Department of Monitoring Evaluation and Research, Amref Health Africa in Kenya, Nairobi, Kenya.
Directorate of Research and Learning, TradeMark East Africa, Nairobi, Kenya.
PLoS One. 2021 Apr 28;16(4):e0249662. doi: 10.1371/journal.pone.0249662. eCollection 2021.
In Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention-community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls and b) explored the attitude, perception and practices of community stakeholders towards FGM/C.
We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008-2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C.
The CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p<0.10), 4.9% (p<0.01) and 6.3% (p<0.01) respectively. 2) increase in girls schooling years by 2.5 years (p<0.05). Perceived CLARP benefits to girls included: reduction in teenage marriages and childbirth; increased school retention and completion; teenage pregnancies reduction and decline in FGM/C prevalence. Community stakeholders in Kajiado believe that CLARP has been embraced in the community because of its impacts in the lives of its beneficiaries and their families.
This study demonstrated that CLARP has been positively received by the Maasai community and has played a significant role in attenuating FGM/C, CEFM and TP in Kajiado, while contributing to increasing girls' schooling years. CLARP is replicable as it is currently being implemented in Tanzania. We recommend scaling it up for adoption by stakeholders implementing in other counties that practice FGM/C as a rite of passage in Kenya and across other sub Saharan Africa countries.
在肯尼亚，女性生殖器切割/切割（FGM/C）在某些社区如马赛和索马里非常普遍。为了减少马赛社区的 FGM/C 发生率，非洲健康行动组织（Amref Health Africa）自 2009 年以来在肯尼亚的卡贾多县设计并实施了一种新的干预措施——社区主导的替代成年礼（CLARP）。该研究：a）确定了 CLARP 模式对 FGM/C、儿童早婚和强迫婚姻（CEFM）、少女怀孕（TP）以及女孩受教育年限的影响；b）探讨了社区利益相关者对 FGM/C 的态度、看法和做法。
我们采用了混合方法。采用差异法来量化该模式的平均影响，以卡贾多县为干预县，以曼德拉、马萨比特和瓦吉尔县为对照县。该方法依赖于对肯尼亚人口与健康调查（KDHS）2003、2008-2009 和 2014 年的二次数据分析。采用焦点小组讨论、深入访谈和关键知情人访谈等定性方法，记录了社区利益相关者对 FGM/C 的经验、态度和做法。
CLARP 有助于：1）FGM/C 发生率、CEFM 率和少女怀孕率分别下降 24.2%（p<0.10）、4.9%（p<0.01）和 6.3%（p<0.01）。2）女孩受教育年限增加 2.5 年（p<0.05）。社区利益相关者认为 CLARP 对女孩的好处包括：减少少女婚姻和分娩；提高学校保留率和完成率；减少少女怀孕率和 FGM/C 发生率。卡贾多的社区利益相关者认为，CLARP 之所以在社区中得到接受，是因为它对受益者及其家庭的生活产生了影响。
这项研究表明，CLARP 受到了马赛社区的积极欢迎，并在卡贾多地区减少 FGM/C、CEFM 和 TP 方面发挥了重要作用，同时也有助于增加女孩的受教育年限。CLARP 是可复制的，因为它目前正在坦桑尼亚实施。我们建议将其推广，供在肯尼亚和其他撒哈拉以南非洲国家实施 FGM/C 作为成年礼的县的利益相关者采用。
