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The Effects of Female Genital Mutilation in Somalia Africa
By: Nikki Coleman
Currently, over 90 million women over the age of 10 years old have had the procedure of female circumcision/female genital mutilation (FGM), as well as each year, 3 million girls are at risk of having the procedure completed on them in African countries (Adiguzel, Bas, Erhan & Gelle, 2018).
Female Genital Mutilation is known as a procedure with partial or the complete removal of the external female genitalia for non-medical reasons (World Health Organization). This procedure is performed for several reasons throughout various cultures and demographics: socially normal, part of one's culture, passed down from generations or females known as being clean or unclean. Several studies were conducted on the effects of female genital mutilation via cross-sectional studies as well as descriptive studies.
This research will focus on Somalia, Africa and the reasons regarding having this procedure completed, health risks for women, psychological effects, and reproductive barriers many women face when such procedures are completed. As said by Gele, Bo, and Sundby, (2013),
Somalia is the most prevalent country that practices female circumcision, although it is among 28 African countries that are part of the tradition. Besides the harmful health consequences of female circumcision, gender inequality replicates women's discrimination emphasized as well. Several approaches were created to take a position to abolish female circumcision in addition to Somali Women's Democratic Association (SOWDA) being created to apply anti-female circumcision missions to eliminate the practice (Gele et al., (2013).
World Health Organization (WHO) reports female genital mutilation as being characterized in 4 types.
Type 1 is the partial or total removal of the clitoris and/or prepuce.
Type II is the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.
Type III is the narrowing of the vaginal orifice with creation of a covering seal by cutting and positioning the labia minora and labia majora with or without the excision of the clitoris.
Type IV includes other harmful procedures to female genitals for a non-medical purpose.
Ninety two percent saw FGM as a health risk; 90.1% reported FGM could negatively affect the baby and mom during childbirth; 74% reported awareness of reduction in sexual feelings; and 75% were aware it could cause infectious disease.
The practice of female genital mutilation is rooted in Somali beliefs in spite of years of global movements to abolish it (Yossuf, Matanda, & Powell, 2020).
Circumcision was considered an advantage in having a successful marriage by 28% of the females; 85% of those interviewed planned to have their daughter circumcised, of which 73% were women, and 27% were men.
The participants in the study, 82.9%, reported the purpose of the female genital mutilation procedure is due to tradition, family values and 14.9% unsure why they were mutilated (Smith et al., 2016).
Throughout the study, women revealed lack of uncertainty with intercourse and their partner, the experience was a festivity (celebration) for those who had the procedure completed on them, as well as lack of understanding why as children they had to be excited because they were about to be a woman (Recchia & McGarry, 2017).
Program Goal And Objectives
The program's goal is to reduce the prevalence of practicing female genital mutilation in Mogadishu, Somalia through the United Nations Populations Fund- United Nations Children's Fund Joint Programme partnering with the FGM Empowerment Program.
Educate 90% of women and men from Mogadishu, Somalia, regarding the adverse health consequences of female genital mutilation by December 2023.
By 2023, 80% of Mogadishu, Somalia women will have access to programs to assist with underlying medical conditions derived from female genital mutilation through partnering with UNFPA-UNICEF Join Programme and FGM Empowerment Program.
The FGM Empowerment Program will advocate for policy change aimed at banning female genital mutilation in Somalia by 2030.
Program part 1
This goal will focus on the social, mass media, and educational workshops utilized to educate and make 90% of women and men from Mogadishu, Somalia, regarding the adverse health consequences of female genital mutilation by 2023. The FGM Empowerment Program will first work with the Joint Program to help break the psychological understanding of FGM with the elders/influencers in Mogadishu. The Joint Programme and FGM Empowerment Program will discuss uncleanliness from the procedure, as well as working with those influencers regarding the negative consequences of having the procedure completed, while being sensitive to the old-time tradition in that area. United Nations Population Fund (2019) reported The Joint Programme serviced 3,960 in Ethiopia, by facilitating conversations with young girls surrounding the dangerous procedure by young adults who completed the programme. FGM Empowerment Program will model The Joint Programme’s open dialogue conversations with the younger generation as well, so they feel empowered and comfortable to discuss sensitive issues regarding FGM. The next step is to implement ways in the village to break the psychology of learning what is defined as uncleanliness and highlighting the negative consequences. Next, FGM Empowerment Program will transition the mindset from generations of traditions with the FGM IN SOMALIA 10 open workshops by having presenters living with FGM discussed within the community. Additionally, FGM Empowerment Program will present an awareness of the new generation mentality and have a dialogue of the mental implications and how it impacts them mentally.
Program part 11
By 2023, 80% of Mogadishu, Somalia women will have access to programs to assist with underlying medical conditions derived from female genital mutilation through partnering with UNFPA-UNICEF Joint Programme and FGM Empowerment Program. According to Adiguzel et al. (2018), the exact amount of procedures completed on young females and women is not forthcoming due to FGM being completed in the home secretly with no history to show for it. One step is working with healthcare professionals in the community who was identified as support regarding the banning of FGM. FGM Empowerment Program will develop a strategy to support Safe Havens for women, children, and young adult females who wish not to participate. We will develop an anonymous plan for the women and young adults to express their concern without repercussions. FGM Empowerment Program works with the Joint Program in regards to funding to assure needs are met to support this strategy. Due to the sensitivity to the community, rapport with the locals will have to be established.
ProGram part 111
Objective Two (continued)
This program will assist in providing quality medical assistance provided to the young girls and women who went through the procedure and battling health issues. FGM Empowerment Group will be able to facilitate through a nearby program named General Assistance and Volunteer Organization (GAVO) who provides in various areas of Somalia (Berbera, Hargeisa, and Burao) to eliminate hardships and difficulties to survive. GAVO (2011) focuses much support on mental health (those who served in the wars) women, children and adult support. FGM Empowerment Program will be able to be candid and receive that emotional support and understanding from the FGM IN SOMALIA 11 community. This program will facilitate health fairs and awareness campaigns to be aired on television and billboards, providing knowledge of the harmfulness of the procedure on girls and women in the community.
Program part 1v
The FGM Empowerment Program will provide 70% support to the government officials by creating laws that ban female genital mutilation and hold those accountable in Mogadishu, Somalia, by 2030. Penetrating the government will be difficult due to long-held traditions regarding FGM but is a need to focus on the banning of FGM procedures and hold those accountable for carrying out the inhumane act on female genitalia. First, the program will have to state proposals to the government to implement more effective options. We are providing healthier options as a tradition in the community. Female Genital Mutilation Empowerment Program would seek continued support through The Joint Programme with meetings to discuss the challenging topics of women’s rights, violence on women and continue the efforts The Joint Programme has provided in some countries. FGM Empowerment Program will assist local politicians to strengthen relationships to continue the fight to ban FGM.
The banning of female genital mutilation is a culturally sensitive matter that requires consistent conversations with government officials, elders, and influencers in the community. The first step is raising money, working with the government for additional funding to ensure the funding is readily available during this process. One recommendation is working with medical students in schools all over Somalia by educating them regarding the harmful effects, the mental aspect of women, and the importance of having a dialogue regarding female sexuality. It is also recommended that the Joint Programme literature and pamphlets are available throughout Mogadishu for people in the community to be able to read daily wherever they are located (grocery stores and doctor offices). Another great way to buy into the community is therapy for men and women throughout the community to be able to process the long-held tradition feelings and thoughts with the new generational changes. UNFPA (2018) Joint Programme assisted service workers (social workers and teachers) modeling as influencers with the banning of FGM. Victims will partner with activists within the community to continue the voice of change.
FGM Empowerment Program will work diligently to fight for female genital mutilation banning and education awareness across Mogadishu and other nearby areas. Extensive research has been completed throughout the various countries regarding FGM, and research will have to be continuous. FGM Empowerment Program will fight uninterrupted to educate Somalian women and men about adverse health consequences, access programs to aid in underlying medical conditions, and working with the government on laws to ban the method used while holding people in the community accountable who continue the use of FGM. This will not be a quick fix for the women and children of Mogadishu but it is steps towards the beginning stages of banning FGM and giving women back their voice.
Water Quality in Kenya
Environmental & Occupational Health
It is a well-known fact that water is essential for the sustenance of life. With the growing cases of pollution globally, there has been a focus on access to water and the quality of water that is being accessed and consumed. The quality of water consumed in Kenya directly affects public health. Many communities in Kenya are consuming water that is not of the standard quality, which has negatively impacted the community and public health, with reported cases of water-borne diseases. The consumption of poor-quality water in Kenya is mostly because most communities rely on natural sources of water such as boreholes, wells, and rivers with untreated water. These water sources are also highly susceptible to pollution by different elements. Water quality considers the quality of the water consumed regarding the water's chemical, biological, and physical condition. The studies reviewed in this paper focus on communities in Kenya and how the water they consume impacts their public health. Some of the objectives of these researches include finding the significance of the quality of water consumed and its effect on public health, determining the impact of water quality on water-borne diseases. With most Kenyan communities relying on boreholes as their only water source, the studies also explore the quality of water found in the boreholes. By looking at these studies and research, it is possible to understand how important water quality is to public health on various fronts. While these studies bring to light several ways that communities are exposed to water-borne diseases by consuming contaminated water, they also offer an insight into the measures and interventions that can be taken to improve water quality and, by extension, public health.
Literature Review: Water Quality in Kenya
Low levels of access to sanitation and water among most communities in Kenya influence the quality of water that ends up being consumed. Many of the affected communities are found in the urban slums as well as in the rural areas. The seasonal scarcity and rationing of water in these Kenyan communities only serve to exacerbate the situation. With most of these communities relying on untreated water from boreholes, streams, and wells, the water they consume does not meet the recommended quality standards. The consumption of poor-quality water by these Kenyan communities has a negative impact on public health, with community members suffering from water-borne and related diseases. The lack of basic sanitation among most Kenyan communities leads to the pollution of these natural water sources. It is the main pollutant o that compromises the quality of the water that is consumed. Data from the Water Services Regulatory Board (WASREB) indicates that only 23 utilities provide good quality water in Kenya; 15 utilities have acceptable water quality. In comparison, 53 utilities have unacceptable water quality standards, with the highest quality of water in the City of Kisumu and Kericho town.
Water Quality and Water-Borne Diseases
Osiemo et al. (2019) researched Marigat, Kenya, whose objective was to determine the water quality as well as the spread of diseases caused by drinking water that is of low quality. Drinking water samples were collected from various sources of water used by the community; these included wells, rivers, and boreholes. The quality of water in the households, regarded as points of use in the study, was also analyzed. The analysis method used was the most probable number method. Calculations of temperature as well as pH were done by using the Wagtech meter. There was also a review of the clinical records obtained from the health centers in the community. The research results were compiled along the chemical and physical parameters based on the mean values of water samples collected at the source and those collected at the point of use. The results were then contrasted and compared with World Health Organization Standards. Out of the ten households where samples were obtained, 50% of them were reliant on borehole water, with 40% sourcing water from the well. During the wet season, it was determined that 90% of the water used by the households was contaminated with faeces. When there were no rains, 60% of the families in the community were reliant on borehole water, with 40% using river water. Samples collected from all the households as points of use were faecally contaminated. There was bacteria in all the samples that were collected and tested for both the dry and rainy seasons.
How Flooding influences Infectious Diseases
Okaka et al. (2019) researched intending to review the scientific evidence relating to the impact of floods on the prevalence of infectious and water-borne diseases in Kenya. There was comprehensive research on the literature about the topic by using Google Scholar, Springer, Online Journals, and Elsevier. The searches were based on certain keywords about the floods in Kenya and the subsequent spread of infectious diseases. From the search results, there was an elimination of studies that did not meet the criteria of covering the effects of floods on the spread of infectious diseases in Kenya. There were gray articles that did not explicitly meet the criteria but were included nonetheless to offer context. The findings of the study indicate, among others, that the primary cause of water-borne diseases during flooding events is the contamination and pollution of drinking water. The floodwaters were responsible for transporting viruses, parasites, and bacteria into the clean drinking water, leading to water-borne diseases. Research also pointed to a direct relationship between flooding and cholera. Other post-flooding diseases that were identified included rotavirus, typhoid, and diarrhea. The largest cholera outbreak, for instance, was recorded after the massive El Nino floods that took place in 1997.
Heavy Metals and Anions contamination of water in the environment
The research conducted by Opere et al. (2019) in Kenya set out to determine the implications of heavy metal contamination of drinking water and the prevalence of viruses in freshwater habitats and how both of those issues affect public health. The study was done in the town of Homa Bay in Kenya. The sites where the samples were to be collected were evenly spread out in the CDB and covered 9 km2. This site marked for sampling was arrived at based on the location of the sites of contamination. There were six sampling sizes, and these were marked as A1 to A6, from which water samples were collected and stored in sterilized containers before being transported for lab analysis. Over six months, more one-liter samples were collected from the sites for chemical analysis. The collected water samples were then analyzed, and the results indicated that twelve chemical pollutants were present. These were heavy metals and anions. The findings indicated that the water in the area was contaminated with anions and heavy metals, which posed a public health risk to the consuming public.
How ruminant fecal matter contaminates drinking water
Hamza et al., 2020, researched Kenya, and the objective was to determine drinking water contamination and pollution by ruminant fecal matter. Water samples were collected from selected households. All the selected households had been visited during a baseline trial conducted earlier. The villages considered had to be rural by definition, where rural meant that less than 25% of the villagers were tenants in rented homes. Other parameters used to determine if a village was rural were if the village had less than two petrol stations, less than ten shops, and finally, if the village was reliant on a communal water source. The sampled households were from Kakamega county in Kenya and were predominantly made up of subsistence farmers. There were also fecal samples collected to provide validation for the molecular targets in the area. The fecal samples were 20 chickens, 20 goats, 17 dogs, 20 cows, 20 sheep, and 19 human beings. Forty-five households were considered for the study, and the contact person interviewed in each household was the female primary caregiver. The findings indicated that in three instances when human behavior and household behavior combined, it resulted in the fecal contamination of clean water stored in the house. These three combinations were ruminants, methods of water extraction used, and the duration of water storage. The research concluded that in all the households considered in the research, all of them had ruminant contamination of drinking water.
Water quality in boreholes
Christine et al., 2018 researched the quality of borehole water in rural communities in Kakamega, Kenya. The study's objective was to determine the water quality in the boreholes used as water sources in the community and the impact on the residents who were consuming the water. The research area was Kakamega town in Western Kenya. Samples were collected from 20 boreholes within Kakamega and analyzed to determine the quality of water. Each of the samples collected from the 20 boreholes was a capacity of one liter and stored in sterilized bags. Each sample was then analyzed using chemicals that were of analytical grades. To determine the presence of heavy metals in the water, the AAS model of analysis was used. The pH measurements were done using a titroline processor as well as the relevant reagents. The research results were as follows: all of the water samples collected and tested had chloride, which was well within WHO parameters. In two of the boreholes, namely Mupenji and Lususli boreholes, there were worryingly high levels of mercury that are unfit for human consumption. These two boreholes should be abandoned immediately.
Water.org is a non-profit entity whose objective is to ensure access to water and sanitation for all in the world. The organization's main aim is to try and make sure that everyone can access safe and cost-effective water for consumption. Water.org helps members of the community to get access to sanitation and safe water by offering them access to financing options that are affordable such as credit facilities. So far, Water.org has impacted the lives of 36 million people in the world (Water.org. 2021). Kenya's population currently stands at 50 million; approximately 32% of the population relies on water not treated for their basic consumption. Sources of this water include rivers, wells, ponds, and lakes. Further to that, 48% of the total population in the country does not have access to basic sanitation. These issues are more pronounced in the urban slums and the rural areas where piped water is not available.
People who reside in rural areas spend about %38 to cope with water supply from distant sources (Water.org. 2021). That figure is high compared to the average water bill for a household using piped water in the urban areas, which comes to about $5 monthly. The difference in the amounts spent to secure safe water is staggering and points to the burden that befalls people in the rural area who, without piped water, are left to their means to fend for themselves. However, it is worth noting that even in the areas where there is piped water, the supply is usually erratic and unreliable. In these areas, primarily peri-urban areas, there is a need for boreholes and tanks that can store harvested rainwater to supplement the piped water.
Water.org has had a significant impact in Kenya in ensuring that people have access to good water quality and sanitation that minimizes water contamination through its program WaterCredit. As already alluded to, financing remains the major challenge in ensuring that people who do not have access to piped water can still access good quality water for consumption. Water.org created the WaterCredit Initiative to address the financing challenges experienced by people in the rural areas who do not have access to quality water while also bringing down the costs of accessing quality water from distant sources (Water.org. 2021). Water.org also believed that providing quality water in households without essential sanitation utilities would mean that the water would be eventually contaminated and its quality compromised. Because of this, the credit offered through the WaterCredit Initiative also covers the provision of basic sanitation to households.
Therefore, through the WaterCredit Initiative, many households can get access to quality water and basic sanitation. The majority of financial institutions in Kenya do not offer financing options that cover quality water and sanitation. By introducing WaterCredit in Kenya, rural households have access to resources and professional consulting that helps them get water and sanitation credit facilities. The WaterCredit Initiative has had astounding success in Kenya (Kwena, 2021). It has also been revolutionary, being the first product of its kind to deploy microfinancing tools and interventions in solving the water and sanitation crisis in rural areas. The first step in executing this solution is to identify an area where the people require sanitation and water and are ready for microfinancing solutions.
Once this is done, institutions are selected to provide affordable credit facilities to these households in the area. The selected institutions are microfinancing partners who then proceed to create water and sanitation credit facilities in their portfolios, and Water.org provides them with technical support to begin offering the loans. Once the loans are disbursed, the needy household uses them to put up a toilet and a tap by using local resources. Once a family has fully repaid their loan, it can then be lent to another family also in need. Critical data from the process indicates that 99% of loans issued through WaterCredit are fully repaid (Kwena, 2021). Women account for the highest number of borrowers, standing at 88%. Most households borrow an average of $367 in loans from WaterCredit.
The goal of the WaterCredit Initiative is to ensure that rural households who do not have access to piped water and have to pay dearly to access water can have access to loans that would offer a permanent solution to their water crisis at a very affordable cost while also providing them with basic sanitation.
Objective one. By year five of the project, the WaterCredit Initiative will have facilitated 70% of the rural households to be connected to quality water for consumption by offering cheap credit facilities. In 2012, 90% of rural areas did not have access to readily available quality water. Of that number, only 25% were able to afford the high costs of sourcing quality water from distant sources. The remaining 75% resorted to using water from natural sources such as rivers and ponds of poor quality and heavily contaminated. For those who could afford the high costs of sourcing quality water, the expenditures affected other household expenses such as food and healthcare (Swaka et al., 2018).
The majority who could not afford the high costs of sourcing quality water and ended up using contaminated water suffered from water-borne diseases and related complications. This affected public health negatively, with households having to spend more on treatment. By liaising with microfinance institutions, WaterCredit offered credit facilities to these needy households to put up taps in their homesteads. This ensured that the households now had quality water without having to spend too much money on it. Households were put in clusters in areas that were identified as needy. Once these houses had been grouped in clusters, meetings were then held to build a consensus in the project. These meetings were usually chaired and moderated by the area chief. During the meetings, the families would agree to share the cost of the credit facility. Sharing the credit facility among families in the same cluster ended up further driving down the cost of credit and freeing up more funds that could then be lent to other families (Swaka et al., 2018).
Once the approvals were done by the partnering microfinance institutions, through Water.org, technicians would be available to do the plumbing and water routing to these families. In so doing, the funds were not directly placed in the hands of the family members. When the work was done, and all the families in the cluster had water taps in their homestead with running water, the agreement made in the presence of the chief would be revisited, and repayments would start. Partnering with local microfinance institutions made disbursement of the money more accessible, and using existing institutions saved Water.org from the need to set up as microfinance (Swaka et al., 2018). Partnering with the chiefs made it more convenient to communicate with the locals and ensured there was a level of government oversight.
Objective two. By the first five months of the project, the WaterCredit Initiative will have increased public awareness by 80% in the rural areas about open defecation and how it compromises water quality by conducting community hygiene sensitization sessions in barazas. In 2012, the percentage of households that practiced open defecation was 88% who relied on open defecation. Open defecation refers to defecation that is done out in the open without any proper disposal. Open defecation in the rural areas was a significant cause of water contamination, especially during the rainy season when the surface run-offs would carry the waste into rivers, streams, and ponds (Muchangi, 2018). These sources of water are relied upon by the local communities as their primary sources of water. House flies, and other vectors could also carry the germs from the waste to food that is supposed to be consumed by human beings.
To create awareness of open defecation and how it compromises water quality, the first people to be trained were the area chiefs and the sub-chiefs. As government representatives, the chiefs and sub chiefs have a lot of influence and can quickly mobilize the area's residents. Once the chiefs and sub chiefs had been trained as champions of the project, they could mobilize residents to attend meetings where they were educated on open defecation and how it contaminated their water. Once the meetings in the area were concluded, Water.org set up teams of educators who then went door to door to reinforce what had been taught and to ensure that the residents understood the relationship between the water-borne diseases they had been suffering from and open defecation.
Objective three. By year five of the project, 70% of the rural population practice defecation in latrines built using funds from the WaterCredit initiative. In 2012 only 12% of the population defecated in latrines, with 88% practicing open defecation. The main reason why open defecation was practiced was the lack of funds to build latrines that could be used to dispose of waste properly. Water.org, through its program WaterCredit Initiative, availed cheap loans to households that would see them put up latrines in their homes and stop the practice of open defecation (Muchangi, 2018). First, there was a need to create an awareness of the program.
Because the rural population had already been made aware of the health risks posed by open defecation through education given in barazas, most of them saw the need to have latrines. Creating awareness about the credit facility was vital because it made the people alive. After all, building a latrine was no longer
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