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Working to prevent sexual assaults in Kenya

Kenyan slumsThe little girl bounded up to us, wearing a filthy pink sweater, with a beaming smile on her face, and gave me a huge hug. Surprised at the reception, I hugged her back and swung her gently back and forth. She giggled and ran to hug my colleagues, then, hopping over an open sewer, darted into an alley that lead to her home. We followed as quickly as we could over the slippery mud, down one alleyway than another. Within a few minutes we reached her house, a 5’ by 10’ structure made of mud and wood, without windows, electricity, or locks. The girl, named Lianna*, lives here with her two year-old brother, who calls her “Mama”, as she is his primary caretaker. Their mother is a bartender and likely also a sex worker, and returns home only occasionally. The home is filthy, smells bad, and is without food or water. Yet this beautiful child, brimming with energy and intelligence, is proud to show it to us and to introduce us to her sibling.

Lianna is a resident of Korogocho, one of the poorest informal settlements (known to many as slums) in the Nairobi region of Kenya. Korogocho itself has about 52,000 residents, and it borders on other, larger informal settlements such as Dandora. Poverty and lack of sanitation are the norm in these communities, and crime is extremely high. Girls in these settlements may be especially vulnerable, with 18-25 percent of adolescent girls reporting being sexually assaulted each year, often by friends and relatives.

A multidisciplinary team at Stanford has been working in these communities on a sexual assault prevention project with two Kenyan non-governmental organizations (NGOs), Ujamaa and No Means No Worldwide (NMNW), for about two years. This past July, my colleague Mike Baiocchi, PhD, and I traveled to Kenya to meet the local NGO staff, become familiar with the communities they work in, and advance their research capacity.

Ujamaa, led by Jake Sinclair, MD, a pediatrician from John Muir Hospital, has been working in these and other settlements, including Kibera, Mathare, Huruma, Kariobangi, for more than 14 years, and has partnered with NMNW for several years. NMNW, led by Lee Paiva Sinclair, developed a curriculum to reduce sexual assault by teaching empowerment and self-defense, and works with Ujamaa to implement this curriculum in the slums. The Stanford team became involved in order to research the effectiveness of this intervention.

This NGO-academia collaboration has led to the publication of two papers in peer-reviewed journals – here and here – which suggests that the NMNW intervention has reduced sexual assault of adolescent girls (aged 13-20) in intervention communities by around 50 percent in the year following the intervention. The collaboration is ongoing, and the Stanford team designed a randomized controlled trial of the intervention which was implemented in late 2013 and finished last month. Early results from the RCT are promising and are expected to be published in early to mid-2015. In addition, The Lancet series on violence against women classified this as a “promising” intervention (the highest possible rating), and the Stanford team has assisted Ujamaa in securing more funding from UKAID and other organizations to expand their program and our research.

But standing inside Lianna’s dark, cold house in Korogocho, all we could think about was that perhaps our involvement in this work will make the future brighter for children like her. She is living proof that hope and intelligence can flourish even under the harshest of circumstances, and provides a call to action of the sort that cannot be ignored. Our time in Kenya was a good reminder that while we, as researchers, cannot solve every problem, collaborations such as these can broaden Stanford’s global impact while affecting some of the world’s most pressing challenges.

Clea Sarnquist, DrPH, MPH is a senior research scholar with the pediatrics department. Her research interests include evaluation of prevention interventions, HIV in women and children, and reproductive health. She can be reached at cleas at stanford dot com.

*Her name has been changed

Previously: Stanford research shows rape prevention program helps Kenyan girls “find the power to say no”, Empowerment training prevents rape of Kenyan girls and Self-defense training reduces rapes in Kenya
Photo, of street outside Lianna’s house, courtesy of Clea Sarnquist