Helping health workers save Ethiopia’s youngest children

By Demissew Bizuwerk

Kejelo, Tiro AFETA, Oromia, 14 June 2018: Inside the small room of Kejelo health post, health extension worker Amelework Getachew carefully monitors her stock of medicines stacked on a small wooden shelf. She checks to make sure that an Oral Rehydration Salt (ORS), a fluid replacement used to prevent and treat diarrhoea, Amoxicillin Dispersible Tablet and Gentamicin injection, antibiotics used to treat children with pneumonia and serious bacterial infections, are available in good quantity. She cross checks the numbers on each bin card and the actual quantities on the shelf. “I can’t afford to run out of these medicines,” says Amelework, pointing towards a stock of sachets of ORS and packs of amoxicillin tablets and gentamicin injections. “They are lifesaving.”

After Amelework is done taking inventory, she collects her essential job-aids for home visits and attends to five-month-old Aziza in her home as part of her routine house-to-house visit. This way, Amelework makes sure that pregnant women and newborn babies get health follow-ups.

When Aziza was only 45 days old, she suffered from pneumonia, the common killer of infants in Ethiopia. “I was so worried when my child was sick,” says Rawda, Aziza’s mother. “She was struggling to breathe and had it not been for ‘doctor’, my child would not have survived.”

“I was so worried when my child was sick. She was struggling to breathe

Amelework, whose name also means “a golden character,” is a committed health worker. Her nine-year journey as a health extension worker started in a remote village of Kereyu Dodo when she was given the daunting task of changing people’s attitudes on a range of health-related misconceptions.  It wasn’t easy for her to convince people to dig toilets or use bed nets to keep them safe from malaria. “They used to call us names like the ‘toilet controllers’ or ‘bed net checkers,” she remembers.

CNBC Jimma, Oromia
Amelework examines five months old Aziza. When Aziza was 45 days old, she suffered from Pneumonia. But now she is growing up healthy. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

But Amelework is now dubbed ‘doctor’, a name bestowed to her out of love and respect by the village women.  She is key to the livelihoods of the community, saving mothers and newborns including little Aziza in the small village of Kejelo.

Although Ethiopia has managed to significantly reduce its under-five child mortality, newborn deaths have declined at a much slower pace.  Twenty-nine newborn babies die out of every 1,000 live births from preventable causes such as complications due to prematurity, birth asphyxia, and infections like sepsis, and pneumonia[1]. Newborn deaths also account for a greater and growing share of all deaths among children under 5; almost 44 per cent.

Supported by UNICEF, the Government of Ethiopia introduced the Community Based Newborn Care (CBNC) strategy in 2012. CBNC aims to empower health extension workers, such as Amelework, with skills to provide maternal and child health services during pregnancy, childbirth and postnatally. Heath extension workers are also trained to identify and treat newborns with severe bacterial infections or sepsis where referral is not possible. They provide treatment for sick children both at the health post and in houses during their regular visits.

“The treatment we are providing is free of charge,” says Amelework. “This is encouraging mothers to bring their children early when they are sick.  It is also helping us to save young children from serious illnesses like pneumonia.”

Amelework is trained to provide CBNC services by JSI Research & Training Institute, Inc/ The Last Ten Kilometers Project (JSI/L10K), which is implementing the programme with technical and financial support from UNICEF.  She also gets constant support and follow-up from the CBNC supervision team who regularly visit her health post to make sure that she is applying the standard operating procedures.

CNBC Jimma, Oromia6658
Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K supports Amelework with regular visits to her health post. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

“We train and support Amelework to deliver her very important work by effectively identifying sick children in the village during her regular immunization outreach work and when she is providing house-to-house postnatal care,” says Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K.  “We also monitor and evaluate her records to ensure key information is recorded and stored in the treatment book.”

Amelework is also provided with guidance and support on supply management. She keeps track of her medical supplies to avoid shortages of crical drugs that she needs for immediate use.

“Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses”

UNICEF is supporting the scaling up of CBNC services with funds from the Margaret A. Cargill Foundation. Working in coordination with the Ministry of Health, it is expected that the positive experiences observed in villages like Kejelo will be expanded to pastoralist areas.

CNBC Jimma, Oromia
Amelework is the indispensable medical person for Kejelo village mothers and children. She is dubbed ‘doctor’ by the local women for saving their children. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

A humble hard worker such as Amelework embodies Ethiopia’s hope to end preventable newborn and child deaths within this generation. “Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses,” she says, “I am a mother myself and I know the feeling.”

Aziza is growing up healthy, her mother’s wish is to see her daughter becoming a ‘doctor’, like Amelework. “She [Amelework] saved my child’s life and I want my daughter to also do the same when she grows up,” says Rawda, with eyes full of hope to see a bright future for her baby daughter.

[1] EDHS 2016

Mass distribution of mosquito nets to South Sudanese refugees in Ethiopia

By Dorosella Bishanga and Bisrat Abiy

Kule Refugee Camp, Gambella, Ethiopia, 29 May 2018: Nyaluak Kun, 24, is a refugee at Kule Refugee Camp in Gambella, western Ethiopia. Originally from South Sudan, the mother of six has just received three long-lasting insecticide treated mosquito nets for her family. She says malaria has been a threat to her health and that of her family since the rainy season started.

“I am happy to receive these mosquito nets. I hope this is the right time that we have received the mosquito nets. Several times I have been sick with malaria. There was no solution for me. I get medicine, after a few weeks, I get sick again because of mosquito bites.”

Distribution of mosquito nets - Gambella
Nyaluak Kun and her child at Kule Refugee Camp in Gambella, Ethiopia. ©UNICEF Ethiopia/2018/Dorosella Bishanga

For Nyaluak, the mosquito nets will not only keep the family safe from mosquito bites but also from other poisonous insects that enter homes during the rainy season.

Malaria is endemic to the Gambella Region and is one of the top three causes of sickness and death across all the refugee camps.  The epidemic occurs mostly from April to June and September to November every year. Mosquito nets, in-door and out-door residual spraying, and environmental management are the most recommended malaria prevention and control interventions.

The standardized expanded nutrition survey of 2017 indicates that the proportion of households with access to at least one mosquito net is below 50 per cent in all the refugee camps, except for Kule at 54 per cent and Pugnido II at 60 per cent. With inadequate mosquito nets, malaria is rampant: last year alone, 128,520 cases and 33 deaths were recorded, 25 of them children under the age of five.

Distribution of mosquito nets to vulnerable groups, such as under five and malnourished children, pregnant and lactating women, and newly arrived refugees, is ongoing in all the refugee camps of Kule, Tierkidi, Nguenyyiel, Jewi, Pugnido I, Pugnido II, and Okugo.

However, the 2018 blanket distribution, targeting 386,000 refugees, started on 29th May in Kule Refugee Camp. It was combined with general food distribution using lists obtained from UNHCR population and household databases. With the overall coordination of the Administration for Refugee and Returnee Affairs (ARRA), UNHCR and UNICEF, refugees received mosquito nets at distribution centres managed by MSF-Holland, an implementing partner. Upon presentation of a mosquito net coupon obtained at the food registration centre showing the family size, the refugees would receive a mosquito net free of charge based on the UNICEF standard of one mosquito net for every two individuals.

UNICEF monitored the distribution exercise and conducted awareness and demonstration on slinging the mosquito nets. The awareness was done by Community Outreach Agents. Special messages with visuals were developed for under five children and pregnant and lactating women. The monitoring team also conducted interviews with refugees to ascertain their knowledge levels on utilisation of mosquito nets.

Distribution of mosquito nets - Gambella
Nyaluak Kun after demonstrating how to hang the mosquito net. ©UNICEF Ethiopia/2018/Dorosella Bishanga

Nyaluak says the demonstrations were important although the refugees faced difficulties in fixing the nets because of the type of housing and beddings they had.

In all, 163,000 mosquito nets were distributed. They were procured by UNICEF with funds from the European Commission (ECHO) under a project to provide lifesaving and resilience-building health and nutrition interventions for South Sudanese refugees and host communities in Gambella.

Healthy mothers, healthy children, making healthy communities in Ethiopia

Dugem, Tigray REGION, Ethiopia, 21 December 2017 – In the health post at Dugem village, in Ethiopia’s Tigray region, Berhan Zebraruk, 25, gently strokes her child’s cheek and then gives him a sweet tickle on the tummy. Her first born, Awot Kaleab, is quick to respond to her touch. He cracks a beautiful smile displaying his toothless gums and looks his mother right in the eye for the play to continue. The little boy is restless. He grabs his mother’s cell phone and when that is taken away from him, he turns his attention to the baby next to him.

“My boy likes to play with everything he holds,” says Berhan. “I have to keep an eye on him, otherwise he put things in his mouth.”

Awot is now 9-months-old and it is time for his measles vaccination, which would complete his set of basic vaccinations for children under the age of 1, as recommended by WHO and the Ethiopia National Expanded Program on Immunization.

It is a special day for Berhan. Shortly after Awot received the vaccine, the health extension worker, Genet Desta, registered his name in the vaccine book. Then she called out Berhan’s name and handed her a certificate, a recognition that is given to mothers when their children complete taking the necessary vaccines.

Maternal and Child Health, TigrayBerhan is applauded by the other mothers in the health post for successfully vaccinating her child. She is also recognized as a role model for her best child feeding practices, including exclusively breastfeeding her son for his first six months.

Berhan attended school up to grade 10. Since she was a little girl, her dream was to become a doctor. Instead, she got married and became a housewife like many other women in her village. Yet, her education is considered an achievement in the eyes of fellow villagers.

“I wanted to become a doctor because I saw health workers treating people in my village,” says Berhan. “That wasn’t meant to happen for me, maybe it will for my son,” she added, gazing down at him.

Berhan understands that her child can only fulfil her unrealized dream if he grows up healthy and well. When she knew that she was pregnant with him, she started her pregnancy follow-up relatively earlier than other mothers.

‘’Berhan attended all of the four antenatal follow-ups and took the iron supplement properly,” says Genet, the health worker. “She was very conscious of her health and that’s why her child is very healthy.”

In Ethiopia, an increasing number of women are receiving care by skilled health workers both during pregnancy and childbirth. In the Tigray region, where Berhan lives, for instance, 90 percent of women receive antenatal care by skilled attendants, at least once, during their pregnancy, which is well over the national average of 62.4 percent.

In addition, 59 percent of the region’s mothers are giving birth in health facilities, instead of the old tradition of home delivery.

The country has seen significant improvement in immunization coverage over the past two decades. In 2000, it was only 14 per cent of Ethiopia’s children under the age of 2 who have received all the basic vaccinations, but in 2016, that number soared to almost 40 per cent.

Owing to its well-established community-based health service provision, Ethiopia is also enjoying a reduction in maternal and child deaths. Maternal mortality which was 871 deaths per 100,000 live births in 2000 has dropped to only 412 in 2016, a reduction by more than half in just 16 years. The same is also true when it comes to child mortality. More children in rural Ethiopia are celebrating their fifth birthday than ever before.

The nearly 40,000 female health workers, together with the women of the Health Development Army, easily access women and children in every household and provide much needed advice and services, including immunization to prevent the most debilitating child illnesses.

UNICEF is supporting the different components of the programme by providing both financial and technical assistance. UNICEF also supports the management of common childhood illnesses including malaria, pneumonia, diarrhoea and severe acute malnutrition at the health post level, contributing to a significant reduction in deaths.

Berhan’s task as a mother, caring and nurturing for Awot, symbolizes the bright future that lies ahead of children in rural Ethiopia. She is well equipped with skills and knowledge that will enable her to provide critical health and nutritional care for her son. Further help is also available since services, even for those in remote communities, are now more accessible.

Canada partners with UNICEF to improve reproductive health and nutrition among adolescent girls in Ethiopia

8 March 2018, ADDIS ABABA – On the occasion of International Women’s Day, the Government of Canada is pleased to provide CDN$ 14.8 million (US$ 12 million) to UNICEF Ethiopia to improve the reproductive health and nutritional status of adolescent girls. The initiative will reach over four million girls in districts with high food insecurity and a high prevalence of child marriage. It will be implemented between 2018 and 2022.

“As part of our feminist approach, Canada is committed to advancing sexual and reproductive health and rights in order to empower women and adolescent girls in Ethiopia and around the world,” says Ivan Roberts, Head of Cooperation at the Embassy of Canada in Ethiopia.

In Ethiopia, 25 per cent of the population is made up of adolescents (aged 10 to 19 years), of which 11 million are girls.  Adolescent girls experience numerous barriers that hinder them from fully realizing their potential. A significant portion of these barriers is related to their sexual and reproductive health and to their nutrition.

Canada’s contribution will help girls access adolescent-friendly sexual and reproductive health services and nutrition facilities by training health workers to clearly understand the physiological and psychological needs of adolescent girls. This initiative will also leverage gender clubs in schools to provide life skills and sexual and reproductive health knowledge to young people. In addition, adolescent-friendly spaces will be created to ensure out-of-school children freely discuss nutrition and sexual and reproductive health issues and practices including family planning.

To improve personal hygiene, the programme will support the local production and supply of sanitary pads, education of girls on pre- and post menstruation, improve sanitary facilities through upgrading and rehabilitation, provide spaces in schools for menstruating girls to rest, enhance counselling and peer-to-peer support, and promote informal discussions among girls on issues that concern them.

“We appreciate the timely support from the Government of Canada which will allow us to address the challenges that Ethiopian adolescent girls face today,” says Gillian Mellsop, UNICEF Representative in Ethiopia. “We believe that this contribution will help adolescent girls break out of discriminatory social and gender norms that hamper their education and hinder their ability to meaningfully contribute to their nation’s development.”

UNICEF will use its strong monitoring and evaluation tools to ensure the success of this programme and invest in regular compilation of health and nutrition data to better understand trends and uptake of services by adolescent girls.

World is failing newborn babies, says UNICEF

Babies from the best places to be born up to 50 times less likely to die in the first month of life

NEW YORK, ADDIS ABABA, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.

“While we have more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old,” said Henrietta H. Fore, UNICEF’s Executive Director. “Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies.”

Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

Unequal shots at life[1]

Highest newborn mortality rates Lowest newborn mortality rates
1. Pakistan: 1 in 22 1. Japan: 1 in 1,111
2. Central African Republic: 1 in 24 2. Iceland: 1 in 1,000
3. Afghanistan: 1 in 25 3. Singapore: 1 in 909
4. Somalia: 1 in 26 4. Finland: 1 in 833
5. Lesotho: 1 in 26 5. Estonia: 1 in 769
6. Guinea-Bissau: 1 in 26 5. Slovenia: 1 in 769
7. South Sudan: 1 in 26 7. Cyprus: 1 in 714
8. Côte d’Ivoire: 1 in 27 8. Belarus: 1 in 667
9. Mali: 1 in 28 8. Luxembourg: 1 in 667
10. Chad: 1 in 28 8. Norway: 1 in 667
  8. Republic of Korea: 1 in 667

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

This month, UNICEF is launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:

  • Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care;
  • Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby;
  • Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life; and
  • Empowering adolescent girls, mothers and families to demand and receive quality care.

“Every year, 2.6 million newborns around the world do not survive their first month of life. One million of them die the day they are born,” said Ms. Fore. “We know we can save the vast majority of these babies with affordable, quality health care solutions for every mother and every newborn. Just a few small steps from all of us can help ensure the first small steps of each of these young lives.”

About Ethiopia

 Ethiopia is the second largest country in Africa with a total population of 94 million, out of which 13 million are under five years of age. Despite making overall progress in child survival, deaths among newborn babies still remain high. At 29 deaths per 1,000 live births, newborn mortality accounts for 44 per cent of all under five deaths. The new UNICEF report indicates that in 2016 alone, 90,000 newborn babies died in Ethiopia, ranking the country among 10 high burden countries globally.

Recognizing the need to accelerate newborn survival, the Government has put newborn survival at the centre of the Health Sector Development Plan. It has developed the Newborn and Child Survival Strategy (2015-2020) to strengthen the capacity of the health system and the skills of health workers to deliver quality health care to every mother and newborn baby. This includes the provision of quality antenatal care, skilled delivery, essential newborn care, postnatal care and neonatal intensive care for sick neonates.

UNICEF’s support to the newborn care programme includes;

  • Antenatal care, delivery, postnatal care, child care;
  • Health posts, health centres, and tertiary level hospitals; and
  • Integrated management of neonatal and childhood illnesses, immunization, community-based neonatal care, newborn care corners, and neonatal intensive care units.

UNICEF will continue to support the Ministry of Health to expand the availability of essential newborn care in the 800 health centers across the country, establish Newborn Intensive Care Units (NICUs) in hospitals, and strengthen the link between community-based and facility-based maternal, newborn, and child health programmes.

 

UNICEF and UNFPA to speed up their efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C)

Addis Ababa, 06 February 2018 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF and UNFPA in Ethiopia commit to accelerate their joint efforts to end the violent practice of FGM/C.

Given the rising number of girls at risk, the two agencies believe that with increased investment and redoubled political commitment, with greater community engagement and more empowered women and girls, it is a race that can be won.

The Sustainable Development Goals recognize that female genital mutilation undermines progress towards a more equal, just, and prosperous world. They set an ambitious target of eliminating all such harmful practices against girls and women by 2030.  UNICEF and UNFPA globally devoted the theme of the year 2018 – “Ending Female Genital Mutilation is a political decision” – to engaging government bodies and policy makers to join efforts.

In Ethiopia, the Government expressed its commitment to ending FGM/C and child marriage by the year 2025 at the London Girls’ Summit in 2014 and committed itself to reducing the practice to 0.5 per cent by 2020 in the Growth and Transformation Plan. The Government has also taken key programmatic actions which include  endorsement of the National Strategy and Action Plan on Harmful Traditional Practices against Women and Children as well as establishment of the National Alliance to End Child Marriage and FGM/C. 

“To accelerate the elimination of the practice , we need to work at grassroots level, at scale and hand-in-hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders –  to reach the hearts and minds of millions of people,” said UNICEF Representative in Ethiopia Gillian Mellsop. “We also believe that it is important to address the health and psychological complications caused by FGM/C by providing the necessary health services to help survivors lead a healthy life,” she said.

“We have seen that rates of female genital mutilation can drop rapidly in places where the issue is taken on wholeheartedly by governments, by communities, by families. Where social norms are confronted, village by village. Where medical professionals come together to oppose the practice, where laws are enacted to make it a crime and where those laws are enforced. Where wider access to health, education and legal services ensure sustainable change. Where girls and women are protected and empowered to make their voices heard,” said Ms. Bettina Maas, UNFPA representative to Ethiopia.

The 2016 Ethiopia Demographic and Health Survey shows a declining  trend in FGM/C from 74 per cent in 2005 to 65 per cent in 2015  in the age group 15-49 years, and from 62.1 per cent to 47 per cent  in the 15-19 year old age group. The survey also shows a more significant decrease in the younger age cohort compared to the older: prevalence is 75 per cent in the age group 35-49 years, 59 per cent in the 20-24 year age group, and 47 per cent in the age group 15-19 years. FGM/C prevention and care Afar

UNICEF and UNFPA have been working  together for many years in Ethiopia on programmes to end FGM/C. One such programme is in the Afar Region which has recently been expanded to the SNNP region. The programme has a social mobilization component which aims to increase community knowledge and change attitudes towards the practice through religious and clan leaders as well as youth and adolescent girls who convene community dialogues. Tailored messages through radio and television also reach a wider audience.

UNICEF and UNFPA also work together to improve enforcement of the law through increasing legal literacy, strengthening special units in the law enforcement bodies, and supporting community level surveillance in tracking cases of FGM/C for better reporting and management of cases. The programme has facilitated the declaration of abandonment of the practice in 6 districts in Afar Region. 

Globally, the prevalence of FGM/C has declined by nearly a quarter since around 2000. In countries where UNFPA and UNICEF work jointly to end female genital mutilation, girls are one third less likely to undergo this harmful practice today than they were in 1997. More than 25 million people in some 18,000 communities across 15 countries have publicly disavowed the practice since 2008.

FGM/C survivors teach communities to end the practice in Ethiopia

By Martha Tadesse

“I used to believe 12 years ago that FGM/C is a mandatory requirement in our religion Islam. I was doing what every mother did back then.”

Mille, Afar, 23 January 2018 – “My labor took two nights and a day. I was in so much pain. It was a very painful experience and most of all, I was a child myself.” says Kedija Mohammod, a mother of three children (ages 12, 8 and 5).

Kedija learned about the harmful effects of FGM/C through community conversations supported by the UNICEF-UNFPA Joint Programme, in partnership with Bureau of Women and Children Affairs (BoWCA), to accelerate the abandonment of FGM/C in the Afar region.

FGM/C or locally known as KetnterKeltti, the removal of some or all of the external female genitalia, is a highly prevalent traditional practice in Ethiopia that has a multi-dimensional impact on the lives of girls and women.

According to Ethiopia and Demographic Health Survey (EDHS) 2016, FGM/C rate in Afar is 91 per cent for ages of 15-49, placing it among the highest prevalent regions in the country next to Somali. Moreover, the region practices Type III infibulation, which is the most severe form of FGM/C characterized by the total elimination of the external female genitalia and stitching, leaving a small opening for urination.

“No one should go through what we Afar women have gone through. I can’t even explain the pain.”

The UNICEF-UNFPA Global Programme, which was launched in November 2008, promotes community-led discussions on harmful practices like FGM/C in which communities are empowered to progress toward collective abandonment.

The programme targets 9 districts (3 in zone 1 and 6 in zone 3) in the Afar region, each having multiple sub-districts. A total of 60 trainers were trained for married and unmarried adolescent girls from these districts and they are trained on harmful practices and menstrual hygiene in order to lead various discussion groups in their communities. These married and unmarried adolescent girls’ clubs aim to facilitate sustained awareness.

FGM/C prevention and care Afar
Zahara Mohammod, 28 discusses about FGM/C with “Unmarried Adolescent Girls’ Club” at Mille Woreda, Afar. © UNICEF Ethiopia /2018/Tadesse

Zahara Mohammod, one of the trainers in Mille Woreda, testifies that the programme has brought a huge difference in the community. She says, “People used to think that FGM/C is required by the Quran, but the programme has raised awareness among the community on the lack of direct link between the practice and religion. People are now listening and most have changed their stance. Women used to give birth in their houses, and we have lost many due to prolonged labor. But now, the Barbra May Maternity Hospital is a few minutes away from our village, so women go to the hospital for delivery and treatment. This is happening because of community conversations and girls’ club discussions in our villages.”

Kedija, an FGM/C survivor herself, regrets having made her daughter go through the same procedure. She says, “I used to think 12 years ago that FGM/C is mandatory and a requirement in my religion Islam. I was doing what every mother did back then.”

However, Kedija is now teaching her community and sharing her experience. “ I have been working with the community for two years now and the change motivates me to do even more. People used to mock me at first because FGM/C is considered as a religious practice, but many have changed their attitude and are thankful for our discussions now. I have never thought FGM/C could have consequences like mental and emotional damage until I had my first intercourse with my husband. No one should go through what we Afar women have gone through. I can’t even explain the pain.”

While talking about her daughter, Kedija says, “I have shared my experience with my daughter. She is aware of the consequences. My daughter is now in grade 7. I will not marry her off to anyone out of her will. She will get married when she finishes her education. I hope she will marry an educated man who can take care of her and take her to the hospital during her labor.”

According to Seada Moahmmod, at BoWCA, these discussions have been increasing awareness and openly challenging community perspectives towards FGM/C. She says, “The community’s awareness has improved a lot, and people discuss openly about the practice. They used to think that exposing stories would lead them to discrimination, but cases are now exposed to local enforcement bodies.  Many households have already rejected FGM/C. It is quite a success.”

While positive outcomes have certainly been observed in the districts, Zahra Humed, Head BoWCA of the region, says, “The outcome of the programme has been very rewarding and the behavioral change we have attained is wonderful. However, we still need to continue working until all districts abandon the practice once and for all. ”