you when you got married?

Age: ______years 98 Don’t know/don’t remember

201 202 203

SECTION 2: FEMALE GENITAL CUTTING Have you ever heard of female circumcision? 1. Yes → 203 2. No In some communities, there is a practice in which a 1. Yes girl may have part of her genitals cut. Have you ever heard about this practice? 2. No Have you yourself ever been circumcised? 1. Yes 2. No 91

→ 309

204

Now I would like to ask you what was done to you 1 Yes at that time. Was any flesh removed from the genital area? 2 No

→ 206 (Non ARs)

3. Don’t Know 205

Was the genital area just nicked without removing 1 Yes any flesh? 2 No 3. Don’t Know

206

Was your genital area sewn closed?

1 Yes 2 No 3. Don’t Know

207

How old were you when you were circumcised?

Age in completed years

IF THE RESPONDENT DOES NOT KNOW THE As a baby / during infancy EXACT AGE, PROBE TO GET AN ESTIMATE Don’t Know 208

Who performed the circumcision?

95 98

TRADITIONAL Traditional Circumciser

Traditional Birth Attendant 2 Other Traditional ______________________(3)

Specify

HEALTH PROFESSIONAL Doctor

Nurse / Midwife

Other 92

professional

Specify

____________________(6)

Don’t Know 209

Where was the circumcision performed?

1. Individual household within the homestead 2. Secluded place 3. Health Facility 4. Across the border in Tanzania

SECTION 3. INTERVENTIONS – ALTERNATIVE RITE OF PASSAGE (ALL) 309

Have you ever heard of messages against female 1 Yes circumcision? 2 No Skip to 312

310

If yes from whom/which source?

1 Community leaders 2 Government Officials

(Record all responses given)

3 Religious leaders 4 Health workers 5 Schools

DO NOT READ OUT ANSWERS

6 Peer Educator 7 Radio 8 Posters 9 Relatives 10 Other (specify): _______________ 311

What kind of messages have you heard?

1 FGC limits girls education 93

2 Can still get a husband without being circumcised (Record all responses given)

3 One can bleed to death 4 Can lead to HIV infection 5 It is a violation of human rights

DO NOT READ OUT ANSWERS

6 Other (specify): _________

312

313

Which rite of passage do you believe in for the 1 FGC girls? 2 ARP 3 None Do you believe that Alternative Rite of Passage 1 Yes (ARP) is acceptable by your community? 2 No 3. Don’t Know Do you believe that Alternative Rite of Passage 1 Yes (ARP) is acceptable by your religion? 2 No 3. No Religion

314

4. Don’t Know Do you think that female circumcision should be 1 Continued continued, or should it be stopped? 2 Stopped 3. Depends 4. Don’t Know

315

Give reasons for your answer in 314 above

(SKIP SECTION 4 IF NON ALTERNATIVE)

SECTION 4. QUESTIONS RELATED TO UNCIRCUMCISED GIRLS(AR GROUP) 401

Who made the decision that you should not be 1 Self circumcised? 2 Mother 4 Father 5 Grandmother 6 Grand Father 7 Brother 8 Sister 9 Other (specify):_________________

402

Have you faced any problems in the community 1 Yes because you are not circumcised? 2 No (Skip to 404)

403

If yes, what kind of problems have you faced?

1 Mistreatment 2 Seen as a child

(Record all responses given)

3 Shunned by boys 4 Ridiculed by peers 5 Disrespected

DO NOT READ OUT ANSWERS

6 Fear of forceful circumcision during delivery 7 Other (specify): __________ 404

In your view, are there differences between 1 Yes circumcised and uncircumcised girls? 2 No (Skip to 406)

405

What kinds of differences are there?

98 Donâ&#x20AC;&#x2122;t Know Circumcised 1 Circumcised are clean 95

2 Marriage prospects

Uncircumcised 12 Better education prospects 13 Reduced risk of early

(Record all responses given)

marriage 14 Reduced risk of delivery complications 4 Acceptance in the 15 Reduces risk of HIV community infection 5 Give pleasure to DO NOT READ OUT ANSWERS husband 6 Improve fertility 7 Preserves virginity 8 Prevents immorality 9 Respected in the community 10 Uncircumcised are promiscuous 11 Other (Specify) Over the last 4 years has FGC increased, 1. Increased 2. Decreased 3. Remained the decreased or remained the same in your area same 98. Donâ&#x20AC;&#x2122;t Know 3 Social acceptance

406

SECTION 5: KNOWLEDGE, ATTITUDES AND PRACTICE TOWARDS FEMALE CIRCUMCISION (ALL) 501

What are health, psychological or social 1 Excessive bleeding problems associated with female circumcision? 2 Painful personal experience (Circle all that are mentioned by the 3 Against rights & dignity of women respondent ) 4 Prevents sexual satisfaction 5 Limited/Limits education of girls 6 Against religion

DO NOT READ OUT ANSWERS

7 Might lead to infertility 8 Has lost its significance 9 Ridiculed by peers 10 Difficulty when giving birth

11 Death 12 Others (Specify): ___________________ 13 Don’t know

502

Do you have any sisters?

1 Yes 2 No (Skip to 506)

503

How many of your sisters are circumcised?

Circumcised___________________ (If NONE, end the interview if respondent is uncircumcised. If respondent is circumcised then skip to 506)

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At what age were they circumcised?

Sister 1 ……………………yrs

Sister 2 ……………………yrs

Sister 3 ……………………yrs

Sister 4 ……………………yrs

Sister 5 ……………………yrs

Sister 6 ……………………yrs

Who made the decision for your sisters to be 1 Self circumcised? 2 Mother (Record all responses given) 4 Father 5 Grandmother DO NOT READ OUT ANSWERS

6 Grand Father 7 Brother 8 Sister 97

9 Other (specify):_________________

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507

Do you wish that you had not been 1Yes circumcised 2 No (Skip to 509) 3 N/A If yes (Q506) why do you wish you were not 1 Medical complications circumcised? (Circle all that apply) 2 Painful personal experience 3 Against rights & dignity of women 4 Prevents sexual satisfaction DO NOT READ OUT ANSWERS

5 Limited my education 6 Against religion 7 Might lead to infertility 8 Has lost its significance 9 Ridiculed by peers 10 Have heard messages against FC 11 Others (Specify): _________ 508

Give reasons for your Answer in Q506 above 1 ……………………………………………………… 2 …………………………………………………….. 3 ……………………………………………………… 4 ……………………………………………………... 5 …………………………………………………….. 6 ……………………………………………………… 98

509

What would be the best cultural ritual that would help a girl who is not circumcised or who undergoes ARP feel she is fully accepted by the community to have become a woman?

8. 9. 10. 11. 12.

Thank the Interviewee and leave for the next household. THE END

FOCUS GROUP DISCUSSION GUIDE

AALTERNATIVE

RITE OF PASSAGE (ARP) SCALE-UP PROJECT IN KENYA AND TANZANIA

Women and Men’s FGD Guide (Adults) including the Cultural Elders

GENERAL

I would like us to talk about the existing socio-cultural, economic and religious reasons promoting the practice of female genital cutting (FGC) in your community.

General issues on gender in the community

1. What are the causes of gender inequality in this community? Probe for:   

Are women allowed to take part in development projects? (please give examples of development activities where women participate in this community / don’t participate in this community) Women’s role in decision making; why do women not have a voice in certain decision making? Are women allowed to take part in leadership within the community? Probe for examples and known women leaders from the community if any who serve as role model?

2. Female Genital Cutting / Circumcision    

What do you think about this practice? What is the historical background of FGC practice in your community? Probe for prevalence of FGC in the community (small extent or widespread), Probe for age at which circumcision take place (why FGC at the stated ages)?

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3. Who makes the decision to circumcise?  

Probe for who decides on the cut within the home and village / community? Probe for the influence of cultural elders, husbands, mothers, morans, religious leaders, others etc?

4. Why does this community practice FGC? What benefits do girls themselves get if they undergo this genital cutting? Probe for description of ideal / potential marriage partners  Circumcised  Educated  Not circumcised Probe for social, cultural and economic benefits and reasons if any why the community still practice FGC e.g. 

  

What are the benefits / advantages for the cut in girls? Probe for the following:  better marriage prospects,  social acceptance,  gives pleasure to the husbands,  reserves virginity,  prevent immorality,  gain respect among peers and in the community  Enjoyment of sex / sexual pleasure What are the advantages for girls if they are not cut? What are the disadvantages for the cut on girls? What benefits do girls themselves get if they do not undergo this genital cutting? Probe for education, marriage prospects, employment, leadership etc

5. Who performs the FGC procedure? Probe for: TBAs, Grandmothers, traditional circumcisers etc What tools are used in the circumcision? When is FGC done? Probe for during school holidays and other periods of the year? 

Probe for cost: how much is the cost of performing the rite per girl?

6. Where is the FGC / circumcision procedure performed in the community? Probe for deep in the bushes or in

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certain special built huts?    

Probe for how such events organized? Probe for if they are individual or group events? Who attends probe for elders, mothers, sisters etc What gifts are given?

7. What consequences are associated with female circumcision in your community? Probe for:  Health  Psychosocial  Social a) What challenges do young girls/women face in your community? Probe for:   

Circumcised girls/women Uncircumcised girls/women? Probe for ability to get marriage partners for the uncircumcised women and types of stigmatization such women face within the community? For Men: ask, would you accept to marry uncircumcised girl? Probe for reasons for and against?

8. a) Do you think female circumcision as a practice should continue in your community? Probe for: 

Reasons for continuity (please elaborate reasons for continuity)

b)   

Do you think female circumcision as a practice should discontinue in your community? Give reasons for discontinuation Organizations in the area advocating for dis/continuation of FGC or alternative rites of passage? Other forms of rites of passage would they prefer?

9. Are Alternative Rites of Passage (ARP) that does not involve genital cutting acceptable as replacements for FGC in this community? Probe for what is acceptable to the mothers/fathers or the community in general? What are the key factors to make an alternative acceptable for the family and community?

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(Q10-12 May Not be Applicable in Tanzania, Skip Accordingly) 10. Describe the coverage, operating structure and procedures of the alternative rite of passage in Samburu, Maasai etc. 11. What are the factors that account for some families and individuals adopting the alternative rite while others, exposed to the same tradition / opt to undertake the traditional rite. 12. What is contribution of the alternative rite of passage intervention in increasing knowledge of harmful effects of FGM, Probe for the role of ARP in creating awareness of women and children’s rights, and fostering positive attitudes towards eradication of FGC in the intervention sites. 13. What is your view on the alternative rite of passage in increasing positive reproductive health behaviour, knowledge, and attitudes among girls undertaking the alternative rite? 14. What are the key social cultural barriers (e.g. myths, beliefs, norms and values) that stand in the way of the community and girls in denouncing FGC



Probe for the role of Moraanism and their role in escalating FGC

15. In your own views what are some of the key social cultural enablers on which alternative rite of passage or anti FGC campaigns would be successfully hinged without unnecessarily antagonizing your culture as a community? Probe for:     



How to promote the idea of an alternative ritual to FGC in the community; Probe for who to target with the messages (Morans, elders or the religious leaders) How to support those who have already made the decision to stop the practice in their own families, or those who are considering doing so and need social support to enable them to carry through with the decision?. Probe for how to generate interest within the community for an alternative ritual for those wishing to publicly declare that their girls are women but are not circumcised? How to mimic the traditional practice whereby young girls could be taught by relatives or friends (who is slightly younger than the girl’s mother) about women’s roles, cultural values and sexuality without the young girls going through the cutting. Probe for the girls going through the alternative ritual e.g. ‘seclusion’ with teaching from AMREF and the Ministry of Health together with other actors such as Ministry of Education in an a hotel or school or community hall, and provides them with formal instruction on family life skills, community values and reproductive health. Probe for public ceremonies involving invited members of the community and local leaders in communal feasting, traditional singing and dancing, gift giving to the girls passing through ARP where gifts will be given to the girls that

they have not been and will not be cut, and declarations by fathers, mothers and community leaders of their commitment to support abandonment of the practice.

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16. What do you recommend for enhancing partnerships between the community members and agencies working in the area of ARP including the Government?

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ALTERNATIVE RITE OF PASSAGE (ARP) SCALE-UP IN KENYA AND TANZANIA

KEY INFORMANTS INTERVIEWS (KIIs): Religious leaders, Chiefs, Medical Officers, County/District Government Officials, Women Leaders etc

A. Female Genital Cutting (FGC):

Introduction: In some communities in Kenya / Tanzania young girls are introduced to womanhood through ceremonies where they undergo specific procedures that require cutting or removing away part of their genitals. AMREF Health in Africa with support of AMREF Netherlands is interested in exploring the practice of Alternative Rite of Passage that is acceptable to the local communities.

1. Comment on female genital cutting (FGC) within your community / County. Probe for prevalence of female genital cutting among women (25-49 years) and young girls (8-24 years)? Probe for the type of female circumcision being practiced in the community and age at circumcision for the girls? Probe for clitoridectomy, excision or infibulation (which type is common in the area). Probe for the procedure of FGC, who performs the procedure and why? Who decides on the cut and when it has to happen? Where is the circumcision performed? At home or deep in the bushes at night? Probe for the type of tools used

2. Why is female genital cutting practice common in this community? Probe for the existing social, cultural, economic and religious contexts promoting the practice of FGC in this community? What are the advantages for the cut? What are the advantages for the girls if they are not cut? Do you think the FGC practice is a religious requirement? Is FGC practice accepted by your religion, please explain.

3. Do you think FGC is a good or a bad tradition?

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a. If good: Please explain why the FGC practice is a good tradition for the community?  Probe for the perceived benefits girls get if they undergo genital cutting?  Probe for the challenges faced by girls if they do not undergo cutting e.g. marriage prospects and leadership roles in the community?  Probe for social cultural barriers (myths, beliefs and norms) that stand in the way of the community and girls in denouncing FGC b. If a bad tradition: what do you mean by a bad tradition?  What are some of the disadvantages for FGC?  Probe for specific complications girls are exposed to when circumcised? c. Probe for the kind of risks circumcised girls suffer during delivery? d. Should FGC be stopped in your opinion? What in your opinion can be done to stop FGC? e. Who is\are the most important decision makers in this community on FGC?

B. Alternative Rite of Passage (ARP)

4. Has there been any activity in the community against female cutting arranged in this area? Is the community ready to abandon FGC? Explain? If no, continue with question d (for Tanzania proceed to d). a) Describe the coverage, operating structure and procedures of the alternative rite of passage in this community. b) What are some of the factors that account for some families and individuals adopting the alternative rite while others are stuck to the traditional rite? c) What is the contribution of AMREF in promoting alternative rite of passage intervention especially in increasing knowledge of harmful effects of FGM, awareness of women and children’s rights, and fostering positive attitudes towards eradication of FGM in the intervention sites? d) Which are important elements to make Alternative Rite of Passage acceptable to this community? e) Probe for eligibility of uncircumcised girls for marriage within the community? f) Probe for men from the community being ready to marry uncircumcised women?

5. What are some of the social cultural enablers on which ARP or anti-FGC campaign would be successfully hinged without unnecessarily antagonizing the culture in in this community? Probe for the following approaches: a) Community sensitization as an enabler in behaviour change process b) Promotion of public ceremony associated with the rite of passage c) Promoting the training and sensitization of elders d) Promoting participation of community members in the Alternative Rite to enhance the transition from an attitudinal change to a behavioural change e) Promoting good understanding of the role of public (as opposed to familial) ceremonies in that culture f) The role of Government in the implementation of Children’s Act 106

6. Are you aware of any specific laws at the National Level or County Level that forbids the practice of FGC? a) Comment on the existing national policy to FGC? b) At the national level explain, probe for the Childrenâ&#x20AC;&#x2122;s Act of 2001 in Kenya and any other in Tanzania c) At the County level, are there by-laws enacted outlawing FGC? Specify d) Probe for the existence of County budgetary allocation for promoting ARP? If yes, how much or what percentage?

7. What is the existing capacity and readiness of local governance structures to support and promote ARP in the county/ district? Probe for the existing partnerships between organizations working in the area of ARP and communities in the project area? Probe for partnerships with District Health Facilities, Schools, School Committees etc. Probe for linkages between the community and the formal health system within the County. Probe for group memberships such as self-help and community development initiatives that deal with health issues, environmental, child and maternal nutrition, HIV/AIDS psycho-social support groups etc.

9. Discontinuation of FGC What do you recommend for the improvement of existing partnerships between the community members and agencies working in the area of ARP including the Government Any recommendations for promotion of ARP activities within the community / county/ district.

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