Amref’s CLARP in evolution

In this section, we explain what is meant by the term CLARP, how it started, and how it evolved to contribute to policy influencing towards ending FGM/C.

Context analysis: to identify both the context of FGM/C and the entry points, and most important stakeholders to involve for change. These are cultural and religious leaders/elders, parents, teachers, boys, morans (warriors), as well as female circumcisers, local governments, etc. who are sensitised and trained to prioritise the FGM/C dialogue within the community.

Community dialogue: with the support of the stakeholders from step 1. The community is involved in conversations and dialogues, steadily building up to sensitive (health) topics like FGM/C, gender, and social norms, and the effects and alternatives that can be designed within the community.

CLARP design: communities define and co-create their own CLARP process, outlining what they wish to carry forward, and clearly reiterating that FGM/C is no longer necessary. This step is largely facilitated by civil society organisations and like-minded stakeholders, and includes isolating the aspects of initiation to be carried forward (good culture) and aspects to be left out (bad culture). The good aspects retained and upgraded include: sex education for girls (some sessions include boys), sexuality, growing up, life skills, negotiation and decision-making; gifts to parents, girls, and elders; blessings by cultural elders, signifying the blessings of fathers which were traditionally conferred during the cutting ceremony. Only one aspect of the ceremony is removed: the cutting of female genitalia.

Engagement with civil society organisations: to build the sustainability of CLARP and the change that this process entails, civil society organisations such as groups led by women and youth are trained to keep FGM/C as a topic on the agenda. Traditional birth attendants (TBAs), who often work as cutters, are reassigned as birth companions, and are incentivised financially whenever they accompany or refer an expectant mother to a health facility. They are educated about the immediate and long-term effects of FGM/C, and encouraged to seek alternative livelihoods. Amref introduces TBAs to financial institutions so that they can apply for loans and provides training on alternative livelihoods. However, according to the Population Council, providing financial incentives to cutters in an attempt to encourage alternative livelihoods has proven ineffective (Matanda et al. 2023). A more successful approach involves connecting TBAs with the Ministry of Culture and Social Services, enabling them to form organised groups which can access loans for independent income-generating activities. The Ministry is responsible for building the capacity of these groups, particularly in financial management and other essential skills.

Sexual and Reproductive Health and Rights (SRHR) life skills and training: girls and boys receive a three-day training on these rights, positive norms and values, self-esteem, life skills, agency, and leadership. As a final celebration, a ‘candle-night’ event2 On the eve of the CLARP graduation ceremony, the vibrant ‘candle-night’ event takes place. At this event, girls compete with one another using the knowledge they have gained about sexual and reproductive health and rights (SRHR), show off their Maa attire, and display confidence as they walk the catwalk. The event celebrates confidence and self-esteem in girls who, for years, have lacked a voice in their highly patriarchal communities. (day four) and a CLARP graduation ceremony (day five) are held, which include blessings by cultural elders and leaders, and a public denouncement of FGM/C.

Sustaining community movement: communities moving towards abandonment of FGM/C can become more sustainable with the help of end-FGM/C champions and existing structures, such as community health promotors and county gender technical working groups, which track and report on progress, and highlight emerging concerns to the various child protection structures linked to initiatives like the Nice Place Foundation.3 The Nice Place Foundation was established by Nice Nailantei Leng’ete, a young Maasai woman who has long collaborated with Amref Health Africa in fighting against FGM/C. Based in Loitoktok, Kajiado County, it is a safe space for girls who are at risk of FGM/C, child marriage, and other threats related to gender-based violence. The Foundation also runs a Girls’ Academy. A real-time mobile app has been designed to follow up CLARP girls until they reach the age of twenty-four. Trained community health promoters conduct biannual review meetings with girls who have gone through CLARP, and report any cases of physical abuse, ridicule, FGM/C, early marriage, or school drop-out, and on the girls’ mental well-being. The ultimate goal for CLARP is to protect girls and women from FGM/C, measured by a reduction in FGM/C cases, reduced cases of child marriage and teenage pregnancy, and improvement in schooling years (Muhula et al. 2021). Key outcomes of the theory of change4 A theory of change is a strategic framework that outlines how specific actions or interventions in a programme are expected to lead to desired outcomes and long-term impacts. It identifies the steps, conditions, and assumptions needed to achieve change, helping organisations plan, implement, and evaluate their efforts effectively. that Amref uses focus on the establishment of a community movement that challenges and transforms related social and gender norms; girls and boys who understand and claim their sexual and reproductive health rights; and policy makers and community leaders who develop and enforce laws against FGM/C.

Since it is a health organisation, Amref started to work on FGM/C from a public health perspective. From its understanding of the complexities of cultural practices in the region, a direct approach focused solely on FGM/C would have likely faced significant resistance, so integrating discussions within a broader framework of sexual and reproductive health seemed more strategic. The focus of CLARP was strongly on the health risks and complications of FGM/C. However, the NGO realised that communities would find new ways to address these health issues, and medicalisation of FGM/C began to emerge. Anaesthesia was used to ward off the pain, and the presence of ‘medical’ personnel was a safety assurance to the girls and families. Therefore, a shift was needed towards a human-rights perspective and FGM/C was redefined as a violation of the rights of women and girls, as sexual harassment, and as a crime. This holistic perspective also put more emphasis on gender equality, recognising power structures that kept the practice in place, and the need for community-based interventions to foster dialogues.

When entering communities, Amref often had to deal with resistance. Community ownership and buy-in were soon recognised as important elements for the success of CLARPs. In the beginning, as is the case with many development programmes, CLARP was introduced by programme implementers who were not from local communities. This outsider status often led to perceptions that these initiatives were encroaching upon the community’s cultural heritage, which contributed to scepticism and resistance. To solve this challenge, the programme later employed local community youth and extended the community dialogues to enable acceptance. Secondly, the presence of various VIPs – including donors, government officials, and educators from other communities – during the CLARP ceremonies further complicated ownership. Many community members viewed these events as an imposition rather than a culturally relevant alternative. This led to a decision to down-size the events and make them less public and more local, as suggested in studies by Graamans et al. (2019) and Matanda et al. (2023) which showed that public ceremonies associated with ARP have not proved to be effective in gaining community acceptance.

It needs to be acknowledged that Amref’s CLARP model was tailored specifically to the cultural context of the Maasai (Amref Health Africa 2015). This approach allowed the CLARP programme to deeply resonate with Maasai traditions and values, making it more effective and culturally sensitive within that ethnic group. However, the model was implemented in a relatively small geographical area, limiting its reach and applicability. As a result, while it worked well within the Maasai community, its success and lessons learned cannot be easily generalised or transferred to other communities or regions with different cultural norms, practices, and geographic contexts. The ARP model is not a one-size-fits-all approach to addressing FGM/C. Broader implementation would likely require the co-creation of specific models to address the unique cultural and social dynamics of other populations.

With continuous learning and adaptation, it was realised that other entry points might also be used to introduce CLARPs. Many communities had other more pressing issues and needs that, if not addressed, were also likely to erode the gains made in ending FGM/C through CLARPs. For the Maasai, a nomadic people living with their livestock in a semi-arid area, such issues included the dire need for water. This realisation led to the integration of CLARP and the NGO’s Water, Sanitation and Hygiene (WASH) programmes. In 2016, this resulted in the first ARP/WASH programmes (in Tanzania and Kenya), effectively addressing the water, sanitation, and hygiene needs of communities and introducing a gender-sensitive approach to prevent FGM/C and other harmful practices (Mbogo et al. 2022). Water committees became pivotal entry points for conversations about harmful cultural practices, including FGM/C, facilitating a more comprehensive and integrated dialogue within the community.

Recognising the vital role of education in changing attitudes and ending FGM/C, it became important to collaborate with teachers to transform schools into centres for identifying girls who were eligible for CLARP. In these educational settings, training on girls’ rights, life skills, and negotiation strategies aimed to empower both girls and boys to assertively say ‘no’ to FGM/C. Cooperation with the Ministry of Education and education sector (at national level) has resulted in educational programmes that address FGM/C, though no specific FGM/C curriculum has yet been introduced in Kenya.

Counties were supported by Amref to domesticate the anti-FGM Act (2011) by developing policies for the eradication of FGM/C (see note 2). These policies are seen both as sustainability mechanisms for ending FGM/C and as local government commitments to end it. Some counties have integrated End FGM activities and budgets into their development plans. For example, the gender department of Kajiado County has an annual budget for anti-FGM/C activities (which was nearly £174,000 in 2023).5 This budget was for implementation of its anti-FGM/C policy and other activities to combat sexual gender-based violence.

Another important programme element of CLARP is monitoring and evaluation. As Graamans et al. (2019) have argued, ‘any intervention with the aim of encouraging people to abandon a historically-embedded cultural practice will likely suffer from some types of side-effects or negative unintended consequences.’6 Seen online, no page numbers. How people behave, and change their behaviour, is highly unpredictable and needs to be monitored to reflect, follow up, and also mitigate unforeseen and unwanted consequences that can easily take place (such as contextual changes due to pandemics or climate change). Therefore, it is key to have a good monitoring system and keep reflecting on what is happening. The organisation had to grow in this aspect as well and came to understand that this was its responsibility. With the introduction of a theory of change, a methodology that allows development actors to exercise backwards mapping from the goal to the interventions, insight was gained by connecting outcomes with preconditions to form causal pathways to change. This methodology allows continuous reflection on the change process. To reach the desired goal of protecting girls and women from FGM/C, it was necessary to test certain assumptions. For example, the assumption that through participating in intergenerational dialogues men and boys become allies in changing social norms informed our male engagement. Or the (negative) assumption that policy makers are as much influenced by social norms as people in communities, which explained why we needed to invest more in lobbying and advocacy of state and policy actors.

When mapping causality and testing how change took place, there was a growing recognition of evidence building and the need to demonstrate the effectiveness and impact of the work against FGM/C in the longer run. In 2018, the NGO conducted a series of studies to assess the effectiveness and outcomes of the CLARP initiative. It was a big challenge (and not without limitations) to move beyond qualitative research and try to also quantify our efforts. The findings from these evaluations highlighted that, at impact level, the protection of girls and women against FGM/C was indeed successful, and we also saw several key related successes such as a reduction in teenage pregnancy, girls’ retention in schools, and a decrease in child marriage. However, attributing change specifically to CLARP remains a challenge. And a pressing question emerged: where are all the girls who have gone through CLARP and how are they doing? In what way is CLARP building sustainable solutions for these girls that supports them to keep protecting and empowering themselves and, through them, their communities too? Empowered girls can also act as role models and inspire and foster younger generations of girls to also make informed decisions and overcome the challenges that continue to persist in fighting FGM/C.

To address the question of where the girls are and how they are doing after CLARP, Amref initiated a programme aimed at tracking their whereabouts. Consultations with girls (every six months until girls reach their twenty-fifth birthdays) are conducted by community health promotors (part of existing health structures) to provide local solutions and support networks on issues that arise.