Sexuality experiences of secondary school students in Nakuru, Kenya: a cross-sectional study

Background: Adolescence is a phase where one is inquisitive about sex and sexuality. It is but natural to exchange the half-baked feelings and experiences with peers. These days the environment that includes public media has sexually suggestive flavors.Objective: This study was conducted to find out the sexual experiences of a selected, few school going adolescents.Methods: A cross-sectional study utilizing stratified sampling to enroll 200 students from secondary schools in Nakuru County, Kenya. A self-administered questionnaire was used to collect data. The data was entered and analyzed in SPSS® version 22. Chi-square test of independence and Fisher’s Exact Test were performed to test for associations.Results: The study found that a large number have had sexual experiences of varying type. It was interesting to learn from the survey that a large number of older adolescents wish that their parents should have talked to them about sexual matters. There is a general conservative outlook that the students had. Although a small percentage had sexual experiences at a very young age, many of them valued ethics and morality.Conclusion: There is urgency for intervention by the parents and the church in filing the gap in sexual knowledge.Keywords: Sexuality experiences, secondary school students, Nakuru, Kenya

Rapid evidence assessment: Quality of studies assessing interventions to support FGM/C abandonment

The last decade has seen increased focus and investment in interventions to eliminate female genital mutilation/cutting (FGM/C), along with the need to accelerate its abandonment. The UK Department for International Development (DFID) commissioned the Evidence to End FGM/C: Research to Help Girls and Women Thrive project to: 1) assess the quality of studies that have evaluated different interventions for the prevention of FGM/C, and 2) describe the FGM/C interventions that were evaluated by high-quality studies. The quality of evidence on the effectiveness and impact of FGM/C interventions is generally moderate to low. In addition, few baseline surveys are conducted prior to implementing interventions, making assessment of effect and generalizability difficult. Despite a high concentration of studies evaluating anti-FGM/C interventions from sub-Saharan Africa, few emphasize adequate reporting on cultural sensitivity and contexts during the design stage, or interpretation of findings for local policy. This rapid evidence assessment provides valuable methodological lessons for the design of future high-quality assessments or evaluations of FGM/C interventions

Debating medicalization of Female Genital Mutilation/Cutting (FGM/C) : learning from (policy) experiences across countries

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030

Sexuality experiences of secondary school students in Nakuru, Kenya: a cross-sectional study

Background: Adolescence is a phase where one is inquisitive about sex and sexuality. It is but natural to exchange the half-baked feelings and experiences with peers. These days the environment that includes public media has sexually suggestive flavors. Objective: This study was conducted to find out the sexual experiences of a selected, few school going adolescents. Methods: A cross-sectional study utilizing stratified sampling to enroll 200 students from secondary schools in Nakuru County, Kenya. A self-administered questionnaire was used to collect data. The data was entered and analyzed in SPSS\uae version 22. Chi-square test of independence and Fisher\u2019s Exact Test were performed to test for associations. Results: The study found that a large number have had sexual experiences of varying type. It was interesting to learn from the survey that a large number of older adolescents wish that their parents should have talked to them about sexual matters. There is a general conservative outlook that the students had. Although a small percentage had sexual experiences at a very young age, many of them valued ethics and morality. Conclusion: There is urgency for intervention by the parents and the church in filing the gap in sexual knowledge

The socio-cultural-symbolic nexus in the perpetuation of female genital cutting: a critical review of existing discourses

Female Genital Cutting (FGC), also known as Female Genital Mutilation (FGM) and Female Circumcision (FC), continues to be a prevalent practice in many parts of the world and especially in Africa. This is somewhat perplexing given the concerted efforts aimed at eradicating this practice. This article argues that the perpetuation of FGC is due to the unintended effects of marginalization experienced by individuals and groups of women as a result of the approach of some of the anti-FGC global discourses and policies put forward to eradicate the practice. This, we argue, happens when the social structure that provides such groups and individuals with a sense of identity and belonging breaks down. Therefore, the attack on what practicing communities consider to be of crucial cultural value causes a re-focus on the practice resulting in a re-formulation and re-invention of these practices in a bid to counter the feelings of alienation. FGC is thus reframed and reconstructed as a reaction against these campaigns. This article intends to investigate the socio-cultural-symbolic nexus surrounding the practice of FGC, its meaning and implications with respect to its continued existence. It draws examples mainly from communities in Kenya that practice FGM as a rite of passage into adulthood. Herein, perhaps, lies the driving force behind the practice in this contemporary age: it carries a lot of significance with respect to transformational processes, and it is seen as crucial in the representation of the body, identity and belonging. The aim of this article is not to defend FGC’s continuation, but rather to explore the interplay between its changing socio-cultural dimensions as a counter-reaction to the eradication discourse and policies. In this way we will try to explore some of the factors that lay behind its perpetuation. Key words: body practices, female genital cutting, female circumcision, femininity, cultural identit

Amref Alternative Rites of Passage (ARP) model for female genital mutilation/cutting, teenage pregnancies, and child, early and forced marriages in Kenya: a stepped-wedge cluster randomised controlled trial protocol

# Background The Amref Alternative Rites of Passage (ARP) model was initiated in 2009. To date, about 20,000 girls have been supported by their communities to denounce female genital mutilation/cutting (FGM/C) and graduate into 'maturity' through ARP. While this intervention has been implemented for decades, there is limited evidence of its effectiveness in ending FGM/C. In order to ascertain the effectiveness of this intervention, Amref has developed a digital tracking tool to follow up on girls who have and haven't gone through the ARP. The key research question is: what effect does ARP have on incidences of FGM/C, teenage pregnancy and child, early and forced marriages among adolescent girls and young women? # Methods The study will adopt a stepped-wedge cluster randomised controlled trial design to assess the effectiveness of the ARP model on the incidence of FGM/C; teenage pregnancy; child, early and forced marriage; and educational attainment. We selected one cluster in Kajiado County where recent ARPs have been conducted as the intervention site at the beginning of the study and 3 wards/clusters in Narok County as control sites. Approximately 604 girls aged 10-18 years who reside in selected sites/clusters in Kajiado and Narok counties will be recruited and followed up for 3 years post-exposure. Quantitative data analysis will be conducted at bivariate and multivariate levels. Content/thematic analysis approach will be used to analyse qualitative data. # Ethics and dissemination The study obtained ethical approval from the Amref Ethics and Scientific Review Committee (AMREF-ESRC P1051-2021). The findings of this study will be shared with local, national and regional stakeholders working in ending FGM/C, teenage pregnancy, and child, early and forced marriages. **Registration** -- Pan-African Clinical Trials Registry (PACTR202208731662190)

Opportunities for linking research to policy: lessons learned from implementation research in sexual and reproductive health within the ANSER network

Background: The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for policy-makers to use research evidence in their work. Methods: A participatory workshop with researchers was organised in November 2017 by the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) to address this gap. ANSER is a consortium of experienced researchers, some of whom have policy-making experience, working on sexual and reproductive health and rights issues across 16 countries and 5 continents. The experiential learning cycle was used to guide the workshop discussions based on case studies and to encourage participants to focus on key lessons learned. Workshop findings were thematically analysed using specific stages from Hanney et al.’s (Health Res Policy Syst 1:2, 2003) framework on the place of policy-making in the stages of assessment of research utilisation and outcomes. Results: The workshop identified key strategies for translating research into policy, including joint agenda-setting between researchers and policy-makers, as well as building trust and partnerships with different stakeholders. These were linked to stages within Hanney et al.’s framework as opportunities for engaging with policy-makers to ensure uptake of research findings. Conclusion: The engagement of stakeholders during the research development and implementation phases, especially at strategic moments, has a positive impact on uptake of research findings. The strategies and stages described in this paper can be applied to improve utilisation of research findings into policy development and implementation globally

The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave

Background: The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. Methods: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Results: Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusion: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings

Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium.

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks

An exploration of the psychosexual experiences of women who have undergone female genital cutting: A case of the Maasai in Kenya

The research explored the link between type II Female Genital Cutting (FGC) and sexual functioning. This thesis summary thus draws from an exploratory ethnographic field study carried out among the Maasai people of Kenya where type II FGC is still being practiced. A purposely sample consisting of 28 women and 19 men, within the ages of 15-80 years took part in individual interviews and 5 focus group discussions. Participants responded to openended questions, a method deemed appropriate to elicit insider’s in-depth information. The study found out that one of the desired effects of FGC ritual among the Maasai was to reduce women’s sexual desire, embodied as tamed sexuality. This consequence was however not experienced as an impediment to sexual function. The research established that esteeming transformational processes linked with the FGC ‘rite of passage’ are crucial in shaping a woman’s femininity, identity, marriageable status and legitimating sexuality. In turn, these elements are imperative in inculcating and nurturing a positive body-self image and sex appeal and consequently, positive sexual self actualization. These finding brings to question the validity of conventional sexuality theory, particularly those that subscribe to bio-physical models as universal bases for understanding the subject of female sexual functioning among women with FGC. Socio-cultural-symbolic nexus and constructions of sexuality should also be considered when investigating psychosexual consequences of FGC.Contents Dedication v Acknowledgments vii Contents xi List of Figures xvi List of Tables xviii Acronyms xix Glossary of Maasai Words xx PART I: BACKGROUND 1 Preface: My Reflexive Stance 3 Chapter One: Female Genital Cutting and Female Sexual Function: A Critical Review of Existing Discourses and Perspectives 9 Introducing Female Genital Cutting 9 Key Definitions and Classifications 9 A Brief History of FGC 11 Current FGC Prevalence 13 FGC in Kenya: A Situational Analysis 15 Demography and Ethnicity 15 FGC Prevalence and Current Trends 16 The FGC Debate: Dominant Epistemic and Discursive Strands 18 FC, FGM,FGC: What’s in a Name? 18 In Opposing FGC 21 In Critiquing the anti - FGC lobby 22 Global Responses to FGC: What Works and What Doesn’t Work? 24 The Religious Onslaught 24 The Health Justified Approaches 25 The Human Rights Approach 28 The Legal approach 29 The Social Convention Approach 29 Other integrated approaches 31 The Local Historical and Socio-Political Context of FGC Eradication in Kenya 32 The Origins of the Anti-FGC Drive: Religious Onslaught on Perceived Barbaric Customs 32 A Battle Lost: The Failures of a Reluctant and Belated Colonial Response 34 Introduction of Global Discourses in Local Women-driven Post-colonial Anti-FGC Advocacy 35 Female Genital Cutting and Female Sexual Function: The Rationale and Approach of a Contextualized Study 37 References 39 Chapter Two: The Socio-Cultural-Symbolic Nexus in the Perpetuation of FGC 49 FGC and FSF: ‘What’s Culture got to do with it?’ 49 Cultural Vectors as Intermediaries of Sexual Function 52 Rite of Passage 52 Bodily Inscription 53 Social Inscription 54 Ritual and Symbolic Significance 55 For Procreative Functions 56 For a Body and Mind Transformational Process 56 The Body in the Reinvention of the Female ‘Rite of Becoming’ 57 Description of Invented Traditions 58 Grounds for Re-Invention of Traditions 58 The Position of Body in the Re-Invention of Traditions 60 Female Agency and Subjectivity 61 In The Context of Patriarchy and Male Dominance 61 In The Context of Female Autonomy 62 Women as Active Agents in Shaping Social Reality 63 Examples in The Light of Changing Socio-Political Status 63 References 66 Chapter Three: The Cultural Context for Female Genital Cutting: The Case of the Maasai of Kenya 75 Abstract 75 The Maasai: A General Description 76 A Brief History: The Rise and Fall of East Africa’s Warrior Tribe 76 Population and Distribution: Conquerors of the Savannah 77 Culture and Society 80 Social and Cultural Development: A Legacy of Resilience 92 “Becoming Maasai” - An Overview of Dominant Rites of Becoming 94 In the Framework of Naturalization 94 In the Framework of Rituals of Maturation 95 A Closer Look at the Phenomenon of Sexuality amongst the Maasai 101 Culture, Society and Sex: Determinacy and Intermediation 101 The Purposive Functions of Sex: Procreation and Socialisation 108 References 114 PART II: RESEARCH DESIGN 119 Chapter Four: Ascertaining the significance of FGC and FSF Amongst the Maasai of Kenya: The Frame of Interrogation 121 The Research Theme, Study Rationale and Aims 121 The Gap, the Aim: In Search of an Alternate Theoretical Orientation 121 Pursuing the Argument 121 The Research Strategy and Design 122 The Lens: “Sex as a Social Construct” 122 Research Objectives: Elucidating the “Culture-Sex Relationship” 123 Research Questions: What is the Nature of “Sex after the Cut”? 123 The Case Study: Explorations in a “Culturally Conservative” Society 124 The Sample: Interrogating Both Alleged Victim and Victimizer 125 Method and Procedures: Consorting with the Perpetuators’ Psyche 125 Data Processing and Interpretation 131 From Individualized Subjectivities to Collectivised Objectivities 131 Encrypting the Seemingly Mundane Tale of the Grassroots 132 In Retrospect: The Challenges and Limitations of the Field and Analytical Exercise 133 References 134 PART III: FINDINGS & CONCLUSIONS 135 Chapter Five: Sex after the Cut: Tales and Experiences of Contemporary Maasai Women 137 Abstract 137 Entering the Field 137 On the Origins of FGC: A Legend from ‘The Legend’ 138 The Abortive Attempt at Mounting a Hospital-based Study 142 Scoping the Changing Culture-scape of Contemporary Maasai 143 Braking the Ice: Scheming to Gain Access 145 The Day of Circumcision: Witnessing Naishorua’s Transition for Girl to Woman 146 ‘Tasaru Ntomonok’: A Visit to a Rescue Centre for Women 149 A Synthesis of Key Research Findings 151 On the Place of FGC in Society 151 On Significance of FGC 152 On FGC and Purposive Function of Sex 152 On FGC and Sexual Experience 152 Regarding the Physiology of Sex 153 On Sexual Desire, Arousal and Satisfaction 153 On Societal Canons Regarding Sexual Relations 154 On FGC and Sex Actualization 154 On The Difference between Circumcised and Un-Circumcised Women 155 Chapter Six: Cultural Bases for Sex Actualization and Optimization: Lessons from the Maasai 157 Abstract 157 Understanding FGC and FSF from Within: Cultural Vectors as Intermediaries of Sexual Function 157 Legitimating the Process of Womanhood 157 Superintending Over Sexual Conduct 158 Conduct of Matrimonial Relations 159 Shaping Knowledge, Attitudes and Perceptions of Sex 160 Women’s perception of FGC and sexual meaning 162 Men’s Perception of Sexual Meanings of FGC 163 Explaining the Experience and Actuality of Sex: A Matrix of Horizontal and Vertical Loyalties 165 The Realm of Self- Actualization 168 The Context of Social /Communal Acceptance 173 The Framework of Cultural Authentication and Historical Inscription 175 Chapter Seven: Returning to the Argument: A Synthesis of Key Research Findings 181 Abstract 181 Concerning the Significance of FGC amongst the Maasai: A Socio-cultural- symbolic Nexus 182 Function of FGC with Regards to Matters of Collective and Individual Sexuality 182 What is the Nature of “Sex after the Cut”? Sex as a Social Construct 184 The Present Borderland: Between Past and Present and Tradition and Modernity 186 Conclusion 189 APPENDICES 192 Appendix 1b Samenvating 194 Appendix 2: Guiding Questions 196 Appendix 3: Professional Career 197 Appendix 4: List of Publications 199nrpages: 219status: publishe