The TOSTAN Program: Evaluation of a Community Based Education Program in Senegal

This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a non-governmental organization based at Thiès, Senegal. The basic education program consists of four modules: hygiene, problem solving, women’s health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyze their own situation more effectively and thus find the best solutions for themselves. The Supra Regional Project for the Elimination of Female Genital Cutting of GTZ funded implementation of the program in 90 villages in Kolda Region, and the Population Council’s Frontiers in Reproductive Health Program, with funding from USAID, used this opportunity to evaluate the program in 20 villages.

All women and men participating in the education program were interviewed before and after the intervention, and again two years later, to measure women’s and men’s awareness, attitudes and behavior concerning reproductive health (RH) and female genital cutting (FGC).  A group of women and men from 20 similar villages that did not receive the education program were interviewed at the same time to serve as a comparison group. To test the impact of the program on community members’ willingness to abandon FGC, the proportion of respondents’ daughters aged 0 to 10 years whose parents reported they had been cut was used as the primary outcome indicator.

The education program significantly increased the awareness of women and men about human rights, gender-based violence, FGC and reproductive health, but awareness of human rights, violence and FGC also increased in the comparison site, although to a lesser extent.  The consequences of FGC were better known, as were issues concerning contraception, pregnancy surveillance and child survival. In general, women’s knowledge improved more than men’s, except for STI/HIV. Diffusion of information from the education program within villages worked well, as other women and men living in the intervention villages also increased their knowledge on most indicators. For all indicators, apart from those concerning violence, the experimental group improved significantly more than the comparison group.

Attitudes improved significantly in the experimental group, with women and men denouncing discrimination, violence and FGC. Attitudes towards FGC also improved significantly in the comparison group, but to a lesser extent than in the experimental group. There was a dramatic decrease in the approval of FGC, although a small proportion of women (16%) participating in the program did not change their attitude. Regret for having cut their daughters increased and fewer women were willing to cut their daughters in the future. Women perceived men’s attitudes towards contraception as improving. However, the intervention group showed higher levels of positive attitudes than the comparison group.

There also appears to have been a positive improvement in behavior in terms of FGC and some aspects of reproductive health. The prevalence of FGC reported among daughters aged 0 – 10 years decreased significantly among women directly and indirectly exposed to the program. Life table analysis confirmed this change in the intervention group, but also that the girls who were cut were being cut earlier than before.

No change in use of contraception was observed over time, but pregnancy surveillance and use of delivery services improved compared with the comparison group, although delivery in health facilities remained low because of their inaccessibility. Communities have mobilized around maintaining peace and reducing discrimination, through establishment of committees for peace and management of conflicts.

A public declaration to support abandonment of FGC took place in 2002 to reinforce these changes in attitudes and behavior. Representatives from approximately 300 villages gathered in Karcia to denounce the practice. The forum organized by young girls was an opportunity to express strongly their opposition to FGC, and early and forced marriage. Although only a small proportion of people from the intervention villages attended this event, those men and women who attended expressed confidence that the declaration would be respected and that no more girls would be cut in those villages. Overall, women were more confident than men, but women who were indirectly exposed to the program were less confident.

The communities recommended that the IEC campaigns should be continued, and men would like to see the new law against FGC applied. Those from the Mandingo ethnic group seem more willing to abandon the practice than those from the Pulaar ethnic group, which may be due to the influence of the Pulaar religious leader who was not in favor of abandonment.

In conclusion, the impact of the TOSTAN program on women and men’s well being has been substantial. The program has been able to bring about a social change within the community and to mobilize the villagers for better environmental hygiene, respect for human rights and improvement of health, as well as specifically reducing support for and practice of FGC.  Extending the TOSTAN program to other areas of Senegal and to other African countries could make a difference to the well being of women and of the community as a whole.