Introduction
Methods
Household survey
Key informant interviews
Data processing and analysis
Results
Background characteristics of respondents
Characteristics | Kenya | Uganda | Ethiopia | Senegal | ||||
---|---|---|---|---|---|---|---|---|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
| |
Gender
| ||||||||
Male | 65 | 20.8 | 52 | 18.7 | 49 | 19.5 | 59 | 28.4 |
Female | 247 | 79.2 | 226 | 81.3 | 202 | 80.5 | 149 | 71.6 |
Location of respondent
| ||||||||
Urban area | 12 | 3.8 | 0 | 0.0 | 7 | 2.8 | 93 | 44.7 |
Rural setting | 300 | 96.2 | 278 | 100.0 | 244 | 97.2 | 115 | 55.3 |
Age of respondent (years)
| ||||||||
15–18 | 70 | 22.4 | 143 | 51.4 | 56 | 37.6 | 55 | 36.9 |
19–25 | 54 | 17.3 | 35 | 12.6 | 68 | 45.6 | 46 | 30.9 |
26–35 | 108 | 34.6 | 32 | 11.5 | 78 | 52.3 | 49 | 32.9 |
36–45 | 54 | 17.3 | 46 | 16.5 | 41 | 27.5 | 46 | 30.9 |
Above 45 | 26 | 8.3 | 22 | 7.9 | 8 | 5.4 | 12 | 8.1 |
Level of education
| ||||||||
No education | 162 | 51.9 | 74 | 26.6 | 173 | 68.9 | 68 | 32.7 |
Completed primary education | 43 | 13.8 | 84 | 30.2 | 29 | 11.6 | 20 | 9.6 |
Incomplete secondary education | 92 | 29.5 | 108 | 38.8 | 44 | 17.5 | 63 | 30.3 |
Completed secondary and/or higher education | 15 | 4.8 | 12 | 4.3 | 5 | 2.0 | 57 | 27.4 |
Marital status
| ||||||||
Married | 196 | 62.8 | 175 | 62.9 | 178 | 70.9 | 120 | 57.7 |
Separated | 8 | 2.6 | 4 | 1.4 | 0 | 0.0 | 0 | 0.0 |
Divorced | 6 | 1.9 | 1 | 0.4 | 8 | 3.2 | 1 | 0.5 |
Widowed | 13 | 4.2 | 0 | 0.0 | 11 | 4.4 | 2 | 1.0 |
Single | 89 | 28.5 | 98 | 35.3 | 54 | 21.5 | 85 | 40.9 |
Total
|
312
|
100.0
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
FGM/C and CFM cases before and during COVID-19
Kenya | Uganda | Ethiopia | Senegal | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
| |
Percentage of respondents reporting that FGM/C cases before COVID-19 were: | ||||||||||||
Same as now | 49 | 15.7 | < 0.001 | 1 | 0.4 | 0.216 | 150 | 59.8 | 0.837 | 13 | 6.3 | 0.22 |
Decreasing | 196 | 62.8 | 257 | 92.4 | 69 | 27.5 | 138 | 66.3 | ||||
Increasing | 48 | 15.4 | 14 | 5.0 | 32 | 12.7 | 22 | 10.6 | ||||
Don’t know/ No response | 19 | 6.1 | 6 | 2.2 | 0 | 0.0 | 35 | 16.8 | ||||
Percentage of respondents reporting that FGM/ cases during COVID-19 were: | ||||||||||||
Same as now | 51 | 16.3 | < 0.001 | 30 | 10.8 | 0.062 | 204 | 81.3 | 0.126 | 22 | 10.6 | 0.592 |
Decreasing | 81 | 26.0 | 228 | 82.0 | 46 | 18.3 | 134 | 64.4 | ||||
Increasing | 171 | 54.8 | 19 | 6.8 | 1 | 0.4 | 5 | 2.4 | ||||
Don’t know/ No response | 9 | 2.9 | 1 | 0.4 | 0 | 0.0 | 47 | 22.6 | ||||
Percentage of respondents reporting that CEFM cases before COVID-19 were: | ||||||||||||
Same as now | 42 | 13.5 | < 0.001 | 3 | 1.1 | < 0.001 | 124 | 49.4 | 0.655 | 17 | 8.2 | 0.423 |
Decreasing | 193 | 61.9 | 234 | 84.2 | 75 | 29.9 | 129 | 62.0 | ||||
Increasing | 67 | 21.5 | 40 | 14.4 | 52 | 20.7 | 27 | 13.0 | ||||
Don’t know/ No response | 10 | 3.2 | 1 | 0.4 | 0 | 0.0 | 35 | 16.8 | ||||
Percentage of respondents reporting that CEFM cases during COVID-19 were: | ||||||||||||
Same as now | 45 | 14.4 | < 0.001 | 10 | 3.6 | 0.111 | 175 | 69.7 | 0.712 | 26 | 12.5 | 0.732 |
Decreasing | 66 | 21.2 | 74 | 26.6 | 60 | 23.9 | 124 | 59.6 | ||||
Increasing | 198 | 63.5 | 193 | 69.4 | 16 | 6.4 | 27 | 13.0 | ||||
Don’t know/ No response | 3 | 1.0 | 1 | 0.4 | 0 | 0.0 | 31 | 14.9 | ||||
Total
|
312
|
100.0
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
“Lack of enforcement and protection, especially those from the boarding schools now, as well as the rescue centres. Since girls are at home, the protection is no more. They are out there, there is no monitoring…they have ample time to practise FGM and child marriage.” Programme Implementer #1, Kenya.
“From the cases that I know, you hear a girl has been married off and then you hear that she was already pregnant. So, it is like the marriage was to avoid the stigma. In our community when a girl gives birth and she is not married then you have that kind of stigma that you are a bad girl, you do not have discipline. So, I think to avoid the stigma that comes with having a baby without a husband, then the moment a girl is pregnant they are married off.” Policymaker #3, Kenya.
“It is increasing, the early marriage compared to the FGM as the law is in place and a few people tend to escape and cut themselves in the bushes. As much as they have tried always to bring in the interventions, but they are still doing it [FGM/C] but not openly. The early marriages are common because the girl child is not going to school.” Programme Implementer #1, Uganda.
“Beware that this is the circumcision year and we have not come to the end of the year more so to the climax because it is mostly in December… We do not know what is going to happen between now and December because since the year begun, I have not come across a girl who has been cut, or any woman who has been mutilated.” Policymaker #2, Uganda.
“Initially when children were going to school, they had no time but being at home they are idle, and I believe that is one of the key reasons. I believe when children are at school these cases of early pregnancies can be minimized.” Programme Implementer #4, Uganda.
“Because of COVID-19, there was a lot of poverty because people were locked down. So, when someone gets into such a problem, they would want to go and negotiate [for bride price] because they know at the end of it, they will get something [money]. Which also forces some of them to marry off their daughters early.” Policymaker #1, Uganda.
“Reports on CFM are coming from police officers, health extension workers, health development army but FGM/C cases are not that much as compared to CFM. We have reviewed the report with the steering committee from police office, health, judiciary, education, and other offices including NGO’s [Non-Governmental Organizations] and FBO [Faith Based Organizations]…we received more cases of child marriage.” Policymaker #1, Ethiopia.
“After Covid cases were identified in our country, it was very difficult to support and sensitize communities by going house to house. People are focusing on COVID-19 than FGM and CFM. As a result, we might have missed information about CFM and FGM. Since communities’ movement was restricted by Covid, police officers might not receive report from health extension workers, and health development army on what is happening in communities.” Programme Implementer #2, Ethiopia.
“COVID-19 has blocked all ongoing activities and slowed progress in achieving results. This in return has led to a resurgence of the practice [FGM/C] … Cutters can excise without people knowing because the practice is done at a very young age; even before the first birthday. This is not controlled because of the COVID-19 restrictions.” Programme Implementer #1, Senegal.
Adequacy of the justice and legal system in addressing FGM/C and CFM
Kenya | Uganda | Ethiopia | Senegal | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
| |
Response of the legal system on FGM/C during COVID-19
| ||||||||||||
Poor | 87 | 27.9 | < 0.001 | 63 | 22.7 | 0.003 | 9 | 3.6 | 0.684 | 61 | 36.7 | 0.794 |
Average | 124 | 39.7 | 72 | 25.9 | 4 | 1.6 | 56 | 33.7 | ||||
Good | 86 | 27.6 | 143 | 51.4 | 236 | 94.8 | 49 | 29.5 | ||||
Excellent | 13 | 4.2 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||||
Don’t know | 2 | 0.6 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||||
Response of the legal system on CEFM during COVID-19
| ||||||||||||
Poor | 86 | 27.6 | < 0.001 | 66 | 23.7 | 0.133 | 9 | 3.7 | 0.089 | 63 | 33.9 | 0.942 |
Average | 126 | 40.4 | 64 | 23 | 14 | 5.7 | 57 | 30.6 | ||||
Good | 82 | 26.3 | 148 | 53.2 | 223 | 90.7 | 66 | 35.5 | ||||
Excellent | 16 | 5.1 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||||
Don’t know | 2 | 0.6 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||||
Total
|
312
|
100.0
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
“When you look at the judicial system, when COVID-19 came or when we went into this period [lockdown], some activities like court hearing were limited, and in some places, there were no staff, we did not have public transport… Now it means that people who were to attend court, the people who were to get justice from court could not access it.” Policymaker #3, Uganda.
“When you look at the police…they have been moving around but, you know police they deal with issues that have been reported, so under COVID-19, you find that many issues were not reported because community members are afraid. The police are also compromised at the community level… the police do not have the guts to reach out to them unless they get the reports.” Policymaker #2, Uganda.
“At this point, the government has strong commitment to support girls not to undergo CFM and FGM/C. The administration office is really helping…it has established steering committee from women, youth and child office, health, education, and police to review and make decisions if any cases or issues are identified. So at least, I can say the government is putting a lot of effort to see FGM/C and CFM are not totally practised in our zones… So, the police officer gets information from the community and checks in person for validation of the information to start the legal procedures.” Policymaker #2, Ethiopia.
Adequacy of the health system in addressing FGM/C and CFM
Kenya | Uganda | Ethiopia | Senegal | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
| |
Services provided for FGM/C cases before COVID-19: | ||||||||||||
Psychological and sexual counselling | 163 | 52.2 | < 0.001 | 247 | 88.8 | 0.282 | 238 | 94 | 0.74 | 107 | 51.4 | 0.235 |
De-infibulation | 7 | 2.2 | 0.011 | 1 | 0.4 | 0.631 | 0 | 0.0 | 7 | 3.4 | 0.407 | |
Clitoral reconstruction | 1 | 0.3 | 0.340 | 1 | 0.4 | 0.631 | 0 | 0.0 | 4 | 1.9 | 0.348 | |
No services | 48 | 15.4 | < 0.001 | 15 | 5.4 | 0.004 | 43 | 17.1 | 0.798 | 0 | 0.0 | |
Rescue | 139 | 44.6 | < 0.001 | 89 | 32.0 | 0.587 | 0 | 0.0 | 7 | 3.4 | 0.617 | |
Reintegration back to the community | 71 | 22.8 | < 0.001 | 2 | 0.7 | 0.003 | 50 | 19.9 | 0.923 | 13 | 6.3 | 0.73 |
Don’t know/No response | 14 | 4.5 | 0.026 | 1 | 0.4 | 0.631 | 2 | 0.8 | 0.484 | 12 | 5.8 | 0.631 |
Other | 0 | 0.0 | 2 | 0.7 | 0.255 | 0 | 0.0 | 1 | 0.5 | 0.521 | ||
Services provided for FGM/C cases during Covid-19: | ||||||||||||
Psychological and sexual counselling | 115 | 69.3 | < 0.001 | 232 | 93.5 | 0.032 | 103 | 41.0 | 0.976 | 117 | 56.3 | 0.713 |
De-infibulation | 24 | 14.5 | < 0.001 | 1 | 0.4 | 0.642 | 21 | 8.4 | 0.973 | 11 | 5.3 | 0.196 |
Clitoral reconstruction | 21 | 12.7 | < 0.001 | 1 | 0.4 | 0.642 | 21 | 8.4 | 0.973 | 10 | 4.8 | 0.403 |
No services | 82 | 49.4 | 0.002 | 0 | 0.0 | 0 | 0.0 | 47 | 22.6 | 0.806 | ||
Rescue | 29 | 17.5 | < 0.001 | 44 | 17.7 | 0.068 | 22 | 8.8 | 0.886 | 41 | 19.7 | 0.038 |
Reintegration back to the community | 11 | 6.6 | 0.001 | 4 | 1.6 | 0.003 | 62 | 24.7 | 0.995 | 57 | 27.4 | 0.053 |
Don’t know/No response | 7 | 4.2 | 0.031 | 2 | 0.8 | 0.510 | 114 | 45.4 | 0.991 | 29 | 13.9 | 0.731 |
Other | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | ||||
Percentage of respondents rating provider’s response to FGM/C during COVID-19 as: | ||||||||||||
Poor | 101 | 32.4 | 0.001 | 46 | 16.5 | 0.446 | 14 | 5.6 | 0.772 | 50 | 27.5 | 0.001 |
Average | 136 | 43.6 | 56 | 20.1 | 25 | 10 | 40 | 22 | ||||
Good | 59 | 18.9 | 172 | 61.9 | 149 | 59.4 | 50 | 27.5 | ||||
Excellent | 6 | 1.9 | 4 | 1.4 | 59 | 23.5 | 26 | 14.3 | ||||
Don’t know/No response | 10 | 3.2 | 0 | 0.0 | 4 | 1.6 | 16 | 8.8 | ||||
Percentage of respondents rating provider’s response to CEFM during COVID-19 as: | ||||||||||||
Poor | 106 | 34.0 | < 0.001 | 36 | 12.9 | 0.503 | 53 | 32.3 | < 0.001 | 58 | 31.9 | < 0.001 |
Average | 135 | 43.3 | 63 | 22.7 | 27 | 16.5 | 37 | 20.3 | ||||
Good | 57 | 18.3 | 176 | 63.3 | 56 | 34.1 | 48 | 26.4 | ||||
Excellent | 6 | 1.9 | 3 | 1.1 | 22 | 13.4 | 27 | 14.8 | ||||
Don’t know/No response | 8 | 2.6 | 0 | 0.0 | 6 | 3.7 | 12 | 6.6 | ||||
Total
|
312
|
100.0
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
“This Corona has stopped us so much. We were on the run, planning big things and running around and just having great plans, but all that stopped, and so people are sitting back and just reflecting on their achievements…and just holding unto those achievements…that is a lesson… And then of course… investing in the mental health of human beings is important. That is a lesson that I have learnt.” Programme Implementer #4, Kenya.
“The health offices and the police are working closely with us. The health system has established structures starting at grass root level using health extension workers and health development armies to respond to FGM/C and CFM.” Policymaker #4, Ethiopia.
Adequacy of the civil society in addressing FGM/C and CFM
Kenya | Uganda | Ethiopia | Senegal | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
|
N
|
%
|
P
-value
| |
Percentage of respondents rating the response of programme implementers to FGM/C cases during COVID-19 as: | ||||||||||||
Poor | 69 | 22.1 | < 0.001 | 62 | 22.3 | 0.048 | 18 | 7.2 | 0.651 | 67 | 32.2 | 0.075 |
Average | 135 | 43.3 | 42 | 15.1 | 30 | 12.0 | 46 | 22.1 | ||||
Good | 65 | 20.8 | 0 | 0.0 | 126 | 50.2 | 47 | 22.6 | ||||
Excellent | 43 | 13.8 | 174 | 62.6 | 73 | 29.1 | 26 | 12.5 | ||||
Don’t know/No response | 0 | 0.0 | 0 | 0.0 | 4 | 1.6 | 22 | 10.6 | ||||
Percentage of respondents rating the response of programme implementers to CEFM cases during COVID-19 as: | ||||||||||||
Poor | 68 | 21.8 | 0.278 | 57 | 20.5 | 0.032 | 19 | 7.6 | 0.792 | 37 | 17.8 | 0.149 |
Average | 174 | 55.8 | 50 | 18.0 | 34 | 13.5 | 70 | 33.7 | ||||
Good | 0 | 0.0 | 170 | 61.2 | 60 | 23.9 | 61 | 29.3 | ||||
Excellent | 70 | 22.4 | 1 | 0.4 | 134 | 53.4 | 22 | 10.6 | ||||
Don’t know/No response | 0 | 0.0 | 0 | 0.0 | 4 | 1.6 | 18 | 8.7 | ||||
Total
|
312
|
100.0
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
“If they were in school, we would be able to control because you would have a way of knowing who is here or who has not reported back to school. If they are in school, it is easy to make a report. You see when they are involved with the parent and it is the parents who are encouraging this [FGM/C, CFM] we may not be able to know exactly where the child is.” Policymaker #6, Kenya.
“Their funding is not always constant. These guys only come to the field when they receive funding… When they do not have the funding, they don’t implement the activities… I think that is one of the challenges these organizations are facing during COVID-19 as far as implementing activities to end the FGM/C programme is concerned.” Programme Implementer #6, Uganda.
“NGOs are working together with health extension workers and health development army structures, the police and judiciary. These are crucial channels for us [NGO] to raise awareness in the community and pass information to the judiciary, health system and the police for further investigation. Non-profit organizations are using these structures to work more efficiently.” Programme Implementer #6, Ethiopia.
“COVID-19 prevention measures were a real obstacle to carrying out awareness-raising activities because one of the instructions was “stay at home” and as a result home visits were no longer being made and therefore people who were no longer being controlled and they did what they wanted to do. What we did was to create awareness activities using community radios.” Programme Implementer #2, Senegal.
Discussion
Programmatic and research implications
-
Integrate economic empowerment initiatives and social safety net programmes targeting the vulnerable and poor in the society during and after the pandemic as part of journey towards recovery and resilience. Specifically, programmes should target communities that are likely to resort to harmful traditional practices such as CFM for economic benefits. This may include exploring cash transfers, food voucher payments, and tax reliefs that can build resilience and cushion families from the impact of COVID-19.
-
Support informal, online, and mobile platforms in reaching women and girls at risk of FGM/C and CFM. There is need to ensure that the online and mobile platforms are safe and accessible as not all women and girls have the privilege to access these platforms. The use of informal support such as friends or family with whom women and girls at risk or survivors may still be in contact with and who may be able to seek help on their behalf is crucial.
-
Put in place measures to ensure that legal and judicial officers, healthcare workers and programme implementers have access to all populations in need. There is need to ensure that COVID-19-related movement restrictions are sensitive to the different needs of vulnerable groups in the population such as women and girls at risk of FGM/C and CFM.
-
Enhance outreach efforts by using local champions, influential community or religious leaders and community healthcare workers. The focus should be on reinforcing behaviour change communication messaging on the consequences of harmful traditional practices, especially during the pandemic. The approach should ensure that the leadership role and agency of women and girls are visible, and their participation is fully embraced at all levels of community engagement.
-
Strengthen relevant government ministries and agencies to enforce instruments and protocols for preventing and ending FGM/C and CFM. This should include putting in place mechanisms to ensure that FGM/C and CFM incidences can be easily monitored and reported during COVID-19. It may also include increasing staff and utilising existing violence prevention and response hotlines and outreach centres.
-
Conduct research on gendered implications of public health emergencies such as COVID-19 and effectiveness of alternative approaches used during COVID-19. This will enable evidence generation on public health preparedness and response plans that can mitigate harm to women, girls, and other vulnerable groups. There is need to conduct research on the effectiveness of alternative approaches such as call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM during COVID-19.