Author: Nadia Refaat & Amal A. Hadi.; Population Council
This evaluation that was piloted by UNICEF in partnership with the the Center for Development and Population Activities (CEDPA) from 2003 to 2006. Female Genital Mutilation Abandonment Programme (FGMAP) is based on the Positive Deviance Approach (PDA), which focuses on identifying individuals within local communities who chose not to practice FGM, and builds on their experiences to encourage other community members to abandon the practice. FGMAP is implemented in 40 communities in four governorates in Upper Egypt in partnership with four partner non-governmental organizations (PNGOs) with the support of twenty local NGOs on the community level. FGMAP consists of two main phases. The first phase establishes the program, identifies positive deviants, raises awareness on the issue of Female Genital Mutilation/Cutting (FGM/C) and identifies girls at risk. The second phase consists of working directly with the girls at risk and their families through home visits and other activities to convince families to abandon the practice of FGM/C.
The purpose of this evaluation is to rigorously examine the implementation and results of project activities and interventions of the FGM/C Abandonment Program (FGMAP) in three key areas: program relevance, effectiveness, and efficiency. The FGM/C Abandonment Program (FGMAP) is an initiative that seeks to contribute to the national dialogue on FGM/C, promote regional exchanges, and promote non-governmental initiatives to prevent FGM/C at sub-national level.
The methodology of this evaluation is based on qualitative methodology, supplemented by extensive analysis of project documents. A total number of 25 interviews at the community level and with governorate and national-level stakeholders, 60 focus group discussions with a total number of 436 participants and 11 case studies were conducted (originally 12 but one was lost due to technical problems). The evaluation covered a total of 8 communities, 2 from each of the four governorates.
Findings and Conclusions
In terms of its relevance, the study key findings and conclusions are that the program is much needed both nationally and on the community level. While the report highlights concerns that program activities need to be integrated as part of a comprehensive developmental approach, this does not undermine its relevance. Data reflects dissident voices who consider an intervention against FGM/C as a “Western conspiracy” against Egyptian traditions and values. FGDs showed that the FGMAP objective of breaking the silence surrounding the issue was relevant as FGM/C was a tabooed issue prior to FGMAP. Fieldwork, however, shows that these dissident voices are most vocal when efforts against FGM/C are provided by Local NGOs (LNGOs) that are not highly integrated into the community and in isolation from other activities of the LNGOs.
The program has been effective in reaching some of its major objectives. Based on information from focus group discussions and in-depth interviews, we note that more efforts are needed for the message to trickle down to target families. Some of these showed a great deal of ambivalence and lack of clarity about the negative consequences of FGM/C. Moreover, data from the field show that the focus on the physical consequences of FGM/C, leads to increasing the medicalization of the process to avoid such harms. Program activities succeeded in empowering volunteers and Positive Deviants (PDs) to be advocates for eradicating the practice and generally broke the silence on the issue. The study shows that the number of targeted families constitutes a small minority of village populations. This hampers the effectiveness of the program and its outreach and achieving the objective of FGM/C free communities. This is indicative of the need to continue program activities to achieve this “critical mass” of families and also, as many indicated, abandoning the project at this time would result in “hesitant” families returning to FGM/C.
In terms of program efficiency, it was emphasized that the workload associated with reporting was heavy and many times exceeded the capabilities of the LNGOs. PNGOs were generally able to accurately support and monitor LNGOs, in many cases avoiding problems by maintaining a high level of involvement. Some PNGOs indicated a great desire to work more closely with community leaders, and many commented on the influence of such individuals.
In terms of sustainability, PNGOs and LNGOs expressed a desire to continue working on the project, but indicated that financial constraints would prevent them from doing so. Cost analysis showed that targeting families was expensive given the results. However, analyzed cost per target families and saved girls varied greatly between governorates.
The most enabling factors to FGMAP on the community level has been the presence of supportive community and religious leaders, active PDs, volunteers, and supportive doctors to the message of FGMAP. Up till the time of data collection for this evaluation, some of the major external factors that hindered the success of the project have been the lack of a unified religious message on the issue of FGM/C and the unclear stance of the Ministry of Health towards those practicing FGM/C. Still, international political events such as the American invasion of Iraq and Israel’s military attacks on Lebanese and Palestinian villages had direct negative impact on the project. Supporters of FGM link the project activities to these events and label the project as a western conspiracy to demolish values and morality.
As a stand-alone intervention against FGM/C, FGMAP is criticized for ignoring more pressing community needs such as poverty, unemployment to rather focus on an issue that community members do not feel is equally relevant to their needs. It is recommended that the message on FGM/C be part of larger awareness activities related to hygiene, health, nutrition or child care as well as the integration of a service provision component into the project. It is recommended that counselling is required for women who went through FGM/C and their husbands, with regards to problems in sexual martial relationships. There is a need for printed materials to inform communities about UN and UNICEF and their other activities. This was seen as a crucial input to addressing the “western conspiracy” accusations, as it makes distinction between UNICEF as an “apolitical” UN agency that provides a variety of services to advance children rights and wellbeing far beyond FGM issues. This will also help situate FGM/C as a human rights issue critical to girls and women’s health. There is a need to build a closer cooperation and coordination between UNICEF/ FGMAP activities and a national partner or “champion” such as the National Council for Childhood and Motherhood, the highest national body entrusted with policymaking, planning, co-ordination and monitoring of activities in the areas of child rights, and the main body that coordinates national and international efforts towards FGM/C abandonment in Egypt. UNICEF should continue to invest in educating and building the capacity of different groups in the community and sensitizing them to FGM issues. Partnership with NGOs at governorate and community levels and with the government, will promote to establishing open communal dialogue on this once taboo issue.
The evaluation highlights a number of learned lessons. First, that efforts against FGM/C need to be from within the community. PDs and volunteers from the community undertook an important role in FGMAP activities. The same applies to supportive community and
religious leaders. Second, the evaluation shows that sustained efforts against FGM/C on the community level yields better results, as communities that had earlier interventions against FGM/C were more receptive of the message. Third, the evaluation highlights the important
role of strong and active NGOs in the success of the program. The success of the implementation is mediated through NGOs. Finally, the evaluation shows that the sole focus on the physical harms of FGM/C leads to the medicalization of the process. Recommendations related to this learned lessons call for the incorporation of the message against FGM/C within the framework of child rights.
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Centre for Development and Population Activities in Egypt and 4 NGOs in Upper Egypt