Guest blog by Chantalle Okondo, Assistant Program Officer with Population Council.
The International Day of Zero Tolerance for Female Genital Mutilation/Cutting (FGM/C) brings awareness of the need to globally eradicate FGM/C. However, it can be difficult to ensure that no girl or women is left behind on a local level. This could not be truer when it comes to West Pokot County on the western side of Kenya, where FGM/C is nearly universal (85 - 94%)1, 2despite the practice being outlawed by the National Government. Type 3 FGM/C—the narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)3—is widely practiced in this region.The practice is valued as a cultural practice and serves as a rite of passage that prepares girls for marriage and ensures family honour. However, given that FGM/C is mostly performed on 12- to 15-year-old girls, who are strongly held down while a traditional cutter performs the procedure, it also takes away their choice to decide what they want for themselves.
Kapenguria, the capital of West Pokot, played an important role during Kenya’s fight for independence. Despite this history the people from this mountainous and vast region, especially girls and women, have been marginalized and left behind on key maternal and child health indicators. Decisions around FGM/C are strongly held by the older generation and after undergoing FGM/C, girls are usually married off and start having children in their teens. Not surprisingly, therefore, 29 percent of adolescents aged 15-19 year in West Pokot are either pregnant or mothers and the county has a fertility rate (7.2) that is almost twice national rate (3.9).4
As part of the Evidence to End FGM/C research program that is led by the Population Council, researchers visited the county in September 2018 and encountered a maternal health innovation—the Kiror Unit—that offers an opportunity to nest FGM/C abandonment interventions. The remote nature of the county means that women face considerable barriers to accessing health information and services, particularly maternal health services. The Kiror Unit or “mothers waiting home” is a delivery waiting house where pregnant women who live very far from the health facility come a few weeks / months prior to delivery to ensure they receive care from skilled birth attendants and avoid any medical emergencies.
If we are truly going to embrace the idea of “no one to be left behind”, then governments, advocates, researchers, and programme implementers need to look constructively at how to engage all actors in the fight towards abandonment of FGM/C. Kiror Units are an essential resource already in use. If scaled up, these units can serve as friendly spaces where women and girls can receive information about their bodies and FGM/C from skilled professionals and participate in group discussions on local values and beliefs around FGM/C that can spur a re-appraisal of the value of FGM/C.
A major thematic area of the Evidence to End FGM/C research program includes “assessing a range of interventions to address FGM/C abandonment that utilize a blend of retrospective evaluations, case studies of ongoing interventions, prospective implementation research, impact evaluations and cost analyses.”
To address this issue, the project is conducting a diagnostic assessment of the health systems response to FGM/C management and prevention in Nigeria and Kenya. The study seeks to understand how health systems in these countries can be strengthened to provide the appropriate care to women and help prevent the FGM/C practice. The Evidence to End FGM/C programme has also released a web feature “FGM/C and Its Health Consequences: Implications for Policy, Advocacy, and Investment” that synthesizes information on the health consequences of FGM/C and outlines ways in which advocates, medical professionals and researchers can contribute to efforts to promote the abandonment of the practice.
On this Day of Zero Tolerance, all stakeholders need to look at how to maximize efforts on the ground and target marginalized populations where FGM/C is still highly prevalent.