Background: In Kajiado County, water, sanitation, and hygiene interventions have been independently implemented in communities that have been targeted with sexual health rights interventions. This approach only achieves a set of disjointed achievements and thus the need for integration. This project implemented and tested the effectiveness of the Integrated Water Hygiene and Sanitation and Sexual Reproductive Health Rights (SRHR)Model to address harmful practices against young girls in the county. This model was implemented on the assumption that addressing a pressing need of the community through providing access to Water hygiene and sanitation services provides a platform to discuss SRHR matters leading to positive change towards WASH and SRHR behaviours such as reduction of FGM, teenage pregnancies and early forced marriages. Methods: A before and after design that compared baseline and endline evaluation data was used to establish the effectiveness of the model. The study was conducted in 4 sub-counties. Data was collected through household surveys. Adolescent Girls and Young Women (AGYW) aged 10-24 years were included. Data were analysed using proportions, frequencies, odds ratios, and adjusted odds ratios. Results: Prevalence of FGM/C dropped to 55.2% from 91% at baseline. More circumcised women (79.5% end line; 28% at baseline) reported that they wished they had not been circumcised. An increase in participants who had ever heard messages of ARP (91.6% end line; 47% baseline) was reported. Approximately 98.1% believed that ARP is acceptable to the community as a means of progressing girls to womanhood. Young girls and Women were more likely to undergo FGM/C if they did not have access to a toilet (AOR, 2.32; 95% CI, 1.50 to 3.59), had never heard of ARP (AOR, 2.50; 95% CI, 1.54 to 4.04) and were not sure if ARP would be acceptable in the community (AOR, 0.51; 95% CI, 0.27 to 0.97). Odds of ever being circumcised were less likely among those that stated that FGC should not continue (AOR, 0.11; 95% CI, 0.01 to 0.81) and had been part of the intervention (AOR, 0.25; 95% CI, 0.17 to 0.38). Conclusions: There is a link between addressing WASH gaps (community-felt needs) in Kajiado and the reduction of FGM/C. Addressing community pressing needs provides a platform to address sensitive social-cultural practices. Recommendations of further studies to explore contextual factors that affect the implementation of this model.

Background: Female Genital Mutilation/Cutting (FGM/C) often has lifelong negative consequences for a woman's physical and mental health but is still practiced in some parts of Kenya including Kajiado County. We aimed to estimate the current prevalence as well as the socio-cultural beliefs and power relations that are in favor of or against the practice in Kajiado, Kenya. Methods: A mixed method cross-sectional study was conducted in Kajiado County. The study targeted: women of reproductive age (15 to 49 years); community health volunteers (CHVs); opinion leaders; health care workers; officials from the ministries of Education, Health, Culture, Gender and Social Services; Community Health Assistants (CHAs); Traditional Birth Attendants (TBAs); teachers; morans and adolescent boys and girls aged 10 to 24 years. Data were collected both quantitatively through a household questionnaire and qualitatively through the focus group discussions and key informant interviews. Factors influencing Female Genital Mutilation/Cutting (FGM/C) were classified as either social, cultural beliefs or economic. Results: From the study, quantitative results revealed that the prevalence of FGM/C in Kajiado County was 91%, with most of them (96.7%) practicing type 2 (excision) circumcisions. From the interviews, girls undergo the cut as a rite of passage to womanhood and thus a prerequisite for marriage. It is also believed that girls who are uncircumcised cannot be helped by TBAs in delivery. It is believed that their blood is poisonous and can cause bad omen to whoever comes in contact with dirty blood. Additionally, it is believed that girls go through the cut to avoid conflict and natural phenomena; for instance, drought and outbreaks of diseases that kill many people. Finally, it is a practice that earns respect for the parents of the girls and incentives as dowry to the father of the girl. TBAs that perform FGM/C get paid in cash and kind. Conclusion: Female genital mutilation/cutting practice in Kajiado County is still high.

Background The Amref Alternative Rites of Passage (ARP) model was initiated in 2009. To date, about 20,000 girls have been supported by their communities to denounce female genital mutilation/cutting (FGM/C) and graduate into ‘maturity’ through ARP. While this intervention has been implemented for decades, there is limited evidence of its effectiveness in ending FGM/C. In order to ascertain the effectiveness of this intervention, Amref has developed a digital tracking tool to follow up on girls who have and haven’t gone through the ARP. The key research question is: what effect does ARP have on incidences of FGM/C, teenage pregnancy and child, early and forced marriages among adolescent girls and young women? Methods The study will adopt a stepped-wedge cluster randomised controlled trial design to assess the effectiveness of the ARP model on the incidence of FGM/C; teenage pregnancy; child, early and forced marriage; and educational attainment. We selected one cluster in Kajiado County where recent ARPs have been conducted as the intervention site at the beginning of the study and 3 wards/clusters in Narok County as control sites. Approximately 604 girls aged 10-18 years who reside in selected sites/clusters in Kajiado and Narok counties will be recruited and followed up for 3 years post-exposure. Quantitative data analysis will be conducted at bivariate and multivariate levels. Content/thematic analysis approach will be used to analyse qualitative data. Ethics and dissemination The study obtained ethical approval from the Amref Ethics and Scientific Review Committee (AMREF-ESRC P1051-2021). The findings of this study will be shared with local, national and regional stakeholders working in ending FGM/C, teenage pregnancy, and child, early and forced marriages. Registration – Pan-African Clinical Trials Registry (PACTR202208731662190).