Table 2 Main themes supported by sample quotes from FGs

1.To determine how the cultural meaning of FGM/C has evolved over time

Theme 1: The changing culture in the practice of FGM/C

1a. Historic meaning of FGM/C

“There are those who believe that if a girl does not undergo circumcision she will not get married, that is why you see some people still continuing with this dirty practice, although nowadays people have understood that circumcision has no importance; whether one has undergone it or not they still get someone to marry them.”(TEF1, FG4).

1b. Reasons why FGM/C persists; Evidence of continued practice

“And for me if I was to add something there, circumcision of girls ended a long time ago, but in our own community here, although we are saying there is no circumcision, there are still people who practice circumcision in secret, and we cannot guarantee that all the young girls that we see are not circumcised. I once visited a lady who is my friend and asked where the daughter was, at that same time her boy had been circumcised, and she told me that her daughter was visiting the auntie in XXX, (anonymised) (… ..) I returned to pay a visit on another day and a small girl told me, ‘auntie you were wondering where their daughter is? She is in that house there’ (laughter from the group), that is probably 2 years ago(… … ….)So you see, this issue has never really gone away, it’s just that not everyone is practicing” (TEF30, FG4).

1c. A change in culture; Evidence of a drop in the practice

“In the past, people used to say they wanted to be circumcised very much, a lot, for example like me, I offered myself to get circumcised, but later on when I got circumcised and forgot about the experience I came to realise that it is not a good thing to do, as for me two of my children are not circumcised, ehhh I realised it is not a good thing, ehhh” (TW2, FG1).

“I would say it’s hard to know whether it is still happening, in the past yes when we were young children, but in my view I think this does not happen anymore, not like it used to happen in the past, I don’t think I would dare to circumcise a girl now “(TW1, FG1).

2.To assess men’s and women’s perceptions regarding the practice of FGM/C

Theme 2: The role of men and women in the continuation or ending of the practice

2a. Cultural beliefs prevail

“The reasons are the same as before, because if one is not circumcised, they are not considered ‘complete’ in the community. It is when you get circumcised that’s when you are considered a proper person, and that is when it is possible to get a man to marry you” (TW4, FG1).

2b. Men and women may play a role in the continuation or the ending of the practice

“Sorry to say mothers or women are the ones who can easily be convinced to get their girls circumcised in this way, so even peer groups today can lead to the continuation of the practice.” (TEM 28, FG4).

“But there are also some men who may not want to have their girls circumcised, but are influenced by their parents who tell them that the reason your wife does not respect you or why your children lack respect for you, it is because they are not circumcised(… … ….) this idea does not come from the man himself, its normally influence from other people outside the family, who tell the man that the reason why your wife does not respect you is because she is not circumcised.” (TW3, FG1).

2c. Vulnerable groups to the practice

“Most of those who get circumcised do not attend school, and parents who are not in a position to educate their children may circumcise their girls. The father also can insist to their children that they must get circumcised; even when the mother insists the girl will not get circumcised.” (TW11, FG 2).

“There are girls who are orphaned and although their parents belonged to the church if those who adopt them believe in the practice, they may force the orphans to get circumcised, particularly if the adopted girl starts misbehaving or spending time with boys. Those who have adopted them might say that the reason they are misbehaving is because they did not get circumcised.” (TW5, FG1).

“But also grandchildren are at risk this is because if a grandchild visits the grandmother and the mother wants her to be circumcised, the grandmother can easily arrange for someone to do this! (TEM 28, FG 4)

3.To understand the effectiveness of interventions designed to fight FGM/C.

Theme 3: The impact of interventions and campaigns to end FGM/C

3a. Church, Christianity. Religious groups

“The churches, especially the Methodist church, played a big role in fighting the practice, and it was made to look like a shame to undergo the practice, and any family linked to the practice was viewed …. ai ai ai ai in a very shameful light!” (TEM 28, FG 4).

3b. The law and prosecution; Community policing; Public meetings

“Most people got into the church; once they are taught the consequences of circumcision in church they will not return home to practice it. Again during meetings with the chief people are told to reveal those who have carried out the practice and these people then get arrested.” (TW5, FG1).

“The law has helped, but very little, because in my view, if for example I take my girl and circumcise them away from my house, where is the law? I will circumcise her and she will return to the community and continue with her daily life, so what is important is working with the community itself, we need to deal with men, the girls, women, engaging directly with them and telling them about it, teaching them and showing them, that’s it, so that they can know themselves.” (TW7, FG1).

3c. Alternative ritualistic programmes (ARPs)-Ntanira na Migambo

“In this area we have these groups known as Ntanira na Migambo and these have helped a lot, since they started a lot has changed, they teach about dangers of the practice. They come especially in December to this school near here and the girls are taught about the dangers and they are even shown a film about the practice and this has helped this area.” (TWM13, FG3).

“There are parents who refused to take their children there, saying she will remain at home and not attend, even when the girls wanted to attend, and the parent refused, we see today that those who attended those programs are now good, they are well behaved, and they are educated, they went ahead with education, yes they continued with their education, because they were taught the consequences of circumcision and refused to go that route, and these are children who are respectful.” (TW2, FG1).

“Some of these girls now serve as role models to others; they talk to those who did not attend such events.” (TW5, FG 1).

“What I can say from my experience and from the girls that I have mentored, none of them wants to be circumcised, I have seen two girls in a family where all other girls got circumcised, these two girls did not get circumcised. The parents of these girls tried to convince them to get circumcised and what they said to them was to try and find out whether there was any difference between them and their circumcised sisters, so nowadays most girls do not want to be circumcised, they have completely refused, that is what I have personally seen. Most of them say they will not get circumcised even if it means they do not get someone to marry them.” (TEF22, FG4).

“There are conferences now for both boys and girls to educate them about circumcision, pregnancy, and this has helped, if you come to my area there are no circumcised girls. Even those who are not church goers are shunning this practice. If men refuse to marry uncircumcised girls and if parents continue shunning the practice it will end.” (TWM, FG3).

3d. Education

“You know first and foremost what we really want to eliminate is circumcision,we want them to forget that thing completely, so we would instil in them the value of education, the importance of being disciplined, to be God-fearing, and leading a good life which is Godly, and nothing else outside that. So very, very much we emphasised the importance of church and education.” (TW4, FG1).

“My husband believed in educating his children and he helped me shun girls’ circumcision.” (TW11, FG2).

“I think it’s even the girls themselves, education and also socialising with others and knowing that doing so (FGM/C) is not beneficial to them.” (TW7, FG2).

3e. Health personnel

“Yes, then again health personnel, in particular public health, have been asked to talk about circumcision whenever there is a public gathering, they start teaching so that those in attendance can hear. Then again even in hospitals there is normally sensitization and teaching, the administration can plan to hold a talk with all the patients present to highlight the dangers of circumcision.” (TW3, FG 1).

4. To identify potentially effective and sustainable interventions

Theme 4: Actions perceived as most likely to bring about change

4a. Reviving and supporting ARPs

“As for us what we would like … what we would like is support so that we can invite these girls for a seminar, say for example in December when schools close, because now you have come and reminded us of what we used to do, what we were unable to carry out, if we can get someone to empower us we can organise ourselves so that say if it’s in December, we call the girls just like we used to before.” (TW2, FG1).

“What I want to add, above all else is the training for advocates like us because once we get trained, we know the villages that have that problem and we can visit that particular village, we would time when they have big meetings/ gatherings, meet them first thing in the morning, because you have the knowledge and you are able to approach them, you go teach them, and anyone who wants to listen and learn will learn there and there, so that they can know there are alternative rites of passage- Ntanira na Migambo, because it is possible that many of them do not know, they do not attend any church, they just stay in the village.” (TW3, FG1).

4b. Educating communities particularly young men about the practice

“It’s through education, we need to educate women about it, and also the young men, If young men took a firm stand and said “we are against FGM” and that none of these men will marry a circumcised girl, that is why you see today that young men say to their prospective wives that they want to marry an uncircumcised girl (… ……… …).” (TEF25, FG4).

4c. Encouraging fathers’ involvement in the upbringing of their daughters

“People need more teaching and seminars in churches are desperately needed. Men also should improve their relationships with their daughters so that they can know what is happening in their lives, because as we said girls tend to confide in their mothers.” (TWM15, FG3).

4d. Including the topic of FGM/C in the current education curriculum and public fora,

“Is it possible to work with the Ministry of Education to include this topic in the curriculum? There is no such topic covered in the curriculum at the moment other than the rites that were performed a long time ago. So this topic has not been introduced in the curriculum and it would be a good idea to incorporate in there.” (TW7, FG2).

4e. Strengthening the community policing strategy -Nyumba Kumi,

“Also there are those who have been elected to be in the ‘Nyumba Kumi’, these people know what happens in every household and report any such cases. So having these people is helping people in the community live well, they are doing a great job, because if you have a visitor in the home as a member of ‘Nyumba Kumi’ I will know. If you have circumcised your daughter I will know as a member of this ‘Nyumba Kumi’.”(TW5,FG1).

4 f. Setting up community centers for orphans.

“I think even as the community works on these issues they should pay attention to the needs of the orphans so that they can even be placed in schools for the orphans, this might help bring down circumcision and like in XXX (anonymised) there are so many children who are not in school, some are orphans and normally if one person volunteers to help such kids people see like that person is doing nothing and do not even support her, in that area there are so many children who are not in school, and circumcision will not end if these kids are not in school. For this to end there is need to target those people who have that problem, not those who already know about it.” (TW6, FG1).