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This chapter should be cited as follows:
Kihara AB, Koigi PK, et al, Glob. libr. women's med.,
ISSN: 1756-2228; DOI 10.3843/GLOWM.417833

The Continuous Textbook of Women’s Medicine SeriesGynecology Module

Volume 1

Female genital mutilation

Volume Editor: Professor Anne-Beatrice Kihara, University of Nairobi, Kenya,
President-elect. The International Federation of Gynecology and Obestetrics FIGO
President, African Federation of Obstetricians and Gynecologists (AFOG)


Communication Advocacy Strategy Toolkit to End Female Genital Mutilation/Cutting (FGM/C)

First published: July 2022

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Female genital mutilation/cutting (FGM/C) remains a global problem.1 As such, there remains a strong need to address the problem on multiple levels. This communication advocacy toolkit is a hybrid of multiple existing models that has been customized to the African context, where the scourge of FGM/C remains highly prevalent.2


The materials used to create this toolkit include the following:

  • The MassTAPP Communications Toolkit.3
  • Create a Communication Toolkit.4
  • Version 3.0 of the Interact Communication Toolkit.5
  • The UNFPA Midwives Toolkit for the abandonment of FGM.6
  • The UNICEF Advocacy Toolkit on ending child marriage.7
  • The 2020 review of web-based toolkits for healthcare practitioners working with women and girls affected/at risk of FGM/C.8
  • The End FGM Advocacy Toolkit by the European Network.9
  • Reporting on Female Genital Mutilation: A toolkit for journalists and editors – guidelines for gender-sensitive reporting.10


In this toolkit, we adopted the End FGM-European Network definition of Advocacy: “A deliberate, strategic and non-discriminatory human rights-based process, formed around evidence and the experiences of rights-holders, aimed at influencing decision-makers and other relevant stakeholders in order to hold duty-bearers to account, achieve change in policy and practice, and thus contribute to the ending of the practice of female genital mutilation”.11


We adapt and modify the MassTAPP model, which focuses on the following steps: contextualized analysis; identifying the target audience; developing the message; crafting the communications strategy; and monitoring and evaluating the communication campaign.3 These steps are outlined as follows:


It is vital to begin by identifying a strategy for prevention/elimination of FGM that can benefit from organizing a communication campaign. At bare minimum, this should include the following: an understanding of the challenges prevalent in the community; determination of the available fiscal, human, and technological and chronological resources to address the problem; and appreciation of how the intended communication advocacy strategy may optimize the overall objective of prevention and elimination of FGM/C. It is vital to remember that not all prevention strategies may directly lend themselves to the use of communications tactics, and that there shall be a need to ensure that there is significant buy-in if the strategy is to bear fruit.3 Analysis of the legal and policy framework and gathering of the available evidence are vital to ensuring that the strategy is appropriately adapted to the prevailing circumstances in the community of interest.9


It is vital to identify and define the primary target audience (the stakeholders who can directly empower the attainment of the objectives) in relation to their expertise, scope of influence, attitude, accountability profile, and mode of access.9 They are the group that contribute to the problem or solution through their action or inaction.3 The secondary target audience, despite not having direct influence over FGM, will typically be the messenger that optimizes contact with the primary audience.3,9 In order to optimize the effectiveness of the intervention and to minimize the effort required to reach the intended target audience, it is important to perform a stakeholder analysis12 and prioritize them accordingly using Mendelow’s power-dynamism matrix.13


This utilizes the knowledge gleaned from the first two steps to empower the development of a culturally appropriate message that can reach the stakeholders and motivate them to respond according to the desired objectives. It requires the development of a message triangle, which comprises the following: the problem statement (include supporting evidence and an example); the problem strategy (outlines the goal); and the call to action.3,9 The main benefit of using a message triangle is its ability to enhance the objectivity of the communication, thereby optimizing emphasis on the saliency of the key points.14,15 It is important to strive for cultural and linguistic sensitivity – pass across your message in a manner that will not evoke untoward reactions or hostility from your target audience.

An example of this is illustrated in the following scenario:

  • If an organization is addressing a certain rural community that practices adolescent FGM as an initiation into womanhood, and has managed to get all of the members of that community together in a social hall or in the market place for a community talk on FGM/C, the message that may be passed may sound something like the following:
    • The problem statement: in community XXXX, we see that women are an important part of the community. This is because there has been a high value in ensuring that women can be identified as being different from girls. Indeed, the women are even seen sitting separately from the girls, and they seem to have a different status. It is also true that they normally undergo "the cut" in order to change from a girl into a woman. Almost every woman here has undergone this cut. However, we found that there are many young ladies that got very sick or died immediately after having this cut done, and many ladies here have died or gotten very sick after having children. Some are even having difficulty having children. Almost all of the ladies we asked about this say that they feel a lot of pain when they come together with their husbands or when they have to pass urine. Indeed, they are suffering a lot because of having undergone this cut, and their ability to live and enjoy their lives is significantly reduced. This, in turn, makes their husbands, children, parents, friends, and work suffer when they are sick or if they die.
    • The problem strategy: since the girls and women are so important in the lives of this community, is it possible to find a way to prevent their suffering? Yes, there is… If we could come up with another way of having a girl graduate into a woman, like being counselled by the older women on how to behave as a woman, changing their dressing as a symbol of the change, and handling them like women, all without putting them through the cut, then they would be able to grow into women who can serve this community better because they will be happier and healthier, will live longer, and will no longer be suffering.
    • Call to action: let us come together and be champions in protecting our girls and women from suffering that can be avoided.
      This strategy has avoided vilifying the victims, practitioners, and relatives, all of whom were part of the equation that resulted in the ongoing suffering, but because of eliciting cultural sensitivity and tailoring the message to the population of interest, then it may have become possible to enlist their support to alleviate suffering from a deeply ingrained cultural practice, thereby stopping the problem at its grassroots.
  • If the same organization was addressing local politicians, they would probably focus on the fact that the loss of life and suffering from illness may adversely affect their ability to get elected.
  • If the same organization was addressing human rights activists and the government, the focus would be on the criminality of FGM/C, the legally binding international treaties in effect, the need for national laws proscribing the practice, the high cost of managing the complications of FGM/C, and the economic impact of the loss of productivity due to the loss of length and quality of life.
    There is therefore an absolute need to tailor the message to the target audience, particularly in the context of using negative messaging.16


In order to effectively reach the target audience, the choice of an appropriate communication channel is vital. Various communication channels are available:3,9

  • Interpersonal communications like lobbying using elevator pitches, negotiating with stakeholders that have different priorities, and taking advisory roles as professional societies/experts.
  • Local educational outreaches: these include meetings with target groups in social halls, public speaking forums, and meetings hosted by those with significant influence in the locality.
  • Campaigns in the mass media: these include interviews, public service announcements, branded advertisements. These are vital to gain and mobilize public support in order to apply democratic tools like peaceful protests, rallies, public actions, and petitions.
  • Use of social media: this is also a platform of campaigning, and reaches audiences that primarily use the internet. It is also an avenue of enforcing mass action.
  • Use of non-traditional communications like mobile billboards, street art, transit communications like posters in vehicles, and guerrilla marketing strategies (human placards or posters in public bathrooms).
  • Partnerships: the formation of strategic partnerships with other organizations that share similar goals expands the scope and sphere of influence by providing strength in numbers and reducing duplicity of effort

“It’s not what you say, but how you say it!”
Mae West


It is important to ensure that you can measure the effectiveness of the advocacy strategy. Some of the parameters that can be used include the following: number of requests for materials or information; attendees at various events; tracking web visits (new and repeated); number of people reached on social media and their reactions; number of positive news stories promoting the message in mainstream media; number of new members/partners gained; and stakeholders expressing support for the prevention/elimination of FGM/C.3 The key areas in evaluating the message passed are the relevance, retention and reach of the message (ibid).

The tools for these steps are provided in Appendix A.


Developing and executing a concise communication advocacy strategy is vital to ensuring that it is possible to address the practice of FGM/C with the aim of preventing and eliminating it.


  • Female genital mutilation/ cutting (FGM/C) remains a significant global problem.
  • Advocacy is a key tool that is available to ensure that the rights of the victims are recognized, respected and protected.
  • Advocacy is a key tool to reach and influence decision-makers and other relevant stakeholders in order to hold duty bearers to account and achieve change in policy and practice.
  • In order to effectively advocate on FGM/C, there is a need to follow the following steps:
    • Undertake a contextual analysis;
    • Identify the target audience;
    • Develop the message;
    • Craft the communication strategy;
    • Undertake objective monitoring and evaluation of the activity undertaken.


The author(s) of this chapter declare that they have no interests that conflict with the contents of the chapter.



Problem to be addressed:

Local evidence of the problem:

Current interventions addressing the problem:

Local legal context of the problem:

Desired Impact


Target audience

Strategic method



Monitoring and evaluation indicators





Aspect of target audience

Analysis profile

1. Who is your target audience?

2. What is the level of the intended target audience?

  • Primary target audience
  • Secondary target audience
  • Victim

3. What are the key characteristics of the intended target audience?

  • Average age
  • Gender
  • Sexual orientation
  • Ethnicity
  • Language
  • Professions
  • Income levels
  • Dominant religion
  • Average literacy level

4. How does your target audience access news and information?

  • Newspaper
  • Radio
  • Television
  • Email
  • Informal channels
  • School or town meetings
  • Facebook
  • Instagram
  • Twitter
  • Other (specify)

5. What are the values and priorities of this target audience?

6. What is the current level of awareness of this target audience about this problem?

  • None
  • Low
  • Medium
  • High

7. What is the attitude of this target audience towards FGM/C?

  • It is vital (strongly pro-FGM/C)
  • It is acceptable (moderately pro-FGM/C)
  • There is no harm if it is avoided (neutral)
  • It is good to avoid it (moderately anti-FGM/C)
  • It is unacceptable and must be avoided (strongly anti-FGM/C)

8. What can they know and feel about us (the team who are presenting this information?)

9. What can they do to empower the achievement of the objective preventing or eliminating FGM/C?


  • What is your core message? __________________________________________________________________________________________________
  • Core components of the message triangle:
    • Problem:
      • What problem are you addressing? ___________________________________________________________________________________
      • Why is it significant to your target audience? _________________________________________________________________________
    • Strategy:
      • How are you and your team addressing the problem? _______________________________________________________________ ________________________________________________________________________________________________________________________
    • Call to action:
      • What steps can your target audience take? __________________________________________________________________________
      • How does your target audience’s intended action get you closer to achieving your desired outcome? ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________
    • Combine the above responses in2 into one concise statement: _________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________
    • Checklist to ensure that the message will reach your target audience: (Indicate “Yes” or “No”)
      • Is your message:
        • Clear? ________
        • Compelling? ________
        • Free of jargon? ________
      • Does your message:
        • State a position? ________
        • Propose a solution? ________
        • Provide a call to action? ________


Aspect of communication strategy

Communication strategy profile

1. Select the desired communication strategy

  • Mass media
  • Interpersonal
  • Community outreach
  • Social media
  • Non-traditional methods

2. Justification of the choice of communication strategy

3. What is the plan for conveying the message through this channel?

4. What are the goals for this campaign? (specify for each channel)

By date _________, we will reach ___________people in the intended audience through _______________ (communication channel).

This communication campaign will lead to _____________________ actions being taken by the target audience.


Aspect of strategy being monitored/evaluated

Profile of aspect being monitored and evaluated

1. What communication strategy was employed?

2. How long did it take to implement this communication strategy?

3. What action were you expecting to occur as a result of the communication campaign?

4. What are the indicators of success for this communication strategy?

  • The number of requests for materials and information
  • The number of attendees at a promoted event
  • The number of visitors at the website
  • The number of people reached via social media
  • The number of positive news/stories promoting the message in the local media
  • The number of negative news/stories against the message in the local media
  • The number of new volunteers or partners
  • The number of new sources of funding
  • Increased amount of funding
  • Number of policies developed or changed
  • The number of stakeholders from the target audience who directly express support the ongoing work
  • Survey data (pre- and post-surveys)

5. How will this data be collected?

6. How often will the data be reviewed/reported on?

7. How long will the evaluation process take?

8. Who will be responsible for the reviews/reports?

9. Who will receive these reports?



UN Human Rights Council passes a strong resolution against FGM [Internet]. Equality Now, 2021 [cited 2022 Feb 12]. Available from:


UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation: Accelerating Change. Beyond the crossing: Female Genital Mutilation across borders: Ethiopia, Kenya, Somalia, Tanzania and Uganda [Internet]. In: Ba A. (ed.) New York: United Nations Population Fund, 2019;1–39. Available from:




University of Michigan. Create a Communication Toolkit. Michigan, 1.


Interact. Communication toolkit Version 3.0. 2018;1–103.


UNFPA. Midwives committed to the abandonment of FGM: Engaging Midwives in the global campaign to end female genital mutilation 1–16.


UNICEF. Advocacy Toolkit: Key Result for Children 6: Ending Child Marriage [Internet]. In: Boothroyd J, Sinden J. (eds.) Dakar, Senegal: UNICEF West and Central Africa, 2021;1–27. Available from:


Shaikh H, McDonnell KA. Review of Web-Based Toolkits for Health Care Practitioners Working With Women and Girls Affected by or at Risk of Female Genital Mutilation/Cutting. J Prim Care Community Health 2020;11.


End FGM European Network. Advocacy toolkit: Towards the National Implementation of the Instanbul Convention as a tool to end Female Genital Mutilation [Internet] 2019. Available from:


Equality Now. Reporting on Female Genital Mutilation: A Toolkit for Journalists and Editors – Guidelines for gender-sensitive reporting. In: Kosgei JJ, Wambui S, Carey T. (eds.) Nairobi, 2021;1–42.


End FGM European Network (ed.) What is Advocacy? In: Advocacy Toolkit: Towards the national implementation of the Instanbul Convention as a tool to end Female Genital Mutilation [Internet] 2019;7–8. Available from:


Bullen PB. Stakeholder Analysis Matrix Template [Internet]. tools4dev: Practical tools for international development 2021 [cited 2022 Feb 12]. Available from:


Mendelow AL. Environmental Scanning – the Impact of the Stakeholder Concept. Proc Int Conf Inf Syst [Internet] 1981;407–17. Available from:


Heffernan P. A 3-Step Guide to Message Triangles [Internet]. Changing Conversations: Insights and Inspiration 2017 [cited 2022 Feb 12]. Available from:


Martin J. Going beyond talking points [Internet]. University of Washington: University Marketing & Communications, 2015 [cited 2022 Feb 12]. Available from:


Bradley I. Ethical Considerations on the Use of Fear in Public Health Campaigns [Internet]. Clinical Correlations 2011 [cited 2022 Feb 12]. Available from:

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