Experience from a Community-Based Education Program in Burkina Faso: The Tostan Program

Executive Summary
"This study describes a project that tested the feasibility and effectiveness of replicating the village empowerment program (VEP) developed by the Senegalese NGO [non-governmental organisation], TOSTAN, in Burkina Faso. Although one of the ultimate goals of this model is the eradication of female genital cutting (FGC), Tostan has found that an effective means to achieve this is by empowering community members to understand and act on their situation through a broad-based functional educational program. TOSTAN's educational model includes four modules on human rights, problem solving, environmental hygiene and women’s health. TOSTAN's hypothesis is that communication of technical information, discussion of human rights issues, and development of strategies for social transformation improve the confidence and self-determination of women through participatory educational methods. Mwangaza Action, a Burkinabé NGO affiliated with the Co-operative League of the United Stated of America (CLUSA), adapted and implemented the VEP model in Bazega/Zoundwego province. Although originally developed for empowering women, the program implemented in Burkina Faso also involved men because of their key role in such decisions. Frontiers in Reproductive Health, with funding from USAID and the GTZ Supra Regional Project Against FGC, supported the adaptation, implementation and evaluation of the VEP model in 23 villages in the province of Bazega/Zoundwéogo.

To test the effect of the VEP program, and associated social mobilization process on knowledge, attitudes and behaviors around health, hygiene, rights, and FGC, a pre and post-intervention comparison group design was used. Forty-six villages participated in the study, with 23 villages in each of the experimental and control groups. Quantitative data were collected through a baseline and end line survey two years later, as well as during an intermediate survey immediately following completion of the intervention. Several groups of respondents were interviewed individually in the intervention communities: women and men who participated in the VEP sessions; husbands of the women participants; and women and men who did not participate. The purpose of interviewing those that did not participate directly in the educational sessions was to determine the degree to which the information communicated was diffused more widely within the communities. In addition, women were asked about the circumcision status of their girl children aged 0-10 years. In the comparison communities, representative samples of men and women were interviewed. In addition, 192 semi-structured interviews and 42 focus group discussions were conducted with facilitators and key informants within the community.

Findings
Participants in the educational sessions mostly enjoyed the training program. Over three quarter of participants attended all sessions in the full program; the main reasons for not attending all modules were lack of time, travel, illness, pregnancy, and funerals within the family. Participants declared a preference for the hygiene and health modules over the human rights and problem solving modules.

As a direct effect of the program, the inhabitants of the 23 experimental communities undertook activities to improve environmental hygiene through cleaning the schools and health centers, as well as the areas surrounding sources of water. Healthcare huts were constructed, improvements made to homes, and water sources repaired. In addition, legal documents such as birth certificates, identity cards and family booklets were requested and issued, and 43 couples went through an official civil marriage ceremony. Cases of denouncing forced marriage and of acknowledging discrimination against educating girl children were also noted. However, community members regretted that the program did not include literacy classes, nor did it include any income generating activities. Also, the change of facilitators, which took place after the first phase of training, was not appreciated.

In terms of awareness, the VEP contributed to a significant increase in awareness about human rights, women's health, and FGC, both among women and men participating in the program. Men and women who had not attended the classes but who were indirectly exposed to the information communicated in the intervention communities also increased their level of awareness of human rights. Mwangaza encouraged a system of formally expecting participants to share the information learned with other individuals in the community as this had been effective in Senegal, but it did not work well in this context, in that it limited the spread of information throughout the whole of the community.

Levels of awareness on the issues covered were much higher among those who had participated in the program. Women and men participating in the program were better able to mention at least two modern methods of family planning, they accepted that there were advantages in spacing births, and they knew that at least three antenatal consultations should be undertaken. They were also more able to identify at least two danger signs during pregnancy, knew that a person in good health could be a carrier of the HIV virus, could refer to at least two ways of preventing STIs [sexually transmitted infections] and HIV/AIDS, and could mention at least two dangers of FGC. Overall, men had higher levels of awareness than women, except for antenatal consultations. All improvements could be attributed to the program given that levels of awareness in the comparison communities did not improve or improved less than in the intervention communities.

In terms of attitudes, positive improvements in attitudes were seen among both women and men participating in the program. These improvements included perceptions that sexual discrimination could change, approval of modern contraceptive methods, denunciation of violence against women, disapproval of FGC, and willingness to discuss FGC with other people. An increasing proportion of women whose daughters were cut regretted this and intention to cut daughters in the future decreased significantly among the participant group. There appears to have been little diffusion of these attitudinal changes among those interviewed who did not participate, as there were no significant differences compared with those in the comparison area.

In terms of behavior change, it was noted that the number of violent acts against women in the communities reduced considerably, with a significantly higher decrease in the intervention communities. Concerning eradication of FGC, a transition towards abandonment has already started in this province, as indicated by the small proportion of girls reported to be cut at baseline. In the intervention group overall, this low prevalence of FGC did not change, but the proportion of girls aged 0 to 10 years who had not been cut clearly increased. Indeed, no girls under the age of 5 years were reported to have been cut, compared to three percent in the comparison area. Nevertheless, the baseline survey also showed a lowering of the age of cutting. Conclusions about the impact of this intervention on FGC abandonment are difficult to draw, however, given the context of Burkina Faso where the law forbidding the practice is well known and strongly enforced, and may therefore influence the validity of responses to questions about cutting. It should be noted that participants in the educational program had a higher level of education (formal schooling, literacy programs and other previous training) than the others, and that among the men there was a high proportion of bachelors. In addition, these participants were younger than the rest. They had a high level of mobility (with many outside contacts) and were generally open to change and already in favor of giving up FGC. This skewed selection of participants could have led to the neglect of less active members of the population and those who were more vulnerable to sustaining the practice.

Greater social mobilization against FGC was observed in the intervention communities. By the endline survey, more than 90 percent of people interviewed reported having discussed the issue, and more than half of them had been present at the public declaration organized in May 2003. Several opportunities were offered to the women to express themselves in public and in front of the administrative authorities as well as the customary and religious authorities. These opportunities had the effect of convincing the women about the possibility of changing the ways in which women are regarded in the community.

The study also evaluated the combined effect of the education program and the social mobilisation process on the community’s intention to give up FGC. On the whole, both men and women disapproved of FGC and did not want to cut their daughters. The majority of the men and women who participated in the education program had been present at the public declaration, and most of them held that the decision expressed during the declaration would be followed and that girls would no longer be cut. Even though the intention to share the issues discussed during the education sessions did not work very well, the education program itself aroused interest among those who had been contacted, as well as in the neighboring villages. This interest was demonstrated by the presence of many community members at the public declaration, which could be interpreted as an intention to work against FGC. In the existing social climate among the Burkinabé, where there is widespread awareness of the law forbidding FGC, the education program has contributed to strengthening the existing measures and to a significant improvement in the level of awareness of human rights and reproductive health."