The Navrongo FGC Trial: Impact and Lessons Learned Reshma Naik, MPH 4 th International Day of Zero Tolerance for Female Genital Cutting February 6, 2007.

The Navrongo FGC Trial: Impact and Lessons Learned

Reshma Naik, MPH4th International Day of Zero

Tolerance for Female Genital CuttingFebruary 6, 2007 

Navrongo Health Research Centre,Kassena-Nankana District

Context of the Trial

More common in the north Rapid social change All three types practiced FGC outlawed in 1994

FGC Beliefs

Engrained cultural practice Unique characteristics

Extreme social pressure ‘Clitoris child’ Burial as a man Restriction from participating in

parents’ funeral rites

Navrongo FGC Trial

Cell 1 Cell 2

Cell 3 Cell 4

Livelihood & Development

Problem-focused: FGCEducation

Y

N

Y N

FGC Education Activities

Film shows and discussions Night Clinic

School outreach Singing/drama

competitions Public declarations

Livelihood & Development Activities

Community change agents

Literacy training

Livelihood skills training

Micro-lending

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

What Worked?

FGC Education 93% reduction in

the hazard of FGC

Combined Approach 94% reduction in

the hazard of FGC

Interpreting the Results

Common Factor

Synergy

Ongoing Social Change

Lessons Learned

Lesson learned: Mechanism of action is important

Need to understand how and why it worked

Need to distinguish intervention activities and separate geographic areas

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

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

Lesson Learned:Need to reframe the dialogue

Challenging to use a human rights approach in the community

Discussion of health effects also challenging

“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

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

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

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

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

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

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

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

Thank You For Your Attention