Please note: This archive was last updated in 2005.

RHO archives : Topics : Harmful Traditional Health Practices

Program Examples

The programs below illustrate some of the strategies that have been developed to overcome logistic, cost, provider, client, and other obstacles to eliminate harmful health practices in developing countries. They also provide lessons learned from experience.

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  • Burkina Faso: Using an integrated human rights model to improve community health and development.
  • Cte d'Ivoire: Expanding legislation to include punishment provisions for FGM, forced and underage marriage, and sexual harassment.
  • Egypt (CEDPA Project): The Positive Deviance Approach searches for solutions to FGM within the community.
  • Egypt (CEOSS Project): Using a multi-faceted, community-based approach to ending FGM.
  • The Gambia: Designing a new rite of passage that excludes FGM.
  • Guinea (CPTAFE): National-level programming for FGM eradication.
  • Guinea (Projet Video): Video project to fight FGM and promote the welfare of women and girls.
  • Kenya (Nyamira District): Mobilizing health professionals and community members against FGM.
  • Kenya (MYWO Project): Using modern communication channels to identify and educate key change agents to advocate against FGM.
  • Nigeria: FGM eradication project implemented in eleven Nigerian states.
  • PATH: Tapping into the positive potential of the life-shaping role of culture.
  • Senegal: A community-based, basic education program changing the traditional practice of FGM by improving the physical and mental well-being of rural women and children.
  • Tanzania: Using drama to raise awareness of FGM and other practices.
  • Uganda: A partnership between traditional chiefs and NGOs working to replace FGM with non-harmful symbolic rituals focused on celebration of positive cultural values.
  • UNICEF: Communication, advocacy, and mobilization packages that focus on practices harmful to girls in Southern Asia and Eastern and Southern Africa.
  • World Bank: Incorporating indigenous knowledge (IK), customs, and values into projects.
  • Special profile: "A Supermodel's Remarkable Battle Against Female Genital Mutilation."

Burkina Faso

A dynamic new program is underway in Burkina Faso, the work of a partnership between Mwangaza Action, the Population Councils Frontiers Project, and Tostan (whose successes in Senegal are described below). Based on Tostans integrated, human rights model that draws communities into a process of reflection and analysis, the outcomes of this project are many and varied. After eight months of meetings involving approximately 6,500 people from 23 villages, the participants have pinpointed and begun to address a wide array of issues, including FGM, birth spacing, early and forced marriages, maternal mortality, health services, sexually transmitted infections and HIV/AIDS, violence against women, illiteracy, public hygiene, drinking water, legal documentation, and income generation.

Outputs include construction of health huts for 15 midwives; creation of an anti-FGM project; procurement of more than 1,000 legal documents, including family health booklets, marriage and birth certificates; procurement of hundreds of environmentally friendly woodstoves; repair of a water pump; and many other achievements.

The program managers emphasize the critical nature of:

  • involving local authorities and religious and traditional leaders,
  • establishing an atmosphere of trust and confidence between participants and program agents,
  • giving communities the responsibility to choose class members and other related decisions, and
  • using the national language fluently, including terminology for human rights and health.

For more information, please contact: Dr. Nafissatou Diop, Population Council/Frontiers, Mermoz Sotrac, 128, B.P. 21027, Dakar-Ponty, Senegal
Telephone: 221-865-1555; Fax: 221-824-1998; Email: [email protected]; Website: www.popcouncil.org

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Cte d'Ivoire

In June 1998, genital excision, forced and under-aged marriage, and sexual harassment became punishable offenses in Cte d'Ivoire. While some of these practices were already officially illegal, they remained widespread. The new bill added punishment provisions to existing legislation.

Forced or under-aged marriages, "whatever the customary, religious or traditional motivation," are now punishable by jail terms of one to five years and fines of between 500,000 and five million CFA francs (US$830 to $8,300) according to the bill put forward by the Ministry of the Family and the Promotion of Women.

FGM is punishable by similar jail terms and by fines ranging from 200,000 to two million CFA francs (US$330 to $3,300). If the victim dies during the excision, the maximum jail sentence rises to 20 years. Some four million Ivoirian women have undergone some form of excision, according to UNICEF. According to Constance Yai, head of the Ivoirian Women's Rights Association (AIDF), the work of educating people who conduct these practices, and who are for the most part illiterate, is still a great challenge.

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Egypt (CEDPA Project)

"Positive Deviance" is the premise on which the Centre for Development and Population Activities (CEDPA) has based their anti-FGM program in Egypt. This framework highlights the actions of community members who stray from cultural norms--sometimes secretly--in order to carry out healthier alternatives. The Positive Deviance Approach recognizes that solutions to problems can be found within communities themselves.

CEPDA's intervention was designed to foster a respectful dialog about FGM among local NGOs, community groups, and individuals. This involved three phases: preparation, implementation, and analysis/planning. The first phase identified Positive Deviants, and built partnerships among NGOs. Implementation consisted of orienting community leaders and staff on FGM and efforts to prevent it, skills training, an overview of the Positive Deviance Approach, and interviews with Positive Deviants. In the final phase, community leaders, CEPDA-Egypt, and NGO staff met to discuss findings and distill them into a foundation for future programming.

The results were encouraging in both expected and unexpected ways. All of the participants, including community members, were energized by the dialog and the stories that unfolded. For example, one 18-year-old woman who had undergone FGM convinced her parents to spare her younger sister. She then mobilized 15 friends to convince them to spare their sisters as well. From the wealth of information obtained during the project, new strategies to end FGM emerged. Local capacity to understand and address the problem was strengthened, most notably through an improved relationship between NGOs and the community.

CEDPA believes the Positive Deviance approach shows great promise.

Lessons Learned

  • There is a need for extensive preparation in communication techniques and extensive involvement of community members.
  • Deeper understanding of this relatively new process necessitates careful replication and evaluation.
  • Finally, CEPDA underscores the critical guiding truth: "Local knowledge is an enormous resource."

An expanded description of this project is available online at www.cedpa.org/publications/PROWID/AFRICA/Egypt1_rib.pdf.

For more information, please contact:
Ms. Pamela McCloud, Country Director, CEDPA, 53 Manial Street, Suite 500, Manial El Rodah, Cairo 11451, Egypt
Telephone: 2-02-365-4567; Fax: 2-02-365-4568; Email: [email protected]

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Egypt (CEOSS Project)

For 50 years, the Coptic Evangelical Organization for Social Services (CEOSS) has been respected for empowering rural women in the Coptic Christian community. In 1995, CEOSS initiated an anti-FGM program that identifies 7-to 13-year-old girls at risk of FGM, and then works with those girls, their mothers, and their entire families. Critical elements of this program include recruitment of local leaders who are assigned responsibilities, programmers who live with families in the communities, and a gradual approach to introducing FGM, due to its sensitive nature.

Programmers begin educational sessions about various health issues and gradually phase in new topics when appropriate. The project has had its most notable successes in homogenous Christian communities, where pressure to conform is a strong behavioral factor. Progress has been made in Muslim communities, but not at the same rate. An assessment of the program identified the most useful factors in the program design: focus on those girls most at risk; use of positive, easy-to-understand information on abandoning FGM; and the involvement and support of local leaders.

For more information, please see the Population Reference Bureau's Abandoning Female genital mutilation: Prevalence, Attitudes and Efforts to End the Practice and the World Health Organization's Female Genital Mutilation Programmes to Date: What Works and What Doesn't.

Or contact:
The Coptic Evangelical Organization for Social Services (CEOSS), P.O. Box 162-11811 El Panorama, Cairo, Egypt.
Telephone: 202-297-5901/2/3; Fax: 202-297-5878; Email: [email protected]; Website: www.ceoss.org.eg.

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The Gambia

In a country where more than 70 percent of women and girls have undergone some form of FGM, the possibility of change was small. Nevertheless, the Gambian NGO Foundation for Research on Women's Health, Productivity and the Environment (BAFROW) has begun to address the issue of FGM, with enthusiastic response. Since 1991, BAFROW has worked on gender and reproductive health at several levels, including the local level. Its FGM eradication program began with research on FGM practices in Gambia; the results were used to create a curriculum for a restructured rite of passage ceremony called "Initiation Without Mutilation." Circumcisors and their assistants were trained to use the new curriculum. Simultaneous outreach efforts were designed to educate community members and parents about the changes. Advocacy work helped gain political support for the effort.

By April 1999, 296 girls had undergone the new ritual. The positive results of the project were possible because of community-level support and trust for BAFROW that had been generated by its history of good work over many years. Survey results indicate a drop in the rate of FGM in target areas, accompanied by a rise in women's support for abolishing the practice.

As a result of the experience, BAFROW recommends in-depth participation at all levels and capacity building of partner organizations. They believe this work demonstrates the value of comprehensive, integrated, and collaborative approaches; and the need for long-term, uninterrupted relationships with the communities.

An expanded description of this project is available online at www.icrw.org/docs/ribs/BAFROW.pdf.

For more information, please contact:
Ms. Fatou Waggeh, Executive Director, BAFROW, 214/217 Tafsir Demba Mbye Road, Tobacco Road Estate, Banjul; Box 2854, Serrekunda, The Gambia
Telephone: 220-225270; Fax: 220-223266; Email: [email protected]

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Guinea (GPTAFE)

Formed in 1988, the NGO La Cellule de Coordination sur les Pratiques Traditionnelles Affectant la Santé des Femmes et des Enfants (CPTAFE) runs a national FGM eradication program. CPTAFE relies heavily on the work of volunteers, including community leaders such as teachers, journalists, health agents, and religious leaders. Power is decentralized, with each regional committee devising its own program strategies. The national office supervises and coordinates with an emphasis on sustainability, integrated information campaigns, and consistent messages. All activities are based on the value of building trust with a careful and sensitive approach. Although the critical nature of the issue often promotes a sense of urgency, CPTAFE recognizes that real social change takes time.

All CPTAFE work is based on local research, conducted with respect for cultural norms. For example, CPTAFE staff in one region had to lie face down in the dirt in front of elders in order to gain permission to discuss the taboo subject of FGM. After learning about and incorporating cultural practices, resulting programs are then carefully tailored.

One important CPTAFE product is a Guinean video about FGM called Le Fardeau (The Burden), a joint effort with Radio Television Guinea. Although drama in Guinea plays a powerful role as tradition, as entertainment, and as a record of history, CPTAFE's library of FGM videos weren't effective tools—because they portrayed "other people in other places." Now CPTAFE uses Le Fardeau to stimulate Guineans' active participation in healthy decision-making. In a country with low literacy rates, high FGM prevalence, and a "video club" in nearly every village, a product like this is able to reach many people.

Themes and issues raised by Le Fardeau include the harmful physical and psychological effects of FGM, including male psychosexual problems; the power that FGM both confers on women and takes away from them; the wide variations in the accompanying ceremonies; and the inadequacy of medicalization and/or "faking" FGM (making only a small cut to produce bleeding and a minor scar).

National Program Lessons Learned and Progress Made

International efforts, particularly by United Nations agencies, have put FGM onto women's and children's health and human rights agendas as a health hazard and a form of violence against women. Lessons learned include:

  • Legal measures can be useful, but only when combined with effective education and outreach.
  • Public discussion and support for eradicating FGM can be powerful government advocacy tools. In contrast, international propaganda that sensationalizes FGM hurts programs.
  • Community-based activities must be matched by international support.
  • In order to sustain high-quality volunteer work, paid, dedicated staff must be part of a program.
  • As long as communities require FGM for marriage, most women and girls, no matter how well informed, do not have true freedom of choice.
  • The three-dimensional model of female genitalia that illustrates the various types of FGM is very useful, especially given low literacy rates of Guinean villagers and the mixed quality of available educational material.
  • Reliable, local FGM data are critical—including prevalence, regional and ethnic variations, types of FGM, and reasons the practice continues.

For more information, please see Connie Hedrington Kamara's Guinea Means Woman (New York: Rainbo, 1998), or contact Dr. Mariama Djlo Barry, CPTAFE, B.P. 585, Conakry, Guinea
Telephone: 224- 462805; Fax: 224-441682

Also see CPTAFE and PATHs Female Genital Mutilation: Identifying Factors Leading to its Perpetuation in Two Regions in Guinea, 1996-98. (Arlington, Virginia: MotherCare Project, John Snow, Inc., 1999). Available at: www.mothercare.jsi.com/RHF/guinea.pdf.

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Guinea (Projet Video Sabou et Nafa)

This innovative approach to stopping female genital mutiliation (FGM) is the fruit of a partnership between a New York-based communications group and a Guinean organization dedicated to ending FGM. Communication for Change (C4C) and La Cellule de Coordination Sur Les Pratiques Traditionelles Affectant La Santé des Femmes et des Enfants (CPTAFE) are collaborating on a participatory video project designed to fight FGM and to promote the welfare of women and girls. Projet Video Sabou et Nafa offers community members video equipment and a range of related skills, enabling the creation of locally conceived and produced videos. Community presentations of these works, or "playbacks," generate interest and dialogue about health, human rights, and the possibility of change.

The project began in July 2002 with a workshop for regional teams. Trainees included a range of CPTAFE personnel and committee members, rural radio journalists, teachers, youth, and several former excisors. Participants learned to use video equipment; critiqued examples of videos that promote health, human rights, women's empowerment, literacy, and community development; and practiced complex production skills.

Participants and technical assistants then fanned out across the country with an array of locally purchased equipment, and created productions that included mini-dramas designed to convince family members to abandon FGM and a documentary featuring music and poetry that show former excisors how to create alternative livelihoods.
Each regional team then conducted community "playbacks" accompanied by facilitated discussions. The playbacks generated intense interest from viewers. A man told of his niece’s death from FGM. Women described the physical, emotional, and spiritual damage they attributed to their own FGM. Mothers lamented putting their daughters through FGM.

Project activities continued to grow in breadth and depth. In May 2003, members of the ProjetVideo Sabou et Nafa teams from across Guinea met for five days for an “Exchange of Experience and Training of Trainers workshop.” The workshop ended with “mini-video festival” sponsored by CPTAFE. Guests represented ministries and organizations including UNFPA, WHO, the national Ministry of Health, the Association to Protect the Rights of Guinean Women, Islamic Youth, AGBEF, and the Peace Corps. This event was featured on national television news.

In 2003, the project continued to build new local and regional partnerships. Work with L’Association Guinéean pour le Bien-Etre Familiale (AGBEF) has resulted in documentaries on reproductive health and the consequences of FGM, as well as family planning. In Upper Guinea, the project paired with a local acting troupe to create a feature-length drama on teen pregnancy and the dangers of abortion (Avortement Provoqué).

These productions continue to be shown across Guinea, most notably to Guinea’s First Lady and Prime Minister at the Conakry’s Peoples’ Palace. Project funders include the Public Welfare Foundation, the Goldman Foundation, and the UNFPA bureau in Guinea.

For additional details on this and related projects, please see the Communication for Change website at www.c4c.org/.

For more information, please contact:
Sara Stuart, Director, Communication for Change
Telephone: 718-624-2727; Email: [email protected]; Website: www.c4c.org/

Lauren Goodsmith, Training Coordinator, Communication for Change
Telephone/Fax: 410-235-2465; Email: [email protected]; Website: www.c4c.org/

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Kenya (Nyamira District)

Starting in June 1995, PATH and the Seventh Day Adventist-Rural Health Services (SDA-RHS) implemented a 2-year project aimed at eradicating FGM in the Nyamira District of Kenya. The focus of the project was to mobilize health professionals and community members against the practice. Despite the fact that the Kenyan government has banned FGM, it is practiced in 50 percent of districts in Kenya. Research in 4 districts suggests that 80 percent of women above the age of 14 have been circumcised. In the Nyamira district, the majority of girls are circumcised under the age of 10.

In developing the program, PATH and SDA-RHS met with key community leaders, including medical officers, religious leaders, chiefs, headmasters, and others. Although the leaders were sensitive about the issues covered by the project (and concerned about community reaction), they endorsed the project's objectives. Based on this endorsement, a community mapping activity was carried out to identify all community resources and infrastructure important to project implementation. Then, quantitative and qualitative research activities were carried out to assess health workers' and community members' knowledge, attitudes and practices regarding FGM.

Surveys of health workers revealed that about 75 percent of health workers see clients who have been circumcised, and about 50 percent have been asked to provide FGM or provide curative services to circumcised girls; over half had treated excessive bleeding from FGM and a quarter have treated FGM-related infections. Some 11 percent admitted to providing FGM at least once. Eighty percent of female health providers were circumcised themselves; among the health workers with young daughters, 80 percent do not plan to circumcise them, because they question the value of the practice and are concerned about health effects.

Focus groups and interviews with community members confirmed that FGM was a deeply rooted practice in Nyamira and often was performed in clinics/hospitals or at homes by trained health workers. This practice makes it difficult to convince families that the practice can be dangerous since they perceive that it must be safe if health providers offer it. Most rural families generally used "old mamas" for FGM: respected, sometimes feared, traditional circumcisors. Male community leaders generally approved of the practice and supported training nurses and other health providers to perform it. Uncircumcised girls are seen as social misfits and parents worry about the psychological consequences to girls who are not circumcised. Many community health workers are unaware of the harmful consequences of FGM.

As a first step, the project disseminated this information to community leaders and government administrators through workshops. These workshops, held in 1996, were quite controversial, as some community members were hearing about the harmful effects of FGM for the first time. They wanted to know, for example, who specifically was interviewed for the study, if harmful effects were proven beyond any doubt, if Nyamira was the only part of Kenya that carried out FGM, and if the government would prosecute circumcisors. There seemed to be a strong feeling that choosing not to circumcise a child should be a family decision, not a government decision.

After the workshops, a "communication for change" strategy based on participatory training techniques was developed and implemented, targeting health providers as the first line change agents and advocates against FGM. The following activities were implemented:

  • A five-day training workshop for health providers, with an aim of increasing knowledge about FGM, FGM elimination strategies, advocacy strategies, and community mobilization and interpersonal communication.
  • Participant personal advocacy plan for changing FGM practice in their own families, workplaces, and communities.
  • A similar workshop for other key change agents such as teachers, religious leaders, chiefs, and assistant chiefs.
  • A media and materials development workshop attended by artists, teachers, social workers, and health workers to design print materials advocating against FGM.
  • Distribution of print materials developed for PATH and MYWO's project (see next project example).
  • Outreach activities to educate community groups about FGM, including lectures for church groups, meetings with health providers, seminars with women's groups, and more.

While the project has not been systematically evaluated, it appears to have been successful at mobilizing health workers as anti-FGM advocates, encouraging trainees to abandon their own support of FGM, and sensitizing the community about the harmful effects of FGM. The information gained through initial qualitative and quantitative research about issues and beliefs perpetuating FGM practice was crucial in developing appropriate intervention strategies.

Lessons Learned

  • The 18-month time frame of the project was too short to bring about significant behavior change, especially for a practice that has existed for 400 years in Nyamira.
  • Involving potential "change agents" from various community groups is key to project success. The project needed to include, for example, more representatives from women's groups and teachers.
  • Participatory training approaches establish a good base for project implementation and help to promote "community ownership" of the project. At the same time, these approaches also require capacity building among local partners.

A full description of project activities also is available: PATH and SDA-RHS, toward Elimination of FGM: Mobilizing Health Professionals and the Community in Nyamira District, Kenya, Final Report, June 1995-November 1997, Submitted to USAID/BASICS, February 1998.

For more information, please contact:
Samson Radeny, PATH Kenya, A.C.S Plaza, Fourth Floor, P.O. Box 76634, Nairobi, Kenya
Telephone: 254-2-577177 or 254-2-577180; Email: [email protected]

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Kenya (MYWO Project)

Since 1993, Maendeleo Ya Wanawake Organization (MYWO) of Kenya and PATH have been implementing an innovative communication project in four districts of Kenya. Wallace Global Fund, Public Welfare Foundation, and Moriah Fund, among others, have provided support for efforts to apply modern communication strategies toward the eradication of FGM. Specific activities include disseminating educational materials and training staff in their use, refining program tools, documenting effectiveness and lessons learned, alternative rituals (see below), peer-to-peer outreach (girls, women, boys, and men), family life education through schools, media dissemination, and qualitative and quantitative research. A primary objective of the project was to identify and educate key change agents who could advocate against FGM. Many project approaches were replicated in the Nyamira FGM elimination project.

The MYWO project was able to go one step beyond the Nyamira project by identifying and implementing alternative rituals to FGM. A need for alternative ways to welcome girls to maturity without circumcision became clear during PATH and MYWO's project activities. Girls and their families were often unwilling to give up important community ritual activities and gift giving that surrounded the practice of FGM. Project staff developed a framework for an alternative ritual and investigated its feasibility within the community.

The first alternative ceremony took place in Tharaka Nithi in Meru District in August 1996. Thirty girls were secluded in the traditional fashion and participated in a week-long training on reproductive health issues including pregnancy and HIV/AIDS prevention, the harmful effects of FGM, and personal hygiene. A community celebration and "gift-giving" by family, friends, and godmothers followed. Girls were also given a booklet that contained the community's traditional wisdom and expected code of conduct information that is typically provided to girls during FGM ceremonies. Since the Tharaka Nithi experience, 49 other girls have graduated to adulthood in Meru without circumcision.

Another district developed their own alternative ritual. Single families organized ceremonies for their own daughters. The homes of initiates were decorated with wildflowers, girls dressed in their best clothes, food was prepared, and family and friends bearing gifts were received.

These successful experiences have encouraged other communities to request assistance in conducting alternative ceremonies for their daughters. By being flexible and building on each community's cultural values, the project has been successful in providing a way for families to welcome their daughters into adulthood without circumcision.

For more information, please contact:
Rikka Transgrud, PATH Kenya, A.C.S Plaza, Fourth Floor, P.O. Box 76634, Nairobi, Kenya
Telephone: 254-2-577177or 254-2-577180; Email: [email protected]

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Nigeria

FGM is commonly performed in Nigeria. A 1985-1986 survey of five states found that 90 percent of women were circumcised, with procedures ranging from Type I (excision) to Type III (infibulation). Given this situation, the National Association of Nigeria Nurses and Midwives (NANNM) implemented, with funding from Population Action International (PAI) and PATH, an FGM eradication program in 11 Nigerian States. The overall aim of the project was to increase the capability of health workers to identify harmful health practices and educate others on the need to abandon the practice. Specific objectives of the project were to:

  • train health workers to identify and describe FGM and other harmful practices;
  • empower trainees to teach others about FGM;
  • equip trainees to work with community members to increase awareness of the consequences of harmful practices;
  • incorporate information about FGM into existing and future health programs; and
  • conduct community awareness campaigns.

NANNM, with some technical assistance from PATH, carried out a variety of activities to achieve these objectives. These included conducting training workshops on FGM and other harmful practices and implementing various community mobilization activities, for example educational campaigns in markets, visits to community groups and social clubs, meetings with traditional and religious leaders, and development of educational dramas for television. Workshop trainees developed educational materials with input from community members and circumcised women.

In 1995, the project was evaluated through a series of in-depth interviews with key people involved in carrying out FGM (including circumcisors and opinion leaders) and a review of documents developed through the project. The evaluation showed that close to 8,000 health workers, media representatives, community leaders, and others had been trained through the project and over 1,000 communities in 13 of Nigeria's 21 states had been reached with various awareness campaigns.

The evaluation concluded that most trainees were more aware of the dangers of FGM and reduced their involvement in the practice. Knowledge about the health risks of the practice seemed particularly important. For example, a former circumcisor noted: "when people come to me for female circumcision I normally discourage them, I explain to them that it is very riskyand that they shouldn't practice it anymore."

Opposition to change was not insignificant, however. As one trainee noted, "some of the places we went to the chiefs saw it as if we were trying to derail their customs". Reasons for continuing the practice range from the expectation that families will receive gifts when a girl or woman is circumcised to the belief that a woman will be "visited by evil" or will be unhappily married if she is not circumcised. In addition, in some communities there is little awareness of the negative effects of FGM.

Overall, although comparative data were not collected, the evaluation suggested that the project had an impact on reducing the incidence of FGM. Senior health officials and opinion leaders stated that there had been a marked decline in FGM practice, although in some areas the practice simply changed (for example, from circumcising pregnant women to circumcising infants). The project clearly was successful at increasing awareness of the negative effects of FGM among health workers and among various community groups. The lack of government involvement in the project was seen as a barrier to progress.

Lessons Learned

  • FGM interventions that emphasize capacity building and grassroots efforts can have an impact at modest costs.
  • Support of local traditional leaders and opinion leaders is important for project success.
  • Actively involving the target audience in the design, implementation, and monitoring of the project was important.
  • Campaigns aimed at changing deeply-rooted behaviors take time and intervention efforts must be maintained long enough for new behaviors to become the norm.
  • Where FGM is associated with superstitious beliefs and religious obligations, behaviors are more resistant to change.

An Evaluation Report of Female Circumcision Eradication Project in Nigeria (1995) was prepared by Dr. S. Babalola and Dr. C. Adebajo.

For more information, please contact:
Rikka Transgrud, PATH Kenya, A.C.S Plaza, Fourth Floor, P.O. Box 76634, Nairobi, Kenya
Telephone: 254-2-577177 or 254-2-577180; Email: [email protected]

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PATH

Tapping into the positive potential of the life-shaping role of culture was the basis for PATHs Culture and Health Grants Program for Africa, which ended in 2003. The program consisted of one-time grants offered to individuals and community groups in Egypt, Nigeria, and Kenya. The overall program goal was to "improve health, well-being, and gender relations of communities by identifying, revising, and promoting cultural practices and beliefs through a small grants program."

Grant applicants were asked to address three specific objectives in each proposal. The objectives were to examine, describe, and analyze the specific cultural practices that affect health, well-being, and gender roles; to increase public awareness of and stimulate dialogue about specific cultural practices that affect health, well-being, and gender relations; and to engage community members in developing strategies and participating in activities that promote cultural practices with a positive impact on health and change those with negative effects. The Human Development and Reproductive Health Program of the Ford Foundation funded the program.

Sample projects include:

  • A community in Nigeria explored ways to celebrate a girls initiation into womanhood without obligating her to leave school and "prove" her virginity through inspection.
  • A community-based organization in rural Kenyan closed the generation gap by reviving and adapting the traditional method of providing life skills education (including sex education) through the use of story-telling by grandparents.
  • Through the use of song and drama, a community group is creating awareness about and encouraging dialogue around the issue of female genital mutilation and the role it plays in a Kenyan village.
  • A young Kikuyu woman in Kenya redesigned Mukwa, the head strap traditionally used by women to carry heavy loads, in hopes of creating a healthier device.

For information on the program, please contact:
PATH Kenya, A.C.S Plaza, Fourth Floor, P.O. Box 76634, Nairobi, Kenya
Telephone: 254-2-577177 or 254-2-577180; Email: [email protected]

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Senegal

In June 1999, 36 village representatives, speaking on behalf of 12,000 Senegalese villagers, publicly and joyfully renewed their pledges not to practice FGM. The centuries-old tradition survived wars, migration, and slavery, and ended for many in 1997 and 1998, after several months of discussions and arguments among villagers—interaction fostered by a broader education program. This story presents a hopeful perspective on the prospects of changing harmful traditions, particularly FGM.

Excision is performed in Senegal as a "village rite" on girls anywhere between the ages of two and eleven. In a few areas, infibulation, the most severe form of FGM, is practiced among the most traditional groups. Various reports suggest that between twenty and fifty percent of Senegalese women are circumcised.

Circumcision is practiced mostly among ethnic groups in rural areas and not in the Dakar region where most of the population is concentrated. Many associate the practice with initiation and tradition, purification, chastity and/or religion (the Marabouts). Although 94 percent of the population is Muslim, it is clear that FGM is practiced more for ethnic rather than religious reasons since many religious leaders do not require, or outwardly discourage, its practice.

TOSTAN (Breakthrough), a Senegalese non-governmental organization, was founded about ten years ago and implements a community-based, basic education program in rural areas. The organization's overall goal is to improve the physical and mental well-being of rural women and children. It does this by offering a basic education program focused on all aspects of women's and children's health; providing education aimed at giving women the skills necessary to take charge of their health and that of their families; and informing women and their husbands about the health challenges that confront women and their children.

One profound result of TOSTAN's activities is that an increasing number of village women who participated in the training, especially Women's Health and Human Rights Modules, have decided to take up the issue of FGM. In fact, many have mobilized the people in their villages to declare that they will all stop practicing FGM altogether. This decision process occurred gradually. TOSTAN staff did not address FGM as an isolated topic, but introduced it within several months spent on broader health topics. FGM was discussed not as a sexuality issue, but rather from the perspective of human rights and health, the latter quickly emerging as the most salient topic. Villagers say long discussions about infections, childbirth and sexual pain made their questioning of FGM itself inevitable.

The anti-FGM activities were embedded in the development and incorporation of two health-related modules into the community based, basic education program. Four steps were involved:

  • Two training modules and supporting materials on health issues specific to rural women and their children were produced.
  • TOT courses were conducted for trainers and facilitators to introduce these modules into the basic education program for interested communities.
  • The modules were included in the basic community-level literacy and education program.
  • Parallel meetings and awareness-raising campaigns with community members and policy makers concerned with women's and children's health were carried out.

As of 1996, TOSTAN had trained 47 facilitators to use the two modules and worked in 232 villages in four of Senegal's ten administrative regions, reaching 13,720 women. After discussing the negative health consequences of FGM, village women decided independently to act to end it their villages. Although the first few women to openly reject FGM were opposed by men and other community members, the women persevered.

After continued discussions with village leaders and men, several inter-related villages declared FGM banned from their communities. The process started in September 1996, when the village of Malicounda Bambara pledged to refrain from FGM, an event known as the "Malicounda Commitment." A year later, after the traditional season for performing FGM had passed, no procedures had been performed in the village. The Malicounda women discussed their decision with other Tostan participants neighboring villages. Other villages began making similar commitments, sometimes after weeks of argument and discussion about the religious and ethnic roots (or lack thereof) of the practice. As of July 2002, 708 communities—representing hundreds of thousands of people—have made the pledge to abandon FGM.

The Tostan model is spreading to other countries as well—see the Burkina Faso program example on this page—and even to India, as an approach to ending gender-based feticide and infanticide. See www.tostan.org/news-nov25-01.htm for more information.

These activities also have caught the attention of high-level policy makers, programmers and women's health advocates worldwide. As a result of the grassroots efforts, President Abdou Diouf (after 32 years in power) made his first declaration against FGM and now is pushing it to criminalize FGM, punishable by six years in jail. In April 1998, on their state visit to Senegal, U.S. President and Mrs. Clinton visited the women of Malicounda and commended their efforts.

Some of the keys to success of the TOSTAN project are as follows.

  • TOSTAN evaluations highlight that the success of the anti-FGM activities cannot be separated from the community-based, educational nature of the project. Addressing illiteracy and providing skills training are key steps to empowering women, which is in turn key to giving women the courage to begin to address their many problems.
  • Addressing illiteracy and providing skills training are key steps to empowering women, which is in turn key to giving women the courage to begin to address their many problems.
  • The TOSTAN process created a forum for villagers to come together and openly discuss the practice of FGM.
  • TOSTAN approached the issue from a health and human rights perspective; this worked well because achieving good health is a goal everyone could agree on.
  • A critical element was getting entire villages to sign on to the plan so that no one carried a stigma.
  • Involving village leaders, particularly religious leaders, was crucial. The Islamic leaders were able to alleviate peoples' concerns about Islam's position on FGM.
  • Publicity and press coverage have helped the movement spread beyond the initial three villages.

For more information, please contact:
Mme Molly Melching, Directrice, TOSTAN, B.P. 326, This, Senegal
Telephone: 221-51-10-51; Fax: 221-51-34-27; Website: www.tostan.org

Adapted from: Mohamud, A. et al. Improving Women's Sexual and Reproductive Health: Review of Female Genital Mutilation Eradication Programs in Africa. Report submitted to the World Health Organization, PATH (Fall 1998).

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Tanzania

Many institutions, including the World Health Organization, have endorsed using drama and traditional folk media to address FGM and other culturally based practices. In Tanzania, this approach arose out of concerns about female genital mutilation, domestic violence, and forced marriage. Three organizations formed a partnership: The Friedrich Ebert Foundation, the Department of Fine and Performing Arts of the University of Dar es Salaam, and HAWOCODE (Hanang Womens Counseling and Development Association).

After three weeks of intensive creative collaboration, the partners produced two plays about these issues. The goal of the plays is to sensitize the Barbaig community—a Northern Tanzanian nomadic group—to the negative repercussions of these forms of violence against women. They also included the theme of sending girls to school. The play addressing FGM included dramatization of the impact on the mother as well as the child. Discussions following the performances address the critical question: "What positive alternative can be suggested to this cultural activity (FGM) rather than simply telling them it is bad and should be stopped?"

For more information, please contact: Dr. Augustin Hatar, Email: [email protected].

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Uganda

FGM is being eliminated in the Kapchorwa region of Uganda, home to 130,000 people. The key to this change lies in powerful partnership between the Sabiny Elders Association (comprised of traditional chiefs) and the REACH project (funded by the United Nations Population Fund). The partners' work in replacing FGM with a symbolic ritual has been so successful that the head of the Elders association, G.W. Cheborian, received the 1998 United Nations Population Award and its $25,000 prize to supplement the work of the Association.

Traditionally, girls in the Sabiny community of Kapchorwa underwent FGM between 15 and 22 years of age. The majority of families preferred to have their daughters undergo the procedure at the same time males are circumcised, which is in December of every even-numbered year. Stories of ongoing health complications and several deaths resulting from FGM are known in the community. Although efforts to stop FGM date back to efforts by the British Government of Uganda in the 1930s, intense work did not begin until the 1980s, when a cross-section of community members began to voice their concerns about the practice. Several approaches were tried with little success, including strong health and human rights messages from the Uganda Inter-African committee, which community members felt were too judgmental and heavy handed.

As recently as 1990, the Sabiny chiefs were staunch defenders of FGM, even clashing with the government of Uganda over the issue. Then, in 1992, the chiefs formed the Elders Association and decided to methodically review their traditional practices. They decided that FGM was indeed a destructive tradition and began an effort to eliminate it.

The goal of the REACH project was to build upon the work of the Sabiny Elders Association to enhance reproductive health of women and girls through discarding FGM, promoting positive community values, and providing accessible reproductive health services. Specific objectives included sensitization of specific target groups including traditional birth attendants, improved reproductive health services, and a newly established district population coordination structure. Efforts to eliminate FGM were developed in partnership with the Sabiny Elders, and focused on celebrating positive cultural values through retaining certain aspects of the FGM ceremony, like feasting and gift-giving. An annual "Cultural Day" was instituted to promote healthy traditions and openly dispel myths about harmful practices. Community seminars and workshops are held regularly, often with participation of the Sabiny Elders Association. Peer education activities and health worker training are ongoing.

Other organizations are involved too, helping strengthen and extend program bonds including the Family Planning Association of Uganda, the International Planned Parenthood Federation, and the Norwegian Agency for Development.

Since its inception in January 1996, the program appears to have had an impact on the practice. An overall 36 percent decrease in FGM has been recorded (in 1994, 854 girls underwent FGM, versus 544 in 1996). In areas where program activities were especially intense, the decrease was even greater: 90, 60 and 43 percent drops were recorded. Other accomplishments include stronger community support and commitment to end FGM; more openness in discussing FGM; meaningful adolescent involvement; and increased demand for information about FGM.

Keys to success of the project include:

  • strong community partnerships from project inception;
  • celebration of positive cultural values;
  • addressing FGM within a broader reproductive health focus;
  • ongoing UN funding support; and
  • use of culturally appropriate persuasive approaches.

For more information, please contact:
Mr. Samuel Jackson, Project Manager, Reproductive, Education and Community Health (REACH) Program, P.O. Box 156, Kapchorwa, Uganda
Telephone: 256-045-51190; Fax: 256-045-51155

Mr. G.W. Cheborion, Chairman, Sabiny Elders Association, Kapchorwa District Council, Kapchorwa, Uganda

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Unicef

UNICEF has developed a series of multimedia communication, advocacy, and mobilization packages that focus on practices harmful to girls. A character named "Meena" can be seen and heard on the radio throughout Southern Asia, while her peer "Sara" covers Eastern and Southern Africa. These communication initiatives raise gender issues through entertaining stories told through videos, comic books, story books, radio series, traveling shows, toys, and a variety of educational materials. Sara's tales serve as a catalyst for addressing sexual harassment, AIDS, early marriage, FGM, girls' domestic workload, school attendance, and related issues. Meena's stories address son preference, unfair treatment of girls in the family, their lesser access to health and education services, early marriage and dowry, and sexual harassment.

"Daughter of a Lioness" is a typical Sara package, comprising a comic book with user's guide, animated film/video, a poster, and a facilitator's resource book. The illustrated story tells of Sara's determination not to undergo FGM, community pressures on Sara to relent (including an ambush), and, finally, village acceptance of Sara's decision, which starts a community dialogue about the dangers of the practice.

To view sample materials and more information on Meena and Sara, see the Animation World Network at www.awn.com/mag/issue1.2/articles1.2/mckeeclark1.2.html.
For a project update, see www.comminit.com/pdskdv22003/sld-7258.html.

For more information, please contact:
Justus Olielo, Project Officer, Sara Communication Initiative, UNICEF-ESARO, P.O. Box 44145, 00100, Nairobi, Kenya
Telephone: 254-2-622183; Fax: 254-2-622679; Email: [email protected]

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World Bank

Indigenous Knowledge (IK), unique to every society or culture, is a critical component of local decision-making around any topic, including health, agriculture, the environment, and income generation. Distinctive features of this type of knowledge include its local nature, tacit properties, state of constant flux, and transmission primarily through oral, experiential, and repetitive means. Taking form within community practices and institutions, IK is woven into the rhythms of everyday life. Proponents of this underutilized resource claim IK-based programs and tools can effectively address poverty.

Sharing beneficial IK practices within and across borders is at the heart of the IK movement. While serving as the basis for programs, this transfer also fosters cross-cultural understanding and promotes the value of the cultural dimensions of development. This exchange has been laid out in six steps by the World Bank: recognition and identification of valuable IK; validation; recording and documentation; storage of data in retrievable repositories (may include various media, and scientific formats); transfer and testing of the knowledge (best through pilot programs); and dissemination to promote greater impact. This learning and sharing process involves the original IK source community, the transfer agents and the community adopting and adapting the IK.

Background

The development potential of IK was formally recognized among major development institutions in June 1997 at the Global Knowledge Conference in Canada. In response, the World Bank agreed to lead an IK initiative. This initiative seeks to promote the incorporation of local knowledge, customs, and values into all types of development projects, primarily in Africa. An IK framework may be an important key to a basic programmatic shortcoming common to many global development institutions: the difficulty translating international best practices into locally effective programs.

Health programs based on IK include using traditional African storytellers or griots to raise AIDS awareness, understanding herbal use to alleviate suffering of HIV/AIDS patients, and using IK approaches to foster abandonment of FGM and reduction in maternal mortality and morbidity.

Challenges and Lessons Learned

At the most basic level, critics of IK worry about the relevancy—and even safety—of practices once taken out of their original contexts. Some also believe Western science is incapable of truly understanding and valuing local knowledge, which could result in the disempowerment of originating communities as they are "robbed" of their culture.

On the project level, the primary challenge of working with IK is how best to learn about it, because it is often hard for outsiders to even become aware of IK. Once recognized, how best to render it relevant and adaptable to other cultures is still relatively new territory in international development. Research indicates that such efforts have a far greater rate of success when the holders of the IK are deeply involved in all facets of a project.

The World Bank has translated lessons learned into four pillars for action. These pillars focus on the critical need to:

  • disseminate IK information;
  • facilitate the exchange of IK among developing countries;
  • apply IK throughout the larger development process; and
  • build partnerships for IK.

Finally, programs must take care not to disrupt or eliminate beneficial indigenous practices through development projects and foreign technologies that offer short-term gains without sustainability.

Program examples, technical guidance, tools, workshop information, and databases of programs by country and sector are available in five languages at www.worldbank.org/afr/ik/. UNESCO documents best practices in IK are available at www.unesco.org/most/bpindi.htm.

For more information, please contact:
Africa Region Learning and Knowledge Center, Reinhard Woytek, 1818 H Street, N.W., Washington, DC 20433 USA
Telephone: 202-473-1641; Fax 202-477-2977; Email: [email protected]

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