By H. Ball
Knowledge of female genital cutting and its adverse consequences increased, and adherence to the practice declined, after implementation of an educational program aimed at empowering women and promoting health in southern Senegal.1 In intervention villages, the proportion of women who approved of female genital cutting declined from 72% at baseline to 16% among program participants, whereas a much smaller decline occurred in comparison areas (from 89% to 60%). Moreover, the proportion of daughters aged 5–10 who had not been cut increased from 21% to 49% among program participants, but did not change in comparison areas.
The program, developed by the Senegalese nongovernmental organization Tostan, consisted of three two-hour classes per week for six months; it discussed the negative aspects of female genital cutting as part of a broader curriculum that covered human rights, women's health and basic hygiene. In each village, roughly 30 women and up to 10 men took part; to facilitate dissemination of the material, participants were encouraged to regularly share the information they learned with a close friend or relative.
The researchers evaluated the intervention using a quasi-experimental, longitudinal approach, conducting surveys at baseline (December 2000), in the postintervention period (January 2002) and at endline (January 2003). Twenty villages were randomly selected to represent the 90 villages participating in the program and were surveyed at all three timepoints. Twenty villages that did not participate in the intervention and that were distant enough from the participating villages to have not been "contaminated" by the intervention were selected to serve as a comparison group; these villages, which were similar to the intervention villages in population size and ethnic makeup, were surveyed at baseline and endline.
At baseline, the researchers surveyed 576 women and 373 men from the intervention area. Because of attrition, and because some of the individuals surveyed at baseline did not actually attend any classes, the researchers were able to interview only 333–350 female program participants and 82–85 male participants (approximately 17 women and 4 men per village) at the two follow-up surveys, as well as roughly 200 nonparticipating women and 200 nonparticipating men from the same villages. Finally, they surveyed approximately 200 women and 200 men from the comparison villages at baseline and endline.
Most study participants in both the intervention and comparison groups were Muslim, married and from the Pulaar ethnic group. Some 97–100% of women reported having experienced genital cutting. At baseline, women in the intervention group were less likely than those in the comparison group to report that their daughters aged five and older had been cut. (In Senegal, genital cutting is typically performed around age 4.)
The proportion of women reporting that they had received information from any source about female genital cutting rose among all groups between baseline and endline, though the increase was greater among residents of intervention villages than among those of the comparison area; 87% of program participants and one-quarter of nonparticipants in the same villages identified Tostan as their main source for this information. No increases were apparent in the proportion of men who had received information about female genital cutting. However, the proportion of program participants who knew at least two consequences of genital cutting increased among program participants of both genders (from 7% to 83% among women and from 11% to 80% among men). Roughly half of nonparticipants in the intervention villages were able to cite at least two consequences, perhaps because of information sharing: At endline, 92% of female program participants had shared information about cutting with nonparticipants, and more than 90% had participated in a public discussion of the issue after the program's end.
The proportion of respondents who supported female genital cutting declined among all groups, but the decreases were greater among residents of intervention villages, and especially among program participants, than among residents of comparison villages. Among women, approval of the practice dropped from 72% in intervention villages at baseline to 16% among program participants and 28% among nonparticipants; among women in the comparison area, the proportion declined from 89% to 60%. The vast majority (85%) of female program participants who disapproved of female genital cutting at endline attributed their attitude to their participation in the Tostan program. In intervention villages, 70% of women initially believed female genital cutting to be a social necessity; by endline, this proportion had declined to 15% among program participants and to 29% among nonparticipants.
In the comparison group, the decrease was again much smaller: Eight-eight percent of women espoused this belief at baseline and 61% did so at endline. Similarly, the proportion of women who reported that they intended to have their daughters cut declined from 71% in intervention villages to 12% among participants and 23% among nonparticipants, and from 89% to 54% among women in the comparison group. Among men, intentions to have their daughters cut in the future declined more among program participants than among their peers in comparison villages; at endline, men's preference for women who had been cut was lower and their willingness to help end the practice was greater among program participants than among men in comparison villages.
Finally, the prevalence of female genital cutting declined significantly in intervention villages. For example, the proportion of girls aged 0–4 who had not been cut increased from 68% at baseline in the intervention area to 78% among program participants and 83% among nonparticipants in the same villages. The proportion aged 5–10 who had not been cut increased from 21% to 49% and 44%, respectively. No such changes occurred in comparison villages.
The researchers conclude that the Tostan program changed attitudes about female genital cutting and helped reduce the practice in participating villages. Further, the findings suggest that the effectiveness of the program was magnified through successful dissemination of information through social networks in intervention villages. In fact, according to the researchers, the attitudinal and behavioral changes achieved as a result of the program contributed to a mass public declaration against female genital cutting in 2002. They posit that "education, when appropriately organized and presented within a wider process of social mobilization, can be a powerful and effective means for facilitating rapid change in long-standing harmful traditional behaviors."—H. Ball