Review of Female Genital Mutilation/Cutting (FGM/C) Projects in Eritrea 5-14 March 2007

Background

This is not a fully fledged evaluation, but more a review as the NCA project had not yet started at the time of the review, and the project proposal was to be revised, the main focus of the review was on the UNFPA/NUEW project.

Norway has since the beginning of the 1990ies supported Norwegian Church Aid's work to combat FGM/C in Eritrea. As the evaluation report of NCA's pilot project on FGM/C , undertaken in 2005, was positive, it was decided to continue the Norwegian support in order that the project could be replicated in other areas. An agreement on NOK 7 mill for 5 years was signed in April 2005 for the project: "NCA-Combating FGM/C in Northern Red Sea Region". Due to delays in obtaining an operational permit, however, the project has not yet started. (As of September 2008, the project is said to be in the pipe-line for approval at the MOH).

The abolishment for FGM/C being given high priority both by the Government of Eritrea and by the Norwegian Government, the Norwegian Embassy in Asmara indicated willingness for a broader support for this purpose. Thus, an agreement on NOK 3,6 million for 4 years was signed with UNFPA in August 2005, for the support of the "Anti-FGM/C Campaign" project, implemented by the National Union of Eritrean Women (NUEW) in Zoba Debub (region)

The review was carried out during March 6 - 14 by a team of professionals composed of: Marit Berggrav, NORAD (Team Leader), Nina Strøm, NORAD, Sølvi Taraldsen, Norwegian Directorate for Health and Social Affairs, and Tesfamariam Yosief Debessai, National consultant.

Purpose/objective

Even somewhat premature (NCA project not started and the UNFPA project just started), it was part of the agreement with UNFPA/NUEW that a review should be undertaken after Phase I in order to:
• Assess administrative and operational aspects
• Review the methodologies chosen and level of coordination
• Provide recommendations on possible amendments in the process.

Methodology

• Review of documents and reports
• Meetings with partners
• Field trip to Segeneiti, Kodofelasi and Mendefera (UNFPA)

Recommendations

(A considerable part of the following belongs to UNFPA, but could easily be / should be applied for NCA projects as well).
• There is a strong commitment by the Government of Eritrea to go for a concerted and collective effort for the abandonment of FGM/C. The "National Strategy on Female Genital Mutilation (FGM/C) Abandonment in Eritrea" was finalized in 2006, and will in the near future be followed by an Action Plan which is still in draft. The national strategy underlines the importance of a broad multi-disciplinary approach, gender equity and community mobilisation, aiming at an integrated and participatory process. Mainstreaming at national level, should be followed by project work and scaling up at the local level.
• In Eritrea, most of FGM/C is undertaken during infancy, between one week and one month, and it is said to be a private and individual exercise. This has implications for the strategies chosen for abandonment of FGM/C practice. Hence, due attention should be given on how to work on FGM/C in the antenatal and postpartum care services. Moreover, evidence indicates that there is a tendency to shift to less harmful circumcisions and this has a high potential for back-lashing and should be seriously considered.
• The UNFPA/NUEW programme has recently started, and it is too early to draw any conclusions on the work in the field. NUEW has stated in the programme document that the health approach is too narrow; on the other hand, gender and right issues should be much higher on the agenda. This is a challenge that should be given priority during the training and follow up, as the medical issues are much easier to communicate.
• There seems to be a widespread opinion that the approach to abolish FGM/C should be holistic, including gender, reproductive health and right issues as well as HIV/AIDS prevention. The multi-disciplinary and community-based approach chosen by NUEW is clearly in line with the national strategy. Furthermore, as transport is a scarcity and field workers going into the rural areas are very few, the resources available should be utilized in the best possible way. Thus, instead of parallel vertical interventions on HIV prevention, FGM/C, gender issues etc., there should be an integrated approach
• Several of the informants stressed the importance of identifying entry points that were appropriate in the local context. Moreover, as large gatherings limit informal interaction, one should try to arrange for smaller gatherings as well, only for a few households and smaller groups. This could be done by training more people from the villages as facilitators. The anti-FGM/C work has to be a continuous process over time, and not only a one-time event. The capacity of the Anti-FGM/C committees may easily be overstretched if all the outreach work is left to them.
• Very few young people were observed during the village meetings. However, youth are an important target group if change is to take place, and NUEYS has an important role to play.
• Targeting the circumcisers with micro credit is one of three main strategies in the programme document. As the experience with this intervention seems to be quite mixed, the team agrees that this intervention should be tested out and handled with some caution.
• It is hard to enforce an anti-FGM/C law when the prevalence is high and the awareness low. Penalties may also result in the practice going underground and the work on abolishment backlash. Therefore, the proclaimed law should be reinforced with aggressive campaigns and awareness raising programmes, until people have received adequate education to understand both the harmful effects of FGM/C and the law itself.
• The capacity within UNFPA to follow up the FGM/C programme with NUEW seems to be sufficient. With the new programme staff in place, NUEW feels that they can cope with the situation. However, if they are going to expand to other areas, they will need more staff in the head quarter. With regard to staff at the lower levels, NUEW has a unique structure down to the grassroots, which definitely has the potentials for developing a national FGM/C movement.
• The Team sees interesting potentials for cross-fertilization with regard to the plans UNFPA has for approaching FGM/C in a broader and more integrated way, including issues as gender equity, gender-based violence, HIV and AIDS, obstetric fistula, abortion and reproductive health and rights, and provide back-stopping on such issues.
• The main challenge regarding the administrative and operational aspects of the 'Anti-FGM/C Campaign' is to develop and implement an appropriate monitoring system. It is furthermore important to strengthen the focus on results in the reporting on all levels in the programme rather than on activities. Moreover, it would be interesting to document synergies between the Anti-FGM/C programme and the two forthcoming joint UN programmes on FGM/C and gender.

Comments from the organisation

When it comes to the NCA FGM project, it is stated in the report that the NCA project is considerably delayed, and that the project proposal for the extension of the project should be revised according to the recommendations of the Evaluation Report from 2005. For this reason the main findings and recommendations from the 2005 evaluation (as listed in the present Evaluation Report) are included as follows:

• Change among religious leaders regarding disconnecting FGM/C from religion is considered one of the big achievements in the project. NCA is advised, however, to continue to build skills and awareness among religious leaders, especially at sub-Zoba and village levels, as most of them were found to not part from their old traditional and cultural values.
• Among the Christians in the target group of NCA`s pilot project, there was a willingness to stop the practice, while among the Muslims the tendency was to shift their practice from infibulations to clitoridectomy. Not all the community immobilizers, which were key change agents in the project, were convinced that all types of FGM/C were harmful. The evaluation suggests to make an effort to convince, train and build capacity of the community mobilizers before the next project phase begins.
• Gender relations should have been addressed early in the pilot project. The evaluation suggests that NCA should build capacity on gender among its staff and partners. Both gender and human rights were found to be lacking in the awareness raising sessions.
• The project did not target schools and teachers, and this was seen as a lost opportunity.