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BASELINE SURVEY REPORT by mikeholy

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									    BASELINE SURVEY REPORT

              ON

FEMALE GENETAL MUTILATION/CUT

               IN

  PUNTLAND STATE OF SOMALIA




        (DRAFT REPORT)




         PRESENTED TO:



 Peace and Collabrative Net Work



         PRESENTED BY:



    Ahmed Abdirahman Hersi

        29th ,June / 2010



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TABLE OF CONTENTS
TABLE OF CONTENTS..................................................................................................................................... 1

LIST OF ACRONYMS ....................................................................................................................................... 3

ACKNOWLEDGEMENT ................................................................................................................................ 4

EXECUTIVE SUMMARY .................................................................................................................................. 5

   Context and Purpose of the Survey .......................................................................................................... 5

   Violence against Women .......................................................................................................................... 5

   Efforts to Eradicate FGM in Somalia ......................................................................................................... 6

   Key challenges during the Survey ............................................................................................................. 6

SUMMARY OF KEY FINDINGS ........................................................................................................................ 7

   FGM Prevalence, Perceptions, Beliefs and Effects ................................................................................... 7

   Child Rights and Child Education .............................................................................................................. 8

   Women Rights and Gender Attitude ........................................................................................................ 8

   Conclusions and Recommendation .......................................................................................................... 9

BACKGROUND ............................................................................................................................................. 12

   Political and Socio-Economic Situation in Somalia ................................................................................. 12

   Objectives of The Study .......................................................................................................................... 12

   Study Methodology................................................................................................................................. 13

METHODOLOGY PROCESS........................................................................................................................... 13

KEY FINDINGS OF THE STUDY...................................................................................................................... 15

   Demographic Characteristics .................................................................................................................. 15

   Attitude and Practice Towards FGM/C in the Community ..................................................................... 17

   Child Rights Issues ................................................................................................................................... 27

   Women Rights and Gender Attitude ...................................................................................................... 29



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   Knowledge of HIV/AIDS .......................................................................................................................... 36

CONCLUSIONS AND RECOMMENDATION................................................................................................... 37

APPENDIX .................................................................................................................................................... 40

   Household Questionnaires ..................................................................................................................... 40

   Semi-structured questionnaires ............................................................................................................. 52

   Focus group Discussions ......................................................................................................................... 53




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LIST OF ACRONYMS
AACC      All African Conference of Churches

AIDS      Acquired Immune Deficiency Syndrome

CBO       Community Based Organization

CHWs      Community Health Workers

FGD       Focus group Discussion

FGM       Female Genital Mutilation

FMC       Female Genital Cutting

GBV       Gender Based Violence

LQC       Las qorey concern

IGA       Income Generating Activities

MDGs      Millennium Developmental Goals

MOWDAFA   Ministry of Women Affairs and Family Development

PUNCHAD   Puntland centre for human rights and Democracy

STDs      Sexually Transmitted Diseases

SYSA      Somali Youth Students Association

SPSS      Statistical Package for Social Scientists

TBA       Traditional Birth Attendant

IDPS      Internally displaced persons

UNFPA     United Nations population fund

UNICEF    United Nations Children’s Fund

VCT       Voluntary Counselling and Testing

VVF       Vesico- Vaginal Fistula




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ACKNOWLEDGEMENT

This Baseline survey was effectively undertaken with the support of a number of constituencies.
First, I would like to thank UNFPA Puntland staff for providing me with the required background
information and logistical support during the survey.

I would also wish to thank the local implementing partners; PUNCHAD, SYSA and Lasqorey
concern and MOWDAFA for their efforts and dedication during the survey.

Last but not least the community leaders (chiefs, elders, health staff, women groups, religious
leaders) and the enumerators for their enthusiasm and commitment to the survey process.



Ahmed Abdirahman Hersi

PUNCHAD Programme Manager

FGM baseline Survey




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EXECUTIVE SUMMARY
Context and Purpose of the Survey
Women in Somalia, like other war–torn countries, have had to bear the brunt of double marginalization
as a result of culture and civil war. Thus exacerbating violation of socio-economic and political women
rights such as property ownership, equity, decision making on issues that affect life including marriage,
access to education, gender based violence practices, access to information especially reproductive
health including HIV/AIDs among others.

This report presents the process and output of a participatory operational survey, which was conducted

From 10 to 31December, 2009 in three major District of Garowe, Galkayo and Bosasso, Puntland. The
survey aimed at obtaining relevant and adequate data on knowledge, attitude and practices including
perceptions and beliefs associated with Gender Based Violence (GBV) including FGM and Child rights.
The information generated is expected to form the basis for project planning and provide benchmarks
for project monitoring and evaluation.

Violence against Women
Violence against Women and Girls is any act of gender-based violence that violates their decency,
dignity and privacy in public or private places (AACC, 2002). Such acts may be physical or psychological
and include spousal battering, sexual abuse, rape, incest, indecent assault, harmful traditional practices
such as female genital Cutting/mutilation, widowhood rites. Such violence could be domestic, cultural,
social-economic violence, and even structural.

Many communities in Africa (and elsewhere) have used culture to justify discrimination against women
which in practice tends to dehumanize women stifle talents and inspirations and in some cases be a
threat to survival.

FGM is one of the widely practiced cultural practices in the world that is a violation against women
rights as well as human rights. The World Health Organization has been on the forefront in the campaign
against FGM globally. WHO classifies different types of FGM procedures as follows?

Type 1: The incision (removal) of the clitoral hood with or without removal of all or part of the clitoris.
This is the mildest form .Modern trained practitioners may insert one or two stitches around the clitoral
artery to stop the bleeding.

Type II: Commonly the clitoris is amputated as described above and the labia minora are partially or
totally removed, often with the same stroke.

Type III: The excision (removal) of part or all external genitalia (clitoris, labia minora and labia majora)
and stitching or narrowing of the vaginal opening ,leaving a very small opening, about the size of a
matchstick to allow for the flow of urine and menstrual blood. The girls legs are generally bound
together from hip to the ankle so she remains immobile for approximately 40 days to allow for the

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formation of the scar tissue. If the opening is too small to start the dilatation, recutting (defibulation)
before intercourse is traditionally undertaken. Defibulation may also be performed during childbirth to
allow exit of the fatal head without tearing the surrounding scar tissue. Because of the extent of both
the initial and repeated cutting and suturing, the physical, sexual and psychological effects of
infibulations are greater and longer lasting than for other types of female genital mutilation.

Efforts to Eradicate FGM in Somalia
Despite the fact that FGM continues to be practiced in Somali efforts have over time being made to
eradicate the practice as early as 1977. The Somali Women’s Democratic organization (SWDO) was
appointed by the collapsed government of Siad Barre for the abolition of the practice. To eradicate the
dangers and damages caused by FGM when performed by traditional circumcisers, the practice was
encouraged to be carried out in a hospital. The government supported an alternative method, which
was to prick the clitoris to obtain a drop of blood. However, the strategy did not work and the practice
was eventually banned in all government hospitals.

Other organization such as Institute of Women Education (IWE) in 1980s initiated activities against the
practice of FGM. However, once the Said Barre’s government was overthrown, the technical basis for
the campaign was destroyed. Some international agencies have recently begun anti-FGM/FGC
educational campaigns in Puntland. Since 1996, UNICEF in Somalia has supported a series of awareness
raising seminars.

Study methodology
Secondary and primary methods of data collection were employed to collect qualitative and quantitative
data in order to establish the statistical impressions as well as the factors contributing to the prevailing
status on Children rights and gender based violence. 450 respondents were interviewed, eight focussed
group discussions and five in-depth interviews conducted. In addition, relevant documents such as
project proposal and reports were reviewed.
Quantitative data was analyzed through Statistical Package for Social Scientists (SPSS). Both descriptive
and analytical statistics such as frequency distributions and cross tabulations were used to analyze key
assessment variables. Qualitative data was analyzed through content analysis by data reduction, data
display and drawing and verifying conclusions by use of comparisons.



Key challenges during the Survey
       Inadequate overall period for the survey
       Inadequate training period for the enumerators and lack of proper understanding of the
        questionnaires leading to spoiling of many household questionnaires
       Lack of cooperation from community members claiming that the assessments were futile as no
        follow ups were made




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SUMMARY OF KEY FINDINGS
FGM Prevalence, Perceptions, Beliefs and Effects
     FGM is a greatly entrenched cultural practice with over 92% of all the girls in the regions being
      circumcised.
     Three main types of circumcision are predominantly practiced in the area with a large majority
      72.9% undergoing infibulations, 17% excision and 10.1% undergoing clitoridectomy
     Majority of the girls (88.8%) are circumcised at the age of 6-10 years. An age at which they
      cannot make an independent decisions.
     Circumcision is believed to increase girls’ chances of marriage, while preserving the much valued
      virginity. Circumcised girls are considered more religious and holy.
     The type of FGM operation to be performed is largely decided by the girl’s mother (66.6%). A
      significant number of decisions to circumcise girls are jointly made by the girl’s grandmother
      (10.4%). Others who may make decisions on type of circumcision include immediate both
      parents and circumcisers.
     The survey established that among the most important reason why FGM is performed is
      religious requirement 25.8%, while 17.3% believed that FGM preserved the virginity of the girl,
      13.1% said it is a good traditional practice hence to be perpetuated while a significant 12%
      believed FGM keeps a girl clean.

     Majority of the community members were able to mention one or more harmful effects of FGM.
      Mostly mentioned harmful effect was painful menstruation 21.1%, painful sexual intercourse
      particularly during the first few days of marriage 18.9% and urinary tract infection 17.3%. Other
      significantly mentioned harmful effects of FGM were excessive bleeding, leads to early marriage
      and against women dignity.
     FGM is performed throughout the year implying that girls can be drawn from schools or might
      miss out of school to undergo FGM. 51.1% of the respondents indicated that FGM is performed
      during the dry season followed by spring 32.2%.

     There are commonly held myths and misconceptions on FGM such as the clitoris is ugly and
      smelly and has to be removed at any cost, the clitoris grows and if not cut would grow
      interfering with sexual intercourse and process of giving birth.
     The girls’ mothers (66.6%) are instrumental in deciding the type of FGM to be performed on the
      girl.
     81.6% of the respondents were in favour of the continuation of FGM while only 18.6% support
      eradication of FGM in their communities.
     For those who thought FGM should be eradicated 31.3% thought FGM to be against Islamic
      religion, 37.3% said FGM is harmful for the girls, 16.9% said it is bad culture or tradition while
      the remaining 14.5% said they have heard anti-FGM campaigns messages that have lead to their
      wish for the elimination of FGM.




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      51.3% of the respondent felt that women were responsible for continuation of FGM while 25.8%
       stated that men were the ones responsible for continuation of FGM while the remaining 19.8%
       felt the elders as mainly responsible for FGM.
      34.7% of the community felt that the religious leaders should be targeted for awareness
       campaign if FGM is to be eliminated in the community. 17.6% felt that the community elders
       should be targeted and 23.3% felt parents should be the main target.



Child Rights and Child Education
      70.7% of the households had school age girls in their households but only 42.8% had their
       daughters enrolled in schools.
      A significant 28.7% of the parents said they do not participate in their children education once
       they were enrolled in schools. 25.7% said they follow up on the progress report of the child,
       22.1% said they participate by paying the school fees for the child, 18.4% said they participate in
       building activities in schools and 5.1% attend PTA meetings in the schools where their children
       were enrolled.

      Majority of girls and women in area are illiterate due to the societal attitudes, cultural practices
       and the economic value placed on a woman and the girl-child.
      The most common child abuse in the communities was corporal punishment 26.9% where
       physical abuse was inflicted on the child. 23.1% mentioned early marriages of girls as the
       rampant while 24.2% cited child labour. A significant 14.4% also mentioned the dehumanizing
       act of rape. There were also cases of child recruitment into clan militia 8.7% and incest 2.7%.



Women Rights and Gender Attitude
       Of the total 367 women interviewed, 47.7% were married in monogamy, 28.1% in polygamy,
        15% divorced and 9.3% were widowed
       Majority of the women 68.9% were getting married at the young age 13-19 years, 28.1%
        between 20-26 years while insignificant 3% above 27 years of age.
       Of the total 367 female (81.5%) of the total respondents for the household questionnaires,
        majority of them 54.2% have never attended school while only 45.8% have been to some school.
       Only 36.3% of the female respondents could read and write while overwhelming majority of
        63.7% could neither read nor write.
       32.7% were primary dropout, 25% primary complete, 19% secondary dropout while 7.7%
        completed secondary education. Insignificant 4.8% managed to complete tertiary education
        while 10.7% attained informal education
       40.6% of the women dropped out due to early marriages, 30.6% lacked school fees while 17.5%
        had no school in the area and since parents were afraid of taking girls far away from home they
        had to drop out.



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        Overwhelming majority of the women 41.7% were housewives while 31.6% were involved in
         small business activities such as sale of vegetables, running butcheries, khat selling and sale of
         candies by the roadside. 15.3% reared livestock while 9% were involved in farming activities.
        Fathers were the most instrumental in deciding whether a girl should get married 48.2%, while
         31.9% believed the girl could decide when to get married.
        The most common form of GBVs were verbal abuse 29.4%, physical abuse 27.5% and economic
         abuse 22.6%.
        25.9% said that GBV should be reported to the community elder, 24% said it should be reported
         to father, 22.3% said cases should be reported to both parents, 17.2% said religious leaders,
         7.6% said they will report to their mothers while insignificant 3% said such cases should be
         reported to the police.
        majority of the women 81.2% felt that uncircumcised girls cannot be married while 18.8% felt
         that it was ok for a man to marry uncircumcised girls




Conclusions and Recommendation
In view of the study findings, FGM and other forms of gender-based violence are deeply entrenched
cultural practices that have been carried out for ages in the communities. With this in mind, there is
need to promote holistic development interventions that will not only increase peoples knowledge
levels but also influence them to change attitudes, core values and behaviour. In this regard, the
following recommendations are considered tenable:

(a)    Co-opting local leadership in anti-GBV
       Promote community training targeting leaders at various levels on the concept of gender and
         development. This will help demystify the myths, beliefs, prejudices different people have about
         women.
       Mobilise and support local leaders who thoroughly understand the existing norms, attitudes as
         well as social dynamics as agents of change. These should be used as entry-points to community
         process of unlearning. It is important that such leaders comprise of representative village based
         committees (youth, elders, women) that would be used to lobby and for change.


(b)    Behaviour change
       There is need to re-orient communication strategies from awareness raising to behaviour
         change intervention approaches. Current strategies on FGM prevention are based on the
         message that FGM is a harmful traditional practice that has negative health consequences to
         women and girls. This message does not address the core values, myths or enforcement
         mechanisms that support the practice.
       Develop appropriate behaviour change training manual for use by field staff. This would not only
         ensure increase knowledge on the harmful effects of FGM but also influence people’s attitudes ,
         perceptions and beliefs about women in society


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(c)    Women empowerment (socio-economic and political)
       Efforts should be made to         address the diverse needs and vulnerabilities of women in this
        region. These should include;.
            o Facilitating formation of groups and strengthening of existing ones as vehicles for
                 women empowerment. Efforts should be made to network the groups for collective
                 bargaining.
            o Promote adult literacy in the region with special focus on women. This should focus on
                 functional adult literacy that will not only empower women to gain numeric and literacy
                 skills but facilitate them to engage actively in development intervention especially those
                 that have a direct impact on their lives.
            o Provide women with appropriate trade skills to enable them earn a living.
       Developing alternative sources of income such as small and micro enterprise programmes in the
        region. This will give women an opportunity to access financial inputs to exploit their business
        potentials and better themselves and their families. Such project should first target
        practitioners/ circumcisers so as to provide them with alternative sources of livelihood.


(d)    Lobbying and advocacy
       Support and promote the already on-going FGM eradication policy development by the
         government in order to ensure mainstreaming of FGM prevention, elimination at national,
         regional and community level.
       Utilize the power of numbers through coalition building with like- minded INGOs, UN agencies,
         local NGOs and CBO’s to Lobby and advocate against FGM cultural practice that denies girls
         and women in general opportunities to education, while posing a danger to their health.
       FGM training and advocacy materials should maintain the focus on eradication as opposed
         moving to a mild form of circumcision in order to address other forms of gender violation
         associated with FGM. It should be noted that FGM is not only bad because of its harmful effects
         on the reproductive and sexual health of women but also because; it is a violation of women’s
         fundamental human rights.


(e)    Enhance awareness raising
       Raise awareness for both men and women on reproductive health for better health of the
         mother, informed and responsible parenting.
       Sensitize communities against domestic violence as a measure of containing      sex and khat
         related violence.
       Design and undertake systematic community mobilization strategies for awareness creation and
         development education amongst all the communities on children and children rights. This
         should target key decision makers perpetuating some of the child abuse practices (FGM, early
         marriage) such as traditional elders, circumcisers, and community leaders. Efforts should be


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          made to establish community based lobby groups (in schools, villages to ensure that child abuse
          practices are monitored.
         Initiate and promote education campaign for children and especially girl child.
         Educate children on their rights including their participation in project activities in school;
          establishing child-rights clubs in schools may be value added
         Promote appropriate sanitary towels for girls in schools.


(f)    Life skills
         In collaboration with other stakeholders, train young girls and boys in primary schools as well as
          youth in life skills to enable them develop their self-confidence, assertiveness necessary in
          making choices in life. This would go along way to ensure children are not so much vulnerable to
          abuses such as early marriages, pregnancies, peer pressure among others.


(g)    Mainstreaming of GBV-CR
       Strengthen integration and collaboration with other UN agencies such as UNICEF sectors
        especially education and health and any other NGOs in the area to facilitate synergy and
        address the needs affecting women and girls holistically.




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BACKGROUND
Political and Socio-Economic Situation in Somalia
Since 1991, Somalia has been without a functional government. With an estimated population of
8.5millon, the country is fragmented both politically and administratively with three distinctive regions;
Somaliland (North West), Puntland (North East) and Central/Southern. A transitional federal
government formed in 2007 in Nairobi, Kenya is yet to gain full control over the country, especially with
the emergence of Islamists militia such as the Al-shabab and Hisbul Islam among others that have
continued to control most of the major towns in south central with the weak Transitional Federal
Government (TFG) not able to provide stability in the region.

Puntland (North East) has been the more stable along with Somaliland with significant gains in stability
and better administration compared to Central and South. Traditional forms of governance in the form
of clan of elders were instrumental in re-establishing political stability, and a governance system which
facilitates access by humanitarian agencies and promotes other economic activities. Economic activities
in the region centre on pastoralist, trade and agriculture.

Despite many positive developments in Puntland, the region remains poor. The instability in Somalia
discouraged the international community which hampers aid flow and her representation in
international fora. This has made many communities to rely on their meagre resources or aid agencies
to provide essential services such as health, food and education. Women and children remain among
the most marginalised in communities in relation to equitable access to basic human rights.
Marginalization of women and children, which is not unique to Somalia, is exacerbated by culture and
traditions which in many societies have been instrumental in passing on a culture of oppression and
submission.

Objectives of the Study
The goal of the study was to obtain relevant and adequate data on knowledge, attitude, perceptions
beliefs and practices, associated with FGM and other forms of Gender Based Violence (GBV), gender
equity and, Child rights.

The specific objective was to understand the effects FGM/GBV on women including the girl child.



Baseline Survey Design

This report presents the process and output of a participatory operational survey, which was conducted
from 10th to 31th December 2009 in Garowe, Galkaiyo and Bosasso District, Puntland (see annex 1 for
schedule of activities). The survey aimed at obtaining relevant and adequate data on knowledge,
attitude and practices including perceptions and beliefs associated with Gender Based Violence (GBV)
including FGM and Child rights. The information generated is expected to form the basis for project
planning and provide benchmarks for project monitoring and evaluation.

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Study Methodology
Secondary and primary methods of data collection were employed to collect qualitative and quantitative
data in order to establish the statistical impressions as well as the factors contributing to the prevailing
status on Children rights and gender based violence. A total of 450 households (100 in Garowe, 150 in
Galkaiyo and 200 in Bosasso) were interviewed, 8 focussed group discussions and 4 in-depth interviews
conducted. In addition, relevant documents such as project proposal and reports were reviewed.

Quantitative data was analyzed through Statistical Package for Social Scientists (SPSS). Both descriptive
and analytical statistics such as frequency distributions and cross tabulations were used to analyze key
assessment variables. Qualitative data was analyzed through content analysis by data reduction, data
display, drawing, and verifying conclusions by use of comparisons.



METHODOLOGY PROCESS

a) Sources of data
This survey utilized both primary and secondary sources of data. This entailed review of documents such
as Report on female Genital mutilation (FGM) or Female Genital Cutting ( FGC) on Somalia by Office for
international women issues, Female genital mutilation: what works and what Doesn’t by WHO and
Project Reports from local NGOs in the region. It also involved collection of primary data from targeted
population by use of Questionnaires, Focus Group Discussions and semi-structured interviews.

b) Data collection
The target respondents for the data collection exercise included Regional leaders, local leaders/elders,
Community Based Organizations, Women groups, youth groups, Staff of local NGOs working in the
region.



A structured questionnaire (annex 1) was administered to a selected sample of households. The
questionnaires were administered to the potential target group of the project. 120 questionnaire for
Garowe town (50, sunachef 35 and 35 Dangoriyo), Galkacyo town 80 and 70 for 4 IDP camps, Bossaso
town 80, 100 for 24 Idps camp. 450 villages were sampled.

The selection of households employed the purposive random sampling ensuring that households
interviewed also represented the categories of people with additional information on FGM practice such
as circumcisers, CHWs, TBAs and religious leaders among others.

The structured interview (questionnaire) sought data based on the following thematic areas, (i)
Demographic characteristics of household members (ii) FGM prevalence, perceptions, beliefs and



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effects(iii) Women rights and marriage and gender attitude (iv) Child rights and Girl child Education (v)
knowledge on HIV-Aids prevention and management.

Other primary data was collected through FGD’s. Eight Focus Group Discussions were conducted. This
method of data collection generated invaluable information about the GBV and Children rights. Data
generated from structured interviews and from FGD were triangulated to ensure validity (see annex for
FGD checklist).

Data was also collected through field observations. The Consultant made observations about the
situation of girls and women as they went on their daily chores. Such information included their living
conditions, presence in schools, the relationships between men and women; and their means of
livelihood.

c) Training of Enumerators
A one-day survey-focusing training workshop was held in each of the Districts of Garowe, Galkayo and
Bosasso. The training was designed to familiarize the enumerators with the questionnaire as wells as
enhancing their skills in techniques of administering the same in the field. Before the actual
administration of questionnaires, a pre-test was done to establish whether enumerators had grasped
data collection techniques and find out level of understanding by target respondents on questions in the
questionnaire.
After the orientation, enumerators were divided into groups to administer questionnaires to sampled
households. To ensure that required data was collected, all the questionnaires completed each day were
collected

d) Data Analysis
Quantitative data was analyzed through the use of Scientific Package for Social Scientists (SPSS), to
establish frequencies distribution, percentages and cross tabulation analysis of the key variables.
The qualitative data obtained from all the respondents was analysed through content analysis. The
method of analysis was by data reduction, data display and drawing and verifying conclusions by use of
comparison. The qualitative data was organized and presented in various themes as per the study
objectives.




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KEY FINDINGS OF THE STUDY
Demographic Characteristics
Gender of respondents

The survey conducted 450 households of which 367 (81.6%) were female and 83 (18.4%) were male as
indicated in the table below. The people interviewed, the FGDs and the in-depth interviews represented
different segments of the community with special focus on mothers, fathers, religious leaders,
circumcisers TBAs and the youth.




Marital status of the respondents

Of the total 450 interviewed 187 (41.6%) were monogamous, 66 (14.7%) were polygamous, 98 (21.8%)
divorced, 67 (14.9%) widowed and the remaining 32 (7.1%) were single men or women as indicated in
the table below.

 Marital status         Frequency   percentage
 married monogamy       187         41.6
 married polygamy       66          14.7
 Divorced               98          21.8
 Widowed                67          14.9
 Single                 32          7.1
 Total                  450         100




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Education Level

As indicated in the table below majority of the respondents 48.2% have never attendant any form of
school while insignificant 3.3% have attained tertiary education either as middle level college or
university. It is also apparent from the study that the education level of the respondents decreased as
one progressed up the education ladder.

The prevailing education status was mainly attributed to the collapse of the central government in
Somalia that saw the collapse of the educational infrastructure. Primary schools were noted to more
functional in urban centres compared to rural villages. Factors attributed to this disparity included;
ability of parents to pay fees, availability of teachers (at least a few who can speak English which greatly
valued by the young learners), availability of teaching and learning materials.

Comparatively, there is significant disparity between men and women in accessing education.
Traditionally formal education is perceived as a domain for men, with women’s main role in society
perceived as taking care of the household duties (reproductive roles) a perception that is still prevailing
in Puntland.




Current occupation of respondents

The graph overleaf indicated that majority of the respondents 23.1% were in small business activities
that include operating small shops, vegetable stands, sell of khat, cloth stalls, soft drinks shops and
candy tables by the roadsides among others. A significant 20.4% were housewives taking care of daily
household chores including washing, cooking and nursing the children. 18.2% were herders, 14.9% said
they were jobless, 12.4% said were in employment while the remaining 10.9% practiced rain fed
agriculture mainly for subsistence with surplus being sold in the local market to earn extra cash for the
household.

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Attitude and Practice Towards FGM/C in the Community
The survey sought to know the attitude, knowledge, practice and perception of the communities in
Garowe, Galkayo and Bossasso Districts in Puntland towards the practice of FGM/C in the communities.
Of the total 450 households interviewed, 377 (83.8%) said they had girls in their households and 347 of
them confirmed that the girls were circumcised. Of the total 1105 girls in the sample households, 1067
representing 96.6% have gone through one of the three types of FGM. Focus group discussions also
confirmed that there were no cases of women who grew to maturity without undergoing FGM implying
that the remaining 38 (3.4%) girls are a waiting their turn of the knife.

Table 5: Circumcised girls

Do you have girls(daughters, female relative) in your Response              N      %
household
                                                      Yes                   377    83.8

                                                          No                73     16.2

If yes, are they circumcised?                                               N      %

                                                          Yes               347    92

                                                          No                26     6.9

                                                          Not sure          4      1.1




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Type of circumcision

The study revealed that there three main types of female genitalia mutilation/cutting predominantly
practiced in this area. These are pharaonic, also known as infibulations/FGM (72.9%) and Excision
(Sunna Kabiir) 17%, and Sunna small- cutting the hood (10.1%) as shown in the chart below. A large
majority of the girls in Puntland undergo the most severe form also referred to as infibulations.




The study revealed that various parts of the female Genitalia are cut as follows:
Clitoridectomy (Sunni small): The circumciser with a sharp blade cuts off the fleshy skin of the clitoris
and a little bit of the sides. Then using the skin of the clitoris the tip of the clitoris is sewn insides. This
takes 2-4 days for the girl to walk normally if there are no infections.
Excision (Sunni kabbiir): In this part of Somalia the survey revealed, Sunna great is just as severe as
infibulations. The circumcisers cuts the tip of the clitoris, peels of the black sides of the clitoris and then
sews up the labia minora covering the already cut tip of the clitoris. The girls’ legs are tied together at
the hip –joint. The girl remains immobile for 7-10 days, when she is untied.
Pharoanic Circumcision or Infibulations: The practitioners completely removes the clitoris, the inner and
the outer lips( labia minora and majora) and the stitching of the two raw sides of the labia majora
leaving only a small opening to allow urine and menstrual flow. In cases where the healing is not

                                                                                          18 P a g e
satisfactory to the practitioner, de-infibulations is done. The wound is then treated by applying mixtures
of local herbs, earth, cow-dung, ash etc depending on the skills of the Practitioner. The child's legs are
bound together to impair mobility for up to 7-14 days. After, this period, the girl has to be helped to
learn to walk which takes about two weeks.
However, even for the above categories, procedures for circumcision slightly differ depending on the
type of the circumcision as well as the orientation of the practitioner (circumciser).

Several of the practitioners, especially those in urban centres, as established during the FGD with
circumcisers use painkillers and antibiotics from the pharmacists while those in rural villages use
traditional herbs to help in the healing.

Who circumcised the girls?

A large majority of the girls are circumcised by traditional circumciser (85%) while 8.9% are carried out
health workers and 4.6% carried out by grandmothers. Few of the circumcisers (especially, those who
are health workers) use one blade per girl. Traditional circumcisers did not demonstrate concern on the
use of one blade per girl, and neither where they keen in observing general hygiene. The main, concern
in circumcision is to ensure that the girl was ‘closed”.




Age at which FGM is performed
In Puntland majority of the girls are circumcised at the age brackets 6-10 years (88.8%). The chart below
indicated that very few girls are circumcised after attaining over 10 years. Reasons for early circumcision
included, circumcising the girl before joining school, small girls are easy to operate and have less
bleeding compared to the older girls. Circumcision for girls at an early age indicates that it is done when
the girls are not mature enough to make independent and informed decisions on the practice. Health
workers interviewed acknowledged that they did it to earn extra income. It was also noted that most
parents in urban centre prefer to have the health personnel circumcise their daughters since they have
access to clean operation blades as well as medicine.




                                                                                      19 P a g e
Decision to circumcise a girl

The type of FGM operation to be performed is largely decided by the girl’s mother (66.6%). A significant
number of decisions to circumcise girls are jointly made by the girl’s grandmother (10.4%). Others who
may make decisions on type of circumcision include immediate both parents and circumcisers. Table 11
provides details of main decision makers. FGDs indicated established that circumcisers tended to
influence mothers to carry infibulations (most severe form) because of their economic gains. It is more
lucrative for circumcisers to perform the most severe form which cost on an average US $15 compared
to small sunna US $8. Pharaonic circumcision is considered a guarantee to virginity since the mother can
occasionally monitor the vaginal opening.




Reasons for circumcision

The survey established that among the most important reason why FGM is performed is religious
requirement 25.8%, while 17.3% believed that FGM preserved the virginity of the girl, 13.1% said it is a

                                                                                    20 P a g e
good traditional practice hence to be perpetuated while a significant 12% believed FGM keep a girl clean
as shown in table 12 below. Further, Focus group discussions revealed that FGM increases girl’s chance
of marriage as men prefer ‘closed’ girls and when a boy marries a ‘closed’ girl then he is applauded with
shots and thus brings honour to the family of the girl. FGD further revealed that FGM is performed to
control a girl’s sexuality. Uncircumcised girls were believed to be sexually wild and has sexual demand
beyond the capacity of the husband hence becomes unfaithful in marriage. “Uncircumcised girl is like an
open well where any thirsty man can draw to his fill…… they cannot resist any temptation and will
obviously budge with a small flirt” lamented one of the male youth during FGD in Lasqorey

 Table 12: Reasons for circumcision
 Response                    Frequency       Percentage
 Good tradition              59              13.1
 Social acceptance           32              7.1
 Cleanliness                 54              12.0
 Easy delivery               9               2.0
 Important rite              32              7.1
 brings honour to family     40              8.9
 Gifts are received          5               1.1
 learning opportunity        25              5.6
 preserves virginity         78              17.3
 religious requirement       116             25.8
 Total                       450             100


Health problems associated with FGM

Majority of the community members (69%) were able to mention one or more harmful effects of FGM.
Mostly mentioned harmful effect was painful menstruation 21.1%, painful sexual intercourse
particularly during the first few days of marriage 18.9% and urinary tract infection 17.3%. Other
significantly mentioned harmful effects of FGM were excessive bleeding, leads to early marriage and
against women dignity. It is notable that only 5.1% related FGM to HIV while even lesser number could
relate to obstetric fistulae which are a common phenomenon particularly during first child birth. Focus
group discussions with circumcisers in Galkayo also indicated that many of them were aware of the
harmful effects of FGM but continue to practice as it was a cultural obligation with many mothers
seeking their services and also for their personal economic gain. Key informant interview with a religious
leader in Garowe also ascertained that FGM is the breadline of circumcisers and while they were aware
of the harmful effects of FGM, they nevertheless encourage mothers to circumcise the girls so that they
earn a living. “Some of my daughters have gone through infibulations which has many harmful effects
but I always favour clitoridectomy (Sunni Fatima) as it is a religious requirement since untouched girl
cannot even pray” said Sheikh Hussein Warsame

 Table 14: Do you know the harmful effects of FGM


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 Response                                     Frequency   Percentage
 Excessive bleeding                           30          9.8
 Obstructed labour                            15          4.7
 School drop out                              5           1.6
 Early marriage                               24          7.8
 Can lead to HIV                              16          5.1
 Bleeding causes anemia                       0           0.0
 Urinary tract infections                     54          17.3
 Painful sex                                  59          18.9
 Painful menstruation                         65          21.1
 Difficulty in urination/urine retention      8           2.7
 Still births                                 4           1.3
 Psychological trauma and depression          5           1.6
 Against dignity of woman                     25          8.2
 Total                                        310         100


Period of the year when FGM is performed

Table 15 indicate that FGM is performed throughout the year implying that girls can be drawn from
schools or might miss out of school to undergo FGM. 51.1% of the respondents indicated that FGM is
performed during the dry season followed by spring 32.2%. Focus group discussions with health
personnel indicated that summer was preferred by most parents as the wound heal faster than in the
wet season when there are more cases of infections.

 Table 15: Period of the year when circumcision is performed
 Cluser             Frequency             Percentage
 Spring             145                   32.2
 Autumn             56                    12.4
 Summer             230                   51.1
 Winter             19                    4.2
 Total              450                   100


Was the girl in school before circumcision?

The chart below indicated that majority of the girls 59.4% are cut before they are enrolled in school at
tender ages of 4-7 years. According to FGD with circumcisers, girls are cut at young age when they
cannot make any decision of their own and also before they get to understand the pain mainly of
infibulations particularly the stitching together which is very long and painful. Some mother in the urban
areas also noted that they do not wish to disrupt the education of the girls once they enroll in koranic
schools or formal schools hence their preference to cut the girls before enrolling them in schools.


                                                                                     22 P a g e
Did the girl go back to school after circumcision?

Table 17 below indicate that 63.1% of the girls went back to school after circumcision while a significant
22% did not go back to school but stayed back home to assist with household chores. In some families
particularly the poor who can ill afford school fees, they prefer to educate the male child and hence
once a girl is circumcised, they are removed from schools to reduce burden for the family.




Payment
Payment is made to the practitioner before, during and after the operation, to ensure the best service.
This payment, either in kind or cash, is a vital source of livelihood for the FGM practitioners. Focus group
discussion indicated that one became a practitioner either by learning the skill from one’s mother or
relative or after being trained as health personnel (CHWs, midwives). The practitioners are paid US $ 5-
15 per girl for Sunna type circumcision and pharaonic respectively. The price also depends on the
economic well-being of the family of girl. Some families are willing to pay much more as a token of
appreciation for the service.



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Interviews with practitioners indicated that they had reasonable knowledge on the short and long term
effects of FGM, but mainly continue to practice for economic gains.
Payment in kind was made in form of goats, foodstuffs or any valuable in appreciation. Most of the
practitioners interviewed perceived this as a business and were ready to do anything to get the money.
Several organized what they termed as “outreach’ to other villages and towns in order to maximize their
gains.


Continuation of FGM
Should FGM continue to be practiced?
81.6% of the respondents were in favour of the continuation of FGM in the community while only 18.6%
support eradication of FGM in the community as indicated in the table below. Among the most notable
reasons mentioned by those in favour of continuation of FGM were; Islamic requirement, removal of
dirty genitalia, good traditions, enhance social acceptance and preserves virginity and hence enhance
dignity of the family of the girl. Focus group discussions with men also indicated that circumcised girls
are clean and have obeyed the religion and also men were willing to pay more pride price when a girl’s
virginity has been preserved.
Circumcised girls and especially those who had undergone pharoanic type (infibulations) were mostly
preferred for marriage for other mild forms of circumcision are associated with promiscuity. “How can
you be sure the girl is pure and virgin, when you find everything can go in and out!” remarked several of
the respondents




                                                                                    24 P a g e
 Table 12: Why FGM should continue to be practiced
 in your community

 Response                    Frequency    Percentage
 Good tradition              59           16.1
 Social acceptance           20           5.4
 Cleanliness                 41           11.2
 Easy delivery               23           6.3
 Important rite              32           8.7
 brings honour to family     35           9.5
 Gifts are received          5            1.4
 learning opportunity        15           4.1
 preserves virginity         58           15.8
 religious requirement       79           21.5
 Total                       367          100.0


Should FGM be abandoned in your community?

Of the total 450 sampled households 83 (18.4%) were in favour of the discontinuation of FGM in their
communities. 31.3% thought FGM to be against Islamic religion, 37.3% said FGM is harmful for the girls,
16.9% said it is bad culture or tradition while the remaining 14.5% said they have heard anti-FGM
campaigns messages that have lead to their wish for the elimination of FGM.




People who facilitate the continuation of FGM

The graph below indicated that women were the most instrumental in continuation of FGM in the
community. 51.3% of the respondent felt that women were responsible for continuation of FGM while

                                                                                   25 P a g e
25.8% stated that men were the ones responsible for continuation of FGM while the remaining 19.8%
felt the elders as mainly responsible for FGM. This was further confirmed by FGD with men where all of
them said that they were not willing to marry uncircumcised girls as they were opened and they have
disregard for Islam.




Target community members for the elimination of FGM

As shown in the graph below, 34.7% of the community felt that the religious leaders should be targeted
for awareness campaign if FGM is to be eliminated in the community. 17.6% felt that the community
elders should be targeted and 23.3% felt parents should be the main target. Key Informant interview
with village heads also confirmed that since the community believes FGM is a religious requirement,
then religious leaders should be targeted to inform the community on the stand of Islam on FGM. FGDs
with youth groups and women organizations also indicated that parents particularly the mothers should
be the target of awareness campaigns should FGM be eliminated in the community.




                                                                                  26 P a g e
Child Rights Issues
The survey sought to know whether the communities upheld child rights particularly for the girls
including rights to education and body integrity and also child rights violations through abuses that were
commonly practiced in the community.

Girl child rights to education

70.7% of the households had school age girls in their households but only 42.8% had their daughters
enrolled in school as indicated in the table 21. FGD with women group indicated that majority of the
parents favour boys to go to schools while girls are from early age trained on household chores and girl
child education is not taken seriously as stated by women group chairlady “girls are considered only
temporary members of the household as they move to their matrimonial homes once married while the
boys become heads of household in future so they need to be empowered”




                                                                                     27 P a g e
Focus Group Discussions with teachers, village heads, women and youth groups showed that several
factors adversely affected girl children rights to education. The main factors mentioned were

       Girls are retained at home to undertake household chores that are culturally reserved for
        women (e.g. cooking, fetching of water, firewood, )
        Complication associated with infibulations predisposes young girls to prolonged painful
        menstruations. This situation is worse by absence of comfortable and hygienic sanitary towels.
       Most mothers are reluctant to enroll their girls in mixed schools for they fear that their girls
        would get interfered with by the boys loosing the much valued virginity.
       Some of the girls are socialized for marriage right from a tender age. This makes some girls
        psychologically absent even when they attend school for they see school as a “waiting place”
        before they are married.
       Educating girls is perceived by some parents as wasting a family’s resource since the girl will be
        married.
       Girls are also perceived as part of a family’s wealth and consequently taking them to school
        denies her family the much-needed dowry. Therefore parents marry off the girls to get wealth in
        form of animals, money among other dowry requirements.
        Some Parents have inadequate awareness in regard to the importance of education for both
        boys and girls for they lack role models in the community. Some parents wonder how education
        would help them solve their immediate problems.
       Long distance / absence of schools in some villages, which makes difficult for children to access
        education.
       Poor quality education in some schools. It was noted that majority of the public schools were
        run by volunteer teachers. These teachers tend to regularly absent themselves. Additionally,
        some of children reported that several of the teachers could only teach in Somali language as
        compared to English which most of the youth were interested in.


Participation of parents in child education

From table 22 below, the survey established that a significant 28.7% of the parents said they do not
participate in their children education once they were enrolled in schools. 25.7% said they follow up on
the progress report of the child, 22.1% said they participate by paying the school fees for the child,
18.4% said they participate in building activities in schools and 5.1% attend PTA meetings in the schools
where their children were enrolled. Focus group discussion with teachers indicated that parents did not
have keen interest in the learning of their children particularly in following up on the performance of the
children at schools. incidents of the children mainly girls been influenced by parents to miss classes so as
to assist at home were the major concern of teachers during the discussions.




                                                                                       28 P a g e
How do you participate in your child education
Response                                         Frequency      Percentage
Follow up on progress report                     35             25.7
Participate in building activities in school     25             18.4
Attend PTA meetings                              7              5.1
Paying school fees                               30             22.1
Do not participate                               39             28.7
Total                                            136            100.0


Common child abuses

The survey revealed that there were wide spread child abuses that were common among the
communities in Puntland. Table 23 below showed that the most common child abuse in the
communities was corporal punishment 26.9% where physical abuse was inflicted on the child. 23.1%
mentioned early marriages of girls as the rampant child abuse while 24.2% cited child labour. A
significant 14.4% also mentioned the dehumanizing act of rape and 8.7% mentioned rape. There were
also cases of child recruitment into clan militia 8.7% and incest 2.7%.




Women Rights and Gender Attitude
Of the total 367 women interviewed, 47.7% were married in monogamy, 28.1% in polygamy, 15%
divorced and 9.3% were widowed. From the table below it was clear that polygamous marriages and
divorce were common phenomenon which were according to Key informant interview with a religious
leader from Garowe was the main cause of child neglect and family breakdown in the society. Table 24
below shows the marital status of female respondents in the survey.



                                                                                29 P a g e
Age at first marriage

As indicated pie chart below majority of the women 68.9% were getting married at the young age 13-19
years, 28.1% married between 20-26 years while insignificant 3% were married above 27 years of age.
The age of 13-19 years at which majority of the women were getting married is considered as school age
when girls were supposed to be in school. This implies that majority of the women were either not
enrolled in schools or were dropped out of school to be married off. Focus groups discussion with
women group indicated that majority of the women were not given any education opportunity
compared to their male counterparts in the households.




                                                                                  30 P a g e
Whether attended school

Of the total 367 female (81.5%) of the total respondents for the household questionnaires, majority of
them 54.2% have never attended school while only 45.8% have been to some school as shown in the
chart below




Whether can read or write

As indicated in table 23 below, of the 168 women who ever attended school, only 36.3% could read and
write while overwhelming majority of 63.7% could neither read nor write. Women once married stay at
home and take care of the family and have little time to go back to school after getting married. Against
the backdrop of mass illiteracy due caused by the prolonged civil war in Somalia, there were no
established adult literacy classes that illiterate women could take advantage of.




Highest education level achieved

Table 24 below indicated that of the total 168 women who attended school, 32.7% were primary
dropout, 25% primary complete, 19% secondary dropout while 7.7% completed secondary education.
Insignificant 4.8% managed to complete tertiary education while 10.7% attained informal education. It

                                                                                    31 P a g e
worth noting from the table those as one progress up the education ladder from primary to higher
education, the number of women continues to reduce. According to focus group with women group,
parents were not enthusiastic about educating a girl child and girls are dropped out of the school to get
married mostly without their consent. “It is an admonition for a girl to refuse a man once her parents
have consented to him regardless of the age and social status of the man.” said one of the women group
members. She sadly continued “I was in class six and fourteen years of age when my father forced me to
marry a man I had never met in my life and I had no choice”

 What is the highest level of education you have achieved
 Response                       Frequency      Percentage
 Informal education             18             10.7
 primary drop out               55             32.7
 primary complete               42             25.0
 Secondary drop put             32             19.0
 Secondary complete             13             7.7
 University/college             8              4.8
 Total                          168            100


Reasons for dropping out of school

Of the total 160 women who dropped out of school before reaching college/university level, the survey
further sought to know the factors that had contributed to their dropout. Table 25 below indicated that
40.6% of the women dropped out due to early marriages, 30.6% lacked school fees while 17.5% had no
school in the area and since parents were afraid of taking girls far away from home they had to drop out.




Current occupation


                                                                                    32 P a g e
Overwhelming majority of the women 41.7% were housewives while 31.6% were involved in small
business activities such as sale of vegetables, running butcheries, khat selling and sale of candies by the
roadside. 15.3% reared livestock while 9% were involved in farming activities. Only an insignificant 2.5%
of the total female respondents were professionals. Focus group discussions with women and youth
groups of mixed gender ascertained that women were discriminated against in job opportunities with
most of the employers being biased towards male




Whose decision is it for a girl to be married?

As indicated in chart below fathers were the most instrumental in deciding for a girl to be married with
48.2% of the respondents vouched that it is the father who decides for marriage of his daughter. 31.9%
said that girls had the freedom to decide whether to get married or not. 18% of the respondents said
both parents made the decision while 1.9% said it was the mother who made the decision particularly in
the event that the father is deceased. Table 26 below shows the decision makers for a girl to be married.




                                                                                      33 P a g e
Payment of dowry

Focus group discussions with community leaders, youth groups and women groups indicated that dowry
Payment was a must for one to have a girl for marriage. This payment, either in kind or cash, is a vital
source of livelihood for the girls’ family. During in-depth interviews with religious leaders cases were
noted where fathers, aunties and other relatives would influence their daughters to marry from well-up
families in expectation for better payment of dowry. Cases were cited where some girls were forced to
marry old men (age of their fathers) in order to please family members who could access the dowry.
This kind of marriages were noted not to last long resulting to increased divorces cases as old men find it
difficult to cope with the sexual demands of their young wives.


Gender based violence
As indicated in the chart below, the female respondents were asked whether there are cases of GBV in
their communities. 58% said there are one or more forms of GBV while 42% said there were no cases of
GBV




Table 27 indicated that the most commonly practiced GBV were verbal abuse 29.4%, physical abuse in
the form of wife bartering 27.5%, economic abuse 22.6% in the form of refusal to engage in business
activities and controlling by husband of income generated from any business his wife is engaged in,
intimidation and harassment 10.9% and sexual abuse 9.5%. Women can easily be abused for any trivial
misunderstanding with her husband and such cases rarey reach the authorities according to discussions
with the women group.
 What is the most common form of GBV in your community
 Responses                        Frequency Percentage
 Physical abuse                   101         27.5
 Sexual abuse                     35          9.5
 Economic abuse                   83          22.6
 Intimidation and harassment      40          10.9


                                                                                      34 P a g e
 Verbal abuse                         108           29.4
 Total                                367           100


Who should women report GBV to?

As shown in table 29 below, all the respondents agreed that cases of GBV should be reported. 25.9%
said that GBV should be reported to the community elder, 24% said it should be reported to father,
22.3% said cases should be reported to both parents, 17.2% said religious leaders, 7.6% said they will
report to their mothers while insignificant 3% said such cases should be reported to the police. In cases
where the girl lives outside with community leaders and religious leaders were the most appropriate to
deal with cases of GBV as such matters are seldom taken to the police as ascertained in the FGDs.

 Who should women report GBV to
 Response           Frequency         Percentage
 Mother             28                7.6
 Father             88                24.0
 Both parents       82                22.3
 Community elder    95                25.9
 police             11                3.0
 Religious leader   63                17.2
 Total              367               100


Marriage of uncircumcised girls

Table 26 indicated that majority of the women 81.2% felt that uncircumcised girls cannot be married
while 18.8% felt that it was ok for a man to marry uncircumcised girls. Focus group discussion with youth
group and key informant interview with village heads and community elders indicated that a girl who is
not circumcised cannot be married because she had disregard for Islam, she is dirty and she will be
unfaithful in marriage as she has insatiable appetite for sex. This underlying stereotype can be attributed
to the infibulations of girls in puntland as in other parts of Somalia.

 Should a man marry uncircumcised girl
 Response      Frequency       Percentage
 Yes           85              18.8
 No            365             81.2
 Total         450             100




                                                                                      35 P a g e
Knowledge of HIV/AIDS
As indicated in the chart below, majority of the respondents, 53% have heard about HIV/AIDS while a
substantial 47% said they have never heard about AIDS. But according to focus group discussions with
various sectors of the community indicated that majority of the populations were ignorant about how
HIV/AIDS is contracted. HIV/AIDS is a curse from God and a bewitchment by witchcrafts.” Said Abdi
Harshi of Garowe youth group. Key informant interview with a village head also indicated that the
community did not believe in condom as a protective measure as the community believed that condom
itself contained a virus. Majority of the community were not also aware of VCT centers that provide
testing and counseling.




HIV/AIDS awareness campaign messages

As indicated in the chart below, even fewer number of community members are aware of HIV/AIDS
campaigns been conducted in the neighborhoods. Only in 37% of the communities are HIV/AIDS
campaigns conducted while overwhelming majority of 63% was not aware of any anti-HIV/AIDS
campaigns being conducted in their communities.

With the prevailing low knowledge levels on HIV/AIDs, modes of transmission and in a cultural situation
were polygamy and divorce is common practices, women/girls remain vulnerable to the disease.




                                                                                   36 P a g e
CONCLUSIONS AND RECOMMENDATION
In view of the study findings, FGM and other forms of gender based violence are deeply entrenched
cultural practices that have been carried out for ages in the communities. With this in mind, there is
need to promote holistic development interventions that will not only increase peoples knowledge
levels but also influence them to change attitudes, core values and behaviour. In this regard the
following recommendations are considered tenable:




(h)   Co-opting local leadership in anti-GBV
         Promote community training targeting leaders at various levels on the concept of gender and
          development. This will help demystify the myths, beliefs, prejudices different people have about
          women.
         Mobilise and support local leaders who thoroughly understand the existing norms, attitudes as
          well as social dynamics as agents of change. These should be used as entry-points to community
          process of unlearning. It is important that such leaders comprise of representative village based
          committees (youth, elders, women) that would be used to lobby and for change.



(i)   Behaviour change



                                                                                      37 P a g e
         There is need to re-orient communication strategies from awareness raising to behaviour
          change intervention approaches. Current strategies on FGM prevention are based on the
          message that FGM is a harmful traditional practice that has negative health consequences to
          women and girls. This message does not address the core values, myths or enforcement
          mechanisms that support the practice.
         Develop appropriate behaviour change training manual for use by field staff. This would not only
          ensure increase knowledge on the harmful effects of FGM but also influence peoples attitudes ,
          perceptions and beliefs about women in society



(j)   Women empowerment (socio-economic and political)
         Efforts should be made to        address the diverse needs and vulnerabilities of women in this
          region. These should include;.
              o   Facilitating formation of groups and strengthening of existing ones as vehicles for
                  women empowerment. Efforts should be made to network the groups for collective
                  bargaining.
              o   Promote adult literacy in the region with special focus on women. This should focus on
                  functional adult literacy that will not only empower women to gain numeric and literacy
                  skills but facilitate them to engage actively in development intervention especially those
                  that have a direct impact on their lives.
              o   Provide women with appropriate trade skills to enable them earn a living.
         Developing alternative sources of income such as small and micro enterprise programmes in the
          region. This will give women an opportunity to access financial inputs to exploit their business
          potentials and better themselves and their families. Such project should first target
          practitioners/ circumcisers so as to provide them with alternative sources of livelihood.



(k)   Lobbying and advocacy
         Support and promote the already on-going FGM eradication policy development by the
          government in order to ensure mainstreaming of FGM prevention, elimination at national,
          regional and community level.




                                                                                        38 P a g e
         Utilize the power of numbers through coalition building with like- minded INGOs, UN agencies,
          local NGOs and CBO’s to Lobby and advocate against FGM cultural practice that denies girls
          and women in general opportunities to education, while posing a danger to their health.
         FGM training and advocacy materials should maintain the focus on eradication as opposed
          moving to a mild form of circumcision in order to address other forms of gender violation
          associated with FGM. It should be noted that FGM is not only bad because of its harmful effects
          on the reproductive and sexual health of women but also because; it is a violation of women’s
          fundamental human rights.



(l)   Enhance awareness raising
         Raise awareness for both men and women on reproductive health for better health of the
          mother, informed and responsible parenting.
         Sensitize communities against domestic violence as a measure of containing         sex and khat
          related violence.
         Design and undertake systematic community mobilization strategies for awareness creation and
          development education amongst all the communities on children and children rights. This
          should target key decision makers perpetuating some of the child abuse practices (FGM, early
          marriage) such as traditional elders, circumcisers, and community leaders. Efforts should be
          made to establish community based lobby groups (in schools, villages to ensure that child abuse
          practices are monitored.
         Initiate and promote education campaign for children and especially girl child.
         Educate children on their rights including their participation in project activities in school;
          establishing child-rights clubs in schools may be value added
         Promote appropriate sanitary towels for girls in schools.



(m) Life skills
         In collaboration with other stakeholders, train young girls and boys in primary schools as well as
          youth in life skills to enable them develop their self-confidence, assertiveness necessary in
          making choices in life. This would go along way to ensure children are not so much vulnerable to
          abuses such as early marriages, pregnancies, peer pressure among others.



                                                                                       39 P a g e
    (n)    Mainstreaming of GBV-CR
              Strengthen integration and collaboration with other UN agencies such as UNICEF sectors
               especially education and health and any other NGOs in the area to facilitate synergy and
               address the needs affecting women and girls holistically.




    APPENDIX
    Household Questionnaires
Section 1. Identification
   The questions are to be posed to the PRINCIPAL CAREGIVER in the household (preferably a mother). If there is
   more than one mother in a household, choose one mother at random to be interviewed about her household and her
   children, spouse, or any adult within the household

    This section is to be completed for each household visited.




    101.       District   magalada
    102.       village     Tuladha
    103.       Household Head madaca qoska
    104.       Name of the respondent magaca jawabaha
    105.       Status of the respondent in society
    106.       Enumerator Name and Number
    107.       Date of interview
    108.       Time interview started
    109.       Time interview ended



    Introductions and eligibility to be interviewed: My name is ……… and I am here on behalf of LASQOREY
    CONCERN , to undertake a baseline survey of FGM funded by UNFPA

    Confidentiality and consent: Assure the respondent that the information he/she will give will be treated with strict
    confidentiality, with no names revealed.

    Would you be willing to allow me to continue with the interview? [1] Yes                   [2] No

    If no, thank him/her and end the interview




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Section 2. Demographic Questions
    No.    Questions and Filters                        Coding Categories                Skip
    201. Age of the respondent Dada                                              1
    202. Gender Jinsiga qofka                           Male                     1
                                                        Female                   2
    203. Marital Status xaas miyaa mise doob            Single                   1
                                                        Married in monogamy      2
                                                        Married in Polygamy      3
                                                        Widowed                  4
                                                        Divorced                 5
                                                        Others                   6
    204.                                                Informal education       1
           What is the highest level of education you   Pre-primary complete     2
           have achieved?                               Lower primary complete   3
                                                        Upper primary complete   4
           Wax barashadiisa halkee gaarsiisantahay      Secondary complete       5
                                                        College                  6
    205.                                                Farming                  1
                                                        Small business           2
                                                        Herding animals          3
           What is your occupationiisa                  Housewife                4
           Shaqadisa maxay tahay                        Others                   5


 Section 3. Attitude and Practice towards FGM/C

    The questions in this section will be used to generate information regarding the change in the
    FGM/C prevalence rate in target region as well as the percentage of girls circumcised by a mild
    form of circumcision (sunnah) or other forms
    No. Questions and Filters                        Coding Categories              Skip
    301    Do you have girls in your households      Yes                         1
           Gabar maleedahay                          No, if no you               2 Skip Q 302
                                                     questionb302
    302    If yes, are they circumcised              Yes                         1
                                                     No                          2
           Haa haduu ku dhaho, malaguday
    303    If yes, are how many are circumcised      Circumcised: _____          1
           and how many are not
           Haii aad haa tiri intee gudan, inteena    Uncircumcised:_____         2
           gudnayn
    304    If yes, who circumcised them?             FGM practitioner            1
           Yaa guday                                 Health worker               2
                                                     Doctor                      3
                                                     Others                      4
    305    At what age were they when they were      0-5 years                   1
           circumcised?                              6-10 years                  2
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No.   Questions and Filters                     Coding Categories             Skip
      Markii lagudayay intee jirayn             11-15 years              3
                                                16 years and above       4
306   At what period of the year is
      circumcision for girls carried out in your
      community?
      Xiligee badanaa gabdhaha lagudaa
307   What type of circumcision was done         Sunnah FATUMA           1
      on them?                                   Clitoridectomy          2
      Gudniinka noocee ah loo guday              Excision                3
                                                 Infibulations           4
                                                 Other                   5
308   Was she or (where they) in school          Yes                     1
      before circumcision?                       No                      2
      Intaan lagudin school ma dhigan jirtay
309   If yes, did she or they go back to school Yes                      1
      after circumcision?                        No                      2
      Hadii ay tahay haa schoolkii dib ma ugu Some went, others did      3
      noqotay                                    not
                                                 Not sure                4
311   Whose decision is it for a girl to         Mother                  1
      undergo FGM?                               Father                  2
      Yaa go aamiyay gudniinka gabadha           Grandparents            3
                                                 Self                    4
                                                 Aunt                    5
                                                 Both parents            6
                                                 Circumciser             7
                                                 Do not know             8
                                                 Other (specify)         9
312   Do you think female circumcision            Yes                    1
      should continue in your community?
      Ma umalynaysaa gudniinku inuu sii
      soconayo                                   No                      2
313   Why do you think female circumcision       Good tradition           1
      should continue? RECORD ALL                Social acceptance        2
      RESPONSES GIVEN                            Marriage prospects       3
                                                 Cleanliness              4
      Maxaa ugu malaynaysaa inay                 Easy delivery            5
      gudniinkuu sii soconayo                    Important rite           6
                                                 Brings Honour to girl
                                                 and family              7
                                                 Gifts are received      8
                                                 Improves fertility      9
                                                                         1
                                                Learning opportunity     0

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No.   Questions and Filters                      Coding Categories                Skip
                                                                              1
                                                 Other (specify)              1
314                                              It is a painful experience   1
                                                 Violates women’s rights      2
                                                 It has lost its social
                                                 significance                 3
                                                 It affects a girl’s
                                                 education                    4
                                                 Uncircumcised women
                                                 are also getting married     5
                                                 Medical complications        6
                                                 Against human rights
                                                 and dignity of women         7
                                                 Might lead to infertility    8
      Why do you think female circumcision,      Limit education              9
      should be eliminated in this community?                                 1
      RECORD ALL RESPONSES GIVEN Against religion                             0
                                              Have heard messages
      Maxaa ugu malysay in la ciribtiro       about female                    1
      gudniinka                               circumcision                    1
                                                                              1
                                                 Other (specify)              2
315                                              Elders                       1
                                                 Women                        2
                                                 Girls                        3
      According to your opinion, which kinds
      of people facilitate the continuation of   Boys                         4
      female circumcision in your                Politicians                  5
      community? RECORD ALL                      Men                          6
      RESPONSES GIVEN                            Other (specify)              7
316                                              Politicians                  1
                                                 Community leaders            2
                                                 Religious leaders            3
      For female circumcision to be              Teachers                     4
      eliminated in your community, who are      Parents                      5
      the most appropriate people to be          Girls                        6
      targeted? RECORD ALL                       Boys                         7
      RESPONSES GIVEN                            Other (specify)              8
317                                              Yes                          1
      Do you know of families who have           No                           2
      refused to circumcise their daughters?
318   How have they been treated in the      Looked down upon                 1
      society? RECORD ALL RESPONSES No respect                                2
      GIVEN                                  Hated                            3

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No.   Questions and Filters                     Coding Categories           Skip
                                                Other (specify)        4
319                                             Regarded as children   1
                                                Are not respected      2
                                                Shunned by peers       3
                                                Considered
      What about their girls, how have they     unmarriageable          4
      been treated in the community?            Other (specify)         4
      RECORD ALL RESPONSES GIVEN                                        5
320                                             Yes                    1
      Have there been any changes in attitude                               Skip 321
      regarding female circumcision practice                                and go to
      in this community?                     No                       2     question 323
321                                          More people are
                                             abandoning the practice  1
                                             Health workers are
                                             performing circumcision
                                             now                      2
                                             Uncircumcised girls are
                                             being accepted in the
                                             community                3
                                             People value education
      What kind of changes? RECORD           for girls                4
      ALL RESPONSES GIVEN                    Other (specify)          5
322                                          Religious readers        1
                                             Education                2
                                             Health workers           3
                                             Intermarriages           4
      What has contributed to these changes? Migration                5
      RECORD ALL RESPONSES GIVEN Other (Specify                       6
323                                          Good tradition           1
                                             Social acceptance        2
                                             Good prospective
                                             marriages                3
                                             Tradition demands        4
                                             Easy delivery            5
                                             Religious demand         6
                                             Remove dirty genitalia   7
                                             Enhance husband’s
                                             pleasure                 8
      In your opinion why does your          Limits woman’s sexual
      community practice female              desire                   9
      circumcision? RECORD ALL               Improves fertility      10
      RESPONSES GIVEN                        Preserves virginity     11

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No.    Questions and Filters                      Coding Categories                 Skip
                                                  Other (specify)            12
324    Do you know of any health,                 Yes                         1
       psychological or social problems                                             skip 325
       associated with female circumcision?       No                            2
325                                               Excessive bleeding            1
                                                  Pain                          2
                                                  Obstructed labour             3
                                                  School drop outs              4
                                                  Early marriage                5
                                                  Can lead to HIV
                                                  transmission                  6
                                                  Bleeding causing
                                                  anaemia                       7

                                                  Urinary tract infections      8
                                                  Keloids growth and
                                                  adhesions                   9
                                                  Painful menstruation       10
                                                  Difficulty in
                                                  urination/urine-
                                                  retention                  11
                                                  Still births               12
                                                  Scarring                   13
                                                  Marital conflict           14
                                                  Psychological trauma
                                                  and depression             15
       What kind of consequences do you           Against dignity of
       know? RECORD ALL RESPONSES                 women                      16
       GIVEN                                      Other specify)             17


Section 4.     Questions related to birth complication (for circumcised female respondents
               only)

      QUESTIONS & FILTERS                         CODING CATEGORIES                     SKIP
1.    Do you have children less than 4 years?     Yes                               1
                                                  No                                2
2.    If yes, have you ever experienced birth     Yes                               1
      complication?                               No                                2
3.    If yes, what kind of complication did you   Bleeding / anaemia                1
      experience                                  Septicaemia                       2
                                                  Difficult labour                  3
                                                  Scarring                          4
                                                  Reduces sexual satisfaction       5

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                                                       Difficulty in urination        6
                                                       Psychological depression       7
                                                       Obstructed labour              8
                                                       Others (specify)               9


Section 5. Questions related to the uncircumcised Daughters Only:

           QUESTIONS & FILTERS                    CODING CATEGORIES                   SKIP
    501.                                          Mother                          1
                                                  Father                          2
                                                  Themselves/herself              3
           Who made the decision that your
           daughters should not be                Religious leader                4
           circumcised?                           Brother                         5
                                                  Sister                          6
                                                  Other (specify)                 7

    502. Have they faced any problems in          Yes                             1
         the community because they are not
         circumcised?                             No                              2
    503.
         If yes, which kind of problems have
         they faced? RECORD ALL
         RESPONSES GIVEN
                                                  Mistreatment                    1
                                                  Seen as a child                 2
                                                  Shunned by boys                 3
                                                  Disrespected                    4
                                                  Other (specify)                 5
    504.
           In your view, are there any            Yes                             1
           differences between circumcised
           and uncircumcised girls?               No                              2
    505.
                                                  Circumcised are clean           1
           What kinds of differences are there?   Uncircumcised are
           RECORD ALL RESPONSES                   promiscuous                     2
           GIVEN                                  Marriage prospect               3
                                                  Social acceptance               4
                                                  Acceptance in the
                                                  community                       5
                                                  Give pleasure to husband        6
                                                  Improved fertility              7
                                                  Preserves virginity             8
                                                  Prevents immorality             9

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            QUESTIONS & FILTERS                     CODING CATEGORIES                        SKIP
                                                    Respected in the
                                                    community                           10
                                                    Other (specify)                     11
    506.                                                                                    For male
            If you were to marry again in future,                                          respondent
            would you marry uncircumcised         Yes                                    1 only
            wife? (Male parent only)              No                                     2
    507.
            Please give reasons your response
            in Q 506 above

Section 6. Questions related to child rights:
   No. Questions and Filters             Coding Categories                                     Skip
   1.  Do you have girls of school going Yes                                             1     If no skip
       age in your household?            No                                              2     question
                                                                                               2,3 and go
                                                                                               to 4
   2.      If yes, are they enrolled in         Yes                                      1
           school?                              No                                       2
   3.      How do you participate in your       Follow-up on progress report             1
           child’s education?                   Participate in building activities in    2
                                                school
                                                Attending PTA meetings                   3
                                                Open school days.                        4
                                                Do not participate                       5
                                                No children.                             6
                                                Paying school fees                       7
                                                Others (specify)                         8
   4.      Which of the following child-        Child labour                             1
           abuse practices are prevalent in     Early marriages                          2
           your community?                      Rape                                     3
                                                Incest                                   4
                                                Recruitment of boys into clan-           5
                                                militia
                                                Corporal punishment                      6
                                                Other (specify)                          7


Section 7. Questions related to Women’s Right and Gender Attitudes:

   6.1.     Background:

   No.       Questions and Filters                    Coding Categories                         Skip
   611.      When were you born?

                                                                                         47 P a g e
No.    Questions and Filters              Coding Categories               Skip
612.   What is your marital Status        Single                   1      Skip and
                                                                          check
                                                                          question
                                                                          no 203
                                          Married in monogamy      2
                                          Married in Polygamy      3
                                          Widowed                  4
                                          Divorced                 5
                                          Others                   6
613.   Is this your first marriage? (if   Yes                      1
       married)                           No                       2
614.   What was your age at first         6-12 years               1
                                          13-19 years              2
       marriage? ( skip for male          20-26 years              3
                                          27-32 years              4
       respondents)                       33 years and above


615.   Have you ever been to school?      Yes                      1
                                          No                       2      If no skip
                                                                          616,617
                                                                          and 618
616.   Can you read and write?            Yes                      1
                                          No                       2
617.   What is the highest level of       Informal education       1
       education you have achieved?       Pre-primary complete     2
                                          Lower primary complete   3
                                          Upper primary complete   4
                                          Secondary complete       5
                                          College                  6
                                          University               7
                                          Never been to school     8
                                          Other (specify)          9
618.   Why did you drop out of school?    Lack of school fees      1
                                          Marriage                 2
                                          Pregnancy                3
                                          Illness                  4
                                          Death of parents         5
                                          Other (Specify)          6
619.   What is your current occupation?   Housewife                1
                                          Student                  2
                                          Businessman              3
                                          Teacher                  4
                                          Community elder          5

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No.      Questions and Filters                   Coding Categories                     Skip
                                                 Other (Specify)                6
6110.    At what age do girls in this            Less than 15 years             1
         community get married?                  15-19 years                    2
                                                 20-24 years                    3
                                                 25-29 years                    4
                                                 30 and above                   5
6111.    Who decides who should marry a          The girl                       1
         girl in your community                  The mother                     2
                                                 The father                     3
                                                 Relatives                      4
                                                 Other (Specify)                5
6112.    Do you think there are cases of         Yes                            1
         Gender-based violence in your
         community?                              No                             2
6113.    Do you know of any reported cases       Yes                            1
         of gender-based violence in your
         village?                                No                             2
6114.    What is the most common form of         Physical abuse                 1
         gender-based violence in your           Sexual abuse                   2
         village?                                Economic abuse                 3
                                                 Intimidation and
                                                 harassment                     4
                                                 Verbal abuse                   5
                                                 Other (Specify)                6
6115.    Do you think that women and             Yes                            1
         children experiencing GBV seek          No                             2
         help outside?                           Don’t know                     3
6116.    If yes, to whom do they report to?      Mother                         1
                                                 Father                         2
                                                 Both parents                   3
                                                 Police                         4
                                                 Community elder                5
                                                 Religious leader               6


6.2.    To what extent do you agree or disagree with the following statement:

No. Question                            Strongly Disagree   Agree     Strongly      Not sure/not
                                        Disagree                      Agree         applicable
                                        1        2          3         4             5
621. It is unacceptable for a man
     to marry uncircumcised girl
622. It is justified for man to hit
     partner

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   No. Question                         Strongly Disagree     Agree    Strongly   Not sure/not
                                        Disagree                       Agree      applicable
                                        1        2            3        4          5
   623. Women should have equal
        opportunities as men
   624. Girls child should have
        equal rights as a boy
   625. Boys should be sent to
        school first before girls
   626. Men and women should
        have equal rights
   627. Men have a right to sexual
        enjoyment every time they                                                 Skip 627
        have sex
   628. Women have a right to
        sexual enjoyment every                                                    Skip 628
        time they have sex
   629. FGM contravenes the rights
        of girls and women

Section 8. Questions related to HIV/AIDS:

  NO       QUESTIONS & FILTERS                     CODING CATEGORIES           SKIP
  801.     Have you ever heard of illness called   Yes                       1
           AIDS?                                   No                        2 Skip Q12
  802.     If yes, are you aware of any HIV/AIDS   Yes                       1
           campaigns conducted by your
           community?                              No                        2
  803.     What are the most common topics of      Safe use of condoms       1
           these HIV/AIDS campaigns conducted      Abstinence                2
           by your community?                      Behavioural change        3
                                                   Knowledge in HIV/AIDS     4
                                                   Being faithful            5
                                                   VCT                       6
                                                   ART                       7
                                                   Others (Please explain)   8
Section 9. Questions related to advocacy and awareness:
    NO       QUESTIONS & FILTERS                   CODING CATEGORIES                  SKIP
    901.     Have you ever heard of messages       Yes                            1
             against female circumcision?          No                             2
    902.     If Yes, from whom?                    Community leaders              1
             RECORD ALL RESPONSES                  Religious leaders              2
             GIVEN                                 Ex-FGM Practitioners           3
                                                   Parents                        4

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                                                Posters                             5
                                                Teachers                            6
                                                Relatives                           7


                                                Other (specify)                     8
903.                                            FC limits girls education           1
       What kind of messages have you           Can still get a husband without
       heard? RECORD ALL RESPONSES              being circumcised                   2
       GIVEN
                                                One can bleed to death              3
                                                Can lead to HIV infection           4

                                                It is a violation of human rights   5
                                                Other (specify)                     6

904.    In your opinion, are they good          Yes                                 1
       messages?                                No                                  2
905.   Who are the main targets of these
       messages?
906.    Are young adults of your age            Yes                                 1
       comfortable with these messages?         No                                  2
907.   If you were to talk about female
       circumcision in your community,
       which messages would you pass on?
908.   What has been the reaction of the        Condemn those involved              1
       religious leaders towards the families   Silent about it                     2
       that have been involved in female        Have offered counselling to the
       circumcision in your community?          victims                             3
                                                Other (specify)                     4
909.                                            Community Meetings                  1
                                                Seminars                            2
       If one is to pass on messages
       pertaining to female circumcision,       Religious leaders                   3
       which is/are the appropriate strategy    Community                           4
       (ies) reaching your community?           Health-workers                      5
       RECORD ALL RESPONSES                     Pamphlets                           6
       GIVEN                                    Others (Specify)                    7




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Semi-structured questionnaires
Semi-structured Interviews


Semi-structured Interviews for Health workers:


   1. What type of FGM/C is most commonly practiced in your community?
   2. Please describe the rationale for the continued practice of FGM/C in your community?
   3. Have there been any recent activities contributing to the abandonment of FGM/C in your
      community? If yes, please provide brief description
   4. What are some of the obstacles encountered by FGM/C abandonment campaign?

   5. Are there any cases of delayed labor in your institution?


   6. What are some of causes of delayed labor?


   7. What are the most common gynecological problems you receive from your patient?


   8. What are the causes of these problems?




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 Focus group Discussions
 Focus Group Discussion


 The Focus Group Discussion: These questionnaires are developed by the consultant with
 experience in research and knowledge of the specific context of the targeted villages and groups.
 A set of questions were constructed to cover the topics of interest, with attention to clarity of
 conceptual content, linguistic phrasing and order. The FGD questions were developed to elicit
 key knowledge, attitudes about the practice of FGM.

 FGD for parents both Male/ Female

1.     How old should a girl be when she has to undergo FGM/C?
2.     Who decides whether a girl should undergo EFM/C? Re-stated as: Within the family, who
       decides whether a girl should undergo FGM/C?
3.     What are some reasons that girls here have to undergo FGM/C?
4.     What is the community’s view/perception regarding families who decline to circumcise their
       daughters?
5.     Have the community’s ideas about the age and the type of FGM/C changed since the anti-
       FGM awareness campaign begun?
6.     Who are people in the community that can help to promote anti-FGM activities in your
       village?
7.     What are some of the problems faced by women in the community who have had FGM/C?

     Problems directly related to FGM/C              Problems directly related to FGM/C




 8.  What does the community think about women who face problems soon after undergoing
     FGM/C?
 9. What is your religion’s view on FGM/C? Is it supportive of FGM/C?
 10. Is FGM a religious practice or a cultural practice?

 Questions related to HIV/AIDS for all FGDS
 1. Have you heard of any sexually transmitted infections? Which ones have you heard of?
 2. Do you think that STIs and HIV are a problem in this community? Why or why not?
 3. How do you think that HIV/AIDS are spread from person to person?
 4. Who is most likely to get an STI/HIV?
 5. Are STI and HIV services available in your community? Where (who) can you go for STI/
    HIV information and services? What type of services do people receive? Do people access
    services with their sexual partners?

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6.    What does the community think about STIs and HIV?
7.    Who are people in the community that can help to educate about STIs/HIV?

Questions related Gender-based Violence (GBV) for all FGDS

1.    What do you think are the different forms of violence against women?
2.    Are there any circumstances that make violence against women acceptable?
3.    Are GBV services available in your community? Where (who) can you go for GBV
      information and services?
4.    Do women who have experienced violence go for assistance? Why or why not?
5.    What does the community think about GBV?
6.    Who are people in the community that can help to educate and prevent GBV?
7.    What are some of the things can be done to help stop violence against women?

FGD for the circumcisers still practicing FGM/C
1. For how long have you been a TBA/ Circumciser?
2. About how many girls do you circumcise per year?
3. Which month of the year do you circumcise most girls?
4. Who decides the type of circumcision a girl is to undergo? Would you describe the
    procedure used for each of these types? (How long does it take for the girl to recover?)
5. How much are you paid to carry out circumcision ( per girl)
6. Why is female circumcision practiced? Rephrase: What is the significance of FGM in your
    community?
7. What forms of female circumcision is most prevalent in your community?
8. Do you believe that the practice of FGM goes against girls and women’s rights?
9. In your opinion, is the practice increasing or decreasing? Why do you say so?
10. Do you value FGM?
11. What advantages do you attribute to FGM?
12. Are you aware of any adverse health and social/psychological problems associated with
    FGM? If yes, please state some of the reasons
13. Do we have families that choose not to circumcise their daughters

WOMEN GROUPS

1.      What is the name of the group?
2.      When was it founded and by whom?
3.      What are the objectives of the group?
4.      Is FGM practiced in your community?
5.      What is the significance/value of FGM in your community?
6.      In your opinion, is the practice increasing or decreasing? Why do you say so?
7.      What advantages do you attribute to FGM?
8.      What are the disadvantages of FGM?
9.      Do we have families that choose not to circumcise their daughters? If yes, what do you
        think motivates?
10.     Apart from the FGM practice, in what other ways are rights of women/girl child violated in
        your community?

                                                                              54 P a g e
11.   In your opinion, should any efforts be made to stop FGM and other practices that violet the
      rights women/girl child? If yes which ones?


CHILDREN

1.    Name and age (This is for climate setting purposes only)
2.    What are their roles and responsibilities in their families?
3.    Whether in school or not. (Probe further)
4.    How do they spend their time in school?
5.    What do would you like to become when they grow up?
6.    What age would you expect to get married and why?
7.    What level of education attainment would like to reach?
8.    What do you see as potential threat to your expectations in life?
9.    What problems do boys and girls face that affect their education?( divide into two groups-
      boys, girls)
10.   What are you rights as a child? Where did you learn about these rights?
11.   What is the role of FGM in the community?
12.   Do you value FGM?
13.   Do you know of girls in the community who have not gone through FGM?
14.   What is the perception of community towards such girls?
15.   What can be done to reduce or stop the practice of FGM


YOUTH GROUP (FGD)

1.    What is the role of youth in the community?
2.    What are the benefits of education to the youth?
3.    What are the benefits of education to a girl?
4.    What development activities are the youth involved in?
5.    What are your career expectations? (Check emerging pattern)
6.    What are the common problems faced by the youth (girls and boys)?
7.    What is the role of FGM in the community?
8.    What are the dangers of early marriage?
9.    Do you value FGM?
10.   Would you accept girls who have not gone through FGM?
11.   Is FGM increasing or decreasing in your opinion?
12.   What do you attribute to the changes on the trend above?
13.   Do girls go for FGM voluntarily or they are forced? And if forced, by who?
14.   What do see as your role in eradication of FGM?


KEY INFORMANT INTERVIEW (FOR RELIGIOUS LEADERS/COMMUNITY
ELDERS):

1. What are the problems facing your community with regards to FGM?
2. What has happened that makes you believe this is a problem?

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3. Tell me more about that.
4. What are your understanding/ belief of Islamic religion on FGM? How does FGM relate to
    Islamic religion, practice?
5. What role can religious people play on FGM eradication? Awareness rising and
    sensitization? Have you circumcised your daughters? Why?
6. Who do these problems affect?
7. How does it affect them? [Encourage them to be specific.]
8. What causes these problems?
9. What interventions have been carried out to stem these problems?
10. What are the key challenges faced in addressing the issue of FGM in our community?



        LOCAL AUTHORITIES (FGD)

   1.  What is the name of your Location? (Include name of the interviewee)
   2.  Is FGM practiced in your community?
   3.  What is the significance/value of FGM in your community?
   4.  In your opinion, is the practice increasing or decreasing? Why?
   5.  Do we have families that choose not to circumcise their daughter(s)? If yes, what do you
       think motivates?
   6. What advantages do you attribute to FGM?
   7. What are the disadvantages of FGM?
   8. In your opinion, should any efforts be made to stop FGM? If yes which ones?
   9. Apart from FGM, what other practices violet the rights of women, men and the rights of
       children (boy and girl) in your community?
   10. Do you know of any organization that trains people on the dangers of FGM and other
       Gender based violence practices in your community?
   11. As a leader, what do think needs to be done on issues of FGM and other forms of gender
       Based Violence practices in your area?




FGD FOR HEALTH CARE PROVIDERS

   1. What are some of the medical effects because of FGM practice?

   2. Do you perform FGM in your institution?

   3. Which types of FGM do you perform?

   4. Why do you prefer that type of FGM?

   5. Are there any fistula cases from your patient?

   6. What are causes of fistula?


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7. What is percentage of fistula in your institution?

8. Is there any programme in your institutions to address the medical effects of FGM?

9. Who are the key people to be involved in address the issues of FGM?

10. What are your capacity needs as a health care provider in the elimination of FGM?

11. What is the significance of undertaking FGM from medical point of view?

12. What is the difference between a circumcised and uncircumcised girl?

13. What are/is the role of health care providers in the elimination of FGM?

14. In your opinion, is FGM increasing or decreasing?




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