Female Genital Mutilation

Ethiopia is one of the 17 countries in which the UNFPA and UNICEF Joint Programme for the Accelerated Abandonment of Female Genital Mutilation (FGM) is being implemented. The Joint Programme which was launched in Ethiopia in November 2008, sought to realize the goal of accelerating the abandonment of FGM by expanding already existing efforts of UNICEF and UNFPA in the region of Afar. The programme was meant to support the development and implementation of policies and programmes and to reinforce the efforts of national partners, development partners and civil society organizations to accelerate the abandonment of FGM. The programme is the first of its kind which brought the two UN agencies globally and at the field level. Each agency brings specific expertise to the Joint Programme. UNICEF brings expertise in the area of social norm change which is at the heart of the innovative programming to support the process of positive social transformation and includes empowering education, community dialogue and public commitments to abandon the practice.

Ethiopia is one of the 17 countries in which the UNFPA and UNICEF Joint Programme for the Accelerated Abandonment of Female Genital Mutilation (FGM) is being implemented. The Joint Programme which was launched in Ethiopia in November 2008, sought to realize the goal of accelerating the abandonment of FGM by expanding already existing efforts of UNICEF and UNFPA in the region of Afar.

The programme was meant to support the development and implementation of policies and programmes and to reinforce the efforts of national partners, development partners and civil society organizations to accelerate the abandonment of FGM.

The programme is the first of its kind which brought the two UN agencies globally and at the field level. Each agency brings specific expertise to the Joint Programme.

UNICEF brings expertise in the area of social norm change which is at the heart of the innovative programming to support the process of positive social transformation and includes empowering education, community dialogue and public commitments to abandon the practice.

UNFPA as an expert in sexual and reproductive health is supporting the integration of FGM in Reproductive Health. UNFPA also brings expertise in working with Faith Based Organizations and supporting policy matters.
The joint initiative is being implemented in two phases: The first phase started in 2008 and ended in 2013 with interventions in six woredas (districts) out of thirty two woredas of the Afar Region. The second phase started in 2014 and will last until 2017 covering three additional woredas and included engagement at the federal level with regard to advocacy.

The Joint Programme addresses the issue of FGM not only because of its harmful impact on the reproductive and sexual health of women, but also because it violates women's and girls' fundamental human rights. This harmful practice has both immediate and long term consequences to the health and well-being of girls and women, negatively impacting maternal and neonatal health outcomes, and also increasing the risk of HIV/AIDS transmission. The practice often leaves girls with severe pain and trauma, shock, haemorrhage, sepsis, urine retention, ulceration of the genital region, and urinary infection, among other complications. Girls' and women's health, their empowerment, and the realization of their rights are negatively affected by FGM as well as the achievement of the Millennium Development Goals related to reducing child mortality, improving maternal health and combating HIV/AIDS.

In the Afar Region girls and women are subjected to the worst form of the practice - infibulation - usually at the ages of seven to nine. In some districts in Afar, this harmful traditional practice is even exercised within some days after the birth of the child. The rights-based approach affirms that well-being, bodily integrity and health are influenced by the way a human being is valued.
Data shows that FGM prevalence rates in Afar are the second highest in Ethiopia after Somali Region. Reliable and regionally comparable data on FGM however remains a challenge due to the sensitivity of the topic and different definitions of mutilation and cutting as well as the use of different age groups.

According to the Ethiopian association for the elimination of harmful traditional practices or "Goji Limadawi Dirgitoch Aswegaj Mahiber" (EGLDAM) the prevalence rate of FGM in Afar has reduced over a period of ten years from 94.5 per cent in 1997, to 87.4 per cent in 2007. The Ethiopian Demographic Health Survey (EDHS) of 2005 calculates the prevalence in Afar with 91.6 per cent compared to a national rate of 74 per cent. The most recent Welfare and Monitoring Survey (WMS) of 2011 measured the practice of FGM for girls under the age of 14 years with a prevalence rate of 60 per cent.

A culturally sensitive perspective

The practice of FGM is highly linked and reinforced by societal norms and thus, legal action by itself is insufficient to bring about change in this social convention. The Joint Programme uses an innovative, human-rights based approach engaging communities to enact effective legislation, strengthen reproductive health care services and initiate youth education activities. Therefore, the program has a strong component of social mobilization interventions with the aim of improving community knowledge, attitude and practice (KAP), enhancing legal response and service provision to deter the practice as well as mitigate the impact.
Through non-formal education to provide new knowledge and skills, non-directive dialogue among women and men and across generations, and the promotion of human rights, UNFPA and UNICEF have encouraged communities to raise the problems, identify the challenges and define solutions - stimulating positive social change in the process.

Commitments of the Government of Ethiopia on Ending FGM/C

During the Girl's summit held in London in July 2014, the government of Ethiopia through his Deputy Prime Minister made the commitment to end both Child Marriage and FGM/C by 2025, through employing a multi-sectoral approach which puts girls at the center and some practical measures are initiated towards realizing the commitment. Further interventions will include strengthening of evidence based programming, monitoring and evaluation, coordination mechanisms and increase of budgetary allocation on ending both practices by 10%.

The Approach

The Joint Programme adopted a strategic approach of gaining the support of an initial core group which decides to abandon FGM and mobilizes a sufficient number of people to facilitate a tipping point - thereby creating a rapid social shift of the norm. The approach is based on the Diffusion of Innovations Theory. The theory addresses how ideas, products, and social practices that are perceived as "new" spread throughout a society or from one society to another.

The Programme heavily relies on the inclusion and participation of the local leaders, including religious leaders, who thoroughly understand the existing norms, attitudes, and social dynamics of the community, and who are the most acceptable and credible persons to disseminate information as agents of change.

Media dialogues were conducted at the community level in Afar and broadcasted on the regional radio in the local language where members of the media, religious leaders and government officials discussed the impacts of FGM on the health of women and girls. The official declarations of abandonment were covered by national and regional media outlets.

Medical professionals and community health workers have been trained and deployed to integrate FGM into reproductive health interventions in the intervention districts of the Joint Programme.

Approaching the FGM issue from the health angle - by drawing connections between the practice and excessive mortality, complications of childbearing and trauma -- has been found to be an effective entry point to changing community attitudes. FGM now forms part of the health education given at schools in the region every month by the Health Extension Workers - community health workers - deployed by the government in rural areas. The issue of FGM has also become one of the topics these health workers discuss when they go house-to-house to provide services. This is especially a very pragmatic approach in the Afar Region where the way of life is so mobile.

The Barbra May Maternity Hospital in Mille is one of the health institutions in the Afar Region which has included FGM interventions as part of their maternal and child health services.

The hospital was established in September 2011 and is run by the Afar Pastoralist Development Association (APDA) - a local partner in the implementation of the UNFPA/UNICEF Joint Programme on the Accelerated Reduction of FGM. In addition to more routine obstetric services, the hospital treats many medical conditions related to FGM such as opening up infibulations.

Though the overriding focus is on the accelerated abandonment of FGM, efforts are being made to tackle other harmful practices like child marriage in a holistic and integrated manner.  For instance, based on lessons learned from the Joint Programme on Accelerated Abandonment of FGM, UNFPA has been implementing a programme in the Afambo District for the past two years integrating child marriage and FGM.

Partners

In the spirit of the Paris Declaration on Aid Effectiveness, the Joint Programme conforms to a development model based on national ownership. It fosters mutual accountability and partnerships between the partners UNFPA, UNICEF and its implementing partners. The implementing partners are the regional Women, Youth and Children Affairs Bureau (BoWYCA), Afar Pastoralist Development Association (APDA) and Rohi Weddu Pastoral Women Development Organization (Rohi Weddu). Each partner has specific areas of intervention which do not overlap rather complement. The regional BoWYCA is mainly responsible for the overall coordination and legal aspects; APDA focuses on the reproductive health aspects while Rohi Weddu emphasizes on community mobilization and community dialogue.

Monitoring and evaluation

A Regular monitoring mechanism is in place by the implementing partners and the results of the regular monitoring feed into a data base run by Rohi Weddu. In addition, UNFPA and UNICEF jointly monitor the program and provide technical support.

After the finalization of the first phase, an assessment was undertaken by the implementing partners. The assessment was done in the six districts with randomly selected kebeles (sub districts) and households. Three kebeles (one town and two rural) were selected from each district. In each district, 50 randomly selected households were interviewed and data on the FGM status of girls/women in the households was collected. In addition to the assessment, information on the status of FGM of unmarried girls was collected from 65 kebeles in the six districts.

The programme included regular monitoring and supportive supervision at woreda and kebele level. During review meetings all targeted kebeles presented the performance with regards to number of community dialogues conducted, topics of the dialogues, conclusions reached, number of people attending the community dialogues; number of newly born girl babies and their status of FGM; problems encountered and recommended solutions and next steps.

Achievement

Fundamental changes have occurred and achieved in the past years' effort including a regional anti-FGM law legislated; thousands of girls have been saved from FGM; hundreds of ex-practitioners have dropped their knives; and marriage of uncut girls has become more frequent.

Because of the successful implementation of Phase 1, the programme will continue in a second phase.

All the six targeted programme woredas (districts) of Zone 3 of the Afar Region have publicly declared abandonment of FGM/C.

As per the assessment made at the end of the first phase of the joint programme in the six districts (Amibara, Argoba, Awash Fentale, Dulesa, Gelaelo and Gewane) the program has brought significant changes in the knowledge, belief, attitude/intention and prevalence/practice of FGM/C. There is a sharp decline from the 90% in 2008 at the beginning of the program to 39% after five years of intervention, which is a 51% decrease in the overall prevalence of FGM.

Data collected from sub-district and community level shows that the number of uncut girls in the six districts of Zone 3 of the Region has passed the 7,000 mark since the start of the Joint Programme. Parents of those girls are expressing their happiness as they are raising children free of the consequences and complications of FGM.

Challenges

Funding: The global financial crisis has decreased the aid budgets of existing donor governments which in return affects the yearly allocation of the Joint Programme.

Behavioural Change: A small, but vocal, set of conservative forces have resisted change in the practice of FGM. The individuals involved vary from religious leaders expressing their belief that cutting is an obligation of their religion, to family members who believe cutting is necessary for a girl to become a woman.

Scale-up: Scaling up the approach and the interventions to the whole region and in particular to remote areas.

Lack of reliable and valid data also puts a challenge to track progresses.

Limited capacity of partners and lack of partner with required capacity in particular in the remote areas where infrastructure is not well in place

Phase II- 2014 - 2017

Phase II of the programme is being implemented in 9 woredas with similar approach of Phase I and strengthened based on lessons learned from the first phase. In addition, engagement at federal level is included with the objective of sharing and replicating best practices and leveraging better support at national level. At the federal level a lot of progress has been made:
National Harmful Traditional Practices (HTPs) Strategy has been adopted at national level with the support of the programme and translation of the strategy in to local language and facilitation of the endorsement at regional level is underway.

Ethiopia has expressed its powerful commitment to end FGM and child, early and forced marriage (CEFM) by 2025 at the London Girls' Summit and one of the experiences shared were the joint programme.
Preparatory work for the realization of the commitment to end FGM and child marriage by 2025 has started, i.e. development of a roadmap with national results framework, theory of change, costed plan and the role of different actors.

The commissioning of a national survey on FGM, child marriage and abduction is underway.

In order to synergize efforts, it was agreed to merge the coordination mechanism for FGM and Child Marriage with the thematic working group on specific technical issues of the two practices. Initial work has started to establish a secretariat of the coordination mechanism.

A national consensus building workshop was facilitated by Muslim religious leaders and institutions; an agreement has been reached to collaborate for the elimination of the practice of FGM.

In addition, Phase II of programme implementation includes the undertaking of a baseline survey which will facilitate systematic tracking and evaluation of the programme performance.

Lessons learned

  1. Law reinforcement. It has become increasingly clear that while national laws against FGM are important, in order to be effective in stopping the practice they must be supported by national policies that confer key responsibilities to government actors to provide support to communities for ending the practice.
  2. The power of community dialogue. The community dialogue sessions are bringing changes in the form of enabling members of the community to dialogue and reach decisions to change their norms for the collective abandonment of FGM.
  3. Involvement of traditional and religious leaders and youth. The involvement of high-profile traditional leaders in the campaign is also an effective strategy that can cause communities to abandon the practice, and the involvement of traditional communicators is not only effective, it also reinforces local culture.

More and more media outlets have been featuring religious and community leaders in radio discussions of FGM. This is especially effective when it incorporates the voices of community members themselves, who are very persuasive in promoting the abandonment of FGM. Young people and men need to be even more actively targeted in the efforts to end FGM and young people's leadership abilities should be developed.

Strengthen the inclusion of FGM programmes in Sexual Reproductive Health services as FGM affects the health of women and girls in all aspects.   This strategy was instrumental in sensitizing the community and providing health related services.

In addition:

  • A participatory approach to the planning, implementation and evaluation processes resulted in greater ownership of the programme by national- and community-level stakeholders and more effective focus on achieving results.
  • Approaching the issue from the health dimension was found to be an effective entry point to show how FGM is contributing to death of women and girls due to infections, birth complications, and traumas such as fistula.
  • Successfully got the support of community and government leaders who become a core-group of the change process;
  • Successful involvement of the religious leaders at all levels and enabling to successfully delink FGM and the Islam;
  • Playing leading role in the process of the legislation of the anti-FGM regional law;
  • Enable to create a wider awareness creation among the general public through various forums such as community dialogue, dagu, radio programs, TV messages, schools;
  • Registering and follow up of the status of girls and successfully monitor them through the kebele committees;
  • The attitudes of thousands of community members have been changed and the number of people who support the abandonment of FGM is increasing;
  • Integration of FGM into the Sexual Reproductive Services helped to create awareness on the health consequences of the practice and many women and girls affected were able to be assisted

Future Plan

FGM is a social norm that is practiced in various parts of the country.  Therefore, depending on resources the program is planned to be replicated in the different zones of the Afar Region for wider and sustainable change. There is also a plan to scale-up to other regions with the first being the Beninshagul-Gumuz Region.