Tag Archives: Kenya

Married women’s negotiation for safer sexual intercourse in Kenya: Does experience of female genital mutilation matter?

Clinical Simulation in Nursing. 2017 Dec;14:79-84. doi: 10.1016/j.srhc.2017.09.003. Epub 2017 Sep 30.

Married women’s negotiation for safer sexual intercourse in Kenya: Does experience of female genital mutilation matter?

Chai X, Sano Y, Kansanga M, Baada J, Antabe R


OBJECTIVE: Married women’s ability to negotiate for safer sex is important for HIV prevention in sub-Saharan Africa, including Kenya. Yet, its relationship to female genital mutilation is rarely explored, although female genital mutilation has been described as a social norm and marker of womanhood that can control women’s sexuality. Drawing on the social normative influence theory, this study addressed this void in the literature. METHODS: We analysed data from the 2014 Kenya Demographic and Health Survey using logistic regression. Our sample included 8,602 married women. Two indicators of safer sex, namely the ability to refuse sex and the ability to ask for condom use, were explored. RESULTS: We found that women who had undergone genital mutilation were significantly less likely to report that they can refuse sex (OR=0.87; p<.05) and that they can ask for condom use during sexual intercourse (OR=0.62; p<.001) than their counterparts who had not undergone genital mutilation, while controlling for theoretically relevant variables. CONCLUSION: Our findings indicate that the experience of female genital mutilation may influence married women’s ability to negotiate for safer sex through gendered socialization and expectations. Based on these findings, several policy implications are suggested. For instance, culturally sensitive programmes are needed that target both married women who have undergone genital mutilation and their husbands to understand the importance of safer sexual practices within marriage.

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Delivering culturally sensitive, sexual health education in western Kenya: a phenomenological case study.

Afr J AIDS Res. 2017 Sep;16(3):193-202. doi: 10.2989/16085906.2017.1349682.

Delivering culturally sensitive, sexual health education in western Kenya: a phenomenological case study.

Lacey G


While generic programmes have been created to raise sexual health awareness, these cannot always be applied to communities whose cultures and circumstances make them especially vulnerable to infection. Taking a phenomenological approach, this paper examines the circumstances of the Gusii people of Kisii, Kenya, and examines the specific challenges of providing sexual health education to the community as experienced by an ethnic Gusii woman, Joyce Ombasa. Joyce’s story reveals that the Gusii living in and around rural villages have several cultural characteristics that make them susceptible to HIV/AIDS and that render community health education problematic, especially if offered by a female educator of the same ethnicity. Women cannot teach men. Discussions of sex and condom use, and viewing the naked bodies of the opposite sex are taboo. Promiscuity is commonplace and there is a reluctance to use condoms and to undergo HIV testing. Female circumcision persists and there is a high rate of sexual violence, incest and intergenerational sexual intercourse. In addition, government policies and legislation threaten to exacerbate some of the sexually risky behaviours. Bringing HIV education and female empowerment to the rural Gusii requires a culturally sensitive approach, discarding sexual abstinence messages in favour of harm minimisation, including the promotion of condom use, regular HIV testing and the rejection of female circumcision and intergenerational sex. Trust needs to be built through tactics such as adopting a complex and fluid outsider identity and replacing formal sex education with training in income generating skills and casual discussions regarding condoms and sexual health.

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Adolescent and Parental Reactions to Puberty in Nigeria and Kenya: A Cross-Cultural and Intergenerational Comparison.

FREEJ Adolesc Health. 2017 Oct;61(4S):S35-S41. doi: 10.1016/j.jadohealth.2017.03.014.

Adolescent and Parental Reactions to Puberty in Nigeria and Kenya: A Cross-Cultural and Intergenerational Comparison.

Bello BM, Fatusi AO, Adepoju OE, Maina BW, Kabiru CW, Sommer M, Mmari K.


PURPOSE: This qualitative study assesses the cross-cultural and intergenerational reactions of young adolescents and parents to puberty in Ile-Ife, Nigeria, and Nairobi, Kenya. METHODS: Sixty-six boys and girls (aged 11-13 years) and their parents participated in narrative interviews conducted in English or local languages in two urban poor settings in Ile-Ife and Nairobi. All interviews were recorded, transcribed, translated, and uploaded into Atlas.ti software for coding and analysis. RESULTS: Reactions of parents and adolescents to puberty were similar across both sites, with few exceptions. Adolescents’ reactions to bodily changes varied from anxiety to pride. Adolescents generally tend to desire greater privacy; trying to hide their developing bodies from others. Most female adolescents emphasized breast development as compared with menstruation as the mark for pubertal initiation, while males emphasized voice changes. Among some ethnic groups in Nairobi, parents and adolescents view male circumcision as the hallmark of adolescence. Parents in both sites reported that with pubertal changes, adolescents tend to become arrogant and engaged in sexual relationships. Parents’ reported responses to puberty include: educating adolescents on bodily changes; counseling on sexual relationships; and, provision of sanitary towels to females. Parents’ responses are generally focused more on daughters. Approaches used by mothers in educating adolescents varied from the provision of factual information to fear/scare tactics. Compared with their own generation, parents perceive that their own children achieve pubertal development earlier, receive more puberty-related education from mothers, and are more exposed to and influenced by media and information technologies. CONCLUSIONS: Adolescents’ responses to their pubertal bodily changes include anxiety, shame, and pride. Adolescents desire greater privacy. Parents’ reactions were broadly supportive of their children’s pubertal transition, but mothers’ communication approaches may sometimes be inappropriate in terms of using fear/scare tactics.

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Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting.

FREEReprod Health. 2017 Mar 14;14(1):38. doi: 10.1186/s12978-017-0300-y.

Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting.

Mwanri L, Gatwiri GJ.


BACKGROUND: It is well acknowledged that Female Genital Mutilation/Cutting (FGM/C/C) leads to medical, psychological and sociocultural sequels. Over 200 million cases of FGM/C exist globally, and in Kenya alone, a total of 12,418,000 (28%) of women have undergone FGM/C, making the practice not only a significant national, but also a global health catastrophe. FGM/C is rooted in patriarchal and traditional cultures as a communal experience signifying a transition from girlhood to womanhood. The conversations surrounding FGM/C have been complicated by the involvement of women themselves in perpetuating the practice. METHODS: A qualitative inquiry employing face-to-face, one-on-one, in-depth semi-structured interviews was used in a study that included 30 women living with obstetric fistulas in Kenya. Using the Social Network Framework and a feminist analysis we present stories of Kenyan women who had developed obstetric fistulas following prolonged and obstructed childbirth. RESULTS: Of the 30 participants, three women reported that health care workers informed them that FGM/C was one of the contributing factors to their prolonged and obstructed childbirth. They reported serious obstetric complications including: the development of obstetric fistulas, lowered libido, poor quality of life and maternal and child health outcomes, including death. Fistula and subsequent loss of bodily functionalities such as uncontrollable leakage of body wastes, was reported by the women to result in rejection by spouses, families, friends and communities. Rejection further led to depression, loss of work, increased sense of apathy, lowered self-esteem and image, as well as loss of identity and communal sociocultural cohesion. CONCLUSION: FGM/C is practised in traditional, patriarchal communities across Africa. Although the practice aims to bind community members and to celebrate a rite of passage; it may lead to harmful health and social consequences. Some women with fistula report their fistula was caused by FGM/C. Concerted efforts which embrace feminist understandings of society, as well as multi-sectoral, multidisciplinary and community development approaches need to be employed to address FGM/C, and to possibly reduce cases of obstetric fistulas in Kenya and beyond. Both government and non-government organisations need to be involved in making legislative, gender sensitive policies that protect women from FGM/C. In addition, the policy makers need to be in the front line to improve the lives of women who endured the consequences of FGM/C.

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The relation of female circumcision to sexual behavior in Kenya and Nigeria

Women Health. 2016 Jun 29:1-18. [Epub ahead of print]

The relation of female circumcision to sexual behavior in Kenya and Nigeria.

Mpofu S, Odimegwu C, De Wet N, Adedini S, Akinyemi J


One of the reasons for the perpetuation of female circumcision is that it controls female sexuality. In this study, the authors examined the relationship between female circumcision and the sexual behavior of women in Kenya and Nigeria. Data on women who were aware of circumcision and were circumcised were extracted from the Kenya Demographic and Health Survey of 2008-09 as well as the Nigeria Demographic and Health Survey of 2008. The sample size was 7,344 for Kenya and 16,294 for Nigeria. The outcome variables were age at first intercourse and total lifetime number of sexual partners. The study hypothesis was that women who were circumcised were less likely to have initiated sex early and to have only one sex partner. Cox proportional hazards regression and Poisson regression were used to examine the relations of female circumcision and other selected variables to sexual behavior. No association was observed between female circumcision and the outcomes for sexual behavior of women in Kenya and Nigeria. The argument of sexual chastity is insufficient to sustain the perpetuation of female circumcision.

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Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).

METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage.

RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy.

CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed.

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Female Genital Mutilation in Kenya: are young men allies in social change programmes?

Reprod Health Matters. 2016 May;24(47):118-25. doi: 10.1016/j.rhm.2016.06.002.

Female Genital Mutilation in Kenya: are young men allies in social change programmes?

Brown E, Mwangi-Powell F, Jerotich M, le May V


The Girl Summit held in 2014 aimed to mobilise greater effort to end Female Genital Mutilation (FGM) within a generation, building on a global movement which viewed the practice as a severe form of violence against women and girls and a violation of their rights. The UN, among others, endorse “comprehensive” strategies to end FGM, including legalistic measures, social protection and social communications. FGM is a sensitive issue and difficult to research, and rapid ethnographic methods can use existing relations of trust within social networks to explore attitudes towards predominant social norms which posit FGM as a social necessity. This study used Participatory Ethnographic Evaluation Research (PEER) to understand young men’s (18-25 years) perceptions of FGM, demand for FGM among future spouses, and perceptions of efforts to end FGM in a small town in West Pokot, Kenya, where FGM is reported to be high (between 85% to 96%). Twelve PEER researchers were recruited, who conducted two interviews with their friends, generating a total of 72 narrative interviews. The majority of young men who viewed themselves as having a “modern” outlook and with aspirations to marry “educated” women were more likely not to support FGM. Our findings show that young men viewed themselves as valuable allies in ending FGM, but that voicing their opposition to the practice was often difficult. More efforts are needed by multi-stakeholders – campaigners, government and local leaders – to create an enabling environment to voice that opposition.

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Circumcising Circumcision: Renegotiating Beliefs and Practices among Somali Women in Johannesburg and Nairobi

Med Anthropol. 2015 Jun 15. [Epub ahead of print]

Circumcising Circumcision: Renegotiating Beliefs and Practices among Somali Women in Johannesburg and Nairobi.

Jinnah Z, Lowe L


Female circumcision amongst Somalis is a deeply personal and subjective practice, framed within traditional norms and cultural practices, but negotiated within contemporary realities to produce a set of processes and practices that are nuanced, differentiated, and undergoing change. Based on ethnographic research amongst Somali women in Johannesburg and Nairobi, we argue that the context of forced migration provides women with opportunities to renegotiate and reinvent what female circumcision means to them. The complex, subjective and diverse perceptions and experiences of circumcision as embedded processes, within the context of migration, we argue has been overlooked in the literature, which has tended to be framed within a normative discourse concerned with the medical effects of the practice, or in anthropological studies, counter to the normative discourse based on personal narratives.

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J Biosoc Sci. 2014 Jul 3:1-16. [Epub ahead of print]


Patra S, Singh RK.


Female genital cutting (FGC) is widely practised in Kenya. However, its prevalence has declined over the last two decades (38.0% in 1998 KDHS, 32.2% in 2003 KDHS and 27.1% in 2008-09 KDHS), implying changes in behaviours and attitudes of Kenyans towards FGC. This study provides an overview of changing attitudes of women towards FGC in Kenya. An extensive literature review was undertaken and 2008-09 Kenya Demographic and Health Survey data were used to focus on the present scenario. Analyses were based on a national sample of 2284 circumcised women. About 68% of these women wanted to discontinue FGC, and attitudes towards discontinuation were found to vary with women’s background characteristics. Surprisingly, 92.5% of circumcised women of the North-Eastern province still wished to continue FGC, and for Muslims the percentage was 72.2%. About 36% of circumcised women responded that their daughters were already circumcised. Only 13% of circumcised mothers intended their daughters to be circumcised in the future. The study shows that the attitude of Kenyan women, irrespective of their circumcision status, has been changing gradually towards the discontinuation of circumcision of their daughters.

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Spatial modelling and mapping of female genital mutilation in Kenya.

BMC Public Health. 2014 Mar 25;14(1):276. doi: 10.1186/1471-2458-14-276.FREE

Spatial modelling and mapping of female genital mutilation in Kenya.

Achia TN.


BACKGROUND: Female genital mutilation/cutting (FGM/C) is still prevalent in several communities in Kenya and other areas in Africa, as well as being practiced by some migrants from African countries living in other parts of the world. This study aimed at detecting clustering of FGM/C in Kenya, and identifying those areas within the country where women still intend to continue the practice. A broader goal of the study was to identify geographical areas where the practice continues unabated and where broad intervention strategies need to be introduced.

METHODS: The prevalence of FGM/C was investigated using the 2008 Kenya Demographic and Health Survey (KDHS) data. The 2008 KDHS used a multistage stratified random sampling plan to select women of reproductive age (15-49 years) and asked questions concerning their FGM/C status and their support for the continuation of FGM/C. A spatial scan statistical analysis was carried out using SaTScan™ to test for statistically significant clustering of the practice of FGM/C in the country. The risk of FGM/C was also modelled and mapped using a hierarchical spatial model under the Integrated Nested Laplace approximation approach using the INLA library in R.

RESULTS: The prevalence of FGM/C stood at 28.2% and an estimated 10.3% of the women interviewed indicated that they supported the continuation of FGM. On the basis of the Deviance Information Criterion (DIC), hierarchical spatial models with spatially structured random effects were found to best fit the data for both response variables considered. Age, region, rural-urban classification, education, marital status, religion, socioeconomic status and media exposure were found to be significantly associated with FGM/C. The current FGM/C status of a woman was also a significant predictor of support for the continuation of FGM/C. Spatial scan statistics confirm FGM clusters in the North-Eastern and South-Western regions of Kenya (p < 0.001).

CONCLUSION: This suggests that the fight against FGM/C in Kenya is not yet over. There are still deep cultural and religious beliefs to be addressed in a bid to eradicate the practice. Interventions by government and other stakeholders must address these challenges and target the identified clusters.

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