Empowering Communities against Harmful Social Practices through Integrated Water Hygiene and Sanitation and Alternative Rites of Passage Model in Kajiado County, Kenya

Abstract

Background: In Kajiado County, water, sanitation, and hygiene interventions have been independently implemented in communities that have been targeted with sexual health rights interventions. This approach only achieves a set of disjointed achievements and thus the need for integration. This project implemented and tested the effectiveness of the Integrated Water Hygiene and Sanitation and Sexual Reproductive Health Rights (SRHR)Model to address harmful practices against young girls in the county. This model was implemented on the assumption that addressing a pressing need of the community through providing access to Water hygiene and sanitation services provides a platform to discuss SRHR matters leading to positive change towards WASH and SRHR behaviours such as reduction of FGM, teenage pregnancies and early forced marriages. Methods: A before and after design that compared baseline and endline evaluation data was used to establish the effectiveness of the model. The study was conducted in 4 sub-counties. Data was collected through household surveys. Adolescent Girls and Young Women (AGYW) aged 10-24 years were included. Data were analysed using proportions, frequencies, odds ratios, and adjusted odds ratios. Results: Prevalence of FGM/C dropped to 55.2% from 91% at baseline. More circumcised women (79.5% end line; 28% at baseline) reported that they wished they had not been circumcised. An increase in participants who had ever heard messages of ARP (91.6% end line; 47% baseline) was reported. Approximately 98.1% believed that ARP is acceptable to the community as a means of progressing girls to womanhood. Young girls and Women were more likely to undergo FGM/C if they did not have access to a toilet (AOR, 2.32; 95% CI, 1.50 to 3.59), had never heard of ARP (AOR, 2.50; 95% CI, 1.54 to 4.04) and were not sure if ARP would be acceptable in the community (AOR, 0.51; 95% CI, 0.27 to 0.97). Odds of ever being circumcised were less likely among those that stated that FGC should not continue (AOR, 0.11; 95% CI, 0.01 to 0.81) and had been part of the intervention (AOR, 0.25; 95% CI, 0.17 to 0.38). Conclusions: There is a link between addressing WASH gaps (community-felt needs) in Kajiado and the reduction of FGM/C. Addressing community pressing needs provides a platform to address sensitive social-cultural practices. Recommendations of further studies to explore contextual factors that affect the implementation of this model.