Five questions to Thierry Nkurabagaya Manager of the "She Decides" — Health and sexual and reproductive rights project in Burkina Faso | Enabel - Belgian Development Agency

"If we want interventions to have a long-term effect, we need to change attitudes."

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Five questions to Thierry Nkurabagaya
Manager  of the project — "She Decides" — Health and sexual and reproductive rights in Burkina Faso
Can you describe the issues in the intervention you are managing?    

The lesser-known dimension of our “She Decides” programme is the fight against female circumcision. The problem of female circumcision is indeed very worrying in Burkina Faso. More than 63% of women are victims. In rural areas, this proportion is even 75%. That said, female genital mutilation is not the only dimension of our work. It is part of a broader context, that of sexual violence and gender-based violence, which are linked to the status of women in Burkina Faso, especially in more rural areas.

Early marriages, forced marriages and domestic violence, for example, are widespread. All of this stems from the fact that women here have little decision-making power, whether it is about their own life or their own bodies. This does not prevent them from contributing themselves to the situation. We know, for example, that female circumcision takes place at a very young age – as early as 5 years, which implies that the family itself is involved. We also know that it is women who practice it. Traditional and modern law are opposites and the socio-cultural context continues to weigh heavily on the situation. 
"We need to understand how things are going within communities and act within them to make a difference."
Project coordinator Thierry – central left on the picture
However, progress has been made in the last decade?

Yes, for sure. Legislation has evolved: Female circumcision is now illegal. We can see that the practice of female circumcision has been decreasing since this law has existed, even if this evolution is still too slow. To achieve a greater and truly sustainable effect, we need to understand how things are going within communities and act within them to make a difference. And here we bump into issues related to the status of women.

Traditionally, once a woman is married, she is no longer dependent on her family, but on her in-laws. However, the whole community still finds it difficult to accept that a man can marry an uncircumcised woman. The decision not to perform female circumcision on a young girl therefore involves a significant financial risk to her family. In addition, the legislation on female circumcision has perverse effects. 

For example, if a health worker finds that a young girl has been circumcised, the law requires them to report the situation to the authorities. As a result, for fear of being reported, some parents are reluctant to go to health centres when their children are seriously ill. On the other hand, even if there is denunciation, other problems arise: for instance, if parents are imprisoned, who will take care of the children? 

So you decided on a different approach. What does it consist of?

If we want interventions to have a long-term effect, we need to change attitudes. But how can this be done in accordance with existing practices and norms within communities? The issue is all the more important because communities have a central role in Burkina Faso: They make up the bulk of the social net. Actions and changes can therefore only come from within the community. We must therefore involve local communities in the design and execution of our actions. And for that, we must first understand them.

That is why we are currently conducting quantitative and qualitative studies to gain such understanding. These studies, ‘action-research’ in our jargon, are conducted by multidisciplinary and multicultural teams: They include Belgian experts of the Université de Liège, the UC Louvain and the University of Ghent, as well as local researchers, namely of the Higher Institution for Population Research and Sciences. Together they cover several disciplines: They are sociologists, psychologists and anthropologists. And the field teams also include members of civil society and representatives of the relevant authorities, such as the Ministry of Health and the Ministry of Women. We started with quantitative studies, followed by a more qualitative, socio-anthropological study. Next, we will work together with local communities and authorities to determine the best approaches and methods of proceeding.  
For example, you explore the idea of comprehensive care centres?

Indeed. We call them "mother-child" centres. The idea is to offer comprehensive medical, psychological, legal and social care. We also want to link these centres with existing care facilities, especially in terms of costs: If you want to create a sustainable system, it does not work to pay medical and nursing staff to stay full-time in a centre waiting for patients. It makes a lot more sense to rely on the staff of an existing medical centre, who will respond upon request.

And because community participation is a crucial element of success, we have also worked to develop a network of foster families to host victims of domestic or sexual violence. Last year, the Centre-Est Region, for which I am responsible, had 17 foster families. We have selected and trained other host families in collaboration with the Ministry of Women. We also work with local women's associations, but also with NGOs and regional department of the ministries concerned. We have also created WhatsApp groups at the local level to help different actors coordinate their work. Last year, this system helped to provide assistance to a victim of violence.    
Recording of a song against FGM
You also work upstream on the prevention of sexual violence and gender-based violence?

Indeed. Once more, this is a local approach. For example, we identified the most popular radio stations in the region and trained journalists to help them communicate on issues related to rights and gender-based violence. In the same spirit, we have also involved traditional singers and musicians, who will produce songs on these issues. We also work in schools, where we have trained people to communicate about sexual violence and gender-based violence, and we put in place a setting where children can be listened to.

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