Background characteristics of respondents
Table 1 summarizes key sociodemographic characteristics of respondents who participated in the household survey in the four countries. There were more women sampled than men with majority of respondents residing in rural areas. In Kenya and Ethiopia, majority of respondents were aged between 26 to 35 years, while in Uganda and Senegal, the majority were aged between 15 to 18 years. Apart from Uganda where most of the respondents had incomplete secondary education, most of the respondents in the other three countries had no education. Across all the countries, most of the respondents were married.
Table 1
Characteristics of respondents in the community survey
Characteristics
|
Kenya
|
Uganda
|
Ethiopia
|
Senegal
|
n = 378
|
%
|
n = 278
|
%
|
n = 251
|
%
|
n = 208
|
%
|
Gender
|
Male
|
65
|
20.8
|
52
|
18.7
|
49
|
19.5
|
59
|
28.4
|
Female
|
247
|
79.2
|
226
|
81.3
|
202
|
80.5
|
149
|
71.6
|
Location of respondent
|
Urban area
|
12
|
3.8
|
0
|
0.0
|
7
|
2.8
|
93
|
44.7
|
Rural setting
|
300
|
96.2
|
278
|
100.0
|
244
|
97.2
|
115
|
55.3
|
Age of respondent (years)
|
15–18
|
70
|
22.4
|
143
|
51.4
|
56
|
37.6
|
55
|
36.9
|
19–25
|
54
|
17.3
|
35
|
12.6
|
68
|
45.6
|
46
|
30.9
|
26–35
|
108
|
34.6
|
32
|
11.5
|
78
|
52.3
|
49
|
32.9
|
36–45
|
54
|
17.3
|
46
|
16.5
|
41
|
27.5
|
46
|
30.9
|
Above 45
|
26
|
8.3
|
22
|
7.9
|
8
|
5.4
|
12
|
8.1
|
Level of education
|
No education
|
162
|
51.9
|
74
|
26.6
|
173
|
68.9
|
68
|
32.7
|
Completed primary education
|
43
|
13.8
|
84
|
30.2
|
29
|
11.6
|
20
|
9.6
|
Incomplete secondary education
|
92
|
29.5
|
108
|
38.8
|
44
|
17.5
|
63
|
30.3
|
Completed secondary and/or higher education
|
15
|
4.8
|
12
|
4.3
|
5
|
2.0
|
57
|
27.4
|
Marital status
|
Married
|
196
|
62.8
|
175
|
62.9
|
178
|
70.9
|
120
|
57.7
|
Separated
|
8
|
2.6
|
4
|
1.4
|
0
|
0.0
|
0
|
0.0
|
Divorced
|
6
|
1.9
|
1
|
0.4
|
8
|
3.2
|
1
|
0.5
|
Widowed
|
13
|
4.2
|
0
|
0.0
|
11
|
4.4
|
2
|
1.0
|
Single
|
89
|
28.5
|
98
|
35.3
|
54
|
21.5
|
85
|
40.9
|
Total
|
312
|
|
278
|
100.0
|
251
|
100.0
|
208
|
100.0
|
Fgm/c And Cefm Cases Before And During Covid-19
In Kenya, before COVID-19, majority of the respondents reported that cases of FGM/C and CEFM were decreasing in Kajiado, Samburu and Marsabit counties (p < 0.001). In contrast, during COVID-19, most of the study respondents believed that the pandemic had led to an increase in both FGM/C and CEFM cases (p < 0.001) (Table 2). The most common reason given for the increasing number of FGM/C cases was closure of schools (50%), people staying at home for longer including potential victims (25%) and economic losses (39%). Policy makers and implementers alike noted that the increase was likely to be associated with lack of protection given that schools were safe spaces for the girls.
Table 2
Perceived status of FGM/C and CEFM cases before and during COVID-19
% of respondents reporting that FGM/C cases before COVID-19 were:
|
Kenya
|
Uganda
|
Ethiopia
|
Senegal
|
n = 312
|
%
|
P-Value
|
n = 278
|
%
|
P-Value
|
n = 251
|
%
|
P-Value
|
n = 208
|
%
|
P-Value
|
Same as now
|
49
|
15.7
|
< 0.001
|
1
|
0.4
|
0.216
|
150
|
59.8
|
0.837
|
13
|
6.3
|
0.22
|
Decreasing
|
196
|
62.8
|
257
|
92.4
|
69
|
27.5
|
138
|
66.3
|
Increasing
|
48
|
15.4
|
14
|
5.0
|
32
|
12.7
|
22
|
10.6
|
Don't know/ No response
|
19
|
6.1
|
6
|
2.2
|
0
|
0.0
|
35
|
16.8
|
% of respondents reporting that FGM/ cases during COVID-19 were:
|
n = 312
|
%
|
|
n = 278
|
%
|
|
n = 251
|
%
|
|
n = 208
|
%
|
|
Same as now
|
51
|
16.3
|
< 0.001
|
30
|
10.8
|
0.062
|
204
|
81.3
|
0.126
|
22
|
10.6
|
0.592
|
Decreasing
|
81
|
26.0
|
228
|
82.0
|
46
|
18.3
|
134
|
64.4
|
Increasing
|
171
|
54.8
|
19
|
6.8
|
1
|
0.4
|
5
|
2.4
|
Don't know/ No response
|
9
|
2.9
|
1
|
0.4
|
0
|
0.0
|
47
|
22.6
|
% Reporting that CEFM cases before COVID-19 were:
|
n = 312
|
%
|
|
n = 278
|
%
|
|
n = 251
|
%
|
|
n = 208
|
%
|
|
Same as now
|
42
|
13.5
|
< 0.001
|
3
|
1.1
|
< 0.001
|
124
|
49.4
|
0.655
|
17
|
8.2
|
0.423
|
Decreasing
|
193
|
61.9
|
234
|
84.2
|
75
|
29.9
|
129
|
62.0
|
Increasing
|
67
|
21.5
|
40
|
14.4
|
52
|
20.7
|
27
|
13.0
|
Don't know/ No response
|
10
|
3.2
|
1
|
0.4
|
0
|
0.0
|
35
|
16.8
|
% Reporting that CEFM cases during COVID-19 were:
|
n = 312
|
%
|
|
n = 278
|
%
|
|
n = 251
|
%
|
|
n = 208
|
%
|
|
Same as now
|
45
|
14.4
|
< 0.001
|
10
|
3.6
|
0.111
|
175
|
69.7
|
0.712
|
26
|
12.5
|
0.732
|
Decreasing
|
66
|
21.2
|
74
|
26.6
|
60
|
23.9
|
124
|
59.6
|
Increasing
|
198
|
63.5
|
193
|
69.4
|
16
|
6.4
|
27
|
13.0
|
Don't know/ No response
|
3
|
1.0
|
1
|
0.4
|
0
|
0.0
|
31
|
14.9
|
“Lack of enforcement and protection, especially those from the boarding schools now, as well as the rescue centres. Since girls are at home, the protection is no more. They are out there, there is no monitoring…they have ample time to practise FGM and child marriage” KII_KEN 01.
Similarly, the increase was likely to be perpetuated by stigma that is associated with teenage pregnancy leading to CEFM as exemplified in the following quote:
“From the cases that I know, you hear a girl has been married off and then you hear that she was already pregnant. So, it is like the marriage was to avoid the stigma. In our community when a girl gives birth and she is not married then you have that kind of stigma that you are a bad girl, you do not have discipline. So, I think to avoid the stigma that comes with having a baby without a husband, then the moment a girl is pregnant they are married off”. KII_KEN 03
In Uganda, before the pandemic, majority of the respondents reported that cases of FGM/C (p < 0.216) and CEFM (p < 0.062) were decreasing. During COVID-19, there was a slight increase in the proportion of community members who believed that the pandemic had led to a slight increase in FGM/C cases (from 5–7%) and a substantial increase in CEFM cases (from 14–69%). The common reason given for the increasing number of FGM/C cases was people staying at home for longer including potential victims (50%); while loss of income (59%) was the most common reason given for perceived increase in CEFM cases during COVID-19.
Key informants were ambivalent on FGM/C status with some respondents being of the view that cases had increased and were being performed in secret while others believed the cases had not increased as the season for cutting (December holidays) had not yet reached as exemplified in the following quotes.
“It is increasing, the early marriage compared to the FGM as the law is in place and a few people tend to escape and cut themselves in the bushes. As much as they have tried always to bring in the interventions, but they are still doing it [FGM/C] but not openly. The early marriages are common because the girl child is not going to school. KII_UG 01.
“Beware that this is the circumcision year and we have not come to the end of the year more so to the climax because it is mostly in December… We do not know what is going to happen between now and December because since the year begun, I have not come across a girl who has been cut, or any women who has been mutilated. KII_ UG 02
The theme of protective effect of schools and the complex interaction of poverty and these practices was evident from discussions as some noted:
“Initially when children were going to school, they had no time but being at home they are idle, and I believe that is one of the key reasons. I believe when children are at school these cases of early pregnancies can be minimized. KII_UG 04
“Because of COVID-19, there was a lot of poverty because people were locked down. So, when someone gets into such a problem, they would want to go and negotiate [for bride price] because they know at the end of it, they will get something [money]. Which also forces some of them to marry off their daughters early. KII_UG 01
In Ethiopia, majority of the respondents were of the view that there were no changes in cases of FGM/C (p < 0.837) and CEFM (p < 0.655) before COVID-19. The situation was the same during COVID-19 with most of the study respondents believing that the number of FGM/C (p < 0.126) and CEFM (p < 0.712) cases had not changed. These community level findings appear to contradict results from policymakers and programme implementers who believed that there was an increase in cases of CEFM due to closure of schools but were uncertain about changes in FGM/C cases. A policymaker reported that the steering committee responsible for children and gender issues had reviewed local data on reported cases of CEFM and FGM/C and noted an increase in CEFM cases but not in FGM/C cases.
“Reports on CEFM are coming from police officers, health extension workers, health development army but FGM/C cases are not that much as compared to CEFM. We have reviewed the report with the steering committee from police office, health, judiciary, education, and other offices including NGO’s and FBO…we received more cases of child marriage. KII_ETH 01.
Nonetheless, other key informants noted that FGM/C was practised discreetly, and stakeholders have shifted their focus on COVID-19 more than FGM/C and CEFM and therefore it may be difficult to report such cases. COVID-19 containment measures including restriction of movement could also have affected reporting from the community and key government agencies as explained in the following excerpt:
“After Covid cases were identified in our country, it was very difficult to support and sensitize communities by going house to house. People are focusing on COVID-19 than FGM and CEFM. As a result, we might have missed information about CEFM and FGM. Since communities’ movement was restricted by Covid, police officers might not receive report from health extension workers, and health development army on what is happening in communities. KII_ETH 02
For those who believed the number of CEFM cases were increasing during the pandemic, the most common reason given was people staying at home for longer including potential victims (80%). Qualitative interviews highlighted other reasons that could explain the observed trends in CEFM and FGM/C during COVID-19 such as difficulty in monitoring FGM/C and CEFM during the pandemic which was a hindrance in acquiring accurate statistics.
“Restricted movement during Covid could have facilitated increase in FGM/C and CEFM. However, during that time [COVID-19], people are focusing on COVID-19, and this leads to lack of information about CEFM and FGM. Since community movement is restricted by Covid, police officers might not receive report from health extension workers, and the health development army on what is happening in communities. Therefore, we are missing cases that should have been reported. KII_ETH 02.
In Senegal, there were minimal differences in respondents’ views on whether the number of FGM/C and CEFM cases had changed because of COVID-19. Before COVID-19, majority of the respondents were of the view that cases of FGM/C (p < 0.220) and CEFM (p < 0.423) were decreasing. Survey respondents were of the view that the number of FGM/C cases were increasing, the most common reason given was people staying at home for longer including potential victims (60%). With regards to CEFM, the most common reason given for increasing cases was reduced efforts in programmes supporting potential victims (26%).
Programme implementers and policymakers observed that there was an increase in the number of FGM/C and CEFM cases due to the COVID-19 restrictions. They were of the view that due to the implementation of COVID-19 prevention guidelines; perpetrators of FGM/C were conducting the practice in secret. They also felt that due to closure of schools, girls were more at risk of getting pregnant which would lead to CEFM as captured in the following excerpts.
“COVID-19 has blocked all ongoing activities and slowed progress in achieving results. This in return has led to a resurgence of the practice [FGM/C] … Cutters can excise without people knowing because the practice is done at a very young age; even before the first birthday. This is not controlled because of the COVID-19 restrictions. KII_SEN 01
“Schools have been closed and there is fear that daughters might become pregnant and then get married. Therefore, during this pandemic, there has been a lot of marriages of girls under 18 years of age. KII_SEN 02
There was also the perception that resources were focussed on COVID-19 at the expense of CEFM and FGM/C, and therefore a resurgence in these harmful practices. Other reasons mentioned included lack of monitoring mechanisms that would allow tracking and reporting of FGM/C and CEFM cases.
“Covid has slowed down the efforts that were being made in the prevention of FGM. Covid has hindered awareness raising activities. Evidently, if there are no more awareness-raising activities, people tend to go back to their beliefs…they practise FGM. KII_SEN 03
“Everyone has focused on the pandemic and so FGM/C and CEFM issues have either stalled or been relegated to the back burner… Certainly, the number of cases of FGM/C and CEFM have increased because the situation was favourable to this. KII_SEN 01
Adequacy of the justice and legal system in addressing FGM/C and CEFM
Survey respondents were asked to rate the response of the justice and legal system in addressing FGM/C and CEFM during the COVID-19 pandemic (Table 3). In Kenya, findings showed that over 60% of community members considered the justice and legal system’s response to FGM/C and CEFM cases to be either poor or average. The main barrier to the justice and legal system to respond effectively during the pandemic was inadequate reporting by victims (46%) or challenges of accessing victims due to restrictions and fear of lack of services being offered.
Table 3
Legal system's response in addressing FGM/C and CEFM during COVID-19
|
Kenya
|
Uganda
|
Ethiopia
|
Senegal
|
n = 312
|
%
|
P-Value
|
n = 278
|
%
|
P-Value
|
n = 251
|
%
|
P-Value
|
n = 208
|
%
|
P-Value
|
Response of the legal system on FGM/C during COVID-19
|
Poor
|
87
|
27.9
|
< 0.001
|
63
|
22.7
|
0.003
|
9
|
3.6
|
0.684
|
61
|
36.7
|
0.794
|
Average
|
124
|
39.7
|
72
|
25.9
|
4
|
1.6
|
56
|
33.7
|
Good
|
86
|
27.6
|
143
|
51.4
|
236
|
94.8
|
49
|
29.5
|
Excellent
|
13
|
4.2
|
0
|
0.0
|
0
|
0.0
|
0
|
0.0
|
Don't know
|
2
|
0.6
|
0
|
0.0
|
0
|
0.0
|
0
|
0.0
|
Response of the legal system on CEFM during COVID-19
|
Poor
|
86
|
27.6
|
< 0.001
|
66
|
23.7
|
0.133
|
9
|
3.7
|
0.089
|
63
|
33.9
|
0.942
|
Average
|
126
|
40.4
|
64
|
23
|
14
|
5.7
|
57
|
30.6
|
Good
|
82
|
26.3
|
148
|
53.2
|
223
|
90.7
|
66
|
35.5
|
Excellent
|
16
|
5.1
|
0
|
0.0
|
0
|
0.0
|
0
|
0.0
|
Don't know
|
2
|
0.6
|
0
|
0.0
|
0
|
0.0
|
0
|
0.0
|
In Uganda, community members’ opinions were divided with slightly over half of the respondents being of the view that the justice and legal system’s response to FGM/C and CEFM was good, while slightly less than half believing that it is response to FGM/C and CEFM was either poor or average. The main barrier to the justice and legal system to respond effectively during the pandemic was inadequate reporting by victims (40%) and challenges of accessing victims due to restrictions (28%) and fear of lack of services being offered (10%).
Qualitative data indicated that the challenges facing legal and judicial system during COVID-19, include restricted movement which made it impossible to conduct court sessions, lack of reporting from community members and corruption within the police:
“When you look at the judicial system, when COVID-19 came or when we went into this period [lockdown], some activities like court hearing were limited, and in some places, there were no staff, we did not have public transport… Now it means that people who were to attend court, the people who were to get justice from court could not access it. KII_UG 03
“When you look at the police…they have been moving around but, you know police they deal with issues that have been reported, so under COVID-19, you find that many issues were not reported because community members are afraid. The police are also compromised at the community level… the police do not have the guts to reach out to them unless they get the reports. KII_UG 02
In Ethiopia, over 90% of community members considered the justice and legal system’s response to FGM/C and CEFM to be good while less than 10%, believed that the justice and legal system’s response to FGM/C and CEFM was either average or poor. The main barrier to the justice and legal system to respond effectively during the pandemic was inadequate reporting by victims (41%), fear of lack of services being offered (21%) and challenges of accessing victims due to restrictions (8%). Policymakers and programme implementers detailed how the justice and legal system had rolled out strategies in dealing with FGM/C and CEFM during COVDID-19:
“At this point, the government has strong commitment to support girls not to undergo CEFM and FGM/C. The administration office is really helping…it has established steering committee from women, youth and child office, health, education, and police to review and make decisions if any cases or issues are identified. So at least, I can say the government is putting a lot of effort to see FGM/C and CEFM are not totally practised in our zones… So, the police officer gets information from the community and checks in person for validation of the information to start the legal procedures. KII_ETH 02.
In Senegal, over 60% of community members considered the justice and legal system’s response to FGM/C and CEFM cases to be either poor or average. The main barrier to the justice and legal system to respond effectively during the pandemic was inadequate reporting by victims (40%), fear of lack of services being offered (26%) and challenges of accessing victims due to restrictions (16%). Qualitative interviews showed a focus by the government to contain the spread of COVID-19 through introduction of curfews with limited strategy on prevention or response to FGM/C and CEFM.
Adequacy of the health system in addressing FGM/C and CEFM
To assess the adequacy of the health system in addressing FGM/C, community members were asked to compare services that were offered by the health system before and during COVID-19 (Table 4). Respondents were also asked to rate the health system’s response. In Kenya, there were perceived difference in services offered before COVID-19 and during the pandemic. For example, before COVID-19, services provided for FGM/C cases included psychological and sexual counselling (52%), rescue (45%) and reintegration back to the community (23%). During COVID-19, there was an increase in psychological and sexual counselling (69%), a reduction in rescue (18%) and reintegration back to the community services (7%), and a remarkable increase in no services offered from 15% (before COVID-19) to 49% (during COVID-19).
Table 4
Health systems and provider’s response to FGM/C cases before and during COVID-19
|
Kenya
|
Uganda
|
Ethiopia
|
Senegal
|
n = 312
|
%
|
P-Value
|
n = 278
|
%
|
P-Value
|
n = 251
|
%
|
P-Value
|
n = 208
|
%
|
P-Value
|
Services provided for FGM/C cases before COVID-19
|
Psychological and sexual counselling
|
163
|
52.2
|
< 0.001
|
247
|
88.8
|
0.282
|
238
|
94
|
0.74
|
107
|
51.4
|
0.235
|
De-infibulation
|
7
|
2.2
|
0.011
|
1
|
0.4
|
0.631
|
0
|
0.0
|
|
7
|
3.4
|
0.407
|
Clitoral reconstruction
|
1
|
0.3
|
0.340
|
1
|
0.4
|
0.631
|
0
|
0.0
|
|
4
|
1.9
|
0.348
|
No services
|
48
|
15.4
|
< 0.001
|
15
|
5.4
|
0.004
|
43
|
17.1
|
0.798
|
0
|
0.0
|
|
Rescue
|
139
|
44.6
|
< 0.001
|
89
|
32.0
|
0.587
|
0
|
0.0
|
|
7
|
3.4
|
0.617
|
Reintegration back to the community
|
71
|
22.8
|
< 0.001
|
2
|
0.7
|
0.003
|
50
|
19.9
|
0.923
|
13
|
6.3
|
0.73
|
Don't know/No response
|
14
|
4.5
|
0.026
|
1
|
0.4
|
0.631
|
2
|
0.8
|
0.484
|
12
|
5.8
|
0.631
|
Other
|
0
|
0.0
|
|
2
|
0.7
|
0.255
|
0
|
0.0
|
|
1
|
0.5
|
0.521
|
Services provided for FGM/C cases during Covid-19
|
Psychological and sexual counselling
|
115
|
69.3
|
< 0.001
|
232
|
93.5
|
0.032
|
103
|
41.0
|
0.976
|
117
|
56.3
|
0.713
|
De-infibulation
|
24
|
14.5
|
< 0.001
|
1
|
0.4
|
0.642
|
21
|
8.4
|
0.973
|
11
|
5.3
|
0.196
|
Clitoral reconstruction
|
21
|
12.7
|
< 0.001
|
1
|
0.4
|
0.642
|
21
|
8.4
|
0.973
|
10
|
4.8
|
0.403
|
No services
|
82
|
49.4
|
0.002
|
0
|
0.0
|
|
0
|
0.0
|
|
47
|
22.6
|
0.806
|
Rescue
|
29
|
17.5
|
< 0.001
|
44
|
17.7
|
0.068
|
22
|
8.8
|
0.886
|
41
|
19.7
|
0.038
|
Reintegration back to the community
|
11
|
6.6
|
0.001
|
4
|
1.6
|
0.003
|
62
|
24.7
|
0.995
|
57
|
27.4
|
0.053
|
Don't know/No response
|
7
|
4.2
|
0.031
|
2
|
0.8
|
0.510
|
114
|
45.4
|
0.991
|
29
|
13.9
|
0.731
|
Other
|
0
|
0.0
|
|
0
|
0.0
|
|
0
|
0.0
|
|
0
|
0.0
|
|
% Rating provider’s response to FGM/C during COVID-19 as
|
n = 312
|
%
|
|
n = 278
|
%
|
|
n = 251
|
%
|
|
n = 208
|
%
|
|
Poor
|
101
|
32.4
|
|
46
|
16.5
|
|
14
|
5.6
|
|
50
|
27.5
|
|
Average
|
136
|
43.6
|
0.001
|
56
|
20.1
|
0.446
|
25
|
10
|
0.772
|
40
|
22
|
0.001
|
Good
|
59
|
18.9
|
|
172
|
61.9
|
|
149
|
59.4
|
|
50
|
27.5
|
|
Excellent
|
6
|
1.9
|
|
4
|
1.4
|
|
59
|
23.5
|
|
26
|
14.3
|
|
Don't know/No response
|
10
|
3.2
|
|
0
|
0.0
|
|
4
|
1.6
|
|
16
|
8.8
|
|
% Rating provider’s response to CEFM during COVID-19 as
|
|
|
|
|
|
|
|
|
|
|
|
|
Poor
|
106
|
34.0
|
|
36
|
12.9
|
|
53
|
32.3
|
|
58
|
31.9
|
|
Average
|
135
|
43.3
|
|
63
|
22.7
|
|
27
|
16.5
|
< 0.001
|
37
|
20.3
|
< 0.001
|
Good
|
57
|
18.3
|
< 0.001
|
176
|
63.3
|
0.503
|
56
|
34.1
|
|
48
|
26.4
|
|
Excellent
|
6
|
1.9
|
|
3
|
1.1
|
|
22
|
13.4
|
|
27
|
14.8
|
|
Don't know/No response
|
8
|
2.6
|
|
0
|
0.0
|
|
6
|
3.7
|
|
12
|
6.6
|
|
Generally, over 70% of respondents rated the response of the health system in addressing FGM/C and CEFM during the pandemic as either poor or average. This was likely due to frustrations experienced in offering services to the community because of COVID-19 restrictions:
“This Corona has stopped us so much. We were on the run, planning big things and running around and just having great plans, but all that stopped, and so people are sitting back and just reflecting on their achievements…and just holding unto those achievements…that is a lesson… And then of course… investing in the mental health of human beings is important. That is a lesson that I have learnt. KII_KEN 04
In Uganda, there were minimal changes in services offered before and during COVID-19. Psychological and sexual counselling which was the most common service offered to FGM/C victims marginally increased from 89% before COVID-19 to 94% during the pandemic. There was also a decline in rescue services from 32% before COVID-19 to 18% during the pandemic. Generally, slightly over 60% of respondents rated the response of the health system in addressing FGM/C and CEFM during the pandemic as good. Although this was the case, key informants underscored the challenges of failure to implement preventive measures at community level due to limitations posed by COVID-19 to healthcare workers in providing services to the community.
In Ethiopia, respondents’ assessment of the health system’s response to FGM/C and CEFM during the pandemic showed that there was a difference in services offered before COVID-19 and during the pandemic. Specifically, before COVID-19, the most common service provided for FGM/C cases was psychological and sexual counselling (95%) which reduced during the pandemic (41%). There was a slight increase in reintegration of girls back to the community and respondents who reported lack of services during the pandemic. Generally, over 80% of respondents rated the response of the health system in addressing FGM/C during the pandemic as either good or excellent while nearly half of the respondents were of the view that the health system’s response on CEFM was either poor or average. It appeared that the government had made efforts to ensure that there was coordination between government agencies including the health system who were given the mandate to make decisions on addressing FGM/C and CEFM cases during COVID-19.
“The health offices and the police are working closely with us. The health system has established structures starting at grass root level using health extension workers and health development armies to respond to FGM/C and CEFM. KII_ETH 04
In Senegal, there were minimal differences in services offered before and during the pandemic. Before COVID-19, the most common service provided for FGM/C cases included psychological and sexual counselling (51%) which slightly increased to 56% during the pandemic. Notably, there was an increase in the number of services offered from 0% (before COVID-19) to 23% (during COVID-19). Generally, 48% of respondents rated the response of the health system in addressing FGM/C during the pandemic as either poor or average, while 52% rated its response on CEFM as either poor or average. Interviews with programme implementers and policy makers revealed a focus by the ministry of health on containment of the spread of COVID-19 through sanitation and observing social distancing but no strategy on prevention or response to FGM/C and CEFM.
Adequacy of the civil society in addressing FGM/C and CEFM
Findings on the adequacy of the civil society's response in addressing cases of FGM/C and CEFM during COVID-19 are shown in Table 5. In Kenya, over 60% of respondents were of the view that the civil society’s response to FGM/C and CEFM was either poor or average. Some of the alternative approaches used by the civil society to reach victims of FGM/C and CEFM during pandemic included dialog forums (45%), radio talk shows (40%) and using local champions as part of risk communication (33%). Interviews with programme implementers and policy makers showed the important role schools play in not only acting as a platform for implementation of interventions but also as a safe space for girls at risk of FGM/C and CEFM.
Table 5
Adequacy of the civil society's response in addressing cases of FGM/C and CEFM during COVID-19
|
Kenya
|
Uganda
|
Ethiopia
|
Senegal
|
n = 312
|
%
|
P-Value
|
n = 278
|
%
|
P-Value
|
n = 251
|
%
|
P-Value
|
n = 208
|
%
|
P-Value
|
Response of programme implementers to FGM/C cases during COVID-19
|
Poor
|
69
|
22.1
|
< 0.001
|
62
|
22.3
|
0.048
|
18
|
7.2
|
0.651
|
67
|
32.2
|
0.075
|
Average
|
135
|
43.3
|
42
|
15.1
|
30
|
12.0
|
46
|
22.1
|
Good
|
65
|
20.8
|
0
|
0.0
|
126
|
50.2
|
47
|
22.6
|
Excellent
|
43
|
13.8
|
174
|
62.6
|
73
|
29.1
|
26
|
12.5
|
Don't know/No response
|
0
|
0.0
|
0
|
0.0
|
4
|
1.6
|
22
|
10.6
|
Response of programme implementers to CEFM cases during COVID-19
|
Poor
|
68
|
21.8
|
0.278
|
57
|
20.5
|
0.032
|
19
|
7.6
|
0.792
|
37
|
17.8
|
0.149
|
Average
|
174
|
55.8
|
50
|
18.0
|
34
|
13.5
|
70
|
33.7
|
Good
|
0
|
0.0
|
170
|
61.2
|
60
|
23.9
|
61
|
29.3
|
Excellent
|
70
|
22.4
|
1
|
0.4
|
134
|
53.4
|
22
|
10.6
|
Don't know/No response
|
0
|
0.0
|
0
|
0.0
|
4
|
1.6
|
18
|
8.7
|
“If they were in school, we would be able to control because you would have a way of knowing who is here or who has not reported back to school. If they are in school, it is easy to make a report. You see when they are involved with the parent and it is the parents who are encouraging this [FGM/C, CEFM] we may not be able to know exactly where the child is. KII_KEN 06
In Uganda, over 60% of respondents were of the view that the civil society’s response to FGM/C and CEFM was either good (61% on CEFM) or excellent (63% on FGM/C). Common alternative approaches used by the civil society to reach victims of FGM/C and CEFM during pandemic was the use of radio talk shows and call centres. Organizations faced challenges such as restrictions on gatherings which meant field staff could not fully interact with community members to implement behaviour change communication interventions. Reduction in funding towards FGM/C and CEFM was also mentioned as a challenge for civil society in addressing FGM/C and CEFM during the pandemic.
“These organizations have also faced the challenge in terms of implementing their activities. They are not allowed to have gatherings, you see, like having gatherings and then spread the information. So, COVID-19 has affected most of their programmes. KII_UG 04.
“Their funding is not always constant. These guys only come to the field when they receive funding… When they do not have the funding, they don’t implement the activities… I think that is one of the challenges these organizations are facing during COVID-19 as far as implementing activities to end the FGM/C programme is concerned. KII_UG 06
In Ethiopia, over 70% of respondents were of the view that the civil society’s response to FGM/C and CEFM was either good or excellent. Some of the common alternative approaches used by the civil society to reach victims of FGM/C and CEFM during the pandemic included use of call centres (62%) and local champions as part of risk communication (33%). There was good collaboration between the civil society and government agencies in intervening against FGM/C and CEFM during COVID-19. Existence of already established structures in monitoring and reporting played a critical role in ensuring synergy between efforts by the government and civil society as exemplified in the following quote:
“NGOs are working together with health extension workers and health development army structures, the police and judiciary. These are crucial channels for us [NGO] to raise awareness in the community and pass information to the judiciary, health system and the police for further investigation. Non-profit organizations are using these structures to work more efficiently. KII_ETH 06
In Senegal, slightly over half of respondents were of the view that the civil society’s response to FGM/C (54%) and CEFM (51%) was either poor or average. Some of the popular alternative approaches used by the civil society to reach victims of FGM/C and CEFM during the pandemic included call centres (61%), radio talk shows (51%) and use of local champions as part of risk communication (42%). Key informants were of the view that COVID-19 guidelines on infection prevention disrupted intervention activities directed towards FGM/C and CEFM. The directive from government that people needed to stay at home and the introduction of curfews limited implementation of programme activities, interaction with community members and monitoring of FGM/C and CEFM:
“COVID-19 prevention measures were a real obstacle to carrying out awareness-raising activities because one of the instructions was "stay at home" and as a result home visits were no longer being made and therefore people who were no longer being controlled and they did what they wanted to do. What we did was to create awareness activities using community radios. KII_SEN 02