Kimani, Samuel

Meroka-Mutua, Agnes K.

Muteshi-Strachan, Jacinta

Mwangovya, Flavia

Shell-Duncan, Bettina

English

Population Council: Knowledge Commons

Population Council Knowledge Commons Reproductive Health Social and Behavioral Science Research (SBSR) 5-14-2020 Using research to understand and accelerate abandonment of FGM/C Bettina Shell-Duncan Jacinta Muteshi-Strachan Population Council Agnes K. Meroka-Mutua Samuel Kimani Flavia Mwangovya Follow this and additional works at: https://knowledgecommons.popcouncil.org/departments_sbsr-rh Recommended Citation Shell-Duncan, Bettina, Jacinta Muteshi-Strachan, Agnes K. Meroka-Mutua, Samuel Kimani, and Flavia Mwangovya. 2020. "Using research to understand and accelerate abandonment of FGM/C," presentation at end-of-project dissemination meeting. Nairobi: Population Council. This Presentation is brought to you for free and open access by the Population Council. End of Programme Webinar Series:Using Research to Understand and Accelerate Abandonment of FGM/CWebinar 1: Improving the Health System and Legal Frameworks’ Response to FGM/CBettina Shell-Duncan, Ph.D. - ModeratorUniversity of WashingtonImproving the Health System and Legal Frameworks’ Response to FGM/CSpeakers: Bettina Shell-Duncan, Moderator Jacinta Muteshi-Strachan – Population Council Kenya Agnes Meroka-Mutua – University of Nairobi Samuel Kimani – University of Nairobi Flavia Mwangovya – Equality NowWhat did we set out to do and what have we accomplished?Jacinta Muteshi-Strachan, Ph.D. Senior Associate & Programme Director – FGM/C Population Council The Project: DFID funded (2015-2020). Build a body of ethical and rigorous evidence to inform programs, policies, investments in support of abandonment. Vision: End FGM/C in One Generation Approach: A research consortium across 8African countries led by Population Council.  Understanding of the Issue: FGM/C: Gendered & socially endorsed harmful practice; form of gender-based violence, violation of rights of women and girls.  Presentation Outline: Research themes, some highlights from emerging vidence and moving forward.IntroductionFour research themesBuilding the picture: where, when and why is FGM/C practised, and are these changing?Interventions: What is working, where, and why?Measurement: what are valid measures of changeWhat are the wider impacts of FGM/C and of interventions to stop FGM/C?Emerging Evidence: Some highlights Provided rigorous evidence on how FGM/C is practiced and how the practice has evolved and is evolving specific to: 1) Changes in the age of cutting;2) Increasing significance of medicalized FGM/C;3) Shifting FGM/C narratives and norms and,4) Complex nature of power and decision-makingaround the practice;5) Historical and continuing absence of men andboys in planned abandonment interventions6) Structural responses.Emerging Evidence: Some highlights Illuminated variations and complexities of local realities both within and between countries--means strategies can’t be standard.Examples: Rural/poor south Senegal families worry about securing the future of their daughters & ensuring entry into social support systems in a context of economic and climatic instability among other concerns. Burkina Faso: Best practice example of law implementation since 1996 but practicing families cross into Mali where there is no law. Emerging Evidence: Some highlights Strengthened understanding of prevalence and risk factors for FGMC in three priority countries (Kenya, Nigeria, Senegal): Sub-national level data hotspots/areas where populations are at a higher risk. With this data, health practitioners and policy makers are now able to have a deeper understanding of the geography and pattern of FGM/C, enabling them to better target investment and efforts where most needed.Moving Forward FGM/C practices serve “valued” societal behaviors & access to social assets.  Consequently upheld by multiple & diverse social and gender norms Thus: Social & behaviour change interventions must address: Whole schemas of cultural values & norms, Inequalities in contextual/community settings  Community ownership of changeWhile Utilizing:1) Data to shed light on complexities that underpin the practices of FGM/C2) High quality evidence as basis of our responses3) Collaborative, multi-sectoral approaches beyond targeting isolated behaviors and isolated individuals”.FGM/C and the Law in Burkina Faso, Mali and KenyaAgnes Meroka-Mutua, Ph.D.University of Nairobi, School of LawAfrica Coordinating Centre for the Abandonment of FGM/C (ACCAF), KenyaThe Role of Law in Reducing FGM/C in Kenya, Mali and Burkina FasoDr. Agnes K. Meroka-Mutua,University of Nairobi, School of LawAfrica Coordinating Centre for the Abandonment of FGM/CAcknowledgements: Joséphine Wouango, Ph.D and Susan   Ostermann Ph.D who led the work in Burkina Faso and Mali Background Objectives Research questions Methodology Findings RecommendationsOverviewBackground Multi-country study conducted in Kenya, Burkina Faso and Mali. Kenya and Burkina Faso have laws prohibiting FGM/C; Mali has no law. FGM/C prevalence in Kenya is 21%; in Burkina Faso it is 42%; and in Mali it is 91%. The three countries provide an interesting basis for comparative analyses of how law is used towards abandonment in plural legal settings.Objectives To find out how much people obey or disobey the law in general;  To investigate the motivations that prompt people either to obey or disobey the law in general and the anti-FGM law specifically;  To use the study findings to inform policy and programme approaches to FGM/C law.Research Questions How much do citizens obey FGM/C laws? Among people who do FGM/C, what are the reasons and causes that motivate them to obey or not the FGM/C law? • Moral, social, and punitive reasons to obey FGM/C law and comparator rules of conduct (e.g., rape, stealing from neighbor).• Local experience with police and courts.Methodology Mixed methods research Use of indirect methods of probing (Vignettes and list experiments) Analysis of the laws in Kenya and Burkina Faso and modes of their implementation Comparative analysis of the way law is used in Kenya and in Burkina FasoHow Law is used to Prevent FGM/CLawCriminalizationRegulationAdministrationFindings• But in plural legal settings, the plurality of law should be appreciated. Law is important• Conflict between formal law and customary/religious law can limit complianceThe nature of law affects behavioral responses to it• Coercive vs Persuasive use of law The way law is administered can promote acceptance of the law at community levelRegulation can strengthen other anti-FGM interventionsRecommendationsProhibition of FGM/C through criminal law should be complemented through other legal provisions that are not necessarily penal in nature. These could include clearly specified roles for community health workers and schools.Involvement of multiple actors, such as community leaders and religious leaders within the legal framework for prohibition of FGM/C is important so as to ensure cultural acceptability of the lawPublic awareness campaigns about FGM/C and the law are more likely to promote behavioral change if they do not instill fear of the law in individualsContinuous generation of data and evidence on how law works to promote abandonment of FGM/C is necessary. Lessons from different countries are necessary for formulating best practice approachesSummary Law is important in promoting abandonment of FGM/C. Effectiveness of law in protecting women and girls from FGM/C can be limited by the nature and content of the law, as well as the process of administration and implementation of the law. Law can be strengthened to contribute more effectively towards abandonment if it is implemented in a manner that does not seem to attack the cultures of practicing communities. Health System Strengthening in Kenya & NigeriaSamuel Kimani, Ph.D.University of Nairobi, School of NursingAfrica Coordinating Centre for the Abandonment of FGM/C (ACCAF), KenyaHealth System Strengthening to Respond to Female Genital Mutilation in Kenya and NigeriaSamuel Kimani, PhD;  University of Nairobi, School of Nursing ACCAF, KenyaAcknowledgment: Otibho Obianwu, Ph.D. & the Population Council Nigeria TeamIntroductionHealth sector FGM/C response is through prevention and provision of curative services as anchored in the legal/policy documents; The legal/policies guiding health in both countries are nation-wide or sector specific;Despite critical role of health sector, existence of policies, FGM/C including medicalization persist in Kenya & Nigeria.National & Sector anti-FGM laws/policies existKenya Nigeria Prohibition of FGM Act, 2011  National policy for the eradication of female genital mutilation 2019 National Adolescent Sexual and Reproductive Health Policy 2015  National School Health Policy 2019 Manual for Health Care Providers (2007) Violence Against Persons Prohibition Act 2015 National Gender Policy Strategic Framework (Implementation Plan) 2008 –2013 National Policy and Plan of Action for the Elimination of Female Genital Mutilation in Nigeria 2013 – 2017Prevalence: 1 in 5 Kenyan women have FGMSource: Kenya Demographic and Health Survey 2014; Nigeria Demographic and Health Survey 20131 in 4 Nigerian women have undergone FGMSource: Nigeria DHS 2013; Kenya DHS 2014Medicalization of FGMHealth workers are critical to FGM response Respected as opinion leaders & role models Ethically bound to the “do no harm” principle Knowledgeable & skillful to manage FGM/C complications & sensitize on abandonmentSource: guardian.ngObjectivesExamine how the health sector supports the prevention of FGM; Determine the role of the health care sector in the management of FGM complications & quality of care offered to clients; Identify possible solutions for strengthening the health care system’s capacity to manage & prevent FGM. MethodologyMixed-methods, cross-sectional, exploratory designPolicy analysis & situational analysis methodologySites – West Pokot County, Kenya & Imo state, NigeriaFieldwork: May 2018 February 2019Findings – Kenya & NigeriaLimited knowledge & awareness of FGM/C legal/policies Lack of guidelines/protocols for FGM/C managementLack of data capture/documentationLimited skills to respond to FGM/C complications Women with FGM/C complications had challenges getting obstetric, Psychological, sexual interventions Limited health sector-related FGM/C prevention due to inadequate resourcesRecommendationsStrengthen policy dissemination & implementation -Action plansIntegrate FGM/C interventions into existing health systems platformsTargeted training of HCPs to build knowledge and skillsIncorporate FGM/C indicators in HMIS & develop data toolsAnchor & strengthen FGM/C content into health training curriculaSummary Health systems in Kenya & Nigeria are responding to FGM/C albeit unstructured & some challenges. The challenges include gaps in policy, capacity, resources, and documentation. Strengthening response to FGM/C should involve integration and leveraging on existing health and other sector programs. Applying research to improve programmes, policies and investments?Flavia Mwangovya, Global Lead – End Harmful PracticesEquality NowRelated Technical Reports and Briefs Include: Reflections from Five Years of Research on FGM/C Burkina Faso and Mali• When and how does law effectively reduce the practice of FGM/C? Kenya• Brief: A diagnostic assessment of the health system’s response to FGM/C management and prevention in Kenya: A case study of West Pokot County• A diagnostic assessment of the health system’s response to FGM/C management and prevention in Kenya.• Assessing the role of law in reducing the practice of FGM/C in Kenya.  Nigeria• Brief: A diagnostic assessment of the health system’s response to FGM/C management and prevention in Nigeria• A diagnostic assessment of the health system’s response to FGM/C management and prevention in Nigeria (forthcoming)The Evidence to End FGM/C programme consortium generates evidence to inform and influence investments, policies, and programs for ending female genital mutilation/cutting in different contexts. Evidence to End FGM/C is led by the Population Council in partnership with the Africa Coordination Centre for Abandonment of Female Genital Mutilation/Cutting (Kenya); Gender and Reproductive Health & Rights Centre (Sudan); MannionDaniels, Ltd.; Population Reference Bureau; University of California, San Diego; and University of Washington. Evidence to End FGM/C is funded by UK aid by the UK Government.

End of Programme Webinar Series: Using research to understand and accelerate abandonment of FGM/C

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End of Programme Webinar Series: Using research to understand and accelerate abandonment of FGM/C

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