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

January 2001

January 2001

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Jane Chege

World Vision International

Ian Askew

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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

CONTENTS

Tables and Figures....................................................................................................................... iv

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

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

iii

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

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

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

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

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

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

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

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

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

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

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

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

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

Better marriage

prospects 7 40 48 34 5 28 39 37

Limit sexual desire

Prevent immorality

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

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

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

Figure 1: Median age at circumcision for mothers and daughters Figure 1: Median age at circumcision for mothers and daughters

15 15 16

14.5 14

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

Mother 91 68 37 15

Self 30 8 77 94

Other 6 13 4 8

Girls

Father

N/a1

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

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

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

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

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

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

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

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.

mother presents a gift to her

daughter at the public AR

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.