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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 . Navrongo Health Research Centre, Kassena-Nankana District. Context of the Trial. More common in the north Rapid social change
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The Navrongo FGC Trial: Impact and Lessons Learned Reshma Naik, MPH 4th International Day of Zero Tolerance for Female Genital Cutting February 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 Livelihood & Development Y N Y Problem-focused: FGC Education 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
FGC Education 93% reduction in the hazard of FGC Combined Approach 94% reduction in the hazard of FGC What Worked?
Interpreting the Results • Common Factor • Synergy • Ongoing Social Change
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