Improving the documentation of female genital mutilation or cutting (FGM/C) abandonment interventions and their evaluations

Female genital mutilation/cutting (FGM/C) is internationally recognized as a violation of human rights. Consequently, there have been extensive efforts to promote the abandonment of the practice. There is limited evidence on the impact of many of the efforts, in part because many interventions are implemented by small organizations with inadequate resources to document and evaluate their activities. The complex nature of FGM/C interventions, as with other interventions aimed at addressing violence against women and girls, also makes it difficult to adequately document what is done, how, when, and with what results. Nonetheless, it is important that implementing organizations make every effort to document and evaluate their interventions, and share the outcomes and lessons learned to ensure accountability and for others to learn from, adapt, replicate, and scale up successful interventions. In this Guidance Note, we provide guidance to help organizations that are implementing FGM/C abandonment interventions better document and report on their programmatic and evaluation activities

Using Demographic and Health Surveys in the campaign to end FGM/C: A Kenyan example

In order to design effective interventions to end female genital mutilation/cutting (FGM/C), we need to map where FGM/C is practiced and what factors influence it. Data from the Demographic and Health Surveys (DHS), nationally representative surveys conducted in low- and middle-income countries every five years, give us the opportunity to explore how FGM/C is influenced by both individual and community-level factors. Where FGM/C prevalence is not uniform, various research and analysis techniques can be used to improve estimates and draw further information from DHS data. This brief shares insights from two studies carried out in Kenya using DHS data collected in 1998, 2003, 2008, and 2014. The brief presents lessons learned and suggestions for the way forward

Shifts in female genital mutilation/cutting in Kenya: Perspectives of families and health care providers

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these communities. The study findings highlight several possible avenues for leveraging positive change, outlined in this report, which also includes future research needs

Tracing change in female genital mutilation/cutting: Shifting norms and practices among communities in Narok and Kisii counties, Kenya

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to assess what changes in FGM/C norms and practices have occurred in Narok and Kisii counties, and identify factors motivating these changes; and 3) to identify barriers to FGM/C abandonment in these key “hot spots,” and assess how, in light of empirical findings and theoretical models of behavior, intervention efforts might be optimized and coordinated to accelerate abandonment. The study clearly shows that norms and practices of FGM/C are not static even in these study areas. While there might not be widespread abandonment yet, people are reassessing norms and traditions in light of the current social climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment

Exploring the nature and extent of normative change in FGM/C in Somaliland

More than 200 million girls and women alive today have undergone FGM/C across 30 countries in Africa, Asia, and the Middle East. While most affected countries have adopted legal frameworks prohibiting FGM/C, these have been varyingly effective in preventing the practice or significantly accelerating its abandonment. The success of programmatic interventions to address FGM/C has also been variable. One possible reason for the limited success of these initiatives is the neglect of the collectively held social norms underpinning the practice’s continuation. This study, conducted in 30 villages in Somaliland, aimed to investigate: 1) if the norms associated with FGM/C are consistent with a social coordination norm; 2) which norms—if any—are associated with different stages of readiness to change; 3) how, to what extent, and by whom the norms and practices are being contested or altered; and 4) if the stages of readiness to change are associated with gender, location (rural/urban), and generational differences

Contraceptive Adoption, Discontinuation, and Switching among Postpartum Women in Nairobi's Urban Slums.

Unmet need for contraception is highest within 12 months post-delivery, according to research. Using longitudinal data from the Nairobi Urban Health and Demographic Surveillance System, we assess the dynamics of contraceptive use during the postpartum period among women in Nairobi's slums. Results show that by 6 months postpartum, 83 percent of women had resumed sexual activity and 51 percent had resumed menses, yet only 49 percent had adopted a modern contraceptive method. Furthermore, almost half of women discontinued a modern method within 12 months of initiating use, with many likely to switch to another short-term method with high method-related dissatisfaction. Women who adopted a method after resumption of menses had higher discontinuation rates, though the effect was much reduced after adjusting for other variables. To reduce unmet need, effective intervention programs are essential to lower high levels of discontinuation and encourage switching to more effective methods

Kenya country profile: A status check on unintended pregnancy in Kenya

Kenya’s mothers are dying at an alarming rate: a woman giving birth in Kenya has a 1 in 38 chance of dying due to inadequate reproductive health services. In response, in 2014 Kenya’s First Lady Margaret Kenyatta launched the Beyond Zero campaign to create awareness and raise funds to tackle maternal mortality and morbidity and improve child health. This brief offers six policy and programmatic recommendations to address significant sexual and reproductive health challenges highlighted throughout the report. These recommendations take into account the policy context in Kenya, which is evolving at a rapid rate in part because of the new devolution process, and increased interest and public debate surrounding maternal health and family planning. Though the Kenyan government has made key strides in improving reproductive health outcomes for its citizens, the recommendations outlined in the report would help the country move closer to achieving its reproductive health goals

Reducing early and unintended pregnancies among adolescents

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews

Adolescent Girls Initiative-Kenya: Qualitative report

The Adolescent Girls Initiative-Kenya (AGI-K) is currently delivering multisectoral interventions, targeting violence prevention, education, health, and wealth creation, to adolescent girls aged 11–14 in two marginalized areas of Kenya. This report provides a brief overview of the research design and intervention components being delivered in AGI-K, and presents findings from the first round of qualitative data collection intended to highlight the strengths and weaknesses of the implementation processes thus far. The findings provide important information about the perceived effects of the program from a diverse set of respondents. Overall, beneficiaries, their parents/guardians, and other key stakeholders value the program and have observed positive changes in girls’ education, knowledge, self-esteem, and money management. In addition, the findings have revealed key areas for improvement within each intervention sector which teams will focus on in the second year

Violence victimisation and aspirations–expectations disjunction among adolescent girls in urban Kenya

Background: Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been minimal research on young women in this region who have multiple induced abortions. The objective of this study was therefore to assess the prevalence and correlates of reporting a previous induced abortion among young females aged 12–24 years seeking abortion-related care in Kenya. Methods: We used data on 1,378 young women aged 12–24 years who presented for abortion-related care in 246 health facilities in a nationwide survey conducted in 2012. Socio-demographic characteristics, reproductive and clinical histories, and physical examination assessment data were collected from women during a one-month data collection period using an abortion case capture form. Results: Nine percent (n = 98) of young women reported a previous induced abortion prior to the index pregnancy for which they were receiving care. Statistically significant differences by previous history of induced abortion were observed for area of residence, religion and occupation at bivariate level. Urban dwellers and unemployed/other young women were more likely to report a previous induced abortion. A greater proportion of young women reporting a previous induced abortion stated that they were using a contraceptive method at the time of the index pregnancy (47 %) compared with those reporting no previous induced abortion (23 %). Not surprisingly, a greater proportion of young women reporting a previous induced abortion (82 %) reported their index pregnancy as unintended (not wanted at all or mistimed) compared with women reporting no previous induced abortion (64 %). Conclusions: Our study results show that about one in every ten young women seeking abortion-related care in Kenya reports a previous induced abortion. Comprehensive post-abortion care services targeting young women are needed. In particular, post-abortion care service providers must ensure that young clients receive contraceptive counseling and effective pregnancy prevention methods before discharge from the health care facility to prevent unintended pregnancies that may result in subsequent induced abortions.This work was supported by UKaid from the Department for International Development (DfID) for the Adolescent Girls Initiative-Kenya [Prime Award: PO 6171; Sub Award: SP1404]. Analysis and writing time was partially supported by general support grants to the African Population and Health Research Center from the Swedish International Development Cooperation Agency [grant number 2011-001578] and the William and Flora Hewlett Foundation [grant number 2015-2530]