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Impact Data - Tostan Program

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About 8.6% of the Senegalese population lives in the Kolda Region. Kolda’s annual population growth rate is high (3%), principally due to a high level of fertility (7 children per woman) and low use of contraceptives (1%). Early marriage is the norm among both men (25 years) and women (17 years). The Kolda Region is economically and socially under-developed. It lacks economic potential, which restricts the provision of services to meet basic needs, leading to a low standard of living. In the rural areas, 57% of households live below the poverty line, compared with 25% in urban areas. Serious gender disparities exist, resulting in even greater economic hardship among women. Female genital cutting (FGC) is estimated to be practiced widely (approximately 88%) among women in the region. The Kolda Region has a poorly developed health infrastructure and lacks qualified personnel, leading to inadequate provision of medical services to the population, and especially to women and children. Illiteracy is particularly high, at around 90% of the population, which, together with its geographical isolation, seriously limits access to information and to the media.

This operations research project evaluated the impact of a basic education programme developed by Tostan. The programme consists of four modules: hygiene, problem solving, women’s health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyse their own situation more effectively and thus find the best solutions for themselves.

Methodologies
All women and men participating in the education programme were interviewed before and after the intervention, and again 2 years later, to measure women’s and men’s awareness, attitudes and behaviour concerning reproductive health (RH) and FGC. A group of women and men from 20 similar villages that did not receive the education programme were interviewed at the same time to serve as a comparison group. To test the impact of the programme on community members’ willingness to abandon FGC, the proportion of respondents’ daughters aged 0-10 years whose parents reported they had been cut was used as the primary outcome indicator.
Knowledge Shifts
According to the evaluation, the education programme significantly increased women's and men's awareness of human rights, gender-based violence, FGC and reproductive health. Awareness of the consequences of FGC was also higher. Specifically, awareness of at least two consequences of FGC significantly increased among both men (11% to 83%) and women (7% to 83%) immediately after participating in the programme, and more than half of the women who did not participate could mention at least two of the dangers of FGC after the intervention.

Indicators on awareness of contraception, pregnancy surveillance and child survival also improved. For most issues, women improved more than men, except for awareness of sexually transmitted infections (STIs) and HIV/AIDS. Dissemination of the information provided through the education programme worked well within the village, as women and men who did not participate in the programme also increased their knowledge on most of these indicators. In the comparison villages there were also improvements in knowledge (e.g., human rights, gender-based violence, and FGC), but only the indicators on awareness of gender-based violence reached the same level of improvement as in the intervention villages. All other indicators show that the intervention group improved significantly more than the comparison group. However, endogenous change was also observed in the comparison area, and key informants in the comparison villages reported receiving information on these topics from the radio programmes prepared by Tostanand broadcast throughout the region.
Practices
The prevalence of FGC reported among daughters aged 0-10 years decreased significantly among women directly and indirectly exposed to the programme. Life table analysis confirmed this change in the intervention group, but also that the girls who were cut were being cut earlier than before. No change in use of contraception was observed over time, but pregnancy surveillance and use of delivery services improved compared with the comparison group, although delivery in health facilities remained low because of their inaccessibility.

At the baseline survey, 7 out of 10 women said they wanted to have their daughters, who had not yet been cut, cut in the future. This proportion fell to about 1 in 10 women among participants and 2 in 10 women indirectly exposed to the program. In the comparison group, more than half (54%) of the women expected to have their daughters cut. Nevertheless, a significant decrease was seen here also. In the medium term, more than three-quarters of the women decided no longer to have their daughters cut.
Attitudes
Attitudes improved significantly in the experimental group, with women and men denouncing discrimination, violence and FGC. Attitudes towards FGC also improved significantly in the comparison group, but to a lesser extent than in the experimental group. There was a dramatic decrease in the approval of FGC, although a small proportion of women (16%) participating in the programme did not change their attitude. Regret for having cut their daughters increased and fewer women were willing to cut their daughters in the future. Women perceived men’s attitudes towards contraception as improving. However, the intervention group showed higher levels of positive attitudes than the comparison group.

Among the majority of women participating in the programme who disapproved of FGC at the endline, 85% said that they had changed their mind since participating in Tostan. Only 10% of these women said that their disapproval dated back several years.

Among those in the comparison group who disapproved of FGC, 61% said they had disapproved for one or two years and 12% said Tostan was responsible for their change of attitude, indicating again the probable importance of the Tostan radio programme in the region and its role in affecting the comparison group.
Source
The Tostan Program: Evaluation of a Community-based Education Program in Senegal [PDF], August 2004.