Introduction
The health organisation Amref Health Africa, as one of the initiators of the eradication of FGM/C in East Africa, is a key player in trying to gather evidence on the effectiveness of FGM/C interventions. Since 2009, the organisation has been working on different means to support communities to abolish harmful practices such as FGM/C. This chapter will reflect on challenges, criticism, and evidence on the Community-Led Alternative Rites of Passage (CLARP) approach, which is one of the models that Amref uses in its programmes. During the last decade the implementation of this intervention has evolved, and learning and adaptation are ongoing. (For an explanation of Alternative Rites of Passage [ARP], see the Introduction to this book. CLARP is a variation upon it.)
The chapter will explain why Amref focuses on FGM/C eradication, the Kenyan and specifically Kajiado County context, and FGM/C trends, before going on to describe the CLARP approach and its development over time (2009–24). We will discuss important challenges and critiques that we faced in recent years and how we relate and responded to them in our programming, incorporating methods of measurement such as difference-in-difference, stepped-wedge clustered random control trials, and formative and longitudinal qualitative data analysis. We will end our chapter by looking at the future of CLARP and FGM/C.
FGM/C in Kenya and in particular Kajiado
The Kenya Demographic and Health Survey (KDHS) put the prevalence of FGM/C in Kenya at 15 per cent of women aged fifteen to forty-nine in 2022. Prevalence fell from 37.6 per cent to 14.8 per cent of women in this age span between 1998 and 2022, and among young women aged fifteen to nineteen prevalence fell from 26 per cent in 1998 to 9.1 per cent in 2022 (KNBS and ICF 2023). Not all ethnic groups in Kenya perform FGM/C, but it is known to be a common practice among the Somali (86.9 per cent), Samburu (75.9 per cent), Kisii (70.9 per cent), and Maasai (56.7 per cent) groups (ibid.). Girls are being cut younger, and in some areas Type 3 is rising as well as medicalisation and cross-border FGM/C (Kimani et al. 2024). In Kajiado, extreme weather patterns and drought have heightened the vulnerability of Maasai women and girls to FGM/C and other forms of gender-based violence. In an attempt to recover from the effects of climate change, families marry off girls in exchange for livestock as bridewealth, with FGM/C being a prerequisite for marriage.
The principal legislation addressing FGM/C in Kenya is the Prohibition of Female Genital Mutilation Act (2011, hereafter the anti-FGM Act), which criminalises all forms of FGM/C. The Children Act (2022), the Protection Against Domestic Violence Act (2015), and Article 4 of Kenya’s Penal Code also recognise FGM/C as a violation. Several policies, along with the establishment of the Anti-FGM Board,
1 The Anti-FGM Board was established in 2013, following the passing of the anti-FGM Act. Its primary mandate is to coordinate efforts to eradicate FGM/C in Kenya. It works with various stakeholders, including government agencies, NGOs, community leaders, and international organisations, to implement policies and strategies. demonstrate the commitment of the Kenyan government to ending the practice. In 2021 the anti-FGM Act was challenged in the High Court, but it was upheld as constitutional (see Chapter 10, Van Bavel
et. al., and Chapter 12, Kamau, this volume).
In Kajiado County, which is predominantly inhabited by Maasai, FGM/C is traditionally part of a rite of passage from girlhood to womanhood. Girls affected by FGM/C in this region are mostly between ten and fifteen years old, though younger girls are sometimes subjected to the practice to avoid law enforcement or prevent them from refusing to give consent as they grow older. Stakeholders include parents and extended family members such as grandmothers, and the practice is performed at home by traditional birth attendants. In the past, ceremonies were held for girls who had undergone the cut, but these have declined since FGM/C was outlawed. The county government enacted a policy for the eradication of FGM/C in December 2019 (County Government of Kajiado 2019).
2 Devolution of power to forty-seven county governments is a process that began in 2013, following the passing of the 2010 Constitution. Kajiado County’s anti-FGM/C policy provides a framework for the eradication of FGM/C by sensitising the community that the practice is illegal and a violation of human rights. It was the first county to enact such legislation. https://newsroom.amref.org/news/2019/12/kajiado-county-enacts-policy-to-end-female-genital-mutilation/ [Accessed 8 July 2025]. The most common type of FGM/C in Kajiado is Type 2. FGM/C intersects with teenage pregnancy, school drop-outs, and child marriage. This is because FGM/C marks the transition to womanhood and allows young women to be sexually active and risk becoming pregnant, which subsequently leads to school drop-out and early marriage (Kok
et al. 2023).
Maasai living in Kajiado have different motives for continuing to practise FGM/C. Graamans et al. (2018) identified marriageability, women’s chastity, endurance of pain, and fear of ancestral curses if FGM/C is abandoned as among the reasons often mentioned. On the other hand, ideas about health, education, progress, religious beliefs, and sexual satisfaction counter support for FGM/C. The leverage for change exists through dialogue between these opposing discourses (Graamans et al. call them discourses and counter-discourses), but also depends on the community, individual, and context.
The earliest known ARP in Kenya dates back to 1996 and was developed by the women’s development organisation Maendeleo ya Wanawake (MYWO), in collaboration with the Programme for Alternative Technology in Health (PATH), among the Tharaka people in Meru (Muteshi and Sass 2005; Van Bavel 2021). ARP as a strategy to end FGM/C was born out of a desire by communities, in dialogue with NGOs, to drop the cut while at the same time keeping certain aspects of their culture, such as preparing their daughters for womanhood through education and a celebratory ceremony. Communities feared that their girls might not find husbands if they had not been initiated. This first ARP programme was assessed by the Population Council, and although the study could not evaluate effectiveness and impact due to data limitations, it accounted for some effect on behaviour change among ‘those who decided to discontinue the practice’ (Chege, Askew and Liku 2001), though these authors noted it was highly influenced by other socio-cultural factors. Other important studies on ARP among the Maasai are Hughes (2018), Graamans et al. (2019), and Van Bavel (2021), all of which have evaluated, informed, and supported NGOs to understand and address the weaknesses of their ARP design. The main criticism by scholars of ARP centres around (lack of) community ownership, its top-down, external (fundraising) focus, and single-issue interventions that deny the complexity of FGM/C. This will be discussed further.