According to the Demographic and Health Survey (DHC-2000) in Ethiopia 80% of all women are circumcised. The prevalence of the practice reaches almost 100% in the Afar and Somali Regions but is less prevelant in Tigray (36%) and Gambela (43%). The AFAR Female Genital Cutting Elimination Project at hand is going to work in Zone 3 (Woredas: Awash Fentale and Amibara) of the Afar Region and will cover an estimated total population of 140.000 persons. In the Afar Region the infibulation type of female genital circumcision is practised. According to a current survey carried out by CARE in the year 2000 at least 94% of Afar women over the age of 20 are infibulated.The above mentioned survey reported main short and long term health, social, psychological and physical complications due to FGC. Most short-term complications occur due to unsanitary operating conditions and inadequate medical services. In the short term, profuse bleeding is common due to cutting of the high-pressure clitoral vessels. Shock also occurs from loss of blood combined with extreme pain when the cutting is performed without anaesthesia. Infections of varying degrees from superficial wound infection to septicaemia are common. Urinary retention from pain, inflammation -mostly from direct obstruction often occurs in the first few days. In addition to physical complications, several sexual and psychological issues emerge over time. Several young women disclosed that they have fear of sexual intercourse with their husbands due to pain. Delivery is the severe challenge for an Afar woman; healthy mothers and infants post-delivery are rare. There is deinfibulation of the infibulated genitalia to widen the outlet but also reinfibulation after delivery to narrow the opening again.Since 1996 CARE has been implementing, with the support of the Austrian Development Co-operation, a Primary Health Care Project (PHC) in the Awash Fentale Woreda. The FGC-survey during 2000 revealed positive impact of the PHC project, as many traditional FGC practitioners (mainly Traditional Birth Attendants - TBAs) stopped the practise. But the main success of the PHC project is that it developed a community base health system (a replicable model). The new project at hand will have a clear focus on FGC elimination but also replicate the developed health model. Out of the experiences from different FGC-projects it is known that FGC is a very sensitive issue and cannot be addressed as an isolated phenomena. It is highly linked with other social, cultural, and health issues. Therefore, interventions against FGC should also be designed in a holistic manner.The FGC-Elimination Project's strategy is therefore: to accept the pastoral way of life of the Afar people and to have the project activities try to concord with the rhythm of the people.The main activities of the project will be implemented during the rainy seasons when people are more settled - during this time main information will be provided and future responsible persons for continuos activities will be built up (mainly the Community Health Workers/CHW, Peer Educators/PE, Village Health Committees/VHC and Civil Society Advocates/CSA). The elders and religious leaders will be involved in the project in order to advocate for the new ideas and women will also be given a voice by the project. The main focus is to improve women's health and social status through the elimination of the FGC practice.During dry seasons the responsibility for the project activities and ideas will be handed over from the extended "project team" (including trainers from the Ministry of Health/MoH and CARE staff) to the community members (mainly CHWs, VHC and CSAs). The project team will move to new Kebeles and will do only limited follow-up activities in the already covered Kebeles (the Woredas are distributed in Kebeles and the project will follows more or less this structure). This strategy of "phase-in" (main activities implementation phase) and "phase-out" (handing over of activities to the community) will allow the project to cover two Woredas with a small project team in a period of three years.The project plans to cover one new Woreda - Ambiara, with about 45,000 persons and the Awash Fentale Woreda with about 23,000 persons, where the PHC project has already been working. Due to innovative components like Radio Programs the project should spread out, at least, to the whole of Afar Region but could even reach a much wider coverage. The FGC-Elimination project is not considered a continuation of the PCH project because it has different objectives - but certainly it will build on the experience gathered over the last years.
