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An Assessment of the Alternative Rites Approach for Encouraging Abandonment of Female Genital Mutilation in Kenya

Authors:
An Assessment of the Alternative Rites Approach
for Encouraging Abandonment of
Female Genital Mutilation in Kenya
FRONTIERS in Reproductive Health
Jane Njeri Chege
Ian Askew
Jennifer Liku
September 2001
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of
Female Genital Mutilation in Kenya. This study was funded by the UNITED
STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) under the
terms of Cooperative Agreement number HRN-A-00-98-00012-00. The opinions
expressed herein are those of the authors and do not necessarily reflect the view of
USAID.
DEDICATION
The late Leah Muuya (died December 2000) has left an invaluable imprint in the
struggle to free young girls from the practice of Female Genital Mutilation. As
Maendeleo Ya Wanawake Organisation’s (MYWO) Programme Officer for Harmful
Traditional Practices, Leah spearheaded activities related to the alternative rites of
passage. Her enthusiasm and willingness to work with various communities in
seeking to influence change of attitudes and behaviour made a great impact in the
success of the programme.
As a tribute to her, we dedicate the work contained in this report to her to
commemorate her contribution to the eradication of this practice, on behalf of all the
young girls she enabled to find hope despite the clutch of culture.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
SUMMARY
Maendeleo Ya Wanawake (MYWO), with technical assistance from the Program for
Appropriate Technology in Health (PATH), has been implementing an Alternative Rite of
passage programme as part of its efforts to eradicate the practice of Female Genital
Mutilation (FGM) in five districts in Kenya. Although the approach has been implemented
since 1996, and is a continuation of anti-FGM efforts that started a few years earlier, the
approach itself has not yet been systematically documented or assessed. This study addressed
the factors that influence some families and individuals to adopt the alternative rite while
others, exposed to the same messages discouraging FGM, decide not to. It also evaluated the
effect of the training component of the Alternative Rite on the girls who participated.
The study was undertaken in three districts (Tharaka, Narok, and Gucha), where
MYWO/PATH have been implementing the approach and which cover four ethnic groups. A
comparison was made of knowledge, attitudes, and practices concerning FGM and
reproductive health among households and individuals who had participated in the alternative
rite and those who had not. Data were collected through 37 focus group discussions, 53 key
informant in-depth interviews, a household survey of 634 parents, 1,068 girls and 364 boys,
and nine case studies of families who have participated in the Alternative Rite.
FGM practices vary among the four sites. Type 1 (clitoridectomy) and Type 2 (excision) are
practised in all four sites. There are indications of changes in the way FGM is practised in all
sites, and particularly a move towards reducing the harm caused through medicalisation,
particularly in the predominantly Abagusii and Maasai ethnic group sites, and the use of
individual instruments.
Those families choosing for their daughters to participate in the Alternative Rite are
somewhat different than those not choosing to do so, in that they are slightly more likely to
have ever attended school, more likely not to be members of the Catholic or Pentecostal
churches, slightly less likely to be labourers or farm workers, more likely to be of higher
socio-economic status, slightly more likely to have females with more positive gender
attitudes, and more likely to already not be cutting their daughters and to express regret for
those already cut.
The Family Life Education (FLE) training that girls who adopt the Alternative Rite are
exposed to does have an effect on the girls’ awareness and knowledge about reproductive
health issues, but it also appears to engender somewhat less positive attitudes towards the
practice of family planning among unmarried partners and adolescents, including condom
use.
The MYWO sensitisation activities that preceded and accompanied the Alternative Rite have
played a role in the behaviour change process among those who have decided to discontinue
the practice and who have adapted the alternative rite. It is also clear, however, that these
sensitisation activities have not functioned in isolation from other influences operating in the
communities, notably the stance taken by certain churches as well as individuals’ existing
beliefs that the practice should be discontinued. The contribution that an Alternative Rite
intervention can make to efforts to abandon the practice depends on the socio-cultural context
in which FGM is practised. For the approach to be replicated successfully in other situations
will require a good understanding of the role of public (as opposed to familial) ceremonies in
that culture, and a judgement as to what format for the ritual is the most appropriate means of
helping those that have decided to abandon the practice to actually do so.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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CONTENTS
Tables and Figures....................................................................................................................... iv
Acknowledgements ....................................................................................................................... v
Acknowledgements ....................................................................................................................... v
Acronyms ...................................................................................................................................... vi
Background ................................................................................................................................... 1
FGM In Kenya ........................................................................................................................... 1
Efforts To Eradicate FGM In Kenya.......................................................................................... 2
Development Of The Alternative Rite Of Passage .................................................................... 3
Methodology .................................................................................................................................. 5
Objectives................................................................................................................................... 6
Study Design .............................................................................................................................. 6
Study Sites.................................................................................................................................. 7
Data Collection........................................................................................................................... 7
Meaning And Practice Of FGM ................................................................................................ 10
Reasons For Practising FGM ................................................................................................... 10
Practice Of FGM ...................................................................................................................... 12
Prevalence ........................................................................................................................... 12
Age At Circumcision............................................................................................................ 12
Decision To Circumcise ...................................................................................................... 13
Type Of Circumcision.......................................................................................................... 13
Who Performed The Procedure?......................................................................................... 14
Where Was The Procedure Performed?.............................................................................. 14
Instrument Used For The Procedure................................................................................... 14
Experience Of Problems...................................................................................................... 15
Implementation Of The Alternative Rite Approach................................................................ 16
Description Of The Approach.................................................................................................. 16
Community Sensitisation Through Peer Educators ............................................................ 16
Training Girls In Family Life Education ............................................................................ 17
Public Ceremony ................................................................................................................. 17
Implementation Of The Alternative Rite In Tharaka............................................................... 17
Implementation Of The Alternative Rite In Gucha.................................................................. 19
Implementation Of The Alternative Rite In Narok.................................................................. 20
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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Effect Of The Alternative Rite Programme On Girls’ Reproductive Health Knowledge
And Gender Attitudes................................................................................................................. 23
Description Of Initiates ............................................................................................................ 23
Reproductive Health Knowledge ............................................................................................. 24
Attitudes And Behaviour Concerning Family Planning And Sexual Activity ........................ 26
Gender Attitudes ...................................................................................................................... 27
Families’ Beliefs And Attitudes About FGM ........................................................................... 28
Perceptions Of Benefits And Disadvantages Of FGM ............................................................ 28
Benefits ................................................................................................................................ 28
Disadvantages ..................................................................................................................... 28
Attitudes Towards FGM .......................................................................................................... 30
Differences Between Circumcised And Uncircumcised Girls............................................. 30
Eligibility Of Uncircumcised Girls For Marriage .............................................................. 31
Regret Concerning Personal Circumcision ........................................................................ 31
Intention To Circumcise Future Daughters ........................................................................ 32
Abandonment Of FGM ........................................................................................................ 32
Factors Associated With Participating In The Alternative Rite ............................................ 34
Education.................................................................................................................................. 34
Religion .................................................................................................................................... 35
Employment ............................................................................................................................. 35
Socio-Economic Status ............................................................................................................ 35
Gender Attitudes ...................................................................................................................... 36
Circumcision Status Of Mothers And Daughters..................................................................... 37
Role Of MYWO’s Sensitisation Activities .............................................................................. 38
Summary Of Key Findings ........................................................................................................ 41
Factors Accounting For Discontinuation Of Genital Cutting And Participation In The
Alternative Rite ........................................................................................................................ 41
Beliefs, Attitudes And Knowledge Concerning FGM ............................................................. 42
Effect Of FLE Training On Reproductive Health Knowledge And Attitudes......................... 42
Discussion..................................................................................................................................... 42
Conclusions And Recommendations......................................................................................... 45
References.................................................................................................................................... 47
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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TABLES AND FIGURES
Table 1: Perceived reasons for the community practising FGM ............................................10
Table 2: Person reported to make the decision for circumcision by ethnic group ..................13
Table 3 Characteristics of AR initiates and other girls sampled........................................... 23
Table 4: Perceived Benefits of FGM ....................................................................................28
Table 5: Harmful effects mentioned by type .........................................................................29
Table 6: Attitudes towards the community continuing or discontinuing FGM ................... 32
Table 8: Gender attitudes by type of household and respondent ..........................................37
Figure 1: Median age at circumcision for mothers and daughters ..........................................13
Figure 2: Proportions of girls aware of reproductive health issues ........................................24
Figure 3: Attitudes towards contraceptive use among girls ...................................................26
Figure 4: Knowledge of any health and social/psychological problems associated
with FGM ................................................................................................................29
Figure 5: Perception that FGM contravenes the rights of girls and women ........................... 30
Figure 6: Proportions of respondents that feel men would marry an uncircumcised
woman ..................................................................................................................... 31
Figure 7: Parents’ levels of education .....................................................................................34
Figure 8: Socio-economic status by type of household...........................................................36
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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ACKNOWLEDGEMENTS
The successful completion of this study is a result of dedicated effort and support from many
individuals. We are grateful to MYWO and PATH/Kenya staff for providing the information
required and for their collaboration, and particularly to Samson Radeny, the late Leah Muuya
and Michelle Folsom. We are also greatly indebted to the staff of MYWO and of the Ntanira
na Mugambo organisation for their support in identifying research assistants, families that
have adopted the alternative rite of passage and for the information they provided regarding
programme implementation in their intervention sites. Thanks to Agnes Paraiyo, Ruth
Chepkwony and Agnes Yiapan of Narok district; Aniceta Kiriga and Florence Kawanja of
Tharaka district; and Jane Arati, Jane Onjera, Rachel Omambia and Bethseba Sanaya of
Gucha district.
The Kenya National FGM Focal Point, a network that brings together organisations and
individuals having interest in FGM in Kenya, made invaluable contributions to this study
through some of its members’ contributions in discussions on the design of the study and
interpretation of the data. Our gratitude goes to all the individuals who participated in the
study design and data interpretation workshops.
We recognise with appreciation the dedicated effort of those who worked as supervisors,
research assistants, and interviewers in the four sites of the study. Our deepest gratitude goes
to all of the respondents who generously gave their time and ideas without which this study
would not have materialised. Last but not least, our gratitude goes to our colleagues in the
FRONTIERS Program and at USAID/Washington and PATH/Washington for their
assistance in reviewing the draft report and providing valuable input in style and content of
this report.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
AR Alternative Rite
FGC Female Genital Cutting
FGDs Focus Group Discussions
FGM Female Genital Mutilation
GTZ German Technical Corporation (Deutsche Gesellschaft für Technische
Zusammenarbeit)
HIV Human immunodeficiency Virus
IEC Information Education and Communication
KDHS Kenya Demographic and Health Survey
MYWO Maendeleo Ya Wanawake Organization
MOH Ministry of Health
NFP National Focal Point on FGM
NGOs Non-Governmental Organizations
Non-AR Non-Alternative Rite
PATH Program for Appropriate Technology in Health
RH Reproductive Health
STDs Sexually Transmitted Diseases
STIs Sexually Transmitted Infections
UNICEF United Nations Children Fund
WHO World Health Organization
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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BACKGROUND
Female Genital Mutilation (FGM), also referred to as female circumcision, Female Genital
Cutting (FGC) and genital surgeries1, refers to several different traditional practices that
involve the removal or cutting of part, or all, of the female genitalia. The World Health
Organisation (WHO, 1995) recommends a three-type classification of FGM2, which includes
varying degrees of severity depending on the amount of tissue excised:
Type 1 or Clitoridectomy: removal of the clitoral hood with or without removal of part or the
entire clitoris.
Type 2 or Excision: Removal of the clitoris together with part or all of the labia minora.
Type 3 or Infibulation: Removal of part or all of the external genitalia (clitoris, labia minora,
and labia majora) and stitching and/or narrowing of the vaginal opening leaving a small hole
for urine and menstrual flow.
All types of FGM can be associated with immediate and long-term complications, although
Type 3 seems to be associated with more serious problems (Jones et. al., 1999). The
immediate complications can include severe pain, trauma, tetanus, urine retention, urethral or
anal damage, excessive bleeding, and shock from haemorrhage. The long-term health and
physical complications may include urinary and bladder incontinence, recurrent urinary track
infections, lack of sexual stimulation and painful sexual intercourse, infertility, vaginal cysts
and abscesses, blockage of menstrual flow and elevated risks of obstructed labour (PATH,
1997). The socialisation process that accompanies the practice may also entrench gender
ideologies and practices that contribute to the disempowerment of women (Chege 1993).
At least two million girls a year worldwide are at risk of experiencing genital mutilation
(Rainb, 1995). The practice has been documented in many countries but is most prevalent
in Africa, being reported in at least 28 countries (Carr, 1997), with some countries reporting
over 90 percent prevalence. During the past decade, the United Nations, many governments,
international development agencies, and international and national women’s organisations
and professional associations have developed policies condemning the practice, and have
proposed guidelines and plans of action towards accelerating the elimination of FGM. In
countries where the practice is prevalent, many governments and national leaders have
publicly denounced the practice. However, few governments have translated their concern
into laws prohibiting FGM or programmes to eradicate the practice.
FGM in Kenya
FGM is prevalent in Kenya, with 38 percent of women aged 15-49 years reporting being
circumcised (KDHS, 1998), and the practice is found in over half of the districts in the
country. There are differences among ethnic groups, however. FGM is nearly universal
among the Kisii (97%) and Maasai (89%), and is also highly prevalent among the Kalenjin
(62%), Taita Taveta (59%) and Meru / Embu (54%) groups, and to lesser extent among the
Kikuyu (43%), Kamba (33%) and Mijikenda/Swahili (12%). Although the Kenya
1 The term FGM is used in Kenya when the practice is discussed by organisations and those working at the
national level, and female circumcision is the term most frequently used by communities and individuals.
Consequently, these terms will be used inter-changeably in this report.
2 There is also a fourth category which is used to include all other practices that “mutilate” the genital organs,
such as pricking, piercing, stretching, cauterising, scraping, or introducing corrosive substances, but this
category is not relevant to this study.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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Demographic and Health Survey (KDHS) does not include data from the North Eastern
province, it is believed that infibulation is nearly universal among the population.
Clitoridectomy and excision are the predominant types practised in the rest of the country.
However recent studies have indicated changes in attitudes, beliefs and practices in
communities that traditionally have upheld the practice. For example, qualitative research by
UNICEF/PATH among the Kikuyu and Kalenjin ethnic groups indicate that families with
higher levels of formal education, higher economic status and that are Christian, are more
likely to have more positive attitudes and practice towards abandoning the practice than other
groups (UNICEF/PATH, 1998).
These qualitative findings are confirmed by quantitative data from the 1998 KDHS, which
indicate that:
The higher the level of mother’s education the lower the prevalence of FGM;
Women residing in rural areas are more likely (42%) to have been circumcised than those
residing in urban areas (23%);
Older women (35 – 49 years) were more likely to have been circumcised (47%) than
those aged 15-24 years (33%).
Recent declines in the practice, measured by differences in these two age groups (35-49 years
versus 15-24 years) as reported in the KDHS, is particularly pronounced among the Kalenjin
(62% to 33%), Kikuyu (43% to 18%) and Kamba (33% to 12%), with the least decline
amongst the Kisii (97% to 93%) and Maasai (89% to 77%).
Efforts To Eradicate FGM In Kenya
Efforts to eradicate FGM in Kenya go back to pre-independence days when the Protestant
Christian missionaries in Central Kenya campaigned against the practice. Consequently,
between 1926 and 1956, the colonial government enacted legislation that sought to
ameliorate the practice by reducing the severity of the cut, defining age at circumcision, and
enhancing parental consent before a girl could undergo the procedure. However, due to the
ensuing opposition and related political outcomes, the colonial government was forced to
revoke all the resolutions related to FGM in 1958 (Chege, 1993; Kenyatta, 1938; Thomas,
1992).
In independent Kenya, some key government officials, including the current President, have
spoken against FGM. To date, however, the Government has not legislated against the
practice, although Kenya is a signatory to many international conventions calling for its
eradication. In 1999, the Ministry of Health launched a twenty-year National Plan of Action
(Ministry of Health, 1999), which was developed with support from the World Health
Organisation. With an overall goal of accelerating the elimination of FGM, the National Plan
has four objectives: to reduce the proportion of girls and women undergoing FGM; to
increase the proportion of communities supporting the elimination of FGM; to increase the
proportion of health care facilities that provide care for girls and women with physical and
psychological problems associated with FGM; and to increase the technical and advocacy
capacity of organizations and communities involved in FGM elimination programmes.
Programme development and management, provision of basic health services, advocacy, and
action oriented research and documentation are the four main programme components for
implementing the National Plan of Action.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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In addition to these efforts, a large number of non-government organisations (NGOs) have
also been actively encouraging communities to discontinue the practice. Following a
consultative conference in March 1997, at which were represented 67 local NGOs,
Governmental, bilateral and international organisations, a National Focal Point (NFP) was
initiated, with the NGO Northern Aid being nominated to host the NFP. A second conference
held a year later attracted 96 organisations, which consolidated and endorsed the role of the
NFP as the co-ordinating body to maximise collaboration between all organisations
concerned with FGM in Kenya.
Clearly, there is much interest and activity at both the grass roots and national levels in
seeking ways to eradicate this practice. Two of the most active of the local NGOs, that work
at both levels, have been Maendeleo Ya Wanawake (MYWO), a nation-wide community-
based women’s organisation, and the Program for Appropriate Technology in Health
(PATH), an international NGO with a national office that focuses on improving the health of
women and children. Over the past decade, these two organisations have worked closely
together using a wide variety of funding support to learn about the practice and to then use
this information to develop strategies for encouraging its abandonment.
Three broad phases in their activities can be identified. Over the period 1991 – 1993, PATH
coordinated a series of qualitative and quantitative research studies with MYWO to learn
about the nature and extent of the practice in four districts (Kisii3, Meru4, Narok and
Samburu). Based on these findings, MYWO and PATH developed and started implementing
numerous community mobilisation, behaviour change communication (BCC) and educational
activities with leaders, religious groups, schools and parents in these districts, and educational
and advocacy activities with opinion leaders and the media at the national level. These
sensitisation activities, which began in 1993 and are still continuing, were implemented under
the auspices of MYWO’s broader ‘Traditional Harmful Practices’ programme and provided
the basis for the most recent phase, which was the development of the ‘Alternative Rite of
Passage’ and its introduction in 1996.
Development of the Alternative Rite of Passage
In 1995, MYWO and PATH organised a national seminar to bring together MYWO national
and grass root level elected leaders and staff from the districts implementing anti-FGM
activities. Among many (but not all) of the ethnic groups, female circumcision features as
the central component of a traditional rite of passage ceremony that girls are expected to pass
through in their transition from puberty to adulthood. In these situations, therefore, having
made the decision to not cut their daughters, parents are then faced with the dilemma of what
to do about the traditional ritual, which allows them and their daughters to publicly announce
the transition to womanhood. To address this problem, PATH introduced the idea of an
‘alternative ritual’, which excluded the genital cutting but maintained the other essential
components such as education for the girls on family life and women’s roles, exchange of
gifts, eating good food, and a public declaration for community recognition.
3 The former Kisii district has now been subdivided into three districts namely, Kisii, Gucha, and Nyamira.
Project activities are implemented in what is now Gucha district.
4 The former Meru district has now been subdivided into four districts namely, Meru North, Meru Central,
Meru South, and Tharaka. Project activities are implemented in all the four districts.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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Attending this seminar were MYWO leaders from many districts, and those from one district
in particular (Tharaka) were immediately inspired to begin discussing the idea of starting an
alternative rite of passage with members of their community. Through consultations with
families that had decided to stop circumcising their daughters, these women leaders worked
with MYWO and PATH to develop and introduce the first ‘alternative’ ritual in 1996. The
first alternative rite took place in August 1996 at Tharaka, with 29 girls participating.
Although this strategy was first tried in a district where the MYWO/PATH programme of
sensitisation on FGM had been undertaken for a short period (1995-1996), several of the
districts where sensitisation had already been implemented rapidly adapted it. Since that
time, approximately 30 alternative rite of passage ceremonies have taken place in Gucha,
Meru North, Meru South, Narok and, most recently, Samburu districts. By December 1999,
about 1,600 girls from these districts had gone through the ritual and by April 2001,
approximately 3,000 girls from these districts had participated as initiates.
An alternative rite of passage ritual refers to a structured programme of activities with
community-level sensitisation to first gain support and to recruit the girls who will
participate, which is followed by a public ritual that includes training for the girls in family
life education (FLE), and a public ceremony similar to that in traditional rites of passage. The
intention is to simulate the traditional ritual as closely as possible without actually
circumcising the girls. A full description of the alternative rite of passage (as implemented in
three districts) is given later, but in brief the approach has three inter-related components.
Community sensitisation: In those areas where MYWO has already been implementing its
FGM sensitisation activities, the idea of an alternative ritual has subsequently been promoted
to provide a tangible mechanism to support those who have already made the decision to stop
the practice in their own families, or who are considering doing so and need social support to
enable them to carry through with the decision. Messages to raise awareness of the health
risks of FGM and that the practice violates human rights are therefore supported by
generating interest within the communities for an alternative ritual for those wishing to
publicly declare that their girls are women but are not circumcised.
These activities can be described in terms of the model of behavioural change for FGM
posited by Izett and Toubia (1999). This model proposes that for a change in a long-running
behaviour to occur, individuals, families and communities need to pass through several stages
before there is a sustained behavioural change. Exposure to new information about the
behaviour (in this case about its health risks, socio-psychological effects, violation of human
rights, among others.) can motivate individuals and families to begin to contemplate a
behaviour change. Although this stage may lead to an intention to change the behaviour,
there is normally a need to ensure that the decision can be fully supported so that the
necessary action can be fulfilled. Consequently, the behaviour change strategy needs also to
prepare individuals prior to them being able to act on the decision.
The community sensitisation activities need, therefore, to provide both sufficient and
appropriate new information to stimulate contemplation about a change, and to create
sufficient familial and social support to prepare individuals and families to actually act by
making the change.
MYWO uses its nationwide network of community-level women’s groups as the entry point
in sensitising communities. Community sensitisation is undertaken through organised public
meetings, small group meetings and workshops targeting various groups in the community
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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such as students and teachers in schools, women’s groups, and church groups. Group
meetings and workshops include demonstrations (using anatomical models), talks by
respected leaders, and if possible the videos that MYWO has produced. An important part of
the sensitisation strategy has been the identification of persons who show active support for
eradicating the practice, who are consequently recruited and trained as peer educators (see
later).
In the sites where MYWO and PATH had been working up to 1995, sensitisation has been
undertaken with the intention of preparing individuals and families to decide not to cut their
future daughters. However, many ethnic groups traditionally believe female circumcision to
be a critical component of a girl’s passage to womanhood, and some form of public
declaration that a girl has completed this passage remains an important part of some cultures
in Kenya. Consequently, it was felt that making the final step of actually acting on the
decision not to cut a daughter could be inhibited if such a decision prevented her from being
publicly recognised as having completed this passage.
Thus providing an alternative rite, which does not feature genital cutting but which is equally
acceptable to the community because it includes seclusion, training and a public ceremony,
offers the opportunity to declare the girl to have made the transition in a socially acceptable
way. This opportunity can both reduce the barrier of perceived social disapproval for those
not yet confident to make the final step from decision to action, and also allows those who
have already taken action to declare this step and reinforce public acceptance of their
daughter’s status as an uncircumcised woman.
Seclusion and training: To mimic the traditional practice whereby girls are put in seclusion
immediately after being circumcised and are taught by an aunt or other relative or friend
(who is slightly younger than the girl’s mother) about women’s roles, cultural values and
sexuality, the girls going through the alternative ritual also undergo three to five days of
‘seclusion’ with teaching. MYWO accommodates them together in a hotel or school or
community hall, and provides them with formal instruction on family life skills, community
values and reproductive health. In addition to the formal sessions that follow a curriculum
developed by PATH and MYWO and that are normally led by MYWO staff, informal
discussions are held in the evenings during which the girls are taught about the positive
aspects of their culture from selected mothers.
Public ceremony: The timing and nature of the public ceremony are dictated by the specific
socio-cultural context in which the alternative ritual takes place. These ceremonies normally
take place immediately after completion of the seclusion training and require the participation
of both of the girl’s parents (if possible), as well as other invited members of the community
and local leaders. The ceremonies include several activities such as communal feasting,
traditional singing and dancing, gift giving to the girls passing through the ritual, declarations
by the girls that they have not been and will not be cut, and declarations by fathers, mothers
and community leaders of their commitment to support abandonment of the practice.
METHODOLOGY
The fact that a large number of girls have participated in the alternative rite, that many such
events have taken place, and that the ceremonies can be implemented with relatively little or
no opposition, indicates clearly that the approach is programmatically feasible, is culturally
acceptable, and that there is a demand for it. Whether this cumulative process of sensitisation
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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and alternative ritual has had an impact on the practice itself is not known, and cannot be
evaluated through this or other studies because systematic baseline data were not collected
and adequate control groups cannot be created post hoc. It should be noted that this is not
through a lack of planning by MYWO or PATH, but is because the approach has evolved
gradually over time. An evaluation study was recently undertaken by MYWO and PATH
(Olenja, 2000), in which a cross-sectional survey was completed in the four districts where
the baseline data were collected in 1991-1993. For several reasons, however, it is not
possible to make direct comparisons with the baseline data and so a conclusive assessment of
the impact of these activities over time cannot be made. Bearing in mind these limitations,
this study had the following objectives.
Objectives
The ultimate objective of this study was to provide policy makers, donors and project
managers with information to strengthen and guide interventions aimed at eradicating FGM.
More specifically, the study sought to5:
Describe the coverage, operating structure and procedures of the alternative rite of
passage in Tharaka, Narok, and Gucha districts.
Determine the factors that account for some families and individuals adopting the
alternative rite while others, exposed to the same sensitisation and IEC intervention, opt
to undertake the traditional rite.
Assess the contribution of the alternative rite of passage intervention in increasing
knowledge of harmful effects of FGM, awareness of women and children’s rights, and
fostering positive attitudes towards eradication of FGM in the intervention sites.
Assess the impact of the alternative rite in increasing positive reproductive health
behaviour, knowledge, and attitudes among girls undertaking the alternative rite.
Assess the impact of the alternative rite in fostering positive gender attitudes among girls
undertaking the alternative rite and their parents.
Study Design
The purpose of this study was to gain a better understanding of how the programme is
currently functioning. The study used a design that allowed a comparison to be made
between:
Families that are exposed to the MYWO community sensitisation activities, and
whose eligible daughter(s) participate in the alternative ritual (hereafter referred to as
AR families);
Families that are exposed to the MYWO community sensitisation activities, and
whose eligible daughter(s) do not participate in the alternative ritual (hereafter
referred to as non-AR families).
Data were collected from families living in the same communities but who could be
differentiated in terms of whether or not any of their eligible daughters had been through the
alternative ritual. Families with at least one daughter aged between 8 and 20 years were
5 The study also intended to measure the costs of implementing the alternative rite and to assess the
sustainability of the intervention. However, it was impossible to collect the necessary data on programme
costs from PATH or MYWO.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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eligible for the study because the extreme younger and oldest ages at which girls are
circumcised are four and 17 years, and the first alternative rituals were held four years prior
to the study6.
Study Sites
The alternative rite approach has been implemented in several districts7, but only those
districts where the approach has been used for at least two years were considered eligible for
the study. Three districts were selected on this criterion, which between them represent four
ethnic groups (see below). Tharaka district was chosen as one of the three districts because it
was the first district where this approach was undertaken. Although it is not formally part of
MYWO’s Harmful Traditional Practices programme and so had not received the sensitisation
activities, funding and technical assistance for the alternative rituals was received from
PATH and the woman instigating the alternative ritual was a MYWO grass root elected
leader.
District Divisions Ethnic
group
Tharaka
Tharaka North
Tharaka Central
Tharaka South
Meru
Gucha
Ogembo
Nyamache
Abagusii
(Kisii)
Mau Maasai
Narok
Mulot Kalenjin
Data Collection
Data were collected from all study sites through a combination of qualitative and quantitative
methods. Altogether, 37 focus group discussions were held with representatives of
community leaders, adolescent girls and boys, male and female parents, and with some of the
community trainers who provide the family life education. In-depth interviews were held
with 53 key informants, including MYWO programme staff, male and female community
leaders, and two traditional practitioners.
6 This may have led to the inclusion of some non-AR families who had “eligible” girls but who had not
necessarily been considered for either ritual at some time during the previous four years. However, it would
have been very difficult to identify such girls practically, and the number is likely to be small anyway.
7 With effect from November 2000, GTZ in collaboration with the Ministry of Health has been implementing
an alternative rite intervention in Trans Mara district.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
7
Case studies were conducted of nine families who had undertaken the alternative rite. In each
site, three of these were purposively selected based on the family’s willingness to participate
in the in-depth interviews. In the selected case study families, male and female parents were
interviewed, as well as girls, and grandparents (where applicable) regarding the socio-
economic status of the family, factors influencing the family’s and individual’s choice and
participation in the AR and experiences with community members due to the family’s or
individual’s choice not to cut daughters or be cut.
In each study site, a questionnaire survey was carried out among AR and non-AR families.
The AR families were identified from the lists kept by MYWO of girls who had been through
the alternative rite. In total, 601 families were identified, with approximately 200 per district.
The non-AR families were identified by first creating eight clusters in each district, and then
listing all households using the listings from the 1998 census (provided by the Central Bureau
of Statistics). Within these clusters, all known AR families were removed from the listing
and a random sample of 200 families with girls aged between eight and 20 years was drawn
from the remainder.
For each AR family and non-AR family selected, individual confidential interviews were
held with: all girls aged 8 – 20 years; one female or male parent8; and for families where the
female parent was interviewed, one male sibling aged 8 – 20 years. This sampling plan
resulted in a total of 1,201 families being included and 2,066 individual interviews
undertaken as follows:
Tharaka Gucha Mulot
(Narok)
Mau
(Narok) Total
AR families 200 223 130 70
601
Non-AR families 200 200 130 70
600
Female parents 115 219 60 42
436
Male parents 56 57 56 29
198
Girls 281 494 170 123
1068
Boys 111 181 41 31
364
Given the close association between ethnicity and FGM in Kenya, the ethnic affiliation of
respondents in each study site was analysed. As seen below, each of the study sites was
found to be remarkably homogeneous for one major ethnic group – the Meru9 in Tharaka, the
Abagusii10 in Gucha, the Kalenjin11 in Mulot, and the Maasai in Mau. Some diversity can be
8 Ideally, if a female parent was selected in one household, a male parent was selected in the next household.
However, due to the widespread unavailability of male parents due to work and temporary migration, more
female than male parents were interviewed.
9 The Meru ethnic group comprises of nine sub-groups, one of which is Tharaka.
10 In the KDHS and elsewhere, the ethnic group known as the Abagusii are usually named the Kisii. As this
name refers to the area where they live it is not strictly correct and so the term Abagusii is used in this report.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
8
noted in Mau, where 12 of the 13 non-Maasai parents and all of the 14 non-Maasai youth
respondents were Kikuyu12. Because of this close association between ethnicity and study
site, and because FGM is itself related to ethnicity, the remainder of the analysis will be
described by ethnic group rather than study site.
% of sample in each ethnic group Tharaka
(Meru)
Gucha
(Abagusii)
Mulot
(Kalenjin)
Mau
(Maasai)
Parents: main ethnic group 98.8% 99.6% 99.1% 81.7%
Parents: other ethnic groups 1.2% 0.4% 0.9% 18.3%
Youth: main ethnic group 99.5% 99.3% 99.0% 90.9%
Youth: other ethnic groups 0.5% 0.7% 1.0% 9.1%
11 The Kalenjin ethnic group comprises of six sub-groups, and in Mulot the majority of respondents calling
themselves Kalenjin are from the Kipsigis sub-group. However, to allow for the possibility of non-Kipsigis
being included in the sample, the term Kalenjin will be used here.
12 From pre-colonial times, there has been intermarriage between the Maasai and the Kikuyu. Although both
communities have traditionally practiced FGM, because of the strong missionary and colonial government
intervention against FGM in areas where the Kikuyu traditionally live, support for and practice of FGM has
declined considerably among the Kikuyu. Because of this, the Kikuyu who have intermarried with the
Maasai are likely to be influenced to take on the practice.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
9
MEANING AND PRACTICE OF FGM
Reasons For Practising FGM
There are striking similarities and some differences in the meaning and importance attached
to FGM among the four ethnic groups represented in this study (see Table 1). Among all four
ethnic groups, focus group and survey respondents gave a multiplicity of reasons why FGM
is practised in their community and their personal views regarding the practice. Analysis of
survey responses indicates a difference between parents and youth, and some differences
between ethnic groups.
The highest proportions of both parents and youth mentioned preservation of custom and
tradition (80% parents and 50% youth) followed by improvement of marriage prospects (27%
parents and 19% youth) as the main reasons for practising FGM in their community.
Limiting a woman’s sexual desire, preventing immorality and a rite into adulthood were also
mentioned, but by only small proportions of respondents, suggesting that these reasons are
not predominant in these cultures.
There were significant differences between the four ethnic groups. Preservation of custom
and tradition is particularly important among the Abagusii and Maasai, although the Abagusii
do not place much emphasis on FGM as being necessary for marriage or as a rite of passage.
The Kalenjin, Meru and Maasai groups appear to be more concerned with circumcising a girl
to make her eligible for marriage.
Table 1: Perceived reasons for the community practising FGM (%)
Parents Youth
Abagusii Meru Kalenjin Maasai Abagusii Meru Kalenjin Maasai
Custom & tradition
Good tradition
92
5
73
7
63
28
81
20
57
4
42
4
38
15
57
17
Better marriage
prospects 7 40 48 34 5 28 39 37
Limit sexual desire
Prevent immorality
10
8
5
20
6
6
1
3
4
8
4
8
1
1
3
0
Rite into
adulthood 0 8 4 10 2 8 4 14
Cleanliness 1 7 3 7 0 6 1 2
Don’t know 2 4 4 3 29 34 28 22
Other Reasons1 3 17 9 9 6 10 7 6
1 = includes responses such as to preserve virginity, remove dirty genitalia, confer respect, and make
delivery easier.
A much higher proportion of youth (30%) than parents (3%) said that they did not know why
FGM is practised in their community, suggesting that the cultural meaning for the practice
may be less strongly promoted now than before. A weaker understanding of the cultural
values associated with the practice may partly explain the secular decline noted earlier.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
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Analysis of in-depth interviews and focus group discussions provide more detail about the
cultural meaning and significance attached to these reasons.
Cultural and Tribal Identity: Circumcision was a requirement for one to be identified as a
full member of the ethnic group. This view is particularly strong among the Abagusii who
hold circumcision as a mark that distinguishes them from their uncircumcised neighbours
such as the Luo. Therefore to be uncircumcised among the Abagusii is a shame.
Confer Social and Spiritual Authority to Marry and Procreate: The adult status gained
through having been circumcised allowed the young woman to participate in adult privileges,
duties, and responsibilities such as marriage and procreation. Some ethnic groups
traditionally follow the cutting with a period of seclusion during which a girl recovered and
was provided with the tribal knowledge on sexuality, procreation, and how to relate with and
treat a husband and in-laws. In addition, the shedding of the blood had spiritual implications
that made it right for a girl to conceive and procreate. Traditionally, the Maasai have a belief
that an uncircumcised girl has unclean blood, which needs to be removed through the cutting
of part of the genitalia. Among the Meru of Tharaka, the Kalenjin and the Maasai, a child
born of or conceived by an uncircumcised girl was considered ritually unclean and she/he
could not participate in some cultural events and activities. Among the Maasai, such a child
was stigmatised through out his/her life and treated as an outcast even in his/her family.
The Meru of Tharaka believe that if a man takes bride price for a girl who is not circumcised,
the ancestors would curse the family. The Abagusii believe it was traditionally required that
girls must be cut so that a “proper man” marry them. If they were not, they would not be
accepted and would be ridiculed as ‘egesagane’, which means an “adult child.” Their peers
and the community would despise them. Among the Kalenjin, circumcision allowed the girl
to perform socially prestigious tasks such as cooking for her father.
Control Women’s Sexuality: Among all the four ethnic groups, there exists a belief that the
clitoris makes a woman easily sexually excited. Since she cannot control her sexual desires,
she becomes sexually immoral and cannot stick to one man. Control of sexual desire is a
definition of true womanhood in these ethnic groups. As one Maasai respondent put it: “A
man can seduce a Maasai girl for 10 years and she will never give in but for some one who is
not circumcised she gives in easily”. Culturally, “not giving in” to sexual advances is
considered honourable for a woman.
Rite Of Passage to Adulthood: In all the groups, FGM is considered a rite of passage from
childhood to adulthood/womanhood. Traditionally, an uncircumcised girl was considered a
child irrespective of age, and as such could not receive any respect in the community and was
ridiculed and scoffed at by peers and the general community. The transition to adulthood was
commonly celebrated through a rite of passage, usually at the time of puberty, involving a
ceremony and a period of seclusion. In some communities, the cutting itself was the
indication that the transition through puberty had been made. In communities where girls are
circumcised at a young, usually pre-pubertal, age, the timing of the cutting is not directly
associated with the timing of the transition to adulthood, although the procedure must have
been undertaken for the later recognition of womanhood.
Confers Physical Cleanliness: In addition to receiving spiritual cleanliness, circumcision
made a girl physically clean. During focus group discussions in all the sites, particularly with
groups that support FGM, it was reported that uncircumcised girls are unclean and their
genitals produce a bad odour.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
11
Make Birth Easy: In all the ethnic groups, circumcision was believed to make child delivery
easier. Among the Maasai, for example, it was believed that if the clitoris was not cut then it
could grow long and obstruct the birth of a baby during delivery.
Practice of FGM
Prevalence
When asked whether they felt the practice was still prevalent in their communities,
participants in the focus group discussions and key informant interviews gave different
responses depending on their ethnic group. Among the Abagusii, it was clear that female
circumcision was still highly regarded and universally practised, and respondents felt there
were no signs of it declining. A similar situation was reported among the Maasai interviewed
in Mau. Among the Meru in Tharaka, however, the feeling was that although FGM was still
practised in some areas, overall it was declining in the district. In Mulot, respondents felt that
there had been a drastic decline in recent years among the predominantly Kalenjin group, and
that it was not practised very much these days.
These perceptions reflect fairly accurately the results of the 1998 KDHS among the same
ethnic groups. The proportions of women reporting that they had been cut13 have dropped
substantially between the oldest (40 – 49 years) and youngest (20 – 24 years14) age groups
among the Kalenjin (90% to 43%) and the Meru/Embu (74% to 46%). However, no decline
was found among the Abagusii (97% to 96%); for the Maasai, the sample sizes in the KDHS
are very small although a comparison of the proportions cut in each age group seem to
indicate a slight decline (12/13 in the older age group and 22/30 in the younger age group).
Among the non-AR families interviewed in this study, substantial differences were found
between the four ethnic groups in terms of the proportions of girls aged over 15 years who
were cut. Among the Abagusii (n=200), 85 percent of these girls were cut, whereas the
equivalent proportions for the other groups were much lower: Maasai: 5 out of 45 girls;
Meru: 4 out of 54 girls; Kalenjin: 0 out of 37 girls. This is further evidence that the practice
is still highly prevalent among the Abagusii, whereas among the other groups the practice is
definitely declining.
Age at Circumcision
As can be seen on Figure 1, the average (median) age at which circumcision is undertaken
has not changed much over time15. This age is similar in three of the sites, although much
younger among the Abagusii in Gucha. This is because, for the Abagusii, the timing of the
cut need not be directly linked with the biological transition through puberty and so is not
normally an integral part of this group’s traditional rite of passage. As genital cutting is a
strongly held cultural definition of womanhood for the Abagusii, however, it is necessary that
it be undertaken some time preceding the public declaration of a girl’s transition to becoming
a woman.
13 The results presented here are drawn from analyses undertaken of the KDHS datasets and do not appear in
the KDHS report.
14 The youngest age group in the KDHS (15-19 years) are not included because there is a possibility that some
of the younger women in this age group reporting themselves as uncut may still be at risk of being cut.
15 Only two circumcised Kalenjin girls were interviewed and so are not included in these analyses.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
12
Figure 1: Median age at circumcision for mothers and daughters Figure 1: Median age at circumcision for mothers and daughters
10
15 15 16
9
14.5 14
0
2
4
6
8
10
12
14
16
18
20
Abagusii Masaai Meru Kalenjin*
Years
Mothers (n=380)
Daughters (n=324)
* only two circumcised Kalenjin girls were interviewed * only two circumcised Kalenjin girls were interviewed
Decision to Circumcise Decision to Circumcise
There are some important differences in decision-making between the sites. Among the
Abagusii and the Maasai, it is clearly a decision made by the parents, as was apparent from
the focus group discussions as well as the household surveys (see Table 2). Conversely,
among the Meru, and to a lesser extent the Kalenjin, the majority of girls and women who
had already been cut indicated that they were the ones who made the decision.
There are some important differences in decision-making between the sites. Among the
Abagusii and the Maasai, it is clearly a decision made by the parents, as was apparent from
the focus group discussions as well as the household surveys (see Table 2). Conversely,
among the Meru, and to a lesser extent the Kalenjin, the majority of girls and women who
had already been cut indicated that they were the ones who made the decision.
Table 2: Person reported to make the decision for circumcision by ethnic group (%) Table 2: Person reported to make the decision for circumcision by ethnic group (%)
Category Category AbagusiiAbagusii MaasaiMaasai KalenjinKalenjin Meru Meru
Mothers
Father
96
95
44
13
Mother 91 68 37 15
Self 30 8 77 94
Other 6 13 4 8
Girls
Father
78
67
N/a1
6
Mother 93 54 N/a 11
Self 1 13 N/a 83
Other 9 4 N/a 6
1 = only two circumcised Kalenjin girls were interviewed
Type of Circumcision
Type 1 and type 2 cuts are found in all study sites, although with some differences in their
proportions between the ethnic groups. No type 3 cuts were reported. Among both the
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
13
Abagusii mothers and daughters, type 1 is the predominant type, whereas type 2 is more
widely practised among the other three groups, particularly among the Meru. There are
difficulties in interpreting the situation for the Abagusii daughters, however, because half of
them reported not knowing which type of cutting had been done. Information from the
qualitative data suggests there may be a move among the Abagusii towards a mild form of
type 1 where only the tip of the clitoris is cut, and not necessarily removed, which may
explain the difficulty in classifying the type of cut.
Abagusii mothers and daughters, type 1 is the predominant type, whereas type 2 is more
widely practised among the other three groups, particularly among the Meru. There are
difficulties in interpreting the situation for the Abagusii daughters, however, because half of
them reported not knowing which type of cutting had been done. Information from the
qualitative data suggests there may be a move among the Abagusii towards a mild form of
type 1 where only the tip of the clitoris is cut, and not necessarily removed, which may
explain the difficulty in classifying the type of cut.
Who Performed the Procedure? Who Performed the Procedure?
Across all four groups, virtually all mothers (94%) who had been cut reported that a
traditional circumciser had cut them. Among the daughters who had been cut, the Meru (15
out of 19 girls) and the Maasai (19 out of 24 girls) still tend to use the traditional circumciser,
but there has clearly been a change in practice among
the Abagusii. Of the 279 Abagusii girls who were cut,
only 29 percent reported being cut by a traditional
circumciser, with 70 percent reporting that a nurse or
doctor had performed the procedure, suggesting a clear
trend towards medicalisation of the practice.
Across all four groups, virtually all mothers (94%) who had been cut reported that a
traditional circumciser had cut them. Among the daughters who had been cut, the Meru (15
out of 19 girls) and the Maasai (19 out of 24 girls) still tend to use the traditional circumciser,
but there has clearly been a change in practice among
the Abagusii. Of the 279 Abagusii girls who were cut,
only 29 percent reported being cut by a traditional
circumciser, with 70 percent reporting that a nurse or
doctor had performed the procedure, suggesting a clear
trend towards medicalisation of the practice.
Where was the Procedure Performed? Where was the Procedure Performed?
The place for circumcision varied by site for both
mothers and daughters. The vast majority of the Meru
(91%) and Maasai (82%) mothers were cut at their own
home, and this tradition has continued for the daughters
in both ethnic groups. Conversely, most of the
Kalenjin mothers (81%) were cut at another person’s
home.
The place for circumcision varied by site for both
mothers and daughters. The vast majority of the Meru
(91%) and Maasai (82%) mothers were cut at their own
home, and this tradition has continued for the daughters
in both ethnic groups. Conversely, most of the
Kalenjin mothers (81%) were cut at another person’s
home.
For the Abagusii, the majority of mothers (68%) were
cut at the home of the traditional practitioner, with a
further 13 percent being cut “in the bush” and the
remainder at their own or someone else’s home; only
two percent reported being cut at a health facility.
Among the Abagusii daughters, however, the location
has changed considerably over time – only 14 percent were cut at the home of a traditional
practitioner and seven percent in the bush, while 37 percent were cut at a health facility and
40 percent at their own or another home. Further analysis shows that of the 70 percent of
Abagusii girls who were circumcised by a medical practitioner, about half (53%) were cut at
a health facility and about half (47%) at their own or another home. This clearly
demonstrates that the procedure is not only being practised at health facilities contrary to
Ministry of Health policy, but also that health staff are privately providing this service at
families’ homes.
For the Abagusii, the majority of mothers (68%) were
cut at the home of the traditional practitioner, with a
further 13 percent being cut “in the bush” and the
remainder at their own or someone else’s home; only
two percent reported being cut at a health facility.
Among the Abagusii daughters, however, the location
has changed considerably over time – only 14 percent were cut at the home of a traditional
practitioner and seven percent in the bush, while 37 percent were cut at a health facility and
40 percent at their own or another home. Further analysis shows that of the 70 percent of
Abagusii girls who were circumcised by a medical practitioner, about half (53%) were cut at
a health facility and about half (47%) at their own or another home. This clearly
demonstrates that the procedure is not only being practised at health facilities contrary to
Ministry of Health policy, but also that health staff are privately providing this service at
families’ homes.
Traditional circumciser from Kenya
Mothers and daughters were also asked whether they were cut alone or in a group. Among
all groups, the proportions of girls (79%) and mothers (81%) who report being cut in a group
is about the same.
Mothers and daughters were also asked whether they were cut alone or in a group. Among
all groups, the proportions of girls (79%) and mothers (81%) who report being cut in a group
is about the same.
Instrument Used for the Procedure Instrument Used for the Procedure
Among the mothers, for whom three-quarters were cut in a group and by a traditional
circumciser, most were cut with either a shared razor (43%) or knife (31%). Indeed, among
the Meru a special knife is used for circumcision called a Kirunya, which is easily sharpened
and has a small handle so that it can fit in the pocket. The Maasai in Narok use a similar
Among the mothers, for whom three-quarters were cut in a group and by a traditional
circumciser, most were cut with either a shared razor (43%) or knife (31%). Indeed, among
the Meru a special knife is used for circumcision called a Kirunya, which is easily sharpened
and has a small handle so that it can fit in the pocket. The Maasai in Narok use a similar
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
14
knife known as an “Ormurunya”. Among the daughters who knew what instrument was used
(11 percent did not know), 77 percent were cut using their own razor blade. Only 13 percent
used a shared razor or knife. This gives further evidence of a trend towards looking for safer
ways of performing the procedure.
Experience of Problems
When asked if they had experienced any problems related to being cut, 15 percent of mothers
and five percent of daughters reported any such problems16. In both groups, bleeding was the
problem most frequently mentioned. These figures should be interpreted with caution,
however, as they represent women’s and girls’ subjective judgements that a particular health
problem they have suffered can be attributed to the genital cutting. The lower level of
reporting among the daughters may be because they have been cut for a shorter period of time
and most have not given birth – stillbirths were the second largest category of problems cited
by the mothers. Even traditional circumcisers are aware of the fact that the practice can lead
to adverse health effects although this is attributed to practitioner’s skills.
“During child birth, you may experience problems with the operated part of
the genitals if the operation is not done well. This used to happen long ago
when people had not been trained to circumcise. It used to cause the inside of
the vagina to swell. During birth, the swelling was removed using a ring-like
leather strap. Today, women experience no problems related to female
circumcision” (Tharaka – active Traditional Circumciser).
ecently circumcised Maasai girl,
coming out of seclusion. The
decorative headband will stay in
p
lace until she gets married.
16 These figures correspond with similar findings from research undertaken in Mali and Burkina Faso, where
five percent and 14 percent of women respectively reported experiencing problems associated with being cut
(Jones et al, 1999).
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
15
IMPLEMENTATION OF THE ALTERNATIVE RITE
APPROACH
Description of the Approach
The idea of the alternative rite of passage, as conceptualised by PATH and MYWO, is to
work with communities to develop and support a rite of passage that excludes genital cutting,
but which is still relevant to the cultural beliefs and behaviours of each ethnic group. The
approach used is to work with communities where MYWO has already undertaken FGM
sensitisation activities over the preceding years through its ‘Harmful Traditional Practices’
programme. In these communities a group of girls are identified who do not want, or whose
parents do not want them, to be cut and a culturally appropriate alternative rite of passage is
developed and supported by MYWO and PATH.
Because of the different ways in which the community sensitisation activities were
undertaken in each site, and because of the differences between the three districts in the
traditional rite of passage itself, the alternative rite approach has been implemented with
considerable variation in the three sites. However, the same peer education approach for
community sensitisation and other IEC activities, the same three-day and five-day curricula
(developed by PATH) for training peer educators and the girls, and a public ceremony are
used in all sites.
Community Sensitisation through Peer Educators
A key sensitisation activity is the training of MYWO field staff so that they in turn can train
selected community members as ‘peer educators’. During their interactions with community
members, MYWO staff identify community members who show support for FGM
eradication and are suitable to receive training as voluntary peer educators. In some cases,
community leaders assist in their identification. In all the three sites, the peer educators are
from all age groups: youth (25 – 30 years), middle aged (35 – 40 years) and older (50 years
and above). Both men and women are recruited, although most peer educators are women.
The youth are girls who have decided not to be circumcised and are used as role models. The
peer educators are expected to undertake one-to-one and group meetings, to identify parents
and girls willing to participate in the alternative rite, and to assist MYWO staff in group
sensitisation workshops.
The role of the peer educators is to educate other community members on FGM, the intention
being to encourage them to contemplate abandoning the practice. With participation from
MYWO and community groups, PATH developed a three-day curriculum for training peer
educators which includes topics such as: the meaning and importance of peer education;
perception and value clarification; interpersonal communication; harmful traditional
practices; types of FGM and related physiology; basic facts on FGM; rumours and
misconceptions about FGM; male and female empowerment, and developing a plan of action.
A review of the current peer educator’s curriculum reveals that it places more emphasis on
the health complications of the practice and its societal meaning than on its violation of a
girl’s basic rights. In 1998, however, PATH produced a manual for the training of trainers
(Crane et al., 1998), which firmly places the eradication of FGM in a human rights
framework, although the health implications are still covered in depth. The extent to which
this greater emphasis on human rights has percolated the practice of MYWO staff and
volunteers at the community level is not clear.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
16
Training Girls in Family Life Education
PATH and MYWO felt that the seclusion component of the traditional rite was still very
relevant because of the teaching about adult life that takes place at that time. To emulate this
traditional practice, the Alternative Rite includes a “seclusion” of three to five days during
which the girls are given information on reproductive health through a formal curriculum,
and receive “words of wisdom” from selected parents regarding their culture. The sessions
are fully participatory and interactive and avoid too much lecturing. Initially, PATH
conducted the training, but afterwards trained staff and volunteers from MYWO and Ntanira
na Mugambo (see a description of this group in the next section) were used as trainers of
trainers (ToTs) to continue with the exercise.
The topics covered in the curriculum include: interpersonal communication, understanding
harmful traditions, Female Genital Mutilation, human anatomy, decision making, pregnancy
and conception, STIs & HIV/AIDS, courtship, dating and marriage, and empowerment of
men and women. The training curriculum does not provide guidance to the parents on the
types of messages they give, and so it is difficult to assess whether girls receive messages that
entrench existing gender roles and stereotypes or whether they receive female empowerment
messages from these “mothers”. However, gender empowerment is covered in the formal
training curriculum and there is some discussion of girl’s and women’s right to equal
education opportunities and sexual enjoyment and how FGM limits these rights. MYWO
staff and trained volunteers cover the formal FLE sessions.
Public Ceremony
At the end of their seclusion and training a public ceremony is held during which the girls
have a “graduation” to mark their coming of age. Public celebrations take place and the
initiates receive gifts from the project and/or their families and members of the community.
Through their songs, dances and drama, the girls make a public pronouncement that they
have abandoned FGM. Influential political, religious and government administrative leaders
are invited to give speeches on this day. In some cases, donor agency and other NGO staff as
well as media personnel are invited to witness the occasion.
Implementation of the Alternative Rite in Tharaka
Although Tharaka is not one of the districts included in MYWO’s ‘Harmful Traditional
Practices’ Programme (through which the FGM sensitisation activities were undertaken), this
district was the first (in 1996) to initiate an alternative rite (AR). Indeed, the AR ceremonies
held in Meru South, Meru North, Gucha and Narok districts started later and sought to
replicate the one developed in Tharaka.
The idea to start an FGM intervention strategy in Tharaka was first raised after the MYWO
leaders from Tharaka attended the seminar organised by the MYWO national headquarters in
1995 to discuss FGM intervention strategies. The Tharaka MYWO leader came away from
the seminar convinced that something could be done. Although Tharaka had not been
selected as a project site for the alternative rite approach by MYWO because it was not part
of the ‘Harmful Traditional Practices’ programme, the Tharaka leader and the then MYWO
Meru District Coordinator went back to their community to try and develop a strategy to
sensitise people about FGM, and to work towards the idea of holding an alternative ritual.
The MYWO leader shared the information gathered on FGM and the idea of an alternative
rite with people in her area and more specifically in her local church.
This information was received with much suspicion and she faced many obstacles.
Nevertheless, using the MYWO network, she sensitised other women and particularly those
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
17
with girls who were old enough to be circumcised. Together they started sensitising the
wider community on the harmful effects of female circumcision, and discussing the
possibility of an alternative ritual. By August 1996, 29 girls and their families had accepted
to undertake the alternative rite.
Although the MYWO volunteers spearheaded these activities, Tharaka was not eligible to
receive funds from MYWO’s ‘Harmful Traditional Practices’ Programme. To respond to this
enthusiasm, PATH provided some direct funding to the group of volunteer individuals
developing the alternative rite and encouraged and supported them to register as a welfare
organisation so that they could solicit for additional funding. Consequently, they formed the
Ntanira na Mugambo (NNM) organisation. Those who support the objectives and activities
of this organisation register as members and to date there are over 200 families who have
participated in this organisation and these are not restricted to families that have girls who
undertake the alternative rite.
Coverage of the alternative rite in Tharaka is not defined in terms of administrative
boundaries (the NNM team has even visited neighbouring Mwingi District). Whenever or
wherever a parent expresses an interest, the NNM mobilises its trained members to sensitise
the parents on the harmful effects of FGM, after which they invite them to seminars where
they are given more information on the alternative rite approach. Once the parents and their
daughters are sensitised and declare that they want their daughters to go through the
alternative ritual, the girls are registered to participate in the next ritual.
When the project began in Tharaka it targeted only girls and mothers. Since only a few
people explicitly wanted to stop the cutting, it was difficult to get the necessary level of
support, and so a decision was made to use lobbying and advocacy strategies targeting
community leaders (local administration, political leaders, and teachers) to gain wider social
acceptance. To increase the participation of men, the team used their wives to gain their
support for stopping the cutting and for participation in the alternative rite. This deliberate
effort to involve men in the rite helped to improve the project’s image. In addition, the
project targets provincial administration officers such as chiefs, District Officers, and District
Commissioners as well as elected political leaders to encourage them to talk about the
harmful effects of FGM and discourage the practice in their area of jurisdiction. The NNM
also uses schools, churches, and women’s groups as avenues for passing on their messages
and identifying parents willing to have their girls to participate in the alternative rite.
The training and ceremonies are organised during the months of August and December when
the schools are on holidays and when traditionally the rite of passage with cutting takes place.
According to the traditional practice, girls are cut at the age of puberty after which they
undergo a period of seclusion. During the period of seclusion the initiate remains indoors and
is visited only by other girls who have gone through the ritual, female relatives, and parents.
A woman who is either an aunt or friend of the initiate is assigned the role of a “supporter”
who takes care of the initiate. She ensures that the initiate receives the traditional family life
education that prepares her for her role as an adult member of the community, as a wife, and
as a mother. Both the cutting and the education received are what transform the girl from a
child to an adult.
To publicly announce this transition, to mark the change, and to get community recognition, a
public celebration is held on the first day she comes out of her hut to mark the end of her
seclusion period. In addition, the initiate receives a new name. This important event brings
honour to the initiate and her parents. Male and female, young and old members of the
community, friends and relatives participate in this public celebration that is marked by
feasting, drinking traditional brew, dancing, shouting and ululations. The initiate receives
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
18
gifts from her parents, relatives, and friends. In keeping with this tradition, community
members in Tharaka and parents of Alternative Rite initiates actively participate in the
‘alternative’ ceremony through dancing, providing and cooking food for the celebration and
giving gifts to the initiate.
gifts from her parents, relatives, and friends. In keeping with this tradition, community
members in Tharaka and parents of Alternative Rite initiates actively participate in the
‘alternative’ ceremony through dancing, providing and cooking food for the celebration and
giving gifts to the initiate.
A
mother presents a gift to her
daughter at the public AR
g
raduation ceremony.
Implementation of the Alternative Rite in Gucha Implementation of the Alternative Rite in Gucha
Gucha was identified as one of the districts for MYWO’s ‘Harmful Traditional Practices’
programme right from the beginning because of the almost universal practice of female
circumcision among the Abagusii. Activities began with exploratory and baseline research in
1991-3, which was followed by sensitisation activities that began in 1994, and in April 1997
the first alternative rite took place. Because of financial constraints, the project in Gucha
cannot possibly cover all of the administrative divisions, and even in divisions where the
project is implemented not all locations and sub-locations have been covered. MYWO staff
and leaders utilise the network of existing women’s grass root groups and recruit and train
peer educators to sensitise the community on FGM. In addition, the project uses schools to
reach teachers and youth. In addition, the project targets provincial administration staff and
other community leaders to influence them to talk about FGM in their public meetings so as
to encourage community members to abandon the practice.
Gucha was identified as one of the districts for MYWO’s ‘Harmful Traditional Practices’
programme right from the beginning because of the almost universal practice of female
circumcision among the Abagusii. Activities began with exploratory and baseline research in
1991-3, which was followed by sensitisation activities that began in 1994, and in April 1997
the first alternative rite took place. Because of financial constraints, the project in Gucha
cannot possibly cover all of the administrative divisions, and even in divisions where the
project is implemented not all locations and sub-locations have been covered. MYWO staff
and leaders utilise the network of existing women’s grass root groups and recruit and train
peer educators to sensitise the community on FGM. In addition, the project uses schools to
reach teachers and youth. In addition, the project targets provincial administration staff and
other community leaders to influence them to talk about FGM in their public meetings so as
to encourage community members to abandon the practice.
Although some families have been influenced to abandon FGM and adopt the AR,
implementation of anti-FGM activities has met strong, although gradually weakening,
opposition in Gucha. Apart from the district provincial administrative officials, most
community leaders have not been forthright in their support, girls undertaking AR are subject
to ridicule by their age-mates, and MYWO elected leaders themselves have been the subject
of public verbal attack by some leaders in the district.
Although some families have been influenced to abandon FGM and adopt the AR,
implementation of anti-FGM activities has met strong, although gradually weakening,
opposition in Gucha. Apart from the district provincial administrative officials, most
community leaders have not been forthright in their support, girls undertaking AR are subject
to ridicule by their age-mates, and MYWO elected leaders themselves have been the subject
of public verbal attack by some leaders in the district.
Before launching the first formal AR in April 1997, some parents who had decided not to cut
their girls organised public ceremonies with the encouragement and support of MYWO staff,
although the girls did not go through the seclusion and FLE training. The girls’ parents,
relatives, and friends met the cost for the food and gifts given to the girls. MYWO staff and
peer educators present at these village-based celebrations also gave gifts to the “initiate girls”.
The parents who had decided not to cut their daughters did this because they felt that since
they had participated and contributed food and gifts at the ceremonies of daughters of their
Before launching the first formal AR in April 1997, some parents who had decided not to cut
their girls organised public ceremonies with the encouragement and support of MYWO staff,
although the girls did not go through the seclusion and FLE training. The girls’ parents,
relatives, and friends met the cost for the food and gifts given to the girls. MYWO staff and
peer educators present at these village-based celebrations also gave gifts to the “initiate girls”.
The parents who had decided not to cut their daughters did this because they felt that since
they had participated and contributed food and gifts at the ceremonies of daughters of their
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
19
friends and relatives who had been cut, the ‘Alternative Rite’ public ceremony would give
them an opportunity to receive the gifts and support from their friends and community in
return. Even after the launching of the official MYWO-supported AR ceremonies, families
wishing to have public ceremonies based in their villages continue to receive moral support
from MYWO staff and peer educators.
By April 2000, only five formal AR ceremonies targeting 350 girls had taken place in Gucha
over the three-year period. The FLE training component presents a challenge in Gucha.
Traditionally among the Abagusii, the end of girl’s seclusion is marked with a public
celebration whereby groups of girls receive gifts from friends and relatives. However,
Abagusii girls are cut at an early age (between 6 and 12 years) and for such young girls the
type of education given through the PATH/MYWO curriculum to prepare them for adult life
is more suitable for older girls. The MYWO staff in Gucha have used this curriculum, but
have introduced some changes to suit the younger girls.
In Gucha, the girls themselves are reached primarily through the schools where MYWO
carries out sensitisation activities. Their parents are fully involved, however, in making
decisions regarding their girls being not cut, and their participation in the alternative rite
ceremony. In the four case studies of AR families carried out in Gucha, all respondents
reported that either the mother or father of the girl had initiated the idea of the girl not being
cut and participating in the AR. Moreover, these parents themselves had usually been
sensitised by MYWO staff or peer educators.
“I took my daughter for the alternative rite in 1999. You know this was the
right age for her circumcision and we had not decided to take her for
circumcision. When we told her that she will go for the alternative rite, she
was not very hard because she had seen and heard from her friends about the
alternative rite… The first time she hesitated to accept because of the obvious
fact that her friends will ridicule her, but when we explained it to her she
easily agreed and she was happy especially when she went for the training
and found many other girls. She was encouraged… You know in our home we
do not have cases where the mother figure is the only person to tell a child
certain things. No. We have set a free atmosphere where the father can tell the
girls anything and I can tell the boys anything.
On this very occasion, we discussed the issue with the father and later
informed the child. Both of us have been involved in the MYWO teachings so
there was no big problem… I introduced the idea because I went for the
MYWO training earlier. When I told him first he squarely asked me what it
was that I was telling him. He did not like the idea but later the MYWO people
visited him and he agreed to the issue. But initially, he was opposed and he
was wondering whether I wanted to make my girl to be like a Luo [laughter].
But when he realised, he became a big supporter.” (A 41 year-old mother of
a 14 year-old AR initiate - Gucha).
Implementation of the Alternative Rite in Narok
The project in Narok started with a baseline study, the findings of which indicated that FGM
was perceived to contribute to teenage pregnancy and early marriage. MYWO decided to
start an anti-FGM campaign using the importance of girls’ education as an entry point.
Although there are cultural differences between the Maasai and the Kalenjin who live in
Narok in relation to FGM, MYWO used similar sensitisation strategies when reaching both
groups. To sensitise community members and provide information on the harmful effects of
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
20
FGM, MYWO staff and volunteers in Narok used the existing network of women’s groups,
schools, and churches. Since 1994 when the sensitisation and IEC activities started, the
project has not been able to cover all the administrative divisions due to financial constraints
and in divisions where the project is implemented not all locations and sub-locations have
been covered.
Among the Maasai of Narok, the end of a girl’s seclusion period after undergoing genital
cutting is not a public ceremony but instead the parents organise a feast at home. The
Kalenjin have also abandoned their traditional public ceremony, by making the cutting an
individual family affair. In view of this cultural practice, the project in Narok began by
holding the seclusion training for the girls who were not being circumcised, but without the
public ceremony. The FLE training in Narok does not, however, always conform to the basic
requirements of the PATH curriculum in terms of duration, organisation, or content. Training
does not necessarily go on for five days and the curriculum used is more relevant for peer
educators. It is not clear whether this is due to financial constraints or to a deliberate choice
by the Narok MYWO staff to do things differently.
Since the public ceremonies were reported to be successful in the other districts where
MYWO was implementing the Alternative Rite approach, the MYWO staff in Narok were
influenced to include the public ceremony component in their alternative rituals. Before
implementing the first Alternative Rite incorporating the public ceremony component, the
project had already implemented two AR activities (comprising of 49 girls) without the
public ceremony component. The first AR incorporating the public ceremony component
took place in December 1998, and up to April 2001 the project had implemented eleven such
ceremonies targeting 750 girls from Mau, Mulot and Trans Mara17 Divisions. MYWO has
held AR ceremonies in Mau and Mulot with both Maasai and Kalenjin participants, as well as
separate ceremonies with only one group participating. Unlike Tharaka and Gucha, however,
where parents and community members actively participate in the public ceremony through
providing gifts, cooking food and dancing, parents in Narok do not make any contributions at
all. Indeed, MYWO also provides transport to the parents to come and witness the
graduation ceremony. Whether this public ceremony component should continue in Narok
with such a notable lack of enthusiasm from the girls’ parents is clearly debatable.
To identify girls who will participate in the alternative rite, MYWO relies on schools and
community leaders to propose girls who are thought to be eligible, i.e. who are thought to not
be circumcised. Information from focus groups and in-depth interviews indicate that, in
some cases, the parents of girls going through the alternative rite are not always fully
informed; indeed, some thought that their daughters were attending a training seminar whose
objective they did not understand. This lack of full involvement by some parents was further
confirmed by the three case studies of families in which girls had been through the alternative
rite. One father commented that:
“My daughter was selected from school. She was given an invitation letter.
She informed me and explained what they were going to do. That is to be given
family life education training by MYWO. I did not like the way they were
selected at school because I believe I should have full responsibility for my
children and when they are just selected and whoever is going to be with them
during the seminar does not come to me as a parent it’s not a good show. …
17 Trans Mara was originally an administrative Division in Narok district, but since 1999 the Division was
given the status of a district.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
21
In fact I did not personally see any MYWO member coming to me to ask for
the girl and I do not think they even explained fully to my daughter what they
were going to do” (Father of a 13 year old initiate from Narok).
A mother of another initiate echoed the same sentiments:
My daughter’s invitation was done when in school. She informed me that she
had to attend a seminar in Narok town. I did not object although I did not like
the approach. A responsible person should have approached me first. It’s not
fair for anyone to approach teachers to get my daughters away from home
over the holidays because I have duties I have assigned my daughter to do
during the holiday which teachers do not know anything about.” (A mother of
a 14-year-old initiate – Narok).
One of the girls stated that:
“I was selected from school and was given an invitation letter. I informed my
parents who did not object although I had to explain what we were going to do
there. It was a tough job because I did not know what it meant to go through
the alternative rite. I thought we were just to be taken for a seminar to be
taught about life. But when we went for the seminar we were told that when
one goes through the alternative rite she will not be circumcised” (Narok AR
initiate, 13 years old).
As these statements indicate, even though most parents of girls attending the alternative rite
support the idea of eradicating the practice and, indeed, have not and will not cut their girls,
the methods used by MYWO to recruit the girls for the alternative rite should have involved
the parents more fully to avoid these situations. Unfortunately, during the study18 it was
found that, for a small number of parents who were not consulted and sensitised about
discontinuing the practice and having their girls participate in the alternative rite, the
discovery that their girls were about to go through the alternative rite, or had already
participated, provoked them into circumcising their girls anyway.
N
ew AR graduands accompanied
by MYWO officials at a street
demonstration, which is part of the
A
R graduation ceremony.
18 This situation was also noted for isolated instances during the study by Olenja (2000).
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
22
EFFECT OF THE ALTERNATIVE RITE PROGRAMME ON
GIRLS’ REPRODUCTIVE HEALTH KNOWLEDGE AND
GENDER ATTITUDES
The MYWO/PATH Alternative Rite programme includes a component that seeks to replicate
and strengthen the traditional period of seclusion during which girls are educated in a group
about the transition from girlhood to womanhood. Within the Alternative Ritual programme,
this component has been formalized into a training activity to educate girls about a variety of
reproductive health and other issues. This section reviews the results of interviews with the
442 ‘initiates’ who went through the alternative ritual and attended the ‘seclusion’ training,
and compares them with those of the 626 girls sampled (from both AR and non-AR families)
who did not attend the training (the ‘non-initiates’).
Description of Initiates
As described in the sampling plan earlier, all girls known to have gone through the alternative
ritual were identified by MYWO, and as many as possible were interviewed during the
fieldwork – 132 in Narok, 152 in Gucha, and 158 in Tharaka. Table 3 describes the
background characteristics of the initiates in each district, and also provides a comparison of
these girls with those who were interviewed from the AR and non-AR families that had not
gone through the alternative ritual.
Table 3 Characteristics of AR initiates and other girls sampled
Narok
(n=132)
Gucha
(n=152)
Tharaka
(n=158)
All initiates
(n=442)
All non-
initiates
(n=626)
Median age 16 14 16 16 13
Read English (%) 96 94 95 95 75
Attended School
Primary
Secondary
Tertiary
99
50
47
3
100
76
24
0
99
63
33
4
99
64
34
2
97
85
14
1
Father can read 82 93 90 89 87
Father attended school 82 92 90 88 86
Mother can read 65 83 80 77 68
Mother attended school 64 86 79 77 73
There were some differences in age between the groups – all the Abagusii girls going through
the alternative ritual in Gucha were less than 20 years and were younger on average than the
Maasai and Kalenjin in Narok and the Meru in Tharaka. In all three sites, and in Narok and
Tharaka in particular, it is notable that almost half of all the initiates (49% in Narok and 50%
in Tharaka) were aged over 17 years and above, and so were beyond the age at which they
would have gone through the traditional rite and at which they would have been expected to
be cut.
There were also a small number of AR initiates (eight in Narok and three in Gucha) who
were actually cut. Interviews with some of these girls indicate that, for the most part, they
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
23
concealed their status from the MYWO staff because they wanted to participate in the
training given during the seclusion period and in the public ceremony. Some of the girls in
Narok also said that as a result of their conversion to “born again” Christianity, they had
become convinced that FGM was “sinful” and wanted to demonstrate publicly their change
of heart by participating in the alternative ritual. However, two of the girls from Gucha were
in support of having been cut, did not regret the fact that they were cut, wished to cut their
future daughters, and expressed the view that FGM should continue, and so it is not clear why
they participated in the alternative rite.
Although levels of education reached by the girls appear to be higher for the initiates, this
may reflect the fact that their average age is higher and so they are more likely to have
completed tertiary education. There is little difference between initiates and non-initiates
reporting their fathers’ education level and reading ability (although those in Narok are
somewhat less educated). A comparison between the girls’ mothers reveals no difference in
proportions ever going to school, but a significant difference (0.003)19 in the reported levels
of ability to read English.
Reproductive Health Knowledge
As can be seen in Figure 2, those initiates who went through the seclusion training are much
more likely than the non-initiates to be aware of important reproductive health issues. As
these are the issues that were covered during the MYWO seclusion training the results are
unsurprising, but they do serve to illustrate the generally low level of awareness of
reproductive health among the non-initiates and the role the MYWO seclusion training can
play in increasing basic levels of awareness on these topics.
Figure 2: Proportions of girls aware of reproductive health issues (%)
98
90
88
88
86
76
73
72
64
84
55
60
61
58
44
44
36
28
0 10203040506070809010
HIV/AIDS
Menstruation
Sexual intercourse
STIs
Getting Pregnant
Dating
How body works
Contraception
Ejaculation
0
Initiates (n = 442) Non-Initiates (n = 626)
19 Fishers’ Exact Test.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
24
When asked more detailed questions on specific issues, however, knowledge was found to be
poor for all girls, although slightly better among the AR initiates. For example, although
overall knowledge was poor about the development of the reproductive system, significantly
higher proportions of initiates than non-initiates knew that a girl could get pregnant when she
starts her monthly periods (36% compared to 15%) and that a boy can make a girl pregnant
when he starts ejaculation (23% compared to 8%). Knowledge about when during the
monthly cycle a girl is most likely to get pregnant if she has unprotected sex was also poor
overall, but the proportion correctly knowing a girl’s fertile period was higher among the AR
initiates (20%) than the non initiates (10%). However, a higher proportion of AR initiates
(44%) compared to non-AR initiates (17%) thought that they knew the correct timing but
actually had incorrect knowledge, indicating that the training needs to make sure that girls
fully understand the menstrual cycle and its relationship with fertility.
AR initiates are twice as likely to have heard of contraceptives than non-AR initiates (68%
and 33%). Among all of those who say they know of family planning, the pill, condoms, and
injectables are the best-known methods. There is no difference in knowledge of specific
methods between AR initiates and non-initiates, however, suggesting that the training needs
to cover the individual contraceptive methods in more depth.
When asked to name the specific STIs known, the AR initiates had much higher levels of
awareness than the non-initiates of HIV/AIDS (97% vs. 86%), syphilis (81% vs. 38%) and
gonorrhoea (82% vs. 45%). There was not much difference, however, between the two
groups in their awareness of other STIs.
Initiates also had higher levels of knowledge than non-initiates about transmission of STIs
and HIV/AIDS – only eight percent of AR initiates compared with 31 percent of non-initiates
did not know how a person gets an STI. Interestingly, within the multiple responses given
when asked how a person gets an STI, both groups gave a ‘partner’s other partners’ as the
main response (44% for AR initiates and 30% for non-initiates), and similar proportions (21-
22%) gave ‘other sexual partners’ as a response. There was a large difference between the
groups responding that a person can get an STI from their regular partner – only nine percent
of non-initiates compared with 27 percent of AR initiates. This suggests that the seclusion
training rightly puts emphasis on the possibility of a woman being infected by her regular
partner.
Similarly, AR initiates had higher levels of knowledge about HIV transmission, with only
four percent of AR initiates compared with 14 percent of non-initiates not knowing how a
person gets infected. On average, AR initiates were able to name more transmission
mechanisms than non-initiates, with almost two thirds naming sexual intercourse, non-sterile
needles and blood transfusions, although only 12 percent could mention transmission during
pregnancy. Whereas only six percent of AR initiates did not know what a person could do to
avoid getting an STI or HIV/AIDS, 29 percent of non-initiates didn’t know any ways. Again,
on average the AR initiates could name more ways of avoiding infection. The majority of
both groups cited abstinence as the main means of prevention, but only 14 percent of AR
initiates and 12 percent of non-initiates mentioned using condoms. Condom promotion for
infection prevention clearly does not feature strongly in the seclusion training.
When asked how they first heard about these reproductive health issues and from whom, or
where have they heard the most useful information, teachers are the first and the most
important source of information for both initiates and non-initiates on all issues except dating
and sexual intercourse. For dating, friends and relatives were the first and most important
sources mentioned most frequently, and for sexual intercourse friends and relatives were the
most frequently mentioned first source, but teachers were slightly more important sources.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
25
Across all reproductive health issues, MYWO was the first source of information for 5 – 10
percent of the AR initiates and the most useful source for 7 – 21 percent of them. After
teachers, MYWO was cited as the second most useful source for how the body works, how
girls get pregnant, contraception, STIs and HIV/AIDS.
Attitudes and Behaviour Concerning Family Planning and Sexual Activity
Approval of condoms and use of other contraceptives was generally low among all girls,
especially by adolescents and by unmarried couples. A slightly higher proportion (45%)
approved of condom use of adolescents for STI prevention, pregnancy prevention, or both,
and three-quarters approved contraceptive use among married couples. As can be seen in
Figure 3, the non-initiates were actually more likely to express approval of contraceptive use
in all situations (although the difference is significant only for ‘use by unmarried couples’).
This suggests that the trainers may encourage a rather negative attitude towards contraceptive
use through the way they teach, perhaps through emphasising pre-marital abstinence rather
than protected intercourse. This seems to indicate that the training that the initiates receive
does not necessarily impart positive attitudes towards contraceptive use or is not capable of
changing existing negative attitudes.
Figure 3: Attitudes towards contraceptive use among girls (%)
75
43
24
23
77
56
37
35
0 10203040506070809010
Approve FP use by
married couples
Approve condom use
by adolescents
Approve FP use by
unmarried couples
Approve FP use by
adolescents
0
Initiates (n=442) Non-initiates (n=626)
In relation to their personal sexual activity and contraceptive use, there is no significant
difference between the AR initiates and non-initiates. Despite the AR initiates being
substantially older on average age than the non-AR initiates, small proportions of both the
AR initiates (15%) and non-initiates (16%) have ever had sex. Out of these, about one
quarter of the initiates (27%) and one half (41%) of the non-initiates had sex during six
months prior to the interview, but this difference is not significant20. Of those who have ever
had sex, only seven percent of the AR initiates and 12 percent of the non-initiates used a
20 Used Person Chi-square and Fishers’ Exact Tests.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
26
contraceptive method the first time, and only 21 percent of the AR initiates and 28 percent of
the non-initiates used a contraceptive method the last time they had sex.
Gender Attitudes
Responses to a series of seven ‘agree/disagree’ questions concerning different aspects of
gender relations indicate that on average both initiates and non-initiates have attitudes
suggesting a belief in gender equality. However, AR initiate girls are more likely to express
gender egalitarian attitudes than the non-initiate girls. The difference between the initiates
and non-initiates was significant for the attitudes that it is not justified for a man to hit partner
(p< .05); women should have equal opportunities as men (p<.001); men and women should
have equal rights (p<.01); men have a right to sexual enjoyment every time they have sex
(p<.001); and women have a right to sexual enjoyment every time they have sex (p<.001).
For the attitude that girls should have equal rights as boys and boys should be sent to school
first before girls, the difference between the two groups was not significant. In addition,
initiates (59%) were more likely than non-initiates (20%) to express the view that FGM
contravenes the rights of women and children.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
27
FAMILIES’ BELIEFS AND ATTITUDES ABOUT FGM
Perceptions of Benefits and Disadvantages of FGM
Benefits
When asked their opinion of the benefits or advantages of FGM, those in AR families were
much more likely than those in non-AR families to state that there were no benefits or that
they did not know of any benefits to the practice (see Table 4). Even within the non-AR
families, however, significant proportions were not able to cite any benefits, especially for the
girls and boys among whom the majority felt it did not have any importance or benefits. For
those giving benefits, the parents were more likely to cite maintenance of tradition or culture,
whereas the adolescents, especially the boys, saw benefits for the girl in terms of eligibility
for marriage and respect. Across both types of families, there were significant differences
between ethnic groups, however, ranging from 35 percent of Maasai to 64 percent of Kalenjin
who did not think there were any benefits to the practice.
Table 4: Perceived Benefits of FGM (%)
Girls Boys Mothers Fathers
AR Non-
AR AR Non-
AR AR Non-
AR AR Non-
AR
No benefits / don’t know 87 67 74 57 79 43 59 32
Maintains tradition/culture 7 7 13 11 16 29 23 42
Eligibility for marriage 4 7 12 23 9 16 14 21
Confers respect for girl 2 13 11 19 9 12 9 14
Disadvantages
One key issue facing all efforts to eradicate FGM is the type of messages and arguments used
to convince those practising female circumcision to stop. Two broad approaches are most
commonly taken, one that highlights the potential for genital cutting to adversely affect the
health (broadly defined) of girls and women, and one that argues that cutting the genitals of
girls and women contravenes their human rights to bodily integrity. The MYWO
sensitisation activities focused primarily on the health effects approach, although reference to
issues of empowerment and equal education were made. To assess the effect of these
messages, respondents were asked about their knowledge of any adverse health /
psychological / social effects of the practice, as well as their opinion as to whether the
practice goes against girls and women’s rights.
In all sites, members of AR families are much more likely to know about any health and/or
social/psychological problems than their non-AR counterparts (see Figure 4). There were
also some differences between ethnic groups, with the Maasai least likely to know and the
Meru the most likely to know any of these problems. Among all the groups interviewed,
knowledge of health problems was higher than knowledge of any social and psychological
problems (see Table 5). Bleeding/anaemia, septicaemia and difficult labour were the most
frequently mentioned health problems.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
28
Figure 4: Knowledge of any health and social/psychological problems associated
with FGM (%)
37
35
19
21
83
72
70
48
0 10203040506070809010
Mothers
Fathers
Girls
Boys
0
AR
Non-AR
Between 15 and 20 percent of all boys, girls and mothers (but only 5% of fathers) mentioned
spread of diseases including HIV/AIDS as a potential health problem. This issue arises
frequently in public discussions about female circumcision, due to fears of disease
transmission through use of a shared instrument (which may have influenced the change in
instruments used as noted above), as well as the real possibility that women who have been
cut may be at greater risk of contracting a genital infection21.
Only small proportions (less than 10 percent) of any respondents mentioned social problems
such as limiting girls’ education and encouraging early marriage, and it was the fathers who
were more likely to mention these problems. This suggests that the anti-FGM sensitisation
activities tend to emphasise health over social and psychological problems.
Table 5: Harmful effects mentioned by type (%)
Children Parents
AR Non-AR AR Non-AR
Bleeding / anaemia 82 71 90 84
Septicaemia 32 18 30 23
Difficult labour 26 13 27 14
Scarring 17 5 25 6
Perineal tears 12 2 17 9
Limits girls’ education 8 1 11 8
Encourages early marriage 6 2 9 4
Reduces sexual satisfaction 7 2 6 6
Against women’s dignity 1 5 5 2
21 Studies of gynaecological morbidity associated with genital cutting in The Gambia (Morison et al, 2001) and
in Burkina Faso and Mali (Jones et al, 1999) indicate that women who have been cut are at greater risk of
Bacterial Vaginosis and Herpes Simplex Virus-2, and that the more the severe the type of cut the greater the
likelihood of a woman having symptoms of a reproductive tract infection.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
29
When asked whether, in their opinion, FGM contravened the rights of girls and women, once
again those in AR families were much more likely to feel that it did do so (see Figure 5). It is
important to note that those in the Abagusii and Maasai ethnic groups were much less likely
to hold this opinion than the Meru or Kalenjin.
Those that did feel this way were then asked, in an open-ended question, which rights in
particular they thought FGM contravened. No single right in particular predominated, with
the right to protection against physical injury and abuse and the right to fully develop their
potential being the most cited by parents and children, with the right to equal educational
opportunities also being cited by the boys and girls.
Figure 5: Perception that FGM contravenes the rights of girls and women (%)
29
23
18
24
67
75
52
54
0 10203040506070809010
Mothers
Fathers
Girls
Boys
0
AR
Non-AR
Attitudes Towards FGM
Differences between circumcised and uncircumcised girls
Although the majority (56 – 82%) of the respondents in all groups expressed the view that
there is no difference between circumcised and uncircumcised girls, a slightly smaller (but
statistically significant) proportion of AR household members feel there is a difference. The
most frequently given reasons are that circumcised girls are more socially acceptable and are
more likely to be respected by their peers.
However, 45 percent of AR mothers and 30 percent of the AR fathers who thought there was
a difference expressed the view that circumcised girls are more likely to be sexually
promiscuous and badly behaved. As noted earlier, this is most likely to be because
circumcised girls are perceived to be adults and so there is an expectation that they will
behave more like adults, including becoming sexually active. Interestingly, there is some
difference in reported sexual activity between circumcised and uncircumcised never married
girls aged 15 years and above (except in Tharaka district), in that 34 percent of the
circumcised girls compared to 19 percent of the uncircumcised girls reported ever having had
penetrative sex. However, among these girls, there is no significant difference between the
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
30
circumcised and uncircumcised girls in terms of their being currently sexually active22, or the
mean number of lifetime sexual partners.
Eligibility of Uncircumcised Girls For Marriage
When asked whether they felt that men would marry an uncircumcised girl, the vast majority
of those in AR households agreed with this view, whereas significantly smaller proportions
agreed from the non-AR households (see Figure 6). Also, respondents from the Kalenjin and
Meru ethnic groups are much more likely to hold this view than the Maasai and Abagusii.
Moreover, uncircumcised girls (86%) and those girls that have participated in the AR as
initiates (96%) are much more likely than those who are already circumcised (30%), and
those living in non-AR households (73%), to believe that uncircumcised girls are likely to get
a marriage partner.
Figure 6: Proportions of respondents that feel men would marry an
uncircumcised woman (%)
41
38
60
64
85
93
99
96
0 20406080100
Boys
Girls
Fathers
Mothers
AR
Non-AR
Regret concerning Personal Circumcision
Whereas three-quarters of the women from AR households who had been circumcised
expressed regret at having been cut, only one quarter of those from non-AR households
regretted being circumcised23. When asked the reasons for regretting having been cut, the
most frequently mentioned are: painful experience (38% mothers and 23% girls); medical
complications (21% mothers and 19% girls); against their religion (11% mothers and 21%
girls); and the practice has lost its significance (14% mothers and 11% girls).
22 Defined as having had sex in the previous six months.
23 About half of the 33 circumcised girls in the AR families (siblings of those girls who have gone through the
alternative rite) also expressed this regret, compared with only 13 percent of the 292 circumcised girls in
non-AR families.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
31
All parents were asked whether they now regretted circumcising those of their daughters who
had already been cut (up to a maximum of four daughters). There are much higher levels of
regret for having had it done among the AR parents than the non-AR parents: of the 124
daughters reported to have been cut by the AR parents, 79 percent of these circumcisions are
now regretted, whereas of the 435 daughters reported to have been cut by non-AR parents,
only 16 percent of these circumcisions are now regretted.
Intention to circumcise future daughters
The proportions of girls (93%) and boys (81%) in AR households who do not intend to
circumcise their daughters are significantly higher than the proportions of girls (36%) and
boys (13%) in the non-AR households. Many reasons were cited for this attitude including:
medical complications, against religion, lost significance, and having learned about harmful
effects through participation in the alternative rite24. Those girls and boys intending to
circumcise their daughters gave the belief that custom and tradition demand that a girl be
circumcised as the main reason, with better marriage prospects also being mentioned,
especially by boys.
Abandonment of FGM
When asked whether they felt FGM should or should not continue in their community, almost
everyone in AR families felt that the practice should be abandoned, as would be expected
(see Table 6). The boys did not feel as strongly as the others, which may be because, of the
four sub-groups, they are least directly associated with the practice.
It is important to note that within the non-AR households more parents were in favour of
discontinuing than continuing the practice. Moreover, although levels of ‘no opinion’ are
low overall, the proportions are higher among those in non-AR families and among the girls
and boys. These results suggest that many of those in the project sites are considering
discontinuation of the practice, i.e. are at the ‘contemplation’ stage of the behaviour change
model, and so may be encouraged to move to the action stage if ‘preparation’ activities (such
as the alternative rite) are promoted that would convince them of the social support for
changing their behaviour.
Table 6: Attitudes towards the community continuing or discontinuing FGM (%)
Girls Boys Mothers Fathers
AR Non-
AR AR Non-
AR AR Non-
AR AR Non-
AR
FGM should continue 3 53 10 46 3 42 2 43
FGM should not continue 93 32 78 38 96 49 97 49
No opinion 4 15 12 16 1 9 1 8
There are, however, some important differences between the ethnic groups within the non-
AR families. Whereas over half of the Abagusii (54%) and Maasai (54%) non-AR parents
24 It is worth noting that, unlike the other sub-groups of adolescents, a substantial proportion of boys in the
non-AR households (37%) were undecided on this issue, although 50 percent of these boys were in favour of
circumcising daughters.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
32
stated that FGM should continue, only small proportions of the Meru (16%) and Kalenjin
(23%) non-AR parents want the practice to continue. These findings suggest that more
sensitisation activities are needed among the Abagusii and Maasai if community-level
attitudes in favour of discontinuation are to become the majority view, thereby creating
conditions for the alternative rite to become an option.
Among those supporting continuation of the practice in the non-AR families, the majority
indicated that this was based on the belief that FGM is a good tradition, with sizeable
proportions also stating that it is ensures a girl’s marriageability, and that the practice brings
honour to the girl and her family.
For those who felt their communities should discontinue the practice, a multiple-response
question brought a wide range of reasons why (see Table 7). The most frequently cited
reasons overall (for both parents and youth) were that it has lost its meaning, it is against
religious beliefs, and has medical complications. There are some slight differences between
those from AR and non-AR families, and overall those in AR families are able to give more
reasons, suggesting they may be better informed about the problems associated with the
practice. For substantial proportions of parents and youth in the AR households, especially
among the mothers and daughters, learning about the alternative rite also seems to have been
an important factor in their thinking.
Table 7: Reasons given why FGM should be discontinued (%)
Girls Boys Mothers Fathers
AR Non-
AR AR Non-
AR AR Non-
AR AR Non-
AR
Lost significance 37 21 50 46 44 47 51 50
Against religion 31 28 29 24 41 36 48 24
Medical complications 37 25 33 27 38 27 33 34
Limits education 20 14 16 16 21 18 29 10
Painful experience 12 18 6 12 27 31 16 10
Learnt about Alternative Rite 37 12 33 4 45 7 23 2
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
33
FACTORS ASSOCIATED WITH PARTICIPATING IN THE
ALTERNATIVE RITE
Information gained from focus group discussions and in-depth interviews undertaken prior to
the survey suggested that factors such as education, religion, socio-economic status,
employment, attitudes towards gender issues, and the mothers’ and daughters’ circumcision
status might pre-dispose an individual or family to abandon the practice of FGM, thereby
making them more likely to want their daughters to go through the alternative rite of passage.
For example, the rise of Christianity is thought to undermine the fear that people have
traditionally had of displeasing the ancestors or drawing a curse upon themselves for failing
to undertake some cultural practices. Some discussants felt that circumcision prevents girls’
maximising their educational achievement because of the traditional expectation that a
circumcised girl becomes a woman who is then free to engage in sex and is expected to marry
immediately after being cut. Moreover, urbanisation brings interactions with people from
various cultural backgrounds, some of which do not practice FGM.
The following section explores each of these factors, and also explores the role that the
sensitisation activities undertaken by MYWO prior to and during the AR programme may
have played in encouraging families to abandon FGM.
Education
A higher proportion of parents and youth from the AR households than from the non-AR
households have ever attended school, but this difference is not particularly significant
overall (although it is significant at the 0.05 level for the female parents). Among those who
have ever attended school, however, significantly higher levels were attained by female and
male youth aged 15 and above and for male parents in AR households, but there are no
significant differences among female parents (see Figure 7).
Figure 7: Parents’ levels of education
19 23 29 39
31
45 44
39
18
21 21 17
28
755
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AR Male(n=90) Non-AR Male (n=108) AR Female (n=212) Non-AR Female
(n=222)
No School Primary
Secondary Post-secondary
There is also a difference in school attendance between the four ethnic groups – the Abagusii
(83%) and the Meru (70%) have higher proportions of parents of both sexes who have ever
been to school than the Kalenjin (58%) and Maasai (41%).
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
34
Religion
As seen above, religion was frequently cited as an important factor influencing the decision
to stop practising FGM. There are substantial variations in religious affiliation among the
parents within and between the ethnic groups:
Among the Abagusii, the Seventh Day Adventist (SDA) church has by far the highest
representation (about 60%), followed by Catholics and Pentecostals.
Among the Meru, most are Methodists (44%) or Catholics (37%), with a small
proportion of Pentecostals.
Among the Kalenjin, by far the predominant denomination is the African Gospel
Church (AGC) (over 50%) followed by Catholics and Pentecostals.
Among the Maasai, the African Inland Church (AIC) (38%) and Pentecostals (18%)
are the predominant formal churches, but 35% of respondents stated that they had no
religion or belonged to a non-mainstream church.
For both parents and youth, there are significant differences in religious affiliation between
the AR and Non-AR households. The Methodists and AGC members were found to be more
likely to participate in the AR programme, whereas the Catholics and Pentecostals are less
likely to participate. Among the SDA and AIC members, no difference was found in whether
or not they participate in the AR programme. This relationship was found consistently for
three of the four study sites, the exception being the Mau site, which is primarily Maasai and
for which the numbers of practitioners of formal religions are too small to draw conclusions.
Information gathered from focus group discussions and in-depth interviews suggest that the
Methodist church in Tharaka (Meru), the AGC in Mulot (Kalenjin), the AIC in Narok
(Maasai) and the SDA church in Gucha (Abagusii) do take a stand against FGM. However,
in all four sites, it was reported that the Catholic and Pentecostal churches do not actively
preach against the practice. Many of those wanting their communities to discontinue the
practice (see previous section) felt that FGM is against their religion, and so clearly the
organised churches can be an important actor in sensitising their congregations about FGM.
For all the study populations, the church plays a major role in their lives (almost 80% of all
parents attend church at least once a week), and so messages from their church can be quite
influential.
Employment
The most common occupation (for 57% of the parents) across the four sites is working as a
rural labourer or farm worker (except among the Maasai for which the most common work is
herding livestock). There is a weak but significant relationship (p = 0.02) between being a
labourer and not participating in the AR programme; however, the occupation with the most
significant difference between AR and non-AR parents is a regular salaried job. Although
the overall proportion of parents in a regular salaried job is low (14%), those in AR
households (18%) are much more likely to be in regular employment than those in non-AR
household (9%).
Socio-Economic Status
The standard DHS indicators were used to assess the socio-economic status of a household:
ownership of land, livestock, radio, T.V., electricity, cash crops, bicycle, and fridge; the type
of water source and toilet; roof, wall, and floor materials of the main house. Each household
was given a score of one point per item if it had a flush toilet or pit latrine; a roof made of
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
35
tiles or iron sheets; the floor made of cement or wood; and the walls made of bricks, stone, or
timber. For each of the other items, a household scored one point per item available.
Households were then categorised by scoring them as low status (1-4 points), medium status
(5-6 points) and high status (7+ points). This categorisation was reached through dividing the
overall distribution of points into three approximately equal groups.
Figure 8: Socio-economic status by type of household
16
31
42
53
42
17
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AR HH (n=301) Non-AR HH (n=326)
High
Low Medium
As can be seen in Figure 8, a significant relationship exists between a household’s socio-
economic status and the participation of its daughters in the Alternative Rite, with AR
households significantly more likely to have higher socio-economic status than non-AR
households.
Gender Attitudes
A series of seven ‘agree/disagree’ questions concerning different aspects of gender relations
were asked of parents and youth to measure their gender attitudes (see Table 8), and these
were compared by whether they were in an AR or non-AR household. A significant
difference exists between the AR and Non-AR households in two of these questions for the
parents and in four of the questions for the youth.
Overall, most respondents indicate attitudes that suggest a belief in gender equality. For the
first five questions, the majority of respondents feel that men should not hit women and that
females should have equal rights and opportunities to males. Despite this apparently high
level of consistency across all groups, there is a general pattern of higher levels of agreement
with positive gender attitudes among AR household members than non-AR household
members, some of which are statistically significant differences.
When the sex of the respondent is controlled, however, the analysis indicates that there is no
significant difference in gender attitudes between AR and Non-AR male parents, and that for
the youth there is only a significant difference between adolescent males for the question of
whether it is justified for a man to hit a partner. In other words, most of the significant
differences observed are due to differences in gender attitudes between the women and girls
in the AR and non-AR households.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
36
The questions on right to sexual enjoyment reveal considerable ambiguity on the part of the
youth, as expressed in having no opinion (which is not surprising given that only a small
proportion have ever had sex), and for about one-fifth of the parents25. While there are no
differences between AR and non-AR parents, there are significant differences for the youth,
with slightly higher proportions of AR youth feeling that both men and women have a right to
sexual enjoyment.
Table 8: Gender attitudes by type of household and respondent (%)
Youth Parents
Question Household AR Non-AR AR Non-AR
Justified for man to hit partner No
Yes
95
5
90***
10 N/A N/A
Women should have equal
opportunities as men
Yes
No
No opinion
65
30
5
54***
36
10
70
30
0
62*
36
2
Girls child should have equal
rights as a boy
Yes
No
No opinion
77
18
6
74
18
8
83
14
3
77**
23
1
Boys should be sent to school
first before girls
Yes
No
No opinion
18
75
7
22
71
7
16
80
4
20
77
2
Men and women should have
equal rights
Yes
No
No opinion
59
32
9
55
34
12
63
36
1
57
40
3
Men have a right to sexual
enjoyment every time they
have sex
Yes
No
No opinion
27
19
54
20***
17
63
51
30
20
51
30
19
Women have a right to sexual
enjoyment every time they
have sex
Yes
No
No opinion
27
21
52
21***
19
61
56
28
16
50
31
19
Note: * Significant at .05, ** at .01 and *** at .001 levels
Circumcision Status of Mothers and Daughters
A slightly smaller proportion of mothers in the AR households (93%) are circumcised than in
the non-AR households (98%), but the difference is not statistically significant. This
suggests that whether or not a mother was circumcised is not a major factor influencing the
decision whether or not to circumcise her daughter, given that virtually all female parents
were themselves cut.
Parents were also questioned about the circumcision status of all their daughters (up to a
maximum of four) to try to gain some understanding of what has happened to daughters in
the family. AR and non-AR parents were first compared in terms of the proportion of
daughters aged 15 years and above that had been circumcised (in line with the KDHS
recommendation to control for age). The results indicate that only one quarter of the 493
25 Controlling for sex of parents reveals that higher proportions of males support the view that men have a
right to sexual enjoyment every time than support the view that women have a right to sexual enjoyment
every time. Conversely, higher proportions of females express the view that women have a right to sexual
enjoyment every time than support the view that men have a right to sexual enjoyment every time.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
37
daughters aged 15 years and above in the AR households had been cut, compared with 81
percent of the 354 daughters in the non-AR households.
Although this suggests that there is a highly significant difference in the likelihood of
families having cut their older daughters, this analysis is somewhat compromised by the fact
that at least one of the daughters aged 15 and above of the AR parents is expected to be
uncircumcised anyway, because all AR parents (by definition) have at least one daughter who
has participated in the Alternative Rite (approximately two-thirds of the AR initiates were
aged 15 and above).
To address this issue, a sub-sample of the first daughters aged 25 and above was analysed so
as to control for age, and for their possible exposure to the MYWO sensitisation activities
(which began when these daughters would have been 19 or 20 years old). Although these
criteria produce a relatively small sample (103 daughters) across both groups, the behavioural
difference observed between the AR and non-AR families remains. Among the 58 daughters
of AR parents, half were cut and half were not, whereas among the 45 daughters of non-AR
parents, all except two were cut. This suggests that many of the parents in families of which
a daughter went through the alternative rite had probably decided not to cut their daughters
prior to the beginning of the sensitisation activities. MYWO’s sensitisation activities have
clearly reinforced this belief, and the alternative rites programme has subsequently provided
the opportunity for them to publicly acknowledge this action for their younger daughters.
Role of MYWO’s Sensitisation Activities
For those parents in both the AR (n=293) and non-AR families (n=161) who said that they
felt FGM should be discontinued, a number of questions were asked to try to assess the role
of MYWO’s sensitisation activities in reaching this decision. Because of the differences in
the way in which sensitisation about FGM was undertaken in each district (see earlier), the
results are also analysed by district.
When asked (in a multiple-response question) why they felt their community should not
continue the practice, both groups were equally likely to cite that they have always believed it
to be unnecessary (64%), but the AR parents were significantly more likely than the non-AR
parents to cite MYWO (81% vs. 35%) and their church (84% vs. 62%) as influences.
Some differences are noticeable between the three project districts. In Gucha, only one-third
of all parents (and only one quarter of AR parents) said that they had always been against the
practice, whereas in Tharaka this reason was given by 93 percent of parents (and 96% of AR
parents), and in Narok by two-thirds of all parents. The church appears to be less influential
in Gucha than in the other two districts (although it is still cited by two-thirds of all parents as
a reason). The MYWO programme seems to have been particularly influential for the AR
families in Gucha and Tharaka, where 91 percent and 85 percent respectively of these parents
cited the MYWO as a reason for changing their attitudes.
Although very high proportions of both groups of parents reported having ever heard
messages against female circumcision, there is a statistically significant difference between
the AR parents (98%) and non-AR parents (89%). Across all respondents, MYWO is given
as the main source (71%) for these messages, although there are large differences between
the AR (83%) and non-AR (46%) parents, with the radio, church and community leaders also
being given as sources for the non-AR parents. MYWO is by far the predominant source for
AR parents in Gucha (93%).
The importance of interpersonal communications by influential persons is emphasised by the
fact that 82 percent of AR parents compared with only 28 percent of non-AR parents said that
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
38
someone from MYWO had directly provided them with information regarding female
circumcision. This type of communication was particularly important for AR parents in
Gucha, where 97 percent said that they had had such direct contact.
As would be expected, the proportions of parents having heard about the alternative ritual are
much higher (96%) among those living in AR households than among those in non-AR
households (47%). There are similar and high levels of support for such interventions against
FGM among both types of parents, with a particularly strong endorsement for anti-FGM
activities by parents in Gucha.
For those parents who have explicitly indicated that they feel the practice should be
abandoned (whether or not their daughters have participated in the Alternative Rite), a
comparison was made between the AR and non-AR parents to assess if they are different in
their socio-demographic characteristics and the extent to which the MYWO/PATH
sensitisation activities may have influenced them. There is no significant difference between
these AR parents (n=293) and non-AR parents (n=161) in terms of their school attendance26,
level of education, employment status, and type of occupation. There is, however, a
significant difference in their religious affiliation, particularly among the Meru and Kalenjin,
where the AR parents are more likely to belong to the Methodist and African Gospel
Churches whereas non-AR parents are more likely to be Catholic and Pentecostals. AR
parents are also more likely than the non-AR parents to have higher socio-economic status.
While the attitudes of both groups indicate that they have passed through the ‘transition’
phase in considering a behaviour change, as would be expected because of the sampling
strategy, the AR parents are more likely than the non-AR parents to not have cut their
daughters aged 15 years and above.
Almost two-thirds of both groups of parents who are against the practice stated that they had
always believed the practice to be unnecessary. Those in the AR families were much more
likely to have heard of anti-FGM messages and cite the MYWO activities and, to a lesser
extent, their church to have influenced them. However, there are differences between the
sites, with higher proportions of AR parents in Gucha and Tharaka than in Narok citing
influence by the MYWO programme. Almost three times as many AR parents as non-AR
parents have had direct contact with a person from MYWO; again, this seems to be
particularly important in Gucha (97% versus 22%) and Meru (76% versus 28%).
A comparison was also made between those parents from non-AR families who support
continuation of FGM (n=139) and those who support abandonment of the practice (n=161).
There is a significant difference in their attitudes and knowledge concerning FGM, with those
in support of FGM eradication being more likely to have the woman express regret for being
cut, to hold the view that an uncircumcised woman would get a husband, to express the view
that FGM contravenes the rights of women and children, and to have knowledge of negative
consequences of FGM.
The analysis also shows that, among the Abagusii and Maasai, those in support of FGM
eradication are more likely to have been exposed to anti-FGM messages. Moreover, among
the Abagusii, those favouring discontinuation are more likely to have been talked to directly
by a MYWO project person than those who support continuation of the practice. However,
there are no significant differences between non-AR parents in support of and opposed to
26 Apart from the Maasai parents, for whom those participating in the AR are more likely (91%) to have
ever attended school than the non-AR parents (20%).
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
39
FGM eradication in terms of socio-demographic and economic indicators27 such as school
attendance, level of education, and employment, occupation and socio-economic status.
When these two groups are compared in terms of the proportions of their daughters aged 15
years and over who have been cut, the proportions are much lower among those in favour of
discontinuing the practice (72% of 160 girls) than those who want FGM to continue (93% of
147 girls); this large difference is not statistically significant, however. This ambiguous
finding suggests that there may be some difference between the two groups, in that those who
have made an attitudinal change may already have started to discontinue the practice, but the
evidence is inconclusive.
Overall, these findings suggest that there has been an attitudinal change in support of FGM
eradication among about half of the non-AR households (although with variations by
district), and that this change is associated with exposure to anti-FGM messages from
MYWO, as well as to messages from the church and to existing attitudes against the practice.
However, this attitude change does not seem to have been fully translated into a behaviour
change (as is evidenced by those holding similar attitudes and who have participated in the
Alternative Rite) because this group is only slightly less likely to have cut their daughters as
those who are in favour of FGM continuing.
27 However, the Abagusii and Kalenjin non-AR parents in support of FGM eradication are more likely to
belong to the SDA and African Gospel churches respectively.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
40
SUMMARY OF KEY FINDINGS
In the absence of a prospective study to test the effect and impact of the MYWO/PATH FGM
alternative rite approach, this assessment addressed a number of objectives that sought to gain
a better understanding of the role that the approach has played in three districts of Kenya.
With reference to these objectives, the key findings from the data collected are as follows.
Factors Accounting for Discontinuation of Genital Cutting and
Participation in the Alternative Rite
Both AR and non-AR families live in communities in which FGM sensitisation activities
have been taking place. The difference between them is that at least one daughter in the AR
family has participated in the Alternative Rite, thereby implying that the family has definitely
discontinued the practice. The data indicate that about half of the parents in the non-AR
families are in favour of discontinuing the practice, but whether they have yet done so is not
possible to judge. The comparison of members of AR and non-AR families indicated that AR
families are:
Slightly more likely to have ever attended school, although the female parents in AR
families are no more likely to have reached a higher level of education.
More likely not to be members of the Catholic or Pentecostal churches;
Slightly less likely to be labourers or farm workers;
More likely to be of higher socio-economic status;
Slightly more likely to have females with more positive gender attitudes;
More likely to already not be cutting their daughters and to express regret for those
already cut.
These findings suggest that those families choosing for their daughters to participate in the
Alternative Rite are somewhat different than those not choosing to do so, but there does not
appear to be a particular bias towards or away from a particular group within the population.
For those parents who have explicitly indicated that they feel the practice should be
abandoned (whether or not their daughters have participated in the Alternative Rite), there is
no significant difference between AR parents and non-AR parents who think the practice
should discontinue except in terms of their religious affiliation and socio-economic status.
While the attitudes of both groups indicate that they have passed through the ‘transition’
phase in considering a behaviour change, the AR parents, as is expected, are more likely than
the non-AR parents to not have cut their daughters aged 15 years and above.
Almost two-thirds of both groups of parents who are against the practice stated that they had
always believed the practice to be unnecessary. Those in the AR families were much more
likely to have heard of anti-FGM messages and cite the MYWO activities and, to a lesser
extent, their church to have influenced them. However, there are differences between the
sites, with higher proportions of AR parents in Gucha and Tharaka than in Narok citing
influence by the MYWO programme. Almost three times as many AR parents as non-AR
parents have had direct contact with a person from MYWO; again, this seems to be
particularly important in Gucha and Meru.
Interestingly, there is a significant difference in attitudes and knowledge concerning FGM
among those non-AR families that support FGM eradication and those that support its
continuation. For the Abagusii and Maasai at least, this difference is associated with having
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
41
been exposed to anti-FGM messages and, for the Abagusii, to having been talked to directly
by a MYWO project person. However, there are no significant differences between them in
terms of socio-demographic and economic indicators. Although those in favour of
abandoning FGM are slightly less likely to have cut their daughters aged 15 years and over,
the difference is not significant, suggesting that this attitude change does not seem to have
been translated fully into a behaviour change.
Beliefs, Attitudes and Knowledge concerning FGM
Those living in AR families are far more likely than those in non-AR families to believe there
are no benefits to FGM and that the practice should be abandoned, and to know of adverse
health problems that can be associated with FGM. The AR families are also much more
likely to believe that FGM contravenes the rights of girls and women. Overall, almost half
the parents in non-AR families believe the practice should be abandoned, indicating that even
if their daughters have not been through the alternative rite, many families are against the
practice in areas where MYWO has had its sensitisation activities. There are important
differences by ethnic group, however, with much higher levels of non-AR parents wanting
the practice to continue among the Abagusii and Maasai than among the Meru and Kalenjin.
Slightly fewer AR family members than non-AR family members feel that there are
differences between circumcised and uncircumcised girls, but overall most respondents in all
groups feel that there is no difference. However, whereas virtually all AR parents feel that
men would marry uncircumcised women, only two-thirds of non-AR parents have this
attitude. Levels of regret for being personally cut or for cutting older daughters were much
higher among AR families than non-AR families, as was the intention not to cut future
daughters among the youth.
Effect of FLE Training on Reproductive Health Knowledge and Attitudes
Awareness of many reproductive health issues, as well as detailed knowledge of these issues,
was significantly higher among girls who have been through the FLE training than those who
have not. Awareness that condoms can be used to prevent STI and HIV transmission was
poor for both groups. Approval of condoms and of other contraceptive methods by
adolescents, by unmarried couples and by married couples was lower among those who have
been through the training. There was virtually no difference between the two groups in terms
of sexual experience and behaviour.
DISCUSSION
These findings provide an in-depth analysis of the circumstances in which the Alternative
Rites programme has been implemented in three quite different situations in Kenya. In
discussing these findings it is important to reiterate the fact that it is not possible to draw
categorical conclusions about the extent to which the programme of activities undertaken by
MYWO and PATH have directly influenced decisions to discontinue the practice of genital
cutting. It is also important to emphasise that what is now commonly referred to as the
‘Alternative Rites’ programme is actually the most recent intervention in an evolving series
of activities that have developed over time. The model described earlier for explaining
behaviour change in relation to FGM argues that such a change requires a series of stages to
be passed through, and so it is unrealistic to expect that one particular stage of the process
(e.g. participation in an Alternative Rite) can be assessed without reference to those
preceding it. Moreover, as is illustrated in the descriptions of how the programme has been
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
42
implemented in the three districts and in the findings from each of the districts, there is no
single way in which the programme has been implemented, and indeed the findings clearly
demonstrate that this approach needs to be adjusted according to the specific socio-cultural
situation.
The data from this study indicate that the MYWO sensitisation activities that preceded and
accompanied the Alternative Rite have played a role in the behaviour change process among
those who have decided to discontinue the practice and who have adapted the alternative rite.
It is also clear, however, that these sensitisation activities have not functioned in isolation
from other influences operating in the communities, notably the stance taken by certain
churches as well as individuals’ existing beliefs that the practice should be discontinued.
Whether the sensitisation activities have sped up a process of attitude and behaviour change
that had already started, or whether they have served to trigger a change through encouraging
families and individuals to ‘contemplate’ changing their behaviour when they were not
previously considering this possibility, is not possible to disaggregate from this study.
Among those living in families that are resident in the areas covered by the MYWO
sensitisation programme but who have not gone through the alternative rite, about one-half
want the practice to discontinue (albeit with large variations by ethnic group), and so clearly
there is a change in attitude occurring in these places. These people are more likely,
however, to cite having been already against the practice and/or being influenced by their
church than being influenced by MYWO’s sensitisation activities.
The role played by offering the Alternative Rite as the logical conclusion in a series of
sensitisation activities is not completely clear. It could be proposed that the opportunity to
participate in an Alternative Rite also acts as a ‘preparation’ activity that precedes actually
the behaviour change of not cutting a daughter, by providing those who have already
contemplated the decision with sufficient social support to act upon it. Or it could be argued
that it represents the ‘action’ stage itself in the change process, by providing an explicit
opportunity for those who have already changed their behaviour by not cutting their
daughters to demonstrate the fact publicly that this action has been taken.
If the alternative rite is fulfilling the second role, where the decision and action have already
been taken, then the Alternative Rite itself will have no direct impact on reducing the
practice. Holding it, however, will probably further reinforce the social validity at the
community level of the decision not to undertake female circumcision. It could be argued
that the Alternative Rite itself may then serve as a ‘trigger’ (thus fulfilling a similar role to
the educational activities during sensitisation) to encourage families currently in favour of
continuing the traditional practice to enter the ‘contemplation’ stage of considering its
discontinuation because of the public display of support demonstrated. Whether there has
been a further change in attitude or behaviour in a community subsequent to Alternative
Rituals is therefore an important issue requiring further research.
If the Alternative Rite is fulfilling the first role, however, then it is clearly an important next
step in the behaviour change process because it facilitates the transition from contemplation
to action. What is not known, however, is whether it is a necessary step for the transition to
occur, or whether families and individuals that have already contemplated the decision and
want to stop the practice would take that action in the absence of the Alternative Rite. The
data show that non-AR families in favour of discontinuing the practice have been cutting
their daughters aged 15 and over, which implies that the Alternative Rite may offer the
impetus to take the final step of actually stopping the practice. Whether this is actually the
case is difficult to know, however, given that it is not possible to know what they are
planning to do with their daughters under 15 years of age.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
43
Whether the existing sensitisation activities need to be strengthened by adding an Alternative
Rite, and if so, whether the formulation for the Alternative Rite used here is the most
appropriate, are not therefore straightforward issues. The findings from the three districts
featured in this study shed some further light because of the differences in the cultural
meaning and practice of female circumcision in each project site, and in the way the approach
was implemented in the three districts.
This study is not able to provide accurate measures of changes in attitude and behaviour over
time. Evidence from the KDHS and from some of the qualitative and quantitative data
collected in this study, however, clearly support the argument that changes in attitudes and
behaviour are happening among some of these ethnic groups generally and in the study sites,
and that there are substantial differences in the speed of such changes between the groups.
Among the Abagusii and the Maasai the practice remains virtually universal and there is
certainly much resistance to change. Consequently, and as demonstrated in this study, the
MYWO sensitisation activities in Gucha and Mau (Narok) have played a considerable role in
triggering a change in attitudes and in the practice. For the Meru and the Kalenjin ethnic
groups, however, there are clear indications that the practice is being seriously reconsidered
and is on the decline. In these situations, the MYWO sensitisation activities are probably
feeding into and working with other factors that are stimulating a contemplation of the
practice, notably messages from the churches. The Alternative Rite has been shown to be
more easily introduced in these situations, but there is going to be some point in time when
the cultural norm is not to cut, at which point the Alternative Rite may not be relevant.
The level of sensitisation needed before the Alternative Rite can be introduced varies also
because of this factor. In Tharaka District for example, where the population is Meru,
sensitisation did not begin until the Alternative Rite approach was introduced, and yet this
has been probably the most successful of the three districts in being able to introduce the
approach with little opposition. Conversely, in Samburu, where MYWO sensitisation
activities have been going on since 1993 and where FGM is almost universal, it has been
virtually impossible to introduce the Alternative Rite, with the first ceremony involving 72
girls being held in April 2000.
The relevance and nature of a rite of passage that includes female circumcision for a
particular ethnic group is also a critical factor. Among the Maasai, there has not traditionally
been a public ceremony associated with the cutting or with the rite of passage – the cutting
and transition ceremony are normally undertaken within the girl’s family and traditionally is
followed almost immediately by marriage. Thus introducing a public ceremony where none
existed before has proved difficult among this group, as evidenced not only by MYWO’s
experience in Narok District but also by the experience of the GTZ project to date in the
primarily Maasai Trans Mara District. Among the Abagusii also, the cutting itself and the
public ceremony after seclusion are not associated directly with celebrations of transition to
womanhood because they are undertaken at a young age, and marriage is not expected to take
place immediately or in a period of less than five years. Conversely, among the Meru and the
Kalenjin, there is a traditional public ceremony associated with the cutting and marking the
transition to womanhood, which was traditionally followed by marriage. Changes in attitudes
towards the role of genital cutting among these groups, however, have led to the practice
gradually becoming less public and more of a family affair. The value of the public
ceremony component, therefore, appears to vary depending on the nature of the traditional
rite of passage for each ethnic group.
A further factor that may explain why the approach appears to have been most successful in
Tharaka District is that the majority of circumcised mothers and daughters among the Meru
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
44
indicated that it was them that made the decision to be cut, rather than their parents as is the
case in the other groups.
Likewise, the value of the FLE training component for the girls also depends on the degree to
which such training is an integral part of the traditional rite, and the relevance of the training
to the girls going through the training. In Gucha, for example, the approach began by not
having a training component, because the public declaration was the more important aspect
for the Abagusii and the content of the training was not directly appropriate for the age of
girls participating. Conversely, in Narok the training component is the central feature of the
alternative ritual, which perhaps reflects the strategy taken by MYWO of trying to reach the
girls themselves first, and then reaching the parents through the girls.
The FLE training does have an effect on the girls’ awareness and knowledge about
reproductive health issues, but it also appears to engender somewhat less positive attitudes
towards the practice of family planning among unmarrieds and adolescents, including
condom use. This suggests that there may be a need to review not only the content of the
training but the way in which it is being taught. Reviewing the curricula of the peer educators
and of the initiates’ training sessions indicates that the emphasis is more heavily on the
adverse health outcomes than on the contravention of human rights. The most recent
curriculum for training of trainers does correct this balance, and the data suggest that those
involved with the Alternative Rite, as parents or adolescents, are better informed about the
health problems associated with the practice, and are also more aware that FGM contravenes
the rights of girls and women.
Relying too much on the health consequences argument could lead to a lack of credibility for
the messages, given the relatively low levels of gynaecological morbidity perceived to be
associated with the types of genital cutting practised in these populations, as reported here
and as found in other populations practising types 1 and 2. It can also lead to medicalisation
of the procedure, as seems to have happened among the Abagusii in Gucha. Conversely,
relying too heavily on the human rights approach can be difficult to articulate in cultures
where rights are not strongly promoted, or where women’s rights are heavily subjugated, or
where rights are a difficult concept to discuss in concrete terms. Nevertheless, it is essential
that future sensitisation activities, including the Alternative Rite itself, make every effort to
ensure that the rights argument is a central message.
CONCLUSIONS AND RECOMMENDATIONS
The combination of intensive community sensitisation about FGM and offering an
Alternative Rite have clearly played a role in the attitudinal and behavioural changes that are
occurring in the project sites. Some differences were noted between those families that have
participated in the Alternative Rite and those that have not (notably type of religion and
socio-economic status), with exposure to anti-FGM messages being an important factor.
Thus the sensitisation activities that have preceded the Alternative Rite are critical for
creating the conditions in which the rite itself can be introduced. There is some evidence that
participation in the Alternative Rite may enhance the transition from an attitudinal change to
a behavioural change, thus supporting the need for this activity to follow the sensitisation
activities, but the data are not sufficiently robust to be conclusive.
The role and meaning of traditional rites of passage and of female circumcision varies
considerably between ethnic groups. While the Alternative Rites approach has been adapted
to local conditions, some of the tensions apparent in its implementation suggest that greater
attention needs to be paid to the way the approach is introduced in different communities, or
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
45
indeed whether a public ceremony with formalised training is necessarily the best way to
conclude the behaviour change process. How girls are invited to participate in an Alternative
Rite and whether and how their parents are involved in the decision, are also factors that have
varied across the sites, and have determined the feasibility and acceptability of the
Alternative Rite itself.
Giving the girls some formal training during the Alternative Rite was demonstrated to be
associated with higher levels of awareness of important reproductive health issues, more
positive gender attitudes and higher levels of awareness that FGM contravenes human rights
of girls and women. These girls were found to have more conservative attitudes towards
family planning, however, and so it is important to ensure that factual information is
communicated in a progressive manner if traditional attitudes and behaviours that
compromise the health and rights of women are not to be perpetuated.
Medicalisation of the practice among some groups indicates that contemplation of the
practice triggered by sensitisation can sometimes result in harm reduction rather than
complete abandonment. It is essential to ensure, therefore, that not only are the adverse
health outcomes discussed but also that the messages communicated during sensitisation are
framed in a rights perspective and that they address directly the meaning attached to genital
cutting in a particular culture.
The study highlighted a number of issues that would benefit from further research. What is
the effect of the public ceremony as a sensitisation activity for triggering or enhancing
contemplation of FGM as a harmful traditional practice among those in favour of its
continuation? In cultures that are clearly resistant to changing this behaviour (e.g. the
Abagusii and Maasai), should resources be allocated primarily to sensitisation, or to
organising Alternative Rites, or to a combination? And related to this, what are the reasons
why these cultures are so resistant to change when many others are changing around them? If
medicalisation of the procedure by health workers is increasing despite government policy
against it, what actions can be taken to stop this happening but without driving the procedure
back to the traditional practitioners? Conversely, while a prospective controlled study to
determine the contribution of this approach to a decline in the practice is attractive, given the
uniqueness with which the approach needs to be implemented in each situation it is
questionable whether such a study would generate results that could be generalised.
The contribution that an Alternative Rite intervention can make to efforts to abandon the
practice depends, therefore, on the socio-cultural context in which FGM is practised. The
study has re-confirmed that an Alternative Rite cannot be introduced without a preceding or
accompanying process of sensitisation in which an attitudinal change has to have occurred.
For the approach to be replicated successfully in other situations will require a good
understanding of the role of public (as opposed to familial) ceremonies in that culture, and a
judgement as to what format for the ritual is the most appropriate means of helping those that
have decided to abandon the practice to actually do so.
An Assessment of the Alternative Rites Approach for Encouraging Abandonment of FGM in Kenya
46
REFERENCES
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Crane, E., A. Mohamud & A. Todd. 1998. Towards the Elimination of FGM: Communication
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Organizers, Youth Advocates, and Teachers, PATH, Washington, USA.
Izett, S. & N. Toubia. 1999. Learning about Social Change: A Research and Evaluation
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Jones, H., N. Diop, I. Askew & I. Kaboré. 1999. “Female Genital Cutting and its negative
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... NGOs such as Amref, World Vision, the Education Centre for the Advancement of Women (ECAW), the German Agency for Technical Cooperation (GTZ), Action Aid, and the Kuria Development Forum (KDF) have implemented ARPs in different districts across Kenya. The handful of studies carried out on ARPs across Kenya have studied ARPs among the Meru (Chege, Askew, and Liku 2001), Kuria (Prazak 2007;Oloo, Wanjiru, and Newell-Jones 2011), Abagusii (Oloo, Wanjiru, and Newell-Jones 2011), Samburu (Mepukori 2016;, Pokot (Hughes 2018), and Maasai (Chege, Askew, and Liku 2001;Hughes 2018). These studies describe a number of characteristics that these ARPs have in common. ...
... Hughes (2018, 286) suggests that the teaching and training that is part of the newly-invented World Vision and Amref ARPs, in fact, reinforces outdated gender expectations. She also remarks that ARPs might not be sustainable as NGOs cannot afford to fund ARPs indefinitely, a sentiment that other scholars and NGO staff shared (Chege, Askew, and Liku 2001;Oloo, Wanjiru, and Newell-Jones 2011;. Graamans and colleagues (2019, 5) found that community members experienced Amref's ARP as profoundly different from their traditional ceremony, which fuelled suspicion of 'outsider' interference. ...
Article
Since the late 1990s, so-called ‘alternative rites of passage’ (ARP) have gained popularity in Kenya as a strategy to end female genital mutilation (FGM). ARPs promise to end FGM while respecting indigenous cultures by mimicking the ‘traditional’ initiation ritual but with the omission of the physical cut. The limited number of studies on ARPs largely point out the approach's weaknesses and challenges. This article explores the case study of the Loita Rite of Passage, an ARP implemented among the Loita Maasai of southern Kenya and associated with NGO SAFE Maa. It analyses how the Loita Rite of Passage differs from the ARPs of other NGOs in Kenya and identifies factors for success.
... guided the inclusion of these variables in the analysis [1,5,13,[23][24][25]. The potential variables are the age of respondents, age and gender of household head, age at first cohabitation, residence (rural or urban) status, religion, ethnicity and wealth index included in the analysis. ...
... Existing empirical evidence on the interplay between FGM/C and CLARP models indicate that the latter plays a significant role in shifting knowledge, attitudes, and perceptions of FGM/C practices in a society (1,3,23,(25)(26)(27)(28). By catalysing influence on its abandonment, CLARP models have directly and indirectly contributed to the declining FGM/ C's prevalence rates, improved educational outcomes for girls, and reduction in child early and forced marriages and teenage pregnancies [1][2][3]18,29] assert that the effectiveness of the CLARP models hinges on its community-led approach in changing social norms on FGM/C, as well as empowerment of girls and women through education. ...
... Much of the existing literature on the evaluation of CLARP models have centred on their impacts on community knowledge, attitudes, and perceptions [1,3,23,[25][26][27][28][29][30]. ...
Preprint
Background: In Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention-community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls, b) explored experiences and stories of CLARP and non-CLARP beneficiaries related to FGM/C, CEFM, TP and years of schooling and c) explored the attitude, perception and practices of community stakeholders towards FGM/C
... The summarised results in Table 3 were estimated from fully specified models controlling for all relevant variables that can, in theory, bias the estimated average treatment effects. Theory and existing literature guided the inclusion of these variables in the analysis [1,9,16,[27][28][29]. The potential variables are the age of respondents, age and gender of household head, age at first cohabitation, residence (rural or urban) status, religion, ethnicity and wealth index included in the analysis. ...
... Existing empirical evidence on the interplay between FGM/C and ARP models indicate that the latter plays a significant role in shifting knowledge, attitudes and perceptions of FGM/C practices in a society [1,6,27,[29][30][31][32]. By catalysing influence on its abandonment, ARP model have directly and indirectly contributed to the declining FGM/C's prevalence rates, improved educational outcomes for girls, and reduction in child early and forced marriages and teenage pregnancies [1,2,6,33,34] assert that the effectiveness of the ARP models hinges on its community-led approach in changing social norms on FGM/C, as well as empowerment of girls and women through education. ...
... Much of the existing literature on the evaluation of ARP models have centred on their impacts on community knowledge, attitudes and perceptions [1,6,27,[29][30][31][32]. Nevertheless, there is growing recognition that ARP can have farfetched impacts beyond changing the social norms and behaviours on FGM/C [3,14,31]. ...
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Full-text available
IntroductionIn Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention-community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls and b) explored the attitude, perception and practices of community stakeholders towards FGM/C.Methods We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008-2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C.ResultsThe CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p
... guided the inclusion of these variables in the analysis [1,5,13,[23][24][25]. The potential variables are the age of respondents, age and gender of household head, age at first cohabitation, residence (rural or urban) status, religion, ethnicity and wealth index included in the analysis. ...
... Existing empirical evidence on the interplay between FGM/C and CLARP models indicate that the latter plays a significant role in shifting knowledge, attitudes, and perceptions of FGM/C practices in a society (1,3,23,(25)(26)(27)(28). By catalysing influence on its abandonment, CLARP models have directly and indirectly contributed to the declining FGM/ C's prevalence rates, improved educational outcomes for girls, and reduction in child early and forced marriages and teenage pregnancies [1][2][3]18,29] assert that the effectiveness of the CLARP models hinges on its community-led approach in changing social norms on FGM/C, as well as empowerment of girls and women through education. ...
... Much of the existing literature on the evaluation of CLARP models have centred on their impacts on community knowledge, attitudes, and perceptions [1,3,23,[25][26][27][28][29][30]. ...
... The medicalization of the procedure resonates with findings reported elsewhere in Africa (Chege et al., 2001;Ministry of Health/GTZ, 2004;Njue & Askew, 2004;Shell-Duncan, 2001;Shell-Duncan et al., 2017). The framing of women who decide to pursue medicalized FGM/C as "modernized mothers" has the potential to reinforce normatively the more 'discerning' choice of the Sunna cut, despite the responses of some healthcare workers suggesting their preference for the practice's total abandonment. ...
Article
The authors’ aim was to examine if the nature of female genital mutilation/cutting (FGM/C) in Somaliland is changing and any contributing factors. In this mixed method qualitative study the researchers used 24 focus groups, 20 key informant interviews and 28 in-depth interviews with multiple stakeholders. We found a shift from the pharaonic to Sunna cut, an age decrease at which FGM/C is performed and an increase in its medicalization. Shift in cut type and medicalization appears to be partly a response to the medical narrative of anti-FGM/C campaigns, partly an intertwining of messaging regarding health risks and religious norms. We recommend a need to consider programs that reflect upon the utility and appropriateness of moving the dominant narrative to issues around the right to bodily integrity and bodily autonomy, and melding that messaging with the Islamic discourse on protecting health that focuses on collective welfare.
... With technology and the march of time, comes an understanding of harmful cultural practices that negatively impact the community and should be actively phased away. An example of a harmful culture is the practice of female genital mutilation (FGM) that because of technology and education, has been mostly phased out and made illegal [11]. The influence of technology is also evident in the transmission of contextual knowledge that lead to different cultural practices and/or new knowledge that contextualizes oral narratives. ...
Conference Paper
Full-text available
Emerging research in Human Computer Interaction (HCI) has considered the use of technology to preserve Intangible Cultural Heritage (ICH) while wrestling with the dilemma of local participation in the face of post-colonialism. There remains a need to understand how ICH is portrayed by museums and texts, how communities regard these representations, and how technology would affect preservation. We conducted a study in the North Rift region of Kenya to understand how ICH is preserved and disseminated by the museum in comparison with the community. The findings describe a respectful technology space where community needs and museum needs can co-exist. We also articulate social challenges that should be considered by designers when recommending or designing technological solutions. This paper concludes by recommending ways for researchers to smoothly integrate technology with ICH through community participation and an awareness of the respectful space.
Book
Full-text available
This book explores recent developments, constraints and opportunities relating to the advancement of sexual and reproductive health and rights in Africa. Despite many positive developments in relation to sexual and reproductive health in recent years, many Africans still encounter challenges, for instance in poor maternity services, living with HIV, and discrimination on the basis of age, gender, sexual orientation or identity. Covering topics such as abortion, gender identity, adolescent sexuality and homosexuality, the chapters in this book discuss the impact of culture, morality and social beliefs on the enjoyment of sexual and reproductive health and rights across the continent, particularly in relation to vulnerable and marginalized groups. The book also explores the role of litigation, national human rights institutions and regional human rights bodies in advancing the realization of sexual and reproductive health and rights in the region. Throughout, the contributions highlight the relevance of a rights-based framework in addressing topical and contentious issues on sexual and reproductive health and rights within Sub-Saharan Africa. This book will be of interest to researchers of sexuality, civil rights and health in Africa.
Article
Despite international commitments to end female genital mutilation/cutting (FGM/C), very little is known about the effectiveness of national policies in contributing to the abandonment of this harmful practice. To help address this gap in knowledge, we apply a quasi‐experimental research design to study two west African countries, Mali and Mauritania. These countries have marked similarities with respect to practices of FGM/C, but differing legal contexts. A law banning FGM/C was introduced in Mauritania in 2005; in Mali, there is no legal ban on FGM/C. We use nationally representative survey data to reconstruct trends in FGM/C prevalence in both countries, from 1997 to 2011, and then use a difference‐in‐difference method to evaluate the impact of the 2005 law in Mauritania. FGM/C prevalence in Mauritania began to decline slowly for girls born in the early 2000s, with the decline accelerating for girls born after 2005. However, a similar trend is observable in Mali, where no equivalent law has been passed. Additional statistical analysis confirms that the 2005 law did not have a significant impact on reducing FGM/C prevalence in Mauritania. These findings suggest that legal change alone is insufficient for behavioral change with regard to FGM/C. This study demonstrates how it is possible to evaluate national policies using readily available survey data in resource‐poor settings.
Article
Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications. PIP This study examines the type of female genital cutting and its possible associated gynecological and delivery complications among females in Burkina Faso and Mali, Africa. Included in the study were women who came to 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali seeking medical services that include a pelvic exam. Trained clinical staff observed the presence and type of cut and any associated complications. It was observed that 93% of the women in Burkina Faso and 94% in Mali had undergone genital cutting. The most prevalent type of female genital cutting in Burkina Faso is clitoridectomy, which is 56% among women observed. In Mali, excision was the most prevalent (74%). About 5% of both samples had undergone type 3 cutting, which is the infibulation. Furthermore, there exist a significant relationship between the severity of genital cutting and the possibility of gynecological and obstetric complications.
Article
This paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15-54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25-2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46-6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin's cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.
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