Advocating for Adolescent Reproductive Health in Sub-Saharan Africa[PDF]

Also available in French in [PDF] format.

Advocacy takes place any time opinions are shared. The most effective advocacy campaigns determine which policy makers or opinion leaders should be convinced to support the issue and offers exactly what they should do to show their support.

Many of the basic strategies for approaching and persuading opinion leaders are the same whether they are at the community, regional, or national level. Use this information to help design the most effective strategy for the advocacy effort.

General Tips for Advocacy

Target efforts. Assess which opinion leaders' agreement and support will be necessary for the advocacy campaign to reach its goals. Decide whom to approach and in what order. Start with people who are very supportive and move on to those who are somewhat supportive or undecided in their views. Be sensitive to any opinion leaders who should be approached very early in the campaign. For example, a traditional leader may want to be aware what is being planned in the community and may be nonsupportive if he or she feels ignored.

Be gracious and respectful. Always begin by thanking the opinion leader for his or her time. Opinion leaders who support adolescent reproductive health may be taking a controversial and difficult position in the community. Sincere thanks will be greatly appreciated.

Be professional. Be professional in both dress and manner. Avoid criticizing other leaders, public figures, or organizations.

Be focused. Talk only about one subject in the visit or letter. Advocates frequently feel they have to share as much information as possible with a leader, but too much information will only confuse the message and dilute the point, especially if the opinion leader's time is limited.

Be prepared. As a part of preparation, try to determine the opinion leader's position on the issue. The position can be discerned through comments he or she has made, the kind of events the leader attends, his/her political affiliation, and past policy decisions. Working within a network helps with this research, because at least one organization will be likely to have had some contact with the opinion leader. Explore the opinion leader's personal connections with youth: is he or she a parent, uncle, aunt, or grandparent of adolescents? Design a persuasive approach that is based on knowledge about the leader's followers, views, background, and interests. Different arguments compel and move different people. Role playing what to say at the meeting and how to respond to possible comments will help in preparations.

Make a personal connection. Let the opinion leader know about friends, relatives and colleagues in common. A personal connection may make the difference in the effectiveness of the visit. Leaders are often more likely to remember and think favorably about a visit that had some personal connection to them.

Be an information source. Some opinion leaders have so much to think about that they cannot focus too long on any one issue. They may not be as informed as they would like to be, so fill the information gap. Encourage leaders to ask questions about the issue. Do not imply that the leader is not intelligent or knowledgeable. Instead, be helpful and informed.

Tell the truth. There is no faster way to lose credibility than to give false or misleading information to an opinion leader.

Know who else supports the issue. Opinion leaders like to know which other leaders and organizations support the position. Providing this information illustrates support and may provide the opinion leader with additional reasons to support the position. When possible, bring community members—including young people—on visits to leaders.

Know who disagrees with the issue. The opinion leader may be faced with a difficult decision if another powerful institution or individual opposes the issue. Anticipate who the opposition will be and what their positions are. Discuss with the opinion leader the potential arguments of the opposition, and why the leader should not support that position. When there is opposition, the ability to anticipate criticism and defend the issue will make a difference.

Acknowledge when more information is needed. If an opinion leader wants information that is not available, or asks something not known, admit a lack of knowledge. Then, offer to get the information he or she is looking for and do so as quickly as possible after the meeting.

Make a specific request. Walk in knowing exactly what the opinion leader will be asked to do in support of the issue. For example, advocates might request that the leader put his or her name on a letter, change a school policy, answer a question, make a public endorsement, or support increased funding for youth programs. Ask directly and attempt to get a direct answer.

Follow up. Find out if the opinion leader did what he or she committed to doing. Send a letter of thanks after the conversation, and restate the position. Thank the leader for any supportive actions. Politely ask for an explanation if he or she has failed to follow up on promises.

Do not create enemies. It is easy to get emotional over strongly felt issues. Be sure to leave the relationship with the opinion leader on good terms to permit working with him or her again. Do not argue heatedly, and never threaten a leader. Even if he or she opposes this issue, the opinion leader could be a strong supporter on another!

Communicating with Opinion Leaders

By letter

Identify the writer, organization, issue, and relationship with the opinion leader. If possible, use paper with a letterhead. When writing on behalf of an advocacy network, identify member organizations either in letterhead or in the text of the letter. Provide a one-line mission statement or statement of purpose that gives the leader a sense of what is at stake. If writing on behalf of a network, include complete contact information for one or two people to whom the opinion leader can respond.

Mention a specific issue. The letter will be more effective if it concentrates on one specific issue.

Be brief and succinct. A one-page letter has the most impact. Give the main point in the first paragraph and cover only one issue per letter. For background, include a fact sheet, newspaper clipping, or short publication that discusses the issue in greater depth. Respectfully, but clearly, indicate what kind of action is desired from the opinion leader.

Make it personal. Opinion leaders are more likely to pay attention and remember letters that include real life experiences. Explain why the issue is important and how the leader's decision will affect people. Describe an experience that illustrates the point. Personal communication can be just as effective as organized campaigns.

Ensure that the opinion leader receives the letter. Verify that the address is correct. If the opinion leader is local, hand deliver the letter.

Follow up. If the opinion leader has a phone, make a quick call to confirm that he or she received the letter. If the opinion leader does what was asked, write again to thank him or her.

Face-to-face visits

Schedule a meeting. Call the opinion leader, or send a representative to schedule a meeting. Make appointments well in advance, prepare for the meeting, confirm the meeting, and invite other colleagues. Keep a record of who attended, what information was shared, and any actions promised.

Be flexible. Expect interruptions and changes in schedule. Be willing to accommodate the opinion leader's busy schedule. If the opinion leader has to reschedule, set up another meeting right away.

Be prompt. Do not be late, as it sets a bad tone for the meeting before it has even started.

Be prepared. Make the most of the visit. Plan the presentation in advance and divide up roles for group members to take on, including a note taker. Plan a 5-minute presentation (10 minutes at the most) and stick to the point. Introduce members of the group, but have one member do most of the talking. Make important points in a clear and succinct manner, and let the opinion leader know respectfully, but clearly, what he or she is being requested to do.

Leave something behind. Develop an information packet to leave with the opinion leader. It should include a short (one or two pages) summary about the group, the issue, the action requested, background information, and any other materials or fact sheets that may be useful to the leader. Avoid loading the packet with too much information. Leave out long publications, detailed reports or research, and unrelated materials, unless the opinion leader expresses an interest in seeing this information as well.

Case Study—Partnerships to Eliminate FGM in Kenya

The Maendeleo Ya Wanawake Organization (MYWO) is Kenya's oldest and largest women's organization, with three million members. Its grassroots network reaches throughout Kenya. Since the 1950's, MYWO has been advocating for changes in laws affecting all aspects of women's lives. The Forward-Looking Strategies for the Advancement of Women, adopted at the 1985 World Conference to Review and Appraise the Achievements of the United Nations Decade for Woman, called for a focus on female genital mutilation (FGM), also known as female circumcision or female genital cutting.

Thus mobilized, the women of MYWO seriously examined the issue. They conducted quantitative and qualitative research in four districts and found that almost 90 percent of women had undergone the procedure, and that it was performed anytime between shortly after birth to just before marriage. Because FGM affects large numbers of women of all ages, MYWO sought to encourage the active participation of all generations of women in carrying out their advocacy strategy. MYWO recognized that any advocacy campaign related to FGM first required the support of women themselves. Their advocacy strategy, therefore, worked on two levels: 1) maximizing the ability of their grassroots network to educate women throughout Kenya, and 2) capitalizing on MYWO's status to directly influence members of parliament to pass laws eradicating FGM. A number of strategies that MYWO used are described below.

Public Education

In 1992, with support from the Program for Appropriate Technology in Health and Population Action International, MYWO began interventions on the grassroots level, assigning field officers to educate women and girls and raise their awareness about FGM. Home visits, dramas, songs, poems, and organized community discussions all served as successful techniques for reaching local women and girls with MYWO's messages about FGM. They emphasized that people believe in the necessity of FGM for the same reasons that people often adhere to other social traditions—to preserve their culture. However, MYWO believed that it is important to question traditions such as FGM, when those traditions negatively affect people's health and the quality of their lives.

MYWO advocated for preserving the social importance of a rite of passage into adulthood, while explaining that FGM leads to harmful health outcomes that will remain with women throughout their lives. Trained peer educators—young women both circumcised and uncircumcised—gave this message directly to other young people. Field officers lobbied traditional birth attendants and local FGM practitioners directly, educating them about the harmful physical and emotional consequences of FGM and asking them to stop the practice or at least to adopt less invasive forms of the procedure. MYWO found that some of their greatest advocates were local women leaders, women who had been circumcised, and women who were willing to speak publicly about why they would not have their daughters circumcised. Women and girls, coming forward to share personal stories about how FGM has affected them and their families, were persuasive in educating others.

However, when the program was evaluated in 1995, MYWO found that more was needed to discourage the practice of FGM. FGM practitioners, often dependent solely on this traditional practice for their livelihood, needed help establishing alternative sources of income. MYWO also needed to offer an alternative rite of passage which would protect the ritual and educational aspects of FGM while eradicating the harmful cutting. By mid-1997, several hundred girls had participated in alternative rites of passage which continue the traditions of gift giving, providing education, and otherwise marking a girl's transition into womanhood.

MYWO found that videos were extremely useful advocacy tools for reaching large numbers of people—Rite of Passage, which chronicles an alternative rite of passage ceremony, and Secret and Sacred, an educational film which highlights the FGM situation in Kenya. Secret and Sacred looks at FGM in a sensitive way and includes a broad range of perspectives. It acknowledges the importance of FGM as a tradition, while systematically pointing out the negative physical, psychological, and social consequences for women and girls. The video was designed for a diverse audience so that MYWO can use it for advocating to women and girls as well as local and national opinion leaders.

National Policy Work

On a national level, MYWO targeted parliamentarians directly with educational campaigns. MYWO found several vocal supporters of the cause and even more silent supporters who oppose the practice but do not wish to say so publicly. Resistance from a powerful leader held up MYWO's work in one district for an entire year. After many meetings during which MYWO sensitized the leader to the consequences of FGM, he appeared in Secret and Sacred stating that the practice is harmful and revealed that his daughters have not been circumcised. MYWO members are now receiving training to prepare them to lobby parliamentarians individually. MYWO also plans to launch civic education programs for women, so that women will know about the candidates running for office and can choose leaders who are supportive of women's issues.

Working in Partnership

Since 1991, the Family Planning Association of Kenya (FPAK) has been working in collaboration with MYWO in Nyambene District, Meru, a region identified as having one of the highest rates of FGM in Kenya. MYWO recognized that, as a large organization with experience in programs, advocacy, and service provision, FPAK had expertise that complemented MYWO's efforts to eliminate FGM.

FPAK began by organizing Project Advisory Committees (PACs) which consisted of influential community leaders and at least one youth representative at each of the 16 sites. PAC members were educated about FGM in workshops and became local authorities on FGM. They worked with FPAK to create advocacy messages sensitive to the needs and beliefs of their own communities. FPAK also recruited 16 volunteer community gender educators (VCGEs) and trained them to mobilize and educate their communities and to develop appropriate information, education, and communication materials. VCGEs and PAC members relied on their communities for assistance in developing and testing brochures, posters, and booklets in English and local languages.

The program was designed after a survey found FGM to be a major obstacle to the empowerment of women. Community members who had increasing concerns about FGM-related problems in their communities also recommended the program. With financial assistance from International Planned Parenthood Federation and Plan International Meru, FPAK expanded its pilot project to a total of 16 sites in Meru District. After PAC activities were in place, FPAK created a national technical steering committee composed of national and international NGOs interested in gender issues, giving them an opportunity to share advocacy experiences and ideas.

Through work with PACs and VCGEs, FPAK was able to develop appropriate messages for traditional law-making bodies (councils of elders), local churches, teachers, local government officials, and men's, women's, and youth groups. VCGEs arranged frequent meetings and educational seminars for local FGM practitioners to educate them about the harmful aspects of FGM. The persistence of these advocates has resulted in four practitioners giving up the practice of FGM and becoming outspoken advocates for the eradication of FGM.

FPAK research has shown that in 89 percent of cases, it is the girls' relatives, rather than the girls themselves, who decide if and when a girl should be circumcised. FPAK has encouraged girls to organize into discussion groups that give circumcised and uncircumcised girls a forum in which to openly discuss FGM and learn strategies for coping with family and community pressures to be circumcised. As a result, several girls reported attempted forced circumcision to local authorities; others have sought refuge in churches or requested assistance from FPAK.

While it is still too early to measure the long-term impact of the project, FPAK has observed a number of promising trends, including:

• Public discussion of FGM and people willing to speak out condemning the practice;
• Promises from circumcised women not to circumcise their daughters;
• Commitment from two area chiefs to ban FGM in their regions;
• Community praise for girls who remain uncircumcised;
• Commitments from young men to seek uncircumcised wives, and public discussion of FGM by adult men;
• Written requests for more IEC materials;
• Parents referring their daughters to VCGEs for counseling; and
• Requests from the Catholic Church for FGM sensitization seminars for church members.

Lessons Learned and Challenges Remaining

• A grassroots, community-based approach was the most successful for conducting advocacy campaigns about FGM. Once a foundation of community support is established, communities pressure local and national leaders to speak out against FGM and create policies that will help eliminate it. However, even when national decision makers are sensitized to the issue of FGM and despite their personal feelings on the issue, they may have difficulty speaking out against FGM. Yet with encouragement from the community, leaders should find it easier over time to work actively to eliminate FGM.
• Continuing changes will only come about through slow social change and sensitization. Change may perhaps take generations. Advocates should not expect immediate results. Some communities may begin circumcising their girls again in a few years when sensitized community leaders have retired. Community support networks must remain in place to continue raising awareness about FGM and assist girls who are being pressured to be circumcised.
• Punitive measures, such as threats of arrest, only encouraged practitioners of FGM to work in secret and made FGM even more difficult to address openly. MYWO and FPAK have found that advocating directly to FGM practitioners, rather than threatening them, caused them to change their attitudes, and has even turned some into advocates for eliminating FGM.
• The reluctance of leaders to address FGM comes largely from difficulty in discussing sexuality issues in general and women's sexuality in particular. The myths underlying FGM cannot be entirely discredited so long as gender bias and widespread misconceptions about sexuality and sexual relationships remain. Raising awareness and concern about FGM gives advocacy groups an opportunity to address other sexuality issues as well and to link sensitized communities to educational resources and service providers.