the navrongo fgc trial: impact and lessons learned reshma naik, mph 4 th international day of zero...
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The Navrongo FGC Trial: Impact and Lessons Learned
Reshma Naik, MPH4th International Day of Zero
Tolerance for Female Genital CuttingFebruary 6, 2007
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Navrongo Health Research Centre,Kassena-Nankana District
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Context of the Trial
More common in the north Rapid social change All three types practiced FGC outlawed in 1994
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FGC Beliefs
Engrained cultural practice Unique characteristics
Extreme social pressure ‘Clitoris child’ Burial as a man Restriction from participating in
parents’ funeral rites
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Navrongo FGC Trial
Cell 1 Cell 2
Cell 3 Cell 4
Livelihood & Development
Problem-focused: FGCEducation
Y
N
Y N
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FGC Education Activities
Film shows and discussions Night Clinic
School outreach Singing/drama
competitions Public declarations
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Livelihood & Development Activities
Community change agents
Literacy training
Livelihood skills training
Micro-lending
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Methodology
Longitudinal study design monitoring FGC incidence
Yearly surveys of 8,473 adolescent girls aged 12-23 from 1999-2003
Cox Proportional Hazard model to control for time, age, education, marital status, and religion
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What Worked?
FGC Education 93% reduction in
the hazard of FGC
Combined Approach 94% reduction in
the hazard of FGC
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Interpreting the Results
Common Factor
Synergy
Ongoing Social Change
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Lessons Learned
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Lesson learned: Mechanism of action is important
Need to understand how and why it worked
Need to distinguish intervention activities and separate geographic areas
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Lesson learned: Must address the underlying cause
May need to explicitly link interventions to the issue of promiscuity
May be helpful to address FGC within a broader context of sexuality and reproductive health
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Lesson Learned:Important to study social change
Social change occurs naturally in some settings Studying change could inform future
interventions Studying change could help isolate
intervention effects
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Lesson Learned:Need to reframe the dialogue
Challenging to use a human rights approach in the community
Discussion of health effects also challenging
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“Denial” Phenomenon
“Denial” influenced by a number of complex factors Social climate and acceptability Perceptions of the NHRC Peer and family member interactions Girl’s theories Interviewer characteristics and attitude Emotions
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Social Climate
Because she wants to be circumcised and FGC is no longer done and most of the girls too do not do it any longer she cannot tell you that she wants to be circumcised.
- Adolescent Girl
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Risk of Arrest
She’s scared to say she is circumcised. She doesn’t know if she says she’s circumcised they will come and arrest her or do anything to her…
– Adolescent Girl
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Interview as a Test
They want to know whether we listen to them or not. Or whether we listen to our parents’ advice and not them.
- 16 year old student
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Peer Interactions
Our peers, when they ask you and you tell them you said you were circumcised then they tell you ‘fool why did you say you were circumcised? If they ask you and you say you aren’t circumcised, who will open your vagina to know whether you are circumcised or not?’ -18 year old student
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Emotions
She is always angry and would be shouting that she didn’t know. If she gets her clitoris she would like to stitch it back, but it has already happened.
– Adolescent Girl
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Lesson Learned:Social context can affect measurement
Collection and interpretation of self-reported FGC data must consider the social context
Need to consider alternate methods to validate data
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In conclusion…
Successful longitudinal trial in this setting though w/ limitations
Unanswered questions remain Need to consider applicability to
other settings Be aware of potential challenges for
measurement and implementation
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Thank You For Your Attention