Ghana

Kenya

Gambia

FGM is legal in Gambia where it is practiced by seven out of nine ethnic groups a rite of passage. 76% of women and girls in Gambia have undergone FGM. Marriage is legal from the age of 12 and, though it is illegal to have sex with anyone under the age of 16, an exception is made for marriage. More than 1 in 3 girls is married before the age of 18.

A three year project implemented by FORWARD and the Foundation for Research on Women’s Health, Productivity and the Environment (BAFROW, the Gambia) was successfully completed in March 1999.

The project was carried out in two districts of the Gambia, Banjul Kombo St Mary (an urban slum district) and the Lower River Division (a rural district) with the overall aim to reduce the incidence of FGM, increase health knowledge in the communities and to enhance gynaecological and sexual health services for women.

The project had four main components including the production of health education and advocacy material; community mobilisation and health promotion (including reproductive health and discussion of the harmful effects of FGM); restructuring puberty rites ceremonies and the promotion of gynaecological and sexual health counselling. The project also included training and alternative methods of income generation for excisors and training for professionals.

In the first year of the project women’s health promotion advocacy materials were produced, including T-shirts, posters and brochures. These were distributed throughout the participating villages. BAFROW also developed new health promotion materials. A handbook for professionals, a flip book for use by local community mobilisers and simple readers for use in schools and local communities were produced and distributed and are used by health workers and community mobilisers in their health sessions. These materials helped to change attitudes and raise awareness of the health issues surrounding FGM.

Emphasis has been placed upon training community mobilisers and ex-circumcisors to take on the task of health promotion and facilitation in their own communities.

A well woman clinic was opened in Banjul, which provides gynaecological and sexual health services. This is a crucial component in the programme.

The ‘Association of Ex-circumcisors for a Better Life’ was formed by those who agreed to stop the practice. The organisationwas active in the campaign against FGM and managed the loan scheme which encourages excisors to set up small income generating projects which are more financially beneficial then the practice of FGM.

BAFROW in association with FORWARD has provided training to different professional groups including community mobilisers, circumcisors and their assistants and village heads to enable them to fulfil their role in the campaign to eradicate FGM. They have also been given training on business management and skills.

This project was funded by the Department for International Development.

Liberia

Women played a pivotal role in ending Liberia’s devastating civil war, but many still bear the physical and psychological scars of battle. Over 250,000 people were killed during the conflict, which began in 1989 and continued to 2003, with just a brief pause between 1996 and 1999.

According to a 2005 World Health Organisation (WHO) report, up to 90 per cent of women suffered physical or sexual violence during this time. The country is slowly being rebuilt, but poverty, gender inequality and sexual violence limit the choices that girls and young women can make regarding their sexual and reproductive health.

There is no law against FGM in Liberia and 66% of women and girls have undergone the practice. The law does state that it is illegal to marry someone under the age of 18 but 38% of girls are married by the age of 18 nonetheless.

FORWARD worked with the Planned Parenthood Association of Liberia (PPAL) and the International Planned Parenthood Federation (IPPF) in the poorest areas of the capital, Monrovia from December 2009 to December 2010.

We trained a group of young girls in interview techniques, and carried out research into attitudes and experiences among girls at risk of childhood pregnancy. The issues raised will inform the development of programmes aimed at supporting girls to prevent unwanted pregnancy, access services and information and make informed decisions about their bodies, their future and their children.

Nigeria

Lack of education is both a result and cause of poverty in the northern region of Nigeria in which FORWARD carried out most of its work. Many poor families send young girls to work at an early age so that they can contribute financially to the household. Officially, marriage is illegal before the age of 18 but not all states have adopted this law and some areas allow marriage from the age of 12.

Some cultural beliefs suggest that women who have not undergone FGM are promiscuous and unclean. While the prevalence of FGM is 27% nationwide, it can be as high as 56.9% in some regions of Nigeria.

FORWARD worked in Nigeria between 1998 to 2010 to improve the service delivery for maternal and child health and to raise awareness about HIV/AIDS and other STIs in Northern Nigeria This programme was undertaken with our then sister organisation FORWARD-Nigeria and was funded by Big Lottery Fund (UK).

This innovative project aimed to strengthen the capacity of existing health workers and systems, including traditional birth attendants, by providing them with necessary training, facilities and equipment. Well Women and Children’s Centres (WWCCs) were set up in Kano and Jigawa states and where trained staff provided ante and post-natal care and general health services to women and children under five. WWCC staff activities include the provision of immunisations, anti-malarials and iron supplements as well as giving health talks to clients on a broad range of maternal and child health topics such as food preparation, nutrition in pregnancy and, sexual health and general child health.

Advocacy, networking and awareness-raising activities were carried out by project staff at both State and local government level as well as with traditional community leaders and local communities who gave their full support to the project. By building upon existing maternal and child health services rather than creating new ones, the project is more likely to achieve its goal of sustainable improvements in Maternal and Child Health.

As part of its advocacy and awareness-raising activities, the project has launched a media campaign using radio as an effective means of reaching the widest audience. Based on a survey conducted within target communities to ascertain a) the health problems affecting girls and women, b) the most suitable times for airing the programme (to ensure a wide audience, particularly of girls and women) and c) a suitable name for the programme, “Tsarabar Mata”, “A Gift for Women”, was a weekly Hausa discussion program, aired on Radio Freedom (99.5 FM), which explores a diverse range of sexual and reproductive health issues. A different topic is explored each week and listeners may participate in the discussion by sending in their questions and comments via text message, emails or post. The program was first aired on the 3rd March 2005 and has since become a popular and extremely valuable tool for information sharing and responding to the information needs of women and children.

The project also supported FORWARD’s ongoing campaign to prevent obstetric fistula among young women in Kano and Jigawa states. In addition to advocacy and awareness raising activities, two fistula centres (one in Kano and one in Jigawa) provided surgical repair and rehabilitation services to women suffering from obstrtric fistula.

Through experience, FORWARD has learned that the provision of surgical repair to fistula sufferers is not enough. A holistic approach, addressing issues of economic empowerment, education and rights, as well as reproductive health issues, is needed in order to ensure a long-lasting impact. This is why FORWARD works with local partners to provide vocational and literacy education, rehabilitation and emotional support services to fistula sufferers alongside the surgical repair.

 Sudan

In Sudan, now separated into Sudan and South Sudan, where FGM is often seen as a religious obligation, 9 out of 10 girls have undergone the practice. Often seen as a symbol of decency, dignity and fertility, FGM is closely linked to a girl’s prospects of marriage. Over one third of girls are married before the age of 18. The type of cutting prevalent in Sudan means that girls are repeatedly cut throughout their lives; first while undergoing FGM and again to allow them to give birth. The average Sudanese woman has four children.

Between 2005 and 2008, FORWARD worked in partnership with the Strategic Initiative for Women in the Horn of Africa (SIHA) to raise awareness about FGM.

FORWARD and SIHA used Moolaadé, an award-winning film about FGM and other forms of gender-based violence, as part of workshops for employees of civil society organisations across the country. A facilitation guide translated into Arabic ensured the programme achieved a wide impact and increased awareness of public health issues and the rights of women. SIHA continues to run various projects in the country, promoting women’s activism and economic rights, carrying out research and providing support to internally displaced people.