The Tostan program: Evaluation of a community based education program in Senegal

Abstract

This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a non-governmental organization based at Thiès, Senegal. The basic education program 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 analyze their own situation more effectively and thus find the best solutions for themselves. The Supra Regional Project for the Elimination of Female Genital Cutting of GTZ funded implementation of the program in 90 villages in Kolda Region, and the Population Council's Frontiers in Reproductive Health Program, with funding from USAID, used this opportunity to evaluate the program in 20 villages.All women and men participating in the education program were interviewed before and after the intervention, and again two years later, to measure women's and men's awareness, attitudes and behavior concerning reproductive health (RH) and female genital cutting (FGC). A group of women and men from 20 similar villages that did not receive the education program were interviewed at the same time to serve as a comparison group. To test the impact of the program on community members' willingness to abandon FGC, the proportion of respondents' daughters aged 0 to 10 years whose parents reported they had been cut was used as the primary outcome indicator.The education program significantly increased the awareness of women and men about human rights, gender-based violence, FGC and reproductive health, but awareness of human rights, violence and FGC also increased in the comparison site, although to a lesser extent. The consequences of FGC were better known, as were issues concerning contraception, pregnancy surveillance and child survival. In general, women's knowledge improved more than men's, except for STI/HIV. Diffusion of information from the education program within villages worked well, as other women and men living in the intervention villages also increased their knowledge on most indicators. For all indicators, apart from those concerning violence, the experimental group improved significantly more than the comparison group.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 program 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.There also appears to have been a positive improvement in behavior in terms of FGC and some aspects of reproductive health. The preval...

A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls

“…In these patriarchal settings in which FGM/C is strongly linked to tradition and religion and in which the target audience received education on hygiene, problem-solving, human rights and women’s health that might not have addressed their needs and wants, little change in FGM/C-related beliefs and behaviour ensued. Rather, women failed to participate because ‘their husbands forbade it’26 and male villagers expressed hostility for not being included from the start and, once included, dominated in committees. Some beneficiaries believed ‘the programme was coming to fight against the traditional culture.’26 None of the included texts suggested that religion was addressed in the Tostan programme, although it was a chief factor in its continuance in all communities.…”

“…Rather, women failed to participate because ‘their husbands forbade it’26 and male villagers expressed hostility for not being included from the start and, once included, dominated in committees. Some beneficiaries believed ‘the programme was coming to fight against the traditional culture.’26 None of the included texts suggested that religion was addressed in the Tostan programme, although it was a chief factor in its continuance in all communities. In Senegal, one religious leader expressed strong support for FGM/C, which might have influenced the faithful.…”

Methodological issues in measuring the impact of interventions against female genital cutting

“…The Village Empowerment Programme in Senegal, for example, is being implemented in 90 villages and many communities have links through marital and other social relationships to villages that are not in close proximity; consequently, the intervention appears to be having impact beyond the study sites themselves. It has proved essential to have researchers resident in the villages who use ethnographic methods to understand these social networks and communication patterns so as to map and document these 'ripple' effects (Diop et al 2004).…”

“…In ongoing studies to evaluate the Village Empowerment Programme in Senegal and Burkina Faso, the key outcome variable is the proportion of young girls being cut who are currently not cut (Diop et al 2004); the indicator used is the proportion of daughter(s) aged 0-10 years whose mother reports that they are cut (in these countries, 95% of girls are cut by age 10 years). These studies, by necessity, followed panels of women who were exposed and not exposed to the intervention over time, and the change over time evaluated is between the two groups and not within each group.…”

Protecting girls and women from harmful practices affecting their health: Are we making progress?

“…Where this has happened, it has resulted from a process of social change in which a significant number of families within a community make a collective, coordinated choice to abandon the practice so that no single girl or family is disadvantaged by the decision [26]. Often this has been done through educational activities geared to empowerment undertaken by community-based organizations, in which information about health, hygiene, nutrition, and women's rights more broadly leads to discussion of FGM and what should and can be done about it [27]. Experience has shown that only if the decision is widespread within the practicing community will it be sustained and thus bring about a new social norm that does not harm girls or violate their rights.…”