Project Report: Cultural Complexity and Talking Trees

Talking Trees is a public health research project and forum which seeks to address female genital mutilation among pastoralists’ communities of Kenya.

Caption: Carolyne Ngara, The Enduring Voices Foundation, Kenya

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Background and cultural complexity

Kenya is grappling with enormous challenges in tackling Female Genital Mutilation (FGM) – the partial or total removal of the external female genitalia. FGM has no known health benefits but severe effects on the physical, mental and psychosocial wellbeing of those who have undergone it. Immediate complications include severe pain, shock, haemorrhage, tetanus or sepsis, acute urine retention, open sores in the genitalia and injury to nearby genital tissue. The long-term consequences include perineal tears, loss of libido, genital malformation, chronic pelvic complications, recurrent urinary retention, obstructed labour, psychological trauma and infertility.

The World Health Organization (WHO) estimates that 130 million women are affected by FGM globally and 10000 pastoralists’ women die from FGM related complications annually. Although a global campaign against FGM was launched in October 2014, abandoning FGM in its totality remains a challenge for Kenya’s pastoralists’ communities where FGM is practiced for traditional and cultural reasons and prevalence stands at 95%.

The Pastoralists’ communities are indigenous tribes of Kenya, comprising mainly of the Maasai, Samburu, Rendile, Kalenjin, Turkana, Pokot and Somali people. They have distinct traditional values, cultural practices and religious belief systems. Some of these traditions and cultures are beneficial to all members, while others are harmful to specific groups, especially women. Female Genital Mutilation (FGM) is one such harmful traditional practice affecting the health of women.

It is believed in these communities that if the clitoris of an uncircumcised woman touches the head of a baby during birth, the child must die. The clitoris is seen as the male characteristic of the woman; in order to enhance her femininity, this male part has to be removed. The practice is primarily performed on girls aged between four and sixteen years old by untrained village midwives. Unsterilised instruments are used without the use of anaesthetic and in very unsanitary conditions. Some of these instruments are used repeatedly, increasing the risk of HIV/AIDS transmission. The operation involves the total removal of the clitoris, labia minora and severing the inner side of the labia majora. The sides of the labia majora are then sutured together, leaving a small hole to allow urine and menstrual discharge to pass. Obstetric complications are the most frequent health problem, resulting from vicious scars in the clitoral zone after excision. These scars open during childbirth leading to haemorrhaging that is often difficult to stop. Infant mortality and maternal deaths in traditional pastoralists’ villages where untrained traditional birth attendants and circumcisers perform the operations rank among the highest in the world.

The Project

Despite its harmful nature, FGM persists due to a lack of coordinated action to bring about change within the pastoralists’ communities. The Talking Trees project aims to raise awareness of FGM practices and stimulate dialogue about increasing maternal deaths by bringing together a multidisciplinary team of gynaecologists, urologists, anthropologists, traditional FGM practitioners, researchers, pastoralists’ elders and the general public. The group are encouraged to discuss and develop an understanding of the discrepancies between modern science and traditional and cultural practices. This fosters, builds and strengthens collaborative health research, planning, implementation, and outcomes between scientists, anthropologists, researchers and indigenous communities in Kenya and beyond.

The project engaged the pastoralists’ communities, indigenous women and village elders, who are the custodians of their own cultures, in Rift Valley, Narok, Samburu, Turkana and Kajiado Counties. They met through an inclusive participatory health forum where the dangers of FGM were raised and alternative rites of passage discussed. Meanwhile, through the same forums, the research team gained a better understanding of the causes and ways through which maternal deaths prevalent among the pastoralists’ communities of Kenya can be reduced.

The project also developed appropriate information materials in indigenous languages to contribute to community outreach work and in raising awareness of FGM.

So far, 200,000 Maasai have been reached in person and many more through a local radio show in their native language. There has been development of a much needed community health research infrastructure; improvement of pastoralists’ communities’ livelihoods through project workshops and seminars; new project collaborations among researchers, gynaecologists, public health providers and the pastoralist communities; and strengthened capacity for future collaboration in quality engagement work locally, regionally and globally.

Cultural sensitivity

Many pastoralists’ communities in Kenya have had to work hard to protect and conserve their cultures. It was therefore very important in the project not to offend or alienate a culture or demonise one community. One step towards this was to stress throughout the project that this is a national problem, not a Maasai one. FGM was not presented as a Maasai issue and engagement was culturally sensitive to internal structures with cultural traditions around communication and dialogue adhered to. For example, the name Talking Trees originates from a Maasai tradition of holding council under trees and women and men were separated for discussions in line with cultural ideals.

Language and imagery were also key to the project. Documentation was developed and tested in collaboration with the Maasai to ensure it was not offensive and brutal imagery and cultural blame were avoided throughout.

Insensitive approaches and implementation could risk driving the practice underground, undermining existing efforts to end the practice, contributing to a backlash and adding tensions to an already volatile subject. The whole project adopted the "Do No Harm" ethical principle to avoid this. This "Do No Harm" approach was designed to mitigate the risk of advocating for social change interventions inadvertently creating societal divisions, particularly in contexts of conflict and fragility or unforeseen and unintended negative effects. The types of harm that the project team avoided included:

• Reinforcing support for the practice of FGM. 
• Cultural insensitivity evoking backlash and denial which could set back efforts to end FGM. 
• Undermining local efforts and leadership to end FGM by reinventing the wheel rather than building on existing work. 
• Fragmenting efforts or causing divisions among actors working to end FGM. 
• Rigid donor-led approaches which may be out of sync with local realities. 
• Putting activists, survivors, young people or other potentially vulnerable people at risk. 
• Stigmatising or causing emotional distress to those who have undergone FGM. 
• Replacing the most severe forms of FGM with so-called minor forms.
• Increasing corruption.

Image Credits: © Eric Lemaiyan - Joint Campaign – Kajiado County Gov and Enduring Voices Foundation 2016 - 2017

The content on this page forms part of the online report for the 2017 International Engagement Workshop "It's Complicated: navigating scientific complexity in public and community engagement". To read more about social and cultural complexity in engagement visit the social and cultural complexity theme from the workshop. To read more about the full workshop and access the rest of the report including video presentations, discussion summaries, and tools, visit the workshop page.

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