Female Genital Mutilation/Cutting in Kenya- Examining Progress Or Lack of Progress at National and Subnational Levels

Female Genital Mutilation/Cutting in Kenya- Examining Progress or Lack of Progress at National and Subnational Levels Robert P Ndugwa PhD1 and Dr Edward Addai2 1Global Urban Observatory, Research and Capacity Development Branch, United Nations Human Settlements Programme, Nairobi, Kenya. 2UNICEF ESARO, Nairobi, Kenya Abstract Female genital mutilation or cutting (FGM/C) is widely outlawed globally, but continues to be practiced in selected communities across the globe. In Kenya, this practice is common among selected communities, and recent national trends show that the prevalence of the practice is declining. Using Multiple Indicator Cluster Surveys data collected in 2011 from 6 counties from the Western region of Kenya, we demonstrate that while national figures conspire to show that the prevalence of FGM has declined but among certain communities the practice remains almost universal. Underlying factors favouring the continuation of the practice within these communities are discussed, including examining the role of cultural traditions, tribe and religion. The study demonstrates the value of collecting data at lower levels, and highlights the need to step up the responses and engagement of communities who continue practicing FGM even after outlawing this practice. Introduction Female genital mutilation or cutting (FGM/C) has continued to dominate the discourse in women’s health and empowerment as well as remaining a dominate subject for human rights violations today. Female genital mutilation or cutting (FGM/C) is a procedure or practice where the parts of the female genitals are removed, and it is practiced in over twenty countries within sub-Saharan Africa. FGM/C practice has been widely documented to interfere with the natural functioning of the body, in addition to causing many short-term and long-term health and psychological consequences (Behrendt et al. 2005; Kaplan et al. 2013) To-date no known health benefits have been recorded as a result of undergoing FGM/C. The real physical consequences of FGM range from bleeding, wound infections, sepsis, shock, micturition problems and fractures, anaemia, infections of the urinary tract, infertility, repetitive abdominal pain, menstruation problems, irritability, etc (Almroth et al. 2005; Jones et al. 1999). Women who have undergone FGM also face an increased risk for HIV infections, plus other mental related consequences such as the feelings of incompleteness, fear, inferiority and low self- esteem (Elnashar & Abdelhady, 2007). According to UNICEF and WHO publications, the prevalence of FGM varies from more than 70% in Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Guinea, Mali, Mauritania, Northern Sudan, and Somalia to less than 40% among Kenya, Uganda, Senegal, Tanzania, etc (WHO,2008). However, the above prevalence vary considerably within countries, reflecting regional, ethnic, religious, tribal and cultural drivers of FGM/C within states (PATH, 2005). Among the proponents of FGM/C, they consider it necessary to raise a girl properly and to prepare her for adulthood and marriage (Yoder et al., 1999; Ahmadu, 2000; Hernlund, 2003; Dellenborg, 2004). FGM/C also occurs due to peer pressure because of fear of stigmatization and rejection by society. Girls who undergo the procedure may receive rewards and gifts (Behrendt, 2005; UNICEF, 2005a). In many communities, the practice is also upheld by beliefs associated with religion (Budiharsana, 2004; Dellenborg, 2004; Gruenbaum, 2006; Clarence-Smith, 2007; Abdi, 2007; Johnson, 2007) although the practice predates most religions (WHO & UNFPA, 2006). FGM/C is often upheld by local structures of power and authority such as traditional leaders, religious leaders, circumcisers, elders and even some medical personnel. In terms of human rights, FGM/C violates the right of women to the freedom from bodily harm, the right to health and to freedom from torture, inhuman or degrading treatment and sometimes, the right to life (WHO, 2008). Support for the abandonment of FGM is well captured in many international and regional human rights treaties and consensus documents (WHO,2008). In some ways, FGM/C is a manifestation of gender inequality that is deeply entrenched in social, economic and political structures (UNICEF, 2005). Where female genital mutilation is widely practised, it is supported by both men and women, and sanctioned by condemnation, harassment, and ostracism at the society level. Primary factors in shaping social attitudes and beliefs towards the eradication of FGM/C as a human rights violation include tribe, religion and cultural impediments. For example, among women from communities that practice FGM/C, but who have since migrated to countries where FGM/C is not practiced openly and have strong legal frameworks in place, research shows that they express negative attitudes towards FGM and know about the serious complications associated with it, but they still exhibit religious justifications for the continued practice of FGM/C, and favour the medicalization of the practice (Thierfelder et al. 2005). Also for migrant women who have already had FGM, the medical attention and needs vary from women who have never had FGM, but appropriate care is often not well understood by caregivers during birth (Chalmers et al. 2000; Leye et al. 2008). Estimations for the impact of FGM on health systems and well-being show that on average, a girl of 15 years who undergoes total or partial excision of the external genitalia and stitching or narrowing of the vaginal opening will lose nearly one-fourth of a year of life and impose on the medical system a cost of US$ 5.82 over her lifetime. Clearly, any form of FGM has an impact on survival and will lead to monetary losses over each woman’s lifespan for many generations (Bishai et al. 2008). Kenya and FGM/C Kenya is one of many countries in the world where FGM/C is practiced in a number of communities with the major tribes being the Somali and Kisii communities. In the last two decades, Kenya has invested considerable educational efforts to increase awareness of the policy issues and health risks associated with FGM/C. The Kenyan government formally outlawed FGM in 2001 and ten years later passed the Prohibition of Female Genital Mutilation Act of 2011. The Children Act of 2001 also describes girls who are likely to be forced into circumcision as children in need of special care and protection. The Act further provides for courts of law to take action against the perpetrators. The existence of a legal framework, alongside the expansion of many educational programmes, has led to a significant increase in knowledge and awareness of health complications of FGM/C, with potential dividends expected in the decline of the prevalence of this practice in the coming years (Livermore et al. 2007) This paper examines trends and predictors of FGM/C across one province in Kenya where in-depth data on women and child related indicators were collected two years after the 2008/9 Kenya demographic and Health survey. The paper provides an in-depth examination of the strength of the documented progress on FGM as observed through national averages, and further examines residual progress at subnational levels recorded on FGM prevalence across one region and within region. Data and Methods For this study, two sources of data are used-namely the Kenya demographic and health surveys conducted in 2003 and 2008/9, and a Multiple Indicator Cluster Survey (MICS) conducted in 2011 in one of Kenya’s provinces i.e Nyanza province. Nyanza MICS data: By 2011, Nyanza province was divided into six counties (Kisumu, Homabay, Siaya, Nyamira, Kisii, and Migori County). Details on the Nyanza Province Multiple Indicator cluster Survey (MICS) methods are described elsewhere [Nyanza Multiple Indicator Cluster Survey 2011]. Briefly, the MICS is an international household survey programme developed by UNICEF. The Nyanza province MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project, questionnaires and methodology is available at www.childinfo.org. For Nyanza MICS, a representative sample survey was drawn using the 2009 Census Enumeration Areas (EAs) as the sampling frame. A stand-alone statistical frame for each of the six Nyanza counties was constructed based on the 2009 census EAs for the purpose of this MICS survey. The survey used a two stage design. In the first stage, 300 EAs were sampled using the probability proportional to size (PPS) sampling methodology, and in the second stage households were selected systematically using a random start from the list of households. Within each sampled household, standard questionnaires for collecting information on characteristics for the household, women, and children under five years were administered. The indicators within MICS Questionnaires are modeled to be comparable to some of the global survey instruments such as those developed by the MEASURE DHS+ programme. Fieldwork was undertaken between October 2011 and December, 2011 and information from a total of 6828 households were collected. The household questionnaire was used to list all the usual members and visitors in the selected households and to identify eligible women for the individual interview and children aged

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