Ministry of Finance and Economic Development and UNICEF in Ethiopia PROGRESS IN ABANDONING FEMALE GENITAL MULTILATION / CUTTING AND CHILD MARRIAGE IN SELF-DECLARED WOREDAS Evaluation Report November 2012 The Federal Democratic Republic of Ethiopia Ministry of Finance and Economic Development Preface Harmful Traditional Practices (HTPs) refer to practices and cultures which affect the health and well-being of women. HTPs are widespread in Ethiopia with over 80 different kinds of HTPs practiced in different parts of the country (NCTPE, 1997). These practices have significant adverse impacts on the physical as well as mental health of the victims. This study focuses particularly on Female Genital Mutilation / Cutting. Figures show that in 2005 the national prevalence rate for FGM/C stood at 74.3 per cent (Health and Demographic Survey, 2005) with the highest prevalence being in Somali region at 97.3 per cent. It is practiced in both Muslim and Christian communities and is deeply embedded in the culture. Various forms are practiced including removing the tips of the clitoris, partial or total removal of the clitoris and labia and sewing together the two sides (infibulations) which is the severest type of FGM/C. As there are variations in the practice, the age at which FGM/C is practiced also different from region to region. In some regions it is practiced at infancy while in others it is practiced at the age of 6-9 and still in others it happens at the young age of 15-17 just prior to marriage. Cultural reasons, religion and societal pressure are used to justify the practice (MOFED, 2012). Other practices included in this study are child marriage, marriage by abduction and wife beating. The national average, in 2003, for marriage by abduction was 69 per cent (NCTPE, 2003) with the highest average being in SNNPR at 92 per cent. The prevalence of child marriage is highest in Afar region. Close to 80% of women in the Afar were married before reaching the age of 18. According to the report of a multi-country study by WHO1 the prevalence of physical and sexual violence against women by an intimate partner in Ethiopia stood at 71%. Of women in Ethiopia, 81% believe that their husband is justified to beat them (DHS 2005). Half of currently married women (49 per cent) know there is a law against a husband beating his wife. Many efforts have been made around the country to combat FGM/C and other HTPs. Efforts have included community conversations, school and health based programmes, legal actions, and religious dialogue and awareness raising. In the woredas on which this study focuses these have led to a declaration of the abandonment of FGM/C. This study looks at the effectiveness of these strategies and resultant declaration in the abandonment of the practice in the evaluation woredas and draws lessons to inform decision making for the scaling up of the scheme and the development of a National HTP plan. It also examines trends in the reduction of other HTPs such as child marriage, marriage by abduction, and wife beating and examines challenges in the abandonment of these HTPs. 1García-Moreno C., Jansen H., Ellsberg M., Heise L., and Watts C.WHO Multi-country Study on Women’s Health and Domestic Violence against Women (2005) Geneva: World Health Organization Acknowledgements This report, prepared by CDC (Center for Development Consulting) was made possible thanks to the significant contributions made by the various stakeholders in helping with the design and implementation of this study. More particularly the evaluators wish to thank UNICEF staff both in the main office in Addis Ababa and in the regions for their help and support. In addition, we wish to thank all those who participated in the study, namely the representatives of MOWCYA and the regional BOWCYAs, members of law enforcement organisations, including police, prosecutors, justice administrators and judges, health extension workers and staff of other health facilities who participated in the study, members of community protection mechanisms, woreda officials and religious and community leaders. Finally, we wish to thank all the men, women and teenage girls that participated in the study and were brave and open enough to answer questions and discuss with us on this sensitive issue. Contents Executive Summary ............................................................................................................................... i 1. Introduction/Background ....................................................................................................... 1 2. Objectives of the Evaluation .................................................................................................. 3 3. Methodology .......................................................................................................................... 4 3.1. Sampling frame and technique .......................................................................................... 4 3.1.1. Geographical scope of the study ................................................................................................. 4 3.1.2. Sample Design ............................................................................................................................. 4 3.1.3. Determination of Sample Design ................................................................................................ 4 3.1.4. Selection of Sample Clusters (EAs) .............................................................................................. 5 3.1.5. Selection of Households .............................................................................................................. 6 3.2. Data collection instruments ............................................................................................... 6 3.2.1. Desk Review ................................................................................................................................ 6 3.2.2. Quantitative Survey .................................................................................................................... 6 3.2.3. Qualitative Survey ....................................................................................................................... 6 3.2.3.1. In-Depth/KII Interviews ............................................................................................................... 7 3.2.3.2. FGDs ............................................................................................................................................ 7 3.3. Data management and Analysis ......................................................................................... 7 3.3.1.1. Recruitment ................................................................................................................................ 7 3.3.1.2. Training ....................................................................................................................................... 7 3.3.1.3. Pre-Testing .................................................................................................................................. 7 3.3.1.4. Data Analysis .............................................................................................................................. 8 3.4. Stakeholders ....................................................................................................................... 8 4. Evaluation Framework ......................................................................................................... 10 5. Programme Overview .......................................................................................................... 11 5.1. Strategy ............................................................................................................................. 11 5.2. Programme Description, Budget and Expenditure .......................................................... 13 5.2.1. Benshangul Gumuz (Guba woreda) .......................................................................................... 13 5.2.2. Afar ........................................................................................................................................... 17 5.2.3. Addis Ababa .............................................................................................................................. 21 5.2.4. SNNPR ....................................................................................................................................... 21 6. Findings ................................................................................................................................ 22 6.1. Respondents’ profile ............................................................................................................ 22 6.2. Female Genital Mutilation/Cutting ...................................................................................... 22 6.2.1. The evidence on the extent of FGM/C practice ......................................................................... 23 6.2.2. Effect of the declaration to abandon FGM/C ............................................................................ 25 6.2.3. Strategies utilized to work towards the abandonment of FGM/C ............................................ 29 6.2.4. Challenges that stand in the way of efforts geared towards the abandonment of FGM/C. .... 41 6.3. Child marriage ...................................................................................................................... 42 6.4. Abduction ............................................................................................................................. 46 6.5. Wife Beating ......................................................................................................................... 49 7. Conclusion ............................................................................................................................ 51 References .......................................................................................................................................... 53 Annex 1: Respondents’ by profiling variable ..................................................................................... 54 Annex 2: The sampled kebeles\EAs allocated using the PPS method to the specified woredas ...... 58 Annex 3: Budget and Expenditure for FGM/C for 2009 and 2010 in Guba Woreda ......................... 60 Annex 4: AWASH Fentale Budget and Expenditure on FGM/C (2008-2011) ..................................... 61 Annex 5: Amibara Budget and Expenditure on FGM/C (2008-2011) ................................................. 62 Annex 6: Gewane Budget and Expenditure on FGM/C (2008-2011) ................................................. 63 List of Tables Table 1: Sample size in the selected woredas .................................................................................. 4 Table 2: Methods of Data Collection (both quantitative and qualitative) ....................................... 9 Table 3: Sample size ....................................................................................................................... 22 Table 4: Women - Reason behind the perceived decline in the practice of FGM/C ..................... 27 Table 5: Teenagers - Reason behind the perceived decline in the practice of FGM/C .................. 28 Table 6: Summary of strategies and achievements for the 10 woredas ....................................... 35 Table 7: Reasons for wife beating in the eyes of men in percentage ............................................ 50 Figures Figure 1: Model of social convention theory ................................................................................. 12 Figure 2: Planned vs Expenditure Amount by Category of Expenditure........................................ 15 Figure 3: Proportion of Expenditure by Category .......................................................................... 16 Figure 4: Unit cost by Major Category of Activities ....................................................................... 16 Figure 5: Average unit cost by major categories of expenditure ................................................... 21 Figure 6: Women who say they have undergone FGM/C .............................................................. 24 Figure 7: Teenagers who say they have undergone FGM/C .......................................................... 24 Figure 8: Awareness about the declaration among women .......................................................... 25 Figure 9: Awareness about the declaration among teenagers ...................................................... 25 Figure 10: Trends in practice after the declaration (women) ........................................................ 26 Figure 11: Trends in practice after the declaration (teenagers) .................................................... 27 Figure 12: Future behaviour ........................................................................................................... 29 Figure 13: Prevalence of child marriage ......................................................................................... 43 Figure 14: Trends in the practice of child marriage in the last five years (women) ...................... 44 Figure 15: Trends in the practice of child marriage in the last five years (teenagers) .................. 44 Figure 16: Future practice .............................................................................................................. 45 Figure 17: Trends in the practice of abduction in the last five years (women) ............................. 47 Figure 18: Trends in the practice of abduction in the last five years (teenagers) ......................... 47 Figure 19: Personal experience among women ............................................................................. 49 Acronyms APDA Afar Pastoral Development Association BOWCYA Bureau of Women’s Children’s and Youth Affairs CEDAW Convention on the Elimination of all forms of Discrimination against Women DHS Demographic and Health Survey EA Enumeration Areas FGD Focus Group Discussion FGM/C Female Genital Mutilation / Cutting HH Household (s) HTP Harmful Traditional Practices KII Key Informant Interview MOFED Ministry of Finance and Economic Development MOWCYA Ministry of Women’s Children’s and Youth Affairs NGO Non Governmental Organisation PPS Probability proportional to size TOR Terms of Reference UNFPA United Nations Population und UNICEF United Nations Children’s Fund WHO World Health Organisation WYCA Women, Youth and Children Affairs Terminology Gott – Ethiopian administrative unit usually containing 60 – 90 households Law of Absuma – law by which a girl is considered ready for marriage as soon as she gets her menstruation Executive Summary The objective of the study is to evaluate the progress in abandoning FGM/C and child marriage in self- declared woredas of Ethiopia. More specifically, the assignment aims at providing evidence on the extent of FGM/C so as to validate the claims of abandonment of FGM/C in the woredas that have declared abandonment and to analyse strategies that have been successful so far to inform decision making for the up scaling of the programme. The evaluation covered pre-selected woredas which had declared abandonment of FGM/C practices before the commissioning of the study. These 10 woredas are found within the three regional states of Afar, Benishangul Gumuz and SNNPR and the capital city Addis Ababa. A set of quantitative and qualitative instruments were prepared and employed to collect data complemented by a thorough review of documentation. A total of 1275 households were covered in the 10 selected woredas. In each household, one adult man, one adult woman and one teenager were interviewed using a quantitative questionnaire. The following stakeholders were approached to conduct the evaluation; mothers and/or primary care givers of daughters who had undergone FGM/C, teenage girls, women above 19, men above 19, community leader/elders, religious leaders, woreda officials, members of law enforcement organs including the police, prosecutors and justice administrators and judges, MOWCYA officials and regional BOWCYA officials, UNICEF staff in Addis and in the regions where the evaluation woredas are located, members of community protection mechanisms, and health extension workers as well as staff of fixed health facilities. Different sets of indicators were employed for the evaluation. For establishing trends in the practice of the selected HTPs, the study utilized the following indicators: Knowledge, attitude and practice in regards to these forms of HTPs among the respondents; health related indicators including data and testimonials from health facilities and health workers and finally indicators related to the administration of the law and/or the declaration such as reporting to the police, cases by public prosecutors and similarly reports to other parts of the government machinery such as the Women, Children and Youth Affairs offices. Female Genital Mutilation/Cutting (FGM/C) The evidence on the extent of FGM/C practice – In order to find evidence on the extent of the FGM/C practice different sets of questions that would allow comparison between the prevalence of the practice in the past and the prevalence after the declaration of abandonment were put to the respondents. The declaration to abandon FGM/C is an important strategy that has been employed to reduce and eliminate the practice in the country. Community conversations were the main vehicle that was used to bring about the declaration. With the exception of Kolfe and Yeka where the percentage of women that have undergone FGM/C is comparatively low, the overwhelming majority of adult women, 90% on average, in all the woredas have undergone this practice. The picture is quite different when it comes to teenagers. Overall, the rate of FGM/C is much lower with close to 64% in Dale and Alaba and below 4% for Kolfe and Yeka. There appears to be a general decline in the practice across the sample areas with lesser rate of FGM/C among the younger generation. i Effect of the declaration to abandon FGM/C – In order to adequately assess the prevalence of the practice in the past and the prevalence after the declaration of abandonment, it is important to look into the level of awareness about the declaration, the trend in the practice after the declaration and intentions regarding future behaviour. Findings show that there is good level of awareness about the declaration to abandon FGM/C among adult women, with over 70% of the women claiming to be aware of the declaration in many of the woredas. Among teenagers, it is only in SNNPR that as much as 50-60% of the respondents reported knowledge about the declaration. The percentage is much lower in the other woredas with the lowest in Elidar at 12%. In all the woredas the survey results show a perceived decline in the practice after the declaration. There seems to be an awareness about the adverse health effects of FGM/C as a large number of female respondents (adults and teenagers) gave this as one of the reasons behind the perceived decline in the practice of FGM/C. Women and girls also seem to be informed that FGM/C is an HTP. Although survey results appear to indicate a perceived decline, the results of key informant interviews as well as focus group discussions for the majority of the woredas show that the practice appears to have gone underground. The future behaviour of respondents in regards to the practice of FGM/C is a strong indication of the impact of the declaration on the practice. The majority of the respondent women in all woredas stated that they do not intend to practice FGM/C on their daughters in the future. The highest percentage of those that claimed they would practice FGM/C on their daughters in the future are in Alaba, 31.5%, 30% in Elidar, 18% in Awash Fentale and 17% in Dale. Culture and religion are given as reasons for wanting to continue the practice in the future. Strategies utilized to work towards the abandonment of FGM/C - The strategies can be broadly categorized into the following approaches: - Efforts geared towards bringing about social change -These refer to activities that were carried out with the purpose of bringing about conversation on the harmful practice of FGM/C. The main instrument employed to bring about social change is the creation of sustained conversation on FGM/C complimented by teaching and/or awareness raising activities from the perspective of health, religion and legal awareness. In terms of actors and participants, the involvement of religious leaders and elders, health extension workers, and law enforcement officials in the actual teaching has contributed immensely to pass on the required message to the community. Utilizing existing community structures -Another strategy that has been widely employed in the woredas is the utilization of existing community structures to fight FGM/C. In most woredas, they are referred to as HTP Committees and are composed of religious leaders, representatives from the youth and women’s leaders as well as the kebele administration. As these people are members of the community and hence live within the community, they have been instrumental in detecting and reporting on underground practices of FGM/C. In Afar they form part of community police structures. Women’s associations and federation which have mass membership at community level are also indicated as another strategic entry point to reach the community both in terms of teaching and reporting on FGM/C cases. ii Health approach - The strategy employed in the various woredas in this regard has been using health extension workers extensively to teach on the adverse health impacts of FGM/C. This was done using different forums: Door to door teaching, community conversations and schools. Similarly, the provision of pre- and post-natal services including counselling, and registering newborn girls in the record books has been suggested as a strategy which serves as a follow-up mechanism to protect them. Religious approach– The religious approach involved using religious leaders to do different kinds of activities: Actual involvement in teaching about the harmful effects of FGM/C, teaching through interpreting the scripture and clarifying that religion doesn’t require that females undergo FGM/C, leading and enforcing the campaign of ostracizing those that break the promise (the declaration) including practitioners, giving their blessing and support to teaching by others like health workers and the police which gives credibility and weight in the eyes of the community and requiring practitioners to undertake an oath in front of religious leaders not to practice anymore. Law enforcement approach -The law enforcement approach in the various woredas employed both the formal legal system as well as the informal/traditional system of justice administration. A combination of the two led to successful results in some woredas. Political commitment and coordination among various stakeholders - It has been emphasized repeatedly among key informants in the various woredas that there is a need for strong political commitment and leadership to fight FGM/C. According to these stakeholders commitment can be expressed in terms of allocating adequate budget; laying out structures that will enable all sections of society to be reached; putting police officers in each kebele; educating the practitioners, training them in other skills and facilitating them to find other forms of income generation; leaders serving as role models by not engaging in the practice of FGM/C and/or by pioneering not to practice FGM/C. Another element to consider in relation to leadership is the need for strong coordination of the activities of various stakeholders that are engaged in the fight against FGM/C including various government sectors, non-governmental organizations and community based organizations. School centered approach - The results of this study have shown school children have an important role to play in the fight against FGM/C. Recognizing that, schools in the various woredas have implemented different strategies to empower school children. These include: Establishing and strengthening girls clubs, empowering female teachers so that when reports/rumours of plans of FGM/C are heard reports are made to the relevant authorities; teaching at schools and provision of cell phones for purposes of contacting responsible people if and when FGM/C about is to take place and using school clubs that have both boys and girls as members (this has contributed significantly because school children have managed to intervene when their younger siblings and/or neighbours’ children were about to undergo FGM/C). Challenges that stand in the way of efforts geared towards the abandonment of FGM/C – The key informant interview and focus group discussion results indicated the following as the major challenges that stand in the way of the fight against FGM/C: i) Interference in law enforcement where the legal process aimed at the prevention and punishment of the perpetrators of the practice of FGM/C is affected by the intervention of elders and religious leaders through the traditional system of settling disputes; ii) weak commitment towards the fight against FGM/C; iii) weak enforcement of the law; and iv) deep rooted culture and religious beliefs. iii Child marriage - The prevalence of child marriage is high in Afar region. It is also practiced in SNNPR and Guba where over 30% of women were married at an early age. A large proportion of the respondents in all the woredas except those in Afar reported a decline in the practice of child marriage in the last five years. The picture is similar among teenagers. In analyzing the reasons behind the perceived decline (where such has been reported), the respondents in both categories have attributed the decline to: awareness raising interventions, increased awareness that it is a harmful traditional practice and increase in reporting to justice administration bodies. The majority of the women respondents reported that they do not intend to marry off their daughters prior to attaining the age of marriage. The strategies discussed under FGM/C also apply to child marriage. Sending more and more girls to school and encouraging them to stay at school helps to delay marriage for girls. In this regard schools play an important role. Similarly, awareness raising efforts on the value of educating the girl child are also important. The legal approach has also worked well in the study areas where a decline in the practice has been observed. Abduction - The overwhelming majority of the respondents in SNNPR and Benishangul reported a perceived decline in the practice of abduction. In Addis 29% perceived a decline while a mere 4% of the respondents reported a perceived decline in Afar. Among the teenage correspondents, 81.4% of teenage girls in SNNPR, 47.2% in Benishangul, 10.25% in Addis and 2% in Afar perceived a decline. The reasons behind the perceived decline (where such has been reported) were attributed to: Awareness raising interventions, increased awareness that it is a harmful traditional practice and an increase in the reporting of the practice to justice administration bodies. Compared to the other forms of HTPs in this study, the practice of abduction appears to have shown a significant decline. The main strategy that appears to have worked is the legal approach. The criminalization of abduction is taken much more seriously than the criminalization of other forms of HTPs. Wife Beating - Personal experience among the respondent women in regards wife beating shows that 30.2% have experienced wife beating in their lifetime. Reasons for wife beating as explained by the respondent women are: Refusing sex, disobeying their husband, food burning and simply due to culture. Any intervention targeted at wife beating has to bring men on board. One mentionable strategy from the results of key informant interviews and focus group discussions is the legal approach. There was an awareness that wife beating is a crime among the women and men that took part in the study. Further, women are beginning to bring their complaints to the authorities mainly the Women’s Affairs Offices. Overall, findings have highlighted strategies that have proven to be efficient in fighting FGM/C. Although it is probably too early to ascertain a decline in the practice of FGM/C, there are, to some extent, encouraging results in terms of awareness creation and behavioral change. A more thorough monitoring and assessment is required to follow-up on the progress made towards fighting FGM/C. The encouraging results identified through this study will last only if there is a concerted effort and strong commitment from all stakeholders and if strategies that work are implemented on a sustained and regular basis with a wider coverage, particularly in remote areas. This also applies for the three other forms of HTPs. iv