Baby WASH: increasing communities’ awareness through health extension workers

by Hiwot Ghiday, Selamawit Yetemegn, Anina Stauffacher

Sekota Woreda, Northern Amhara region, 5 October 2018– Nigist lives 20km north of Sekota town in the mountainous and remote northern part of Ethiopia. Together with her husband and two children she lives in a one-room rock-built house in the centre of the village. The village is surrounded by rocky crop fields, where the men plough with the help of two oxen.

In early August, during the rainy season, everything looks not lush but pleasantly green. As Nigist takes a seat on a dusty plastic chair, the neighboring children come closer sitting and standing on the gravely dirt curious to hear and see what she is about to tell.

With the youngest child safely on her back, Nigist starts talking about how she cares for him. She explains how she washes the baby’s hands and face three times per day often with soap. “I would always like to wash my baby with soap, but we sometimes find it difficult to afford soap, then I wash him with water only”, she says. “I also wash his body every other day, for my older child it is less frequent”. Nigist’s understanding of the consequences of not properly washing her children’s hands and face with soap seems limited and leads her not to prioritize buying soap rather than other items.

UNICEF in collaboration with the BBC Media Action is currently piloting an EU-funded Baby WASH project in Zequalla and Sekota Woredas, Wag Himra Zone, northern Ethiopia. The aim of the Baby WASH project is to reduce the microbial burden encountered by young children in their play and feeding environments. In addition, the project aims to reduce trachoma and other disease exposure of children and therefore help reducing child stunting [1].

In August 2018, health extension workers were trained to work with the communities to change hygiene practices improving early childhood development. The focus lies on safe disposal of child feces, handwashing with soap, face hygiene, shoe wearing, protective play areas and food hygiene.

During the training, health extension workers learnt about Baby WASH activities and how to work with the communities to effectively change behavior. Listening groups and group discussions at community level using radio recordings are part of the methods the health extension workers use to raise Baby WASH issues in their own community. Additionally, during public discussion led by the local health office, key expectations were raised and discussed.

Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF2018Stauffacher
Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF/2018/Stauffacher

Debessa is one of the two health extension workers in the kebele where Nigist lives. Debessa says: “I know about safe sanitation and hygiene practices, but these interventions focusing on babies and young children are new for me. It is very interesting and I am learning a lot during the training.” Debessa is happy about attending the training together with other colleagues from Sekota Woreda.

She and her colleague working in the same kebele agree: “we are very motivated to go back home and work with the mothers on the Baby WASH, it is exciting. For the handwashing practices specifically focusing on babies and young children, we will connect it to previous handwashing promotion activities. To encourage families to properly dispose child feces, we expect that it will need some time for the change to be effective because this is a new concept for many in the community. And potties are expensive, it isn’t a priority for the families to spend money on potties particularly at this time of the year where families invest most of their money in farming”.

The key actions promoted during the training are summarized in form of pictures with both Amharic and Hemtegna language so training material can be used at community level.

Piloting the EU-funded Baby WASH project in collaboration with the government is a promising way forward to start triggering behavioral change with a focus on pregnant women, babies and children under 3. Shifting from a “have to” approach to a stronger focus of “how to”, Baby WASH requires close integration with existing interventions on maternal, new born and child health, early childhood development and nutrition.

A paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child feces. UNICEF Ethiopia WASH has included Baby WASH into its strategy for the new country program to contribute to the improvement of early childhood development.

[1] Stunting is a sign of ‘shortness’ and develops over a long period of time. In children and adults, it is measured through the height-for-age nutritional index. In Ethiopia approximately 40 per cent of children are stunted.

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.

In Ethiopia, Community-Based Approaches Help to Improve Nutrition among Women and Children

By Victor Chinyama and Tiguaded Fentahun

South Gondar Zone, Ethiopia: Enalem Asnakew (40) had no idea why her one-year-old son Misganaw Asmare would not stop vomiting. His arms, legs, and abdomen were swollen and his appetite was failing. After about a month, she had had enough and decided to bring him to the local hospital.

“He was put on blood transfusion for three days,” she says in a barely audible voice.Then, they administered [therapeutic] milk through his nostrils in addition to [intravenous] medicine. The nurses frequently visited my child and now, after nine days, the swelling has disappeared, the vomiting is almost gone, and my child takes therapeutic milk orally.”

Misganaw was diagnosed with severe acute malnutrition, a serious but entirely preventable and treatable condition which the WHO estimates accounts for 35 per cent of deaths among children under five globally. Typically, severe acute malnutrition is treated in a hospital but the advent of ready-to-use therapeutic foods has enabled children like Misganaw to be treated at home if they have no underlying medical complication requiring hospitalization.

In general, Ethiopia has made strides in reducing undernutrition in children, with stunting in particular dropping from 58 per cent in 2000 to 38 per cent in 2016. However, the number of children with severe acute malnutrition spikes up during the ‘lean’ season between June and August, the period when most households will have exhausted their food stocks as they await the next harvest beginning September. Prolonged and chronic humanitarian crises, such as droughts and floods, also contribute to increased malnutrition in children.

Inadequate food however is not the only cause of malnutrition. Multiple factors, such as the child’s size at birth and the mother’s weight, predispose a child to malnutrition. Acute illnesses and poor feeding practices are other contributing factors. The key to preventing malnutrition therefore lies in improving the nutritional status of the mother, ensuring the child has access to an improved and diverse diet, providing safe water and sanitation, improving hygiene, and building a strong and supportive system at community level.

In 2011, with a US$ 50 million grant from the Government of Canada, UNICEF embarked on a project to improve nutrition in children and women in 100 food insecure districts in the Amhara, Oromia, and SNNP regions of Ethiopia. The six-year project, later extended for another year, was to improve the use of health and nutrition services by children, adolescent girls, and breastfeeding mothers, and increase the availability of water and sanitation services. The project focused on the community level, where efforts were made to increase the scope and coverage of nutrition activities. These included multi-media campaigns, education of mothers and caregivers on nutrition, promotion of breastfeeding, and increasing production of local complementary foods. Wells were drilled to supply safe water to communities and households were encouraged to construct their own improved latrines.

To improve service delivery, 2,000 community-based health extension workers responsible for mobilizing people and agriculture development agents were trained in nutrition. Water was supplied to health posts and committees to oversee water, sanitation, and hygiene activities were established at kebele level (smallest administrative unit in Ethiopia).

Students line up to receive deworming tablets at Gurumu Koysha Primary and Secondary School in the SNNP Region of Ethiopia. Deworming of adolescents became a national programme after being introduced through the Canada-funded project.
© UNICEF Ethiopia/ 2016/ Meklit Mersha

In total, the number of community-based nutrition activities doubled and 24 per cent more households cultivated a garden (the largest increase was observed among the poorest households). Nutrition knowledge among health workers and health extension workers increased from 51 to 80 per cent while exclusive breastfeeding increased from 71 to 80 per cent. The proportion of mothers stating that water should not be given to babies under six months of age increased from 61 to 78 per cent.

The project also marked a milestone as the first ever in Ethiopia to target nutrition for adolescents (children aged between 10-18 years). Deworming of adolescents was first introduced under the project as a pilot but was subsequently scaled up to national school deworming campaigns, reaching 3.9 million school children.

These results were achieved against a backdrop of unforeseen challenges, such as the civil unrest of 2016 which limited travel and access and the El Nino drought in 2016 which shifted attention and resources.  Notwithstanding, a survey at the end of the project showed that stunting among children had declined from 40 per cent to 35 per cent and the prevalence of underweight children from 22 per cent to 17 per cent. Put differently, the odds of children in the 100 districts being stunted or underweight had been reduced by 19 per cent and 20 per cent respectively.

The education, mobilization, and support given to the 100 districts in Amhara and the other two regions will ensure that mothers like Enalem will never have to wonder again why their children are vomiting, or why their abdomen and limbs are swollen. They will also ensure that children like Misganaw can grow up healthy and strong, free from dangerous yet preventable conditions like malnutrition.

Linking One WASH National Programme and Water Resources Management: UNICEF Ethiopia’s Leverage in the Sector

By Kaleab Getaneh and Jorge Alvarez-Sala

There is a high interdependence between Water, sanitation and hygiene (WASH) services and Water Resources Management. A sustainable supply of good quality drinking water highly depends on how properly the water sources are managed. Similarly, if WASH services provision is not sustainably managed it will have a huge negative impact on the water resource.

The UNICEF and USAID supported project to strengthen the Water Sector Working Group (WSWG) Secretariat started in July 2015 with the aim of establishing a well-functioning platform for the water sector consisting of the WASH and Water Resources Management (WRM) subgroups that contribute to the sustainable development and management of the water resources in the country.

The project has been supporting the reactivation of the WRM Sub Group and the organization of the first-ever Joint Technical Review (JTR) for the WRM sub-sector. The main purpose of the JTR is to bring various stakeholders together and ensure a sustainable coordinated development and management of water, land and related resources in order to maximise the economic and social welfare of the population. This is the basis for the ongoing and future water sector interventions in general and One WASH National Programme in particular.

Developing climate resilient sustainable WASH services under the umbrella of One WASH National Programme require looking into the bigger water resources management picture, including the protection of water sources and the overall water governance issues. To this end, the reactivation and capacitation of the WRM subgroup and the launching of the JTR is significantly contributing to the development of a clear and common agenda for the water resources sector in Ethiopia.

The WRM sub-group has been able to bring together three concerned Ministries: Ministry of Water, Irrigation and Electricity (MoWIE); Ministry of Agriculture and Livestock Resources (MALR); and Ministry of Environment Forest and Climate Change (MoEFCC) and key development partners (DPs), academia and civil society organizations (CSOs).

The priorities established by the WRM sub-group include: 1.Irrigation for growth; 2.Legislation of groundwater use; 3. Conflict resolution; 4. Communication/Management Information System; 5. Institutional and Human Capacity; 6. Water quality; and 7. Water Charges/Tariff and Scheme Sustainability. Following the identification of the priority areas, six WRM technical working groups have been established to further pinpoint key bottlenecks and gaps.

Opening speech by H. E. Ato Kebede Gerba, the state Minister of MoWIE. © UNICEF Ethiopia/2018/Jorge Alvarez-Sala

On the 19th April 2018, the WRM JTR kick-off meeting was successfully held by involving more than 85 participants from academic institutions, CSOs, development partners, basin authorities, concerned federal ministries, and regional bureaus of water, environment and agriculture. The workshop was attended by H.E. Ato Kebede Gerba, the state Minister of MoWIE and H.E Ato Kare Chewicha, the state Minister of MoEFCC. It has laid the foundation by bringing the three ministries (MoWIE, MoEFCC and MoANR) together to talk about water resources management in the country.

 

Currently, the six working groups are actively organizing a field mission to review the state of WRM in three selected river basins (Awash River Basin, Rift Valley Lakes Basin and Abay River Basin) and come up with high impact implementable actions. The findings of the field mission will feed into the upcoming Multi Stakeholders Forum, which will bring both WASH and WRM subsectors together for the first time.

The whole process of JTR and MSF is expected to culminate in the preparation of a National WRM Programme document, which is currently being developed with technical and financial support from UNICEF.

UNICEF’s support to the Water Sector Working Group (WSWG), and its sub-groups is possible thanks to the generosity and support of USAID. The JTR kick-off meeting was also financially supported by JICA and the Italian Cooperation Agency.

In Ethiopia, Child Victims of Sexual Violence Communicate through Art Therapy

UNICEF and Government Communication Affairs Office Provide Training on Ending Violence Against Children

By Frehiwot Yilma

ADAMA, OROMIA REGION, 26 March 2018 – The explanation of the first picture immediately grabbed everyone’s attention in the room as psychologist Mekonnen Belete described how the child that drew it was showing that she had been abused by an uncle.

Here at the UNICEF-supported One-stop Centre in Adama Hospital in the Oromia region, counsellors are using a model adapted from the Thutuzela Care Centres of South Africa to provide timely and comprehensive medical and counselling services to victims of Violence Against Women and Children.

IMG_2972“Usually when children draw disfigured faces it indicates the people they are drawing are not very helpful. As you can see the woman’s mouth is wider than usual to indicate the woman (the child’s mother) was laughing at her when she told her of the abuse she experienced by the uncle who came from the rural areas indicated by the child in a form of a hut,” said Mekonnen, who noted that most of the children he counsels are abused by acquaintances, stepfathers and relatives.

The Adama One-stop Centre was introduced in 2013, the second to be established in Ethiopia after the centre in the Gandhi Hospital in the capital Addis Ababa and it has been successful in rehabilitating survivors as well as prosecuting the perpetrators by offering medical and legal services to victims of sexual violence. In the Oromia region, there are two other such centres in Shashemene and Jimma towns that were established and supported by UNICEF.

The centre is staffed by three prosecutors and four female investigative police officers. Clinical and counselling services are managed by a medical doctor, nurse and a psychologist provided by the hospital. Overall management of the centre is entrusted to the Justice Office, which coordinates through a multi-sectoral steering committee comprising, but not limited to, representatives from the Women, Children Affairs Office, the Health Office, the High/Woreda Court, the Adama Police Commission, the Education Office and selected child care institutions, showing how protecting women and children cannot be left to one party – everyone has a role to play. Concerted efforts bring tangible and sustainable change to ensure that not even one case is treated as the norm.

The second picture, in the sequence of the five pictures drawn by the child as she recovered from the trauma of the abuse by her uncle, is brighter than the first one but still has traces of uncertainty. According to Mekonnen, the flag in the picture indicates the medical and legal services she received. Until the girl gains confidence in these services, the flag remains at the side of the picture, showing her doubt about the system surrounding her.

Before the establishment of the One-stop Centre, victims of sexual violence were hidden for a number of reasons, including the families believing their children (especially if they accused family members), the stigma around sexual violence, blaming the victim, the lack of victim friendly services, denial that the actions took place and the difficulty of proving the abuse.

IMG_2975“The number of victims we support has been increasing from year to year,” said Inspector Etenesh Deresse of the Adama Police, the focal person for women and children cases. “This is not because children were not abused before, but people are now putting their trust in the confidentiality, speed, victim friendly and accuracy of the services provided in the centre. Now, parents and caregivers are bringing alleged reports (to us) just to make sure.”

UNICEF helped the Oromia Police College to revise its curriculum to include issues of violence against children as well as have courts include social workers on the government payroll. Currently, 40 courts have child-friendly benches and the One-stop Centre service has been scaled up from three to 17 hospitals in the region.

In the final picture the child drew, a new thought, the product of several counselling sessions, has emerged – hope for her and justice for her uncle. She was finally able to put herself in the picture and imagine and dream again.

IMG_2971When Mekonnen showed pictures drawn by children who were not abused, the difference in the attitude and aspirations was evident. Those who were not abused were able to write about the subjects they were learning, draw their house or a landscape in a free and lively way, but the ones with some trace of abuse tend to focus on one particular aspect of their life and sometimes were not even be able to depict that.

UNICEF has provided critical support to improve child justice in Ethiopia by providing equipment, supplies and capacity building trainings to the centres as well as other child friendly services such as child friendly courts, child protection units and justice offices in different regions. UNICEF works with the bureau of justice, Women and Children Affairs, the Supreme Court and police to prevent violence against children.

Survivors of FGM facilitate discussions to end the practice

By Martha Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure.

Chifra, Afar, 23 January 2018 – “I had severe period pain, and my labour was a life and death situation,” says Fatuma Abdu, 28, who had undergone Type III FGM/C as a child. Fatuma has two daughters, a 4–year-old and a 20-months-old.

She recalls her first pregnancy experience saying, “I was very weak during my first pregnancy. I was in labour for 24 hours before they took me to the hospital. I gave birth at the hospital. However, because of our tradition, I have stitched again. My menstrual cycle pain was agonizing. I got pregnant again, and it was worse than my first experience. I was in labour for three days until I was unconscious and found myself at Mille Maternity hospital.

The doctor told me I would have suffered from fistula had I stayed home longer than that. I had a stillbirth.  I was physically and emotionally hurt. My third pregnancy was much better because of the surgery at the hospital.”

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

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure. She explains how it was difficult to convince her husband on her decision saying, because “The day I went through all that because of my FGM/C procedure was the same day I made that decision. My husband disagreed because we had always thought we were right to practice FGM/C. Mind you, even though he knew how much I have suffered, he still could not make up his mind. I told him I would sue anyone who would touch my daughters and that was it.”

The UNFPA-UNICEF Joint Programme has been working in collaboration with Bureau of Women and Children Affairs (BoWCA) to accelerate the abandonment of FGM/C in Afar region since November 2008. During the implementation of its first phase that ended in 2013, the programme targeted six districts out of the 32 districts in the region, which have declared abandonment of FGM/C presently.

According to the assessment made at the end of this first phase, the programme has resulted in substantial changes in belief and practice of FGM/C in target districts, with a practice decline from 90 per cent in 2008 to 39 per cent after five years of intervention. The second phase of the programme is currently implementing social mobilization interventions in three districts with the aim of improving community knowledge, attitude and practice. The programme heavily focuses on the engagement of community and religious leaders who are the most influential persons in the community. Additionally, the programme promotes community conversations through various discussion groups to create awareness and empower community members for a lasting change.

Fatuma is among the trainers who have been selected to facilitate discussion groups in their communities. The UNFPA-UNICEF Joint Programme has trained 176 facilitators for community conversation and dialogue from 3 districts on FGM/C and early marriage. This community conversation and dialogue on FGM/C is inclusive of girls, boys, men, women, and the youth in the community.

“I hope everyone listens to our suffering and refuses to undergo the FGM/C procedure.”

Sharing her experiences with the training, Fatuma states, “The training was such an eye-opener. I was challenged regarding my wrong beliefs, and it helped me speak up for others.”

According to Sheikh Mohammod Dersa, President of the Islamic Affairs Supreme Council in Afar, the FGM/C intervention by UNFPA-UNICEF has brought a behavioural change in the community.

He states, “We are grateful for what UNFPA and UNICEF have done in our region. We have been working with them hand in hand. But, we still need to work harder, because the issue is deeply rooted in social and religious norms. Social norms are powerful. We need to know that this is a generational issue, as well. It takes a lot of effort and collaboration to challenge communities and achieve the goal of ending FGM/C. We are always ready to teach our community, and we hope the programme continues and expands to other districts.”