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Impact Data - Ndukaku (Health is Better than Wealth)

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In 2002, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHUCCP) and Save the Children developed a programme promoting public dialogue and action on eliminating female genital cutting (FGC) in Enugu State, Nigeria. Ndukaku (Igbo for 'health is better than wealth') is supported under the Health Communication Partnership (HCP), Nigeria.

According to organisers, Nigeria has the largest number of circumcised women in the world, with an estimated 27.1 million. Within southeastern Nigeria, Enugu state has one of the highest rates of FGC prevalence, most recently estimated at 59% (RMS Report, 1999). In response to these findings, JHUCCP conducted participatory formative research in three geographically distinct areas of Enugu to explore community beliefs and practices surrounding FGC, as well as women's perceived reproductive health needs and problems. The research revealed that:

  • FGC is commonly practiced, usually within a newborn's first week of life.
  • FGC is primarily practiced because both men and women believe it prevent women's promiscuity later in life.
  • Women frequently experience serious reproductive health problems - the most frequently cited are complications and/or death during or after delivery and infertility.
  • A high degree of social organisation and experience with collective action in Enugu State presents an opportunity for mobilising communities to address women's rights and reproductive health needs, including reduction in FGC.
Methodologies
Researchers evaluated the programme using a control-intervention design with pre- and post-intervention surveys. For the purpose of assessing the impact of programme activities, HCP selected Ebonyi as the control state. (Ebonyi is similar to Enugu State in terms of ethnicity, cultural practices, and socio-economic conditions.) HCP conducted a baseline survey in three LGAs in Ebonyi and Enugu in 2003. In 2004, HCP conducted a follow-up survey in the same LGAs and enumeration areas as the baseline.
Knowledge Shifts
The evaluation found that women in the project areas became empowered advocates and change agents on health issues and FGC through the Community Action Cycle (CAC). Referring to themselves as the “Ndukaku Women”, they "acquired a level of awareness that has placed them in a ready position not only to campaign actively against FGC but also to replicate the CAC in other communities."
Attitudes
The data showed that while the attitudinal and behavioral indicators relevant to FGC either became worse or remained stagnant in Ebonyi, they improved significantly in Enugu. For example, the proportion of women that believed that there are benefits to FGC declined significantly (from 42.1% at baseline to 24.6% at follow-up) in Enugu, while this indicator did not change much in Ebonyi (from 33.9% to 28.4%). Similarly, while perceived social support for FGC discontinuation either declined or stagnated in Ebonyi, this perception became more widespread in Enugu.

The data further showed the following improvements in Enugu but not in Ebonyi: decreased personal approval for FGC, increased perceived self-efficacy to resist the pressure to perform FGC, a decline in the belief that FGC is a religious obligation, and increased personal advocacy in favour of FGC abandonment. Furthermore, the data showed that the intention not to perform FGC on daughters increased considerably in Enugu. In Ebonyi, the situation remained the same as at the baseline.
Increased Discussion of Development Issues
In Ohuala Amede, the core group gathered more than 100 community members to discuss FGC and encourage discontinuation. The traditional ruler of Ohuala Amede, Igwe Ogbuebo, acknowledged the importance of stopping the practices in Ohuala Amede and pledged to give his support to all future core group resolutions.
Access
Exposure to programme activities was relatively high: 67.1% of men and 61.4% of women in the programme local government associations (LGAs) reported exposure to at least one programme activity.
Source
Strategic Communication Changes Norms, Intentions Related to FGC in Nigeria [PDF], Communication Impact!, No. 18, June 2005.