COVID-19 is Leaving More Girls at Risk of Female Genital Mutilation and Child Marriage

The global COVID-19 pandemic is taking a particularly heavy toll on girls and young women across Africa.

Sadly, many girls in Africa are disenfranchised from birth.

They are born into poverty and vulnerable to inequalities in health and education, along with socio-economic and gender inequalities. Access to health and education is not automatic. Many girls remain marginalized throughout their lives, both geographically and economically. This exposes girls to collateral risks associated with poverty – and, at the moment, with COVID-19.

I have been lucky to be able to pursue my passion for the health and rights of women and girls for a number of years now. My work has focused on sexual and reproductive health, gender-based violence, female genital mutilation or cutting (FGM/C), and child, early and forced marriage. My experience has mainly been built by working with marginalized communities in Kenya that practice FGM/C – including the Maasai, Samburu, Kalenjins, Meru, and Somali communities.

Education Opens Horizons

In 2016, in the early years of my work in Kenya, I visited a rescue center in Samburu County. I was devastated by the reality of life for many Samburu children. Living a nomadic lifestyle in geographically vast areas, basic infrastructure to support health and education was lacking.

It took us a whole day to drive to the main town, Maralal, where the center was located. Along the road, I saw children herding cattle and goats within the national park, which is full of wild animals such as lions, elephants, giraffes, zebras, and antelopes.

The perplexing thing was that among the children were many girls, the youngest of whom looked about six years of age. Spending their days and evenings herding cattle in the woods away from home. Outside the protection of adult family members, means these girls are exposed to sexual and gender-based violence.

While visiting the center the next day, we found a newly rescued nine-year-old girl. She was rescued from forced child marriage to a seventy-year-old man who already had multiple wives. The young girl had just undergone FGM/C. Her wounds were still raw. She was brought to the center to heal and attend school, since she hadn’t previously had the chance to receive an education.

My colleagues and I were left debating how a girl will ever make it in life without an education, good health, or any future economic opportunities. For many girls in Kenya and elsewhere, their progress is curtailed and their horizons limited from childhood as a result of traditional practices which are linked to livelihoods.

Co-existing Crises Leave Girls at Risk

I can only imagine how much harder life is for girls in Samburu in the face of COVID-19. I have heard many horrific stories from my colleagues about how lockdown measures, combined with school closures and the subsequent dwindling of family resources and general livelihoods, have left more girls exposed to FGM/C and child marriage.

They are forced by their circumstances to be “sold” into marriage, either for money or cattle.

Unfortunately, in Kenya the COVID-19 crisis has also been accompanied by many natural calamities including a locust invasion, drought and flooding in many parts of the country, meaning that food is scarce.

Nomadic communities like the Samburu have been hit particularly hard. They rely on markets to sell their animals for money to satisfy their basic needs. When markets are closed, as they are currently, they cannot sell. The food crisis is likely to lead to even more girls being married in exchange for food for their families and a semblance of security.

At the same time, the focus of law enforcement in Kenya has been on stopping the spread of the coronavirus. This has resulted in many cases of gender-based violence, FGM/C and child marriage being shoved onto the back burner. As if they are not a crisis that deserves immediate attention.

Community activists working in Samburu have reported feeling powerless and hopeless. They are between a rock and a hard place, sometimes having to choose between reporting cases to the authorities and their lives being threatened.

Listening to Communities is More Important Than Ever

The Kenyan government has not embraced a multi-sectoral approach in dealing with the overall impact of COVID-19. Instead, they’ve taking a rather narrow approach to public health. Because of the focus on curbing transmission, fostering strategic engagement that includes stakeholders working in gender-based violence, FGM/C, and child marriage has been sidelined.

Including community systems in the prevention of and response to FGM/C and child marriage is more important than ever. More women and girls are now at risk of harmful practices and gender-based violence.

These strategies should include:

  • working closely with community advocates and activists,
  • working with community health workers who can play a significant role in surveillance of at-risk girls,
  • mapping them and linking them up with healthcare and legal services, and
  • setting up rescue homes and centers that could house them temporarily until the COVID-19 crisis subsides.
The majority or all of the safe centers or homes were ordered to close as part of the lockdown measures. The girls and women being housed in those centers were asked to return home in the midst of Covid-19. A doubly tragic situation for them.

So what can we do, in the face of these co-existing crises?

The greatest lesson that we can learn is that it is crucial to deliver multi-sectoral responses to FGM/C and child marriage. This means actors working together. A broader approach is needed. One that considers the wider socio-ecological aspects of livelihoods including education, health, emergencies, climate crisis and other factors which impact on the harmful practices of these communities.

State and non-state actors need to widen their nets and protect African children and girls in particular – who, as is so often the case, carry the heaviest burdens of poor health and well-being.

Dr Esho is the Director of the Amref Health Africa End-FGM/C Centre of Excellence; Secretary General, African Society for Sexual Medicine; and Associate Member, Africa Coordinating Centre for the Abandonment of FGM/C.

Accessing Safe Abortion during Lockdown in Africa

We have seen how pandemics negatively impact access to reproductive health services, especially access to safe abortion. As the pandemic spread globally, MAMA Network saw a growing demand for self-managed abortion and access to telemedicine across Africa.

As a Network we have seen how the COVID-19 pandemic disrupted availability and access to safe abortion medication and contraceptives. Transport is less accessible. Clinics have reduced hours or are closed. Services are more expensive and community activities are on hold.

MAMA Network is a regional movement of activists working to share evidence-based and stigma-free information about self-managed medical abortion.

Sexual and reproductive health and rights (SRHR) information is shared with women at the community level across Sub-Saharan Africa.

In 2016, MAMA network was founded by Trust for Indigenous Culture and Health (TICAH) in Kenya and Women Help Women. Over the years, the network has supported organizations in their efforts to increase access to safe abortion services and information. This is possible through mentorship, coaching, trainings, sharing of information, joint activism and creating spaces for linking and learning.

The pandemic led to an increase in demand for self-managed abortion, post abortion care, contraceptives and telemedicine or tele-counseling. In May 2020, we launched three hotlines in Cameroon, DRC and in Zambia. This brings the total of hotlines in the network to 9 including Nigeria, Kenya, Tanzania, Malawi and Uganda. MAMA Network’s approach to telemedicine and tele-counseling trusts women to have autonomy over their bodies.

In Kenya, Aunty Jane Hotline (launched in 2012) provides reliable, safe and confidential information to save women’s lives.

The hotline is toll-free since 2018. Recently women calling the hotline faced difficulties in accessing misoprostol in pharmacies due to global shortage of commodities. Women who accessed services, said they were asked to pay between $90 and $250. Before COVID-19, services in private clinics were $30. Online campaigns by Aunty Jane Hotline have intensified, including virtual meetings and strategies to strengthen collaboration with service providers.

In Nigeria, Ms. Rosy Hotline (launched in 2014) is toll-free since 2016 and operates 24 hours daily. The hotline has received approximately 135,000 calls from across Nigeria. Aunt Kaki was launched in Uganda in 2017. In Tanzania, Shangazi Shani was launched in 2018. Women Help Women’s online platform also exists to assist women and girls from all over the world.

In Uvira, DRC Congo, MAMA partner organizations have supported at least 10 women to access safe abortion in recent weeks. The rise in transportation costs has created barriers in accessing reproductive health services. With secure communication; a WhatsApp group is used to record community cases and refer to nearby healthcare providers and clinics. Community champions are doing home delivery of pills, one on one counseling, and follow ups. They have noticed a spike in the demand of pregnancy prevention methods in the Uvira region.

Changed Women Project in Zambia offers in-person services on a case by case basis. “Public hospitals are overwhelmed, women and girls are not going to hospitals. They are sent back due to congestion and go back to quacks because they can’t be helped,” a representative said. In the previous week a girl in the community unsafely induced an abortion and suffered serious complications. Changed Women stepped in and assisted her to go for post abortion care at a government hospital.

MAMA Network has remained active to shine a light on the importance of access to information and services for safe abortion.

On May 28th, the International Day of Action for Women’s Health, we ran a campaign receiving support from 10 countries and collected 56 photos of solidarity with the hashtag #AbortionBeyondLockDown. The purpose of the campaign highlighted that despite the lockdown, safe abortion remains an essential service.

MAMA Network has also continued to implement capacity building webinars, providing necessary tools to support activists and actively fundraise to support community based organizations. These efforts have been successful and we expect to launch 4 more hotlines in 4 countries in the coming weeks.

MAMA Network (Mobilizing Activists around Medical Abortion) is a collaboration of grassroots activists and feminist groups based in Sub-Saharan Africa. MAMA Network is a Safe Abortion Action Fund grantee partner.

What does COVID-19 mean for Young Women in the Kibera Slum?

COVID-19 has forced countries around the world to take unprecedented measures to combat the rapid spread of the virus. Although the pandemic affects all of us, it has hit people in urban poor settlements in developing countries especially hard. The global focus has rightfully been on containing the virus, but some sectors are being dangerously neglected. One of these is sexual and reproductive health and rights (SRHR), including safe abortion services. 

At Women Promotion Centre-Kenya (WPC-K), we work with vulnerable and marginalized communities (women, youth, LGBTQ groups) in the Kibera slum. It is the largest urban slum in Africa, characterized by high unemployment and crime rates, deplorable sanitation, poor housing conditions, and a lack of schools and healthcare facilities. The facilities that do exist are poorly structured private entities lacking qualified personnel or adequate equipment.

With the outbreak of COVID-19, the health situation has worsened in the Kibera slum.

This is especially true for girls and young women who need access to comprehensive SRHR – including safe medical abortion. Cases of rape and unprotected forced sexual encounters are on the rise due to movement restrictions. This has led to an increase in unplanned pregnancies and demand for abortion.

Girls and young women are facing hostility from already overstretched healthcare services. The majority of service-seekers are turned away without any form of support or service. After receiving numerous complaints from our beneficiaries, I decided to see what was happening for myself at one of the privately-owned healthcare facilities.

On arrival, I was received by a receptionist who seemed disgusted by my appearance. I was adhering to all sanitizing and social distancing guidance, so I ignored her and asked to see the clinical officer (we rarely have doctors in Kibera). After waiting 30 minutes to be seen, I inquired about family planning options I could use during the current situation. The clinical officer was not willing to help me. Instead, she advised me that contraceptives are ‘not good’ for girls and young women.

This might sound shocking, but it’s common for health workers to make judgements towards young women who are sexually active.

It is also common for them to discourage use of contraceptives by overstating negative side effects and creating excuses about availability. On this particular day, I tried to convince the clinical officer that I and other girls of my generation need contraception desperately. She told me to seek services elsewhere since this facility did not have supplies of contraceptives – even basic ones like condoms – due to restrictions on movement.

Young women are also being denied access to safe medical abortion services. One young woman we work with, Adhiambo (not her real name), found herself in a life-threatening situation. Adhiambo was denied safe services at her local healthcare facility due to the social distancing directed by the governement. Since movement in and out of Nairobi has been restricted, she could not travel to another town. As a result, she attempted to procure abortion secretly with the help of her friend who was equally unqualified.   

In Kibera, due to the measures put in place to combat Coronavirus, many girls and young women are resorting to unsafe abortion practices. These include drinking a herbal concoction, inserting metal clothes hangers into their bodies, drinking Jik (washing detergent) and taking an overdose of prescribed medicines. This is all because they cannot access safe abortion services at a health facility, and will lead to unprecedented health issues in the near future. 

Although there is a need to focus on COVID-19, it is self-defeating for governments to ignore ongoing healthcare needs like SRHR.

It is the right of every girl and woman to have control over her body. This right can only be realized if she is enabled to access comprehensive SRHR, including safe abortion. Women Promotion Center is one of the leading feminist organizations in the Kibera slum. We are currently implementing a SAAF-funded project to tackle community-level, abortion-related stigma. During the current pandemic, we have stepped in to fill the SRHR gap, too. We are distributing essential contraceptives, such as pills and condoms, as well as re-usable sanitary towels and other COVID-19 related personal protective equipment (PPE).

Our staff and volunteers are using public forums to talk to community members about the major symptoms and prevention measures of COVID-19. Additionally, WPC is promoting safe self-managed abortion by strengthening the capacity of community volunteers. These volunteers can provide information and appropriate commodities (such as Misoprostol and Mifepristone) to those who need them.

Despite its overstretched resources, WPC continues to work with young women to strengthen their capacity to demand their rights to comprehensive SRHR services and information – including safe abortion. We are working to ensure that the Ministry of Health and other key stakeholders in the Kenyan health sector prioritize SRHR, especially in the slums like Kibera where they are so urgently needed.  

Women Promotion Centre is a Safe Abortion Action Fund grantee partner.

Girls Just Wanna Have Fun-damental Rights in Kenya

Imagine waking up one morning with a really bad flu. Your immediate recourse would be to take fluids and maybe some medication. Should a sore throat develop, you might take cough syrup or lozenges. Commonly here in Kenya, a ‘dawa’ (a hot drink of honey, ginger and lemon) might hit the spot. Now, imagine that the law requires you to acquire permission from your boyfriend, husband, parent, guardian, neighbour, religious and faith leader, Ministry of Health, County Governor or even your President to go into a pharmacy, health center or hospital to receive the healthcare you need.

This scenario seems intrusive, unfair and even irrational. What justification beguiles such restrictive control on your flu? You obviously know you have it, you know how and where to seek medical treatment and you understand which actions would help you recover. Despite this, you need permission from others before seeking medical attention.

This scenario, whilst metaphorical, represents many of the challenges encountered by women and girls in Kenya and elsewhere in Africa when it comes to their bodily autonomy. Specifically, when it comes to their access to comprehensive Sexual and Reproductive Health and Rights (SRHR).

Girls and young women bear the brunt of the unmet need for contraception in Kenya, resulting in almost a quarter of Kenyan women giving birth before they are 18. 

Restrictive abortion laws in the region have not translated into a reduction in the incidences of abortion. Instead, they have increased the magnitude of unsafe abortion – 3 out of every 4 abortions in Africa are unsafe. Here in Kenya, the Constitution provides for instances under which a woman can access safe and legal abortion services. Article 26(4) of the Constitution states that “abortion is not permitted except, in the opinion of a trained health professional, there is a need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law”.

Ultimately, women in Kenya are not trusted to seek their own sexual and reproductive health care. The decision to access safe abortion as espoused in the Constitution places the entire burden on the trained health professional – leaving no room for the woman’s right to access.

Moving from law to practice and implementation is a whole other ball game. Existing evidence attributes high levels of severe maternal health outcomes to adverse complications such as sepsis, cervical and uterine ruptures, haemorrhage and death – the ‘terrible 5’ as coined by Sexual and Reproductive Justice advocates in the country. In addition, these specific outcomes vary across the country. SRH services are devolved to county level, and so the quality of care you can access is a postcode lottery, depending on which of the 47 counties you happen to live in. For example, the proportion of women with high fertility risk ranges from 24% in Nairobi to 66% in Migori.

Fighting the barriers to good quality reproductive health care forms the crux of one of KELIN’s projects, funded by the Safe Abortion Action Fund.

The ultimate goal is to have model SRHR Laws developed to promote women’s right to access safe abortion in Kenya. The intervention targets counties of Kilifi and Nakuru. We engage local communities through community-centered and community-driven dialogues in a bid to empower them with knowledge of how to engage with their county’s legislative processes. This is intended to increase public participation in policy making and to strengthen and build community movements to monitor implementation and champion legal reform.

Ultimately, laws are intended to create social change, spur on reform and maintain social order. But this is dependent on how they are made, implemented and interpreted. Even if a law is considered ‘good’, with its spirit and intent seen to be in the right place, it does not necessarily translate to a ‘good’ outcome.

We at KELIN envision a country and a world where women and girls can make decisions and enjoy rights related to their sexual and reproductive health. This includes the right to access safe abortion. We want to make reproductive care as simple as getting flu medication at the pharmacy or seeing a doctor without barriers, judgement or condemnation.

 KELIN is a Safe Abortion Action Fund grantee partner.

Finding My Voice & Protecting Girls from FGM/C

Most people who knew me as a child knew me as a very shy and timid little girl. Yet, today I am outspoken: I can argue with you on the subjects I feel strongly about! One of those subjects is gender equality. My passion is protecting girls and young women, in my own community and beyond, from female genital mutilation/cutting (FGM/C).

I work as a community facilitator with Amref Health Africa in Marsabit County, Kenya. The project is called Koota Injena, which means “come, let’s talk”. We work within four communities – the Borana, the Gabra, the Rendile, and the Samburu – to end FGM/C and early and forced marriage, and to redefine the value of girls.

My parents come from different communities. My mother comes from the Gabra community while my father is from the Borana. I have the most amazing parents who taught me the importance of embracing both these cultures and loving them deeply. Among the Borana and the Gabra, FGM/C is a deeply-rooted and culturally significant practice. The prevalence rate is around 98%, which tells you that almost every girl you meet will have suffered the cut.

“It’s only by talking openly that we will change things for good.”

The focus of Koota Injena, as the name suggests, is dialogue. In my community, like most African communities, it’s taboo for a young person to discuss cultural issues with clan elders. This is especially true for women and girls. Yet, I won’t give up. It’s only by talking openly with each other that we will change things for good.

No one can tell my story the way I can tell my story. That’s why I started speaking out. I decided, why not inspire people? Why not inspire young girls from villages deep in Marsabit County and make sure that they know the importance of education and that they know their rights.

Listening and Learning

All kinds of people cut their daughters, even political leaders, professors, and doctors. In Marsabit, we have women traveling from other countries (the UK, the Netherlands, the USA) to have their daughters cut, before returning home. Many of these people are highly educated. Yet they continue to believe that FGM/C is the right thing to do for their daughters.

That’s why I always say that it’s not just a question of education. It’s important to change mindsets and attitudes, too. I really believe that the work of changing culture can best be done by people from that culture. You have to meet people where they are. There is no one approach that works for all the different countries and communities where FGM/C is practised. We must listen and learn. And we need to make space for different perspectives and different voices.

Safe Spaces

In late 2019, I came to London for the first time and met local activists working to end FGM/C in the UK. I attended a workshop facilitated by Sarian Karim-Kamara, founder of the Keep the Drums, Lose the Knife collective, which brought together women from Sierra Leone, Kenya, and Guinea. Some were survivors of FGM/C, while some had been affected in other ways. They had friends or family members who had suffered the consequences of the cut or daughters they were trying to protect.

It was amazing to see these women, who didn’t know each other, speak so openly. They spoke not just about FGM/C, but about gender-based violence, relationships, family planning, reproductive health, and sex and pleasure. It was very emotional.

This is the same kind of safe space that we try to create in Marsabit. We have mother-daughter forums where women can talk about whatever affects them in their day-to-day lives. This is actually the most impactful part of the project: it’s the part people always ask for more of.

“You cannot force change.”

Meeting with these women reinforced to me the importance of understanding and respecting a culture before we try to change it. We all need to recognise that there are aspects of our cultures that are harmful to girls – but you cannot force change. 

Changing culture takes a lot of time. And people are not very receptive: first you’ll be insulted, you’ll be called names, and people won’t even come to your meetings. But as you keep talking with them, people will slowly come to you and they will want to speak out and tell their own stories.

If we are going to end FGM/C, we all need to take responsibility: start from your home and make sure you protect your daughters, nieces and sisters from this harmful act. We need more people to join us on the journey. Together, let’s end FGM/C!

Diram Duba is a survivor of FGM/C who works as a community facilitator with Amref Health Africa in Marsabit County, Kenya.

In Conversation with Christine Sayo

Christine Sayo is a sexual and reproductive health and rights advocate from Kenya. In this conversation with Girls’ Globe, she talks about feeling judged by others for simply talking openly about issues related to sex.

“The community looks at you as a deviant, as someone who is going against the norm.”

The good news, though, is that Christine is seeing a shift in attitudes thanks to globalization and increased access to information from different channels.

“Having information coming in from different sources has helped to destigmatize some of these issues around sexual and reproductive health in young people.”

This video was made possible through a generous grant from SayItForward.org in support of women’s advocacy messages.

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