This 58-page publication analyses available statistics on female genital mutilation/cutting, with the aim of improving understanding of related issues in the wider context of gender equality and social change. The study centres on women aged 15-49 and their daughters, presenting estimates and examining differentials in prevalence, and highlighting patterns within the data that can strategically inform programmatic efforts.

Female genital mutilation/cutting (FGM/C) is “the partial or total removal of the female external genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons.” It is estimated that more than 130 million girls and women alive today have undergone FGM/C, primarily in Africa and, to a lesser extent, in some countries in the Middle East.

The procedure is generally carried out on girls between the ages of 4 and 14. It is also done to infants, women who are about to be married and, sometimes, to women who are pregnant with their first child or who have just given birth. It is often performed by traditional practitioners, including midwives and barbers, without anaesthesia, using scissors, razor blades or broken glass. The Immediate complications of the practice include excruciating pain, shock, urine retention, ulceration of the genitals and injury to adjacent tissue. Other complications include septicemia (blood poisoning), infertility and obstructed labour Haemorrhaging and infection have caused death.

The objective of the study was is to estimate the prevalence levels of FGM/C across and within countries, as well as the circumstances surrounding the practice. The study presents a global assessment of FGM/C levels and examines differentials in prevalence according to socioeconomic, demographic and other proximate variables, including type of FGM/C, practitioners and attitudes towards ending the practice. It further seeks to highlight patterns that exist within the data, illustrate how much can be learned by disaggregating variables and suggest how these data can be used to strategically inform programmatic efforts.

The analysis is centred on women aged 15–49 and their daughters and is based on household survey data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). It focuses on national prevalence rates, the distribution of FGM/C within countries and the circumstances surrounding the practice. Attitudes towards female genital mutilation and support for the discontinuation of FGM/C are explored to determine opportunities for programmatic interventions.

Conclusions and Recommendations

In its many and complex cultural meanings, FGM/C is a long-standing tradition that has become inseparable from ethnic and social identity among many groups. As stated by the International Conference on Population and Development, “For women it is not only a painful ordeal but a means of social bargaining and negotiation; for societies it is a collective identity marker – a status symbol in the fullest sense – as well as a creator of cohesion.” The DHS and MICS data analysed for 20 countries show substantial variations in FGM/C prevalence within and between countries. In the hope of providing a better understanding of FGM/C, this study attempts to summarise differences in the way it is practiced and perceptions surrounding the practice, as well as to identify girls most at risk.

This study further outlines three groups of prevalence that exist throughout the countries where FGM/C is practised, which suggest that programmatic interventions and approaches towards ending FGM/C need to be adjusted to properly reflect specifics on the ground. The section on type of practitioner illustrates the gradual shift towards medicalisation occurring in many countries. It points out the challenges to advocacy efforts this shift presents by serving as a tool to perpetuate and legitimise the practice. In addition, this study notes that better understanding is needed on who participates in the decision making surrounding the practice, so that effective points of programmatic entry can be identified. The following summarises five essential points resulting from this statistical analysis.

FGM/C prevalence rates are slowly declining in some countries.

While it is not possible to conclude that there is an overall global drop in prevalence, DHS and MICS data indicate a slow decline in FGM/C prevalence rates in some countries. Evidence of change can be obtained by comparing the experiences of different age cohorts within a given country. The most recent survey data indicate consistently, for all countries, that women aged 15–19 are less likely to have been circumcised than women in the older age groups. In countries with high prevalence rates (particularly in Egypt, Guinea, Mali and Sudan), the difference between the 15–19 and 20–24 age cohorts is less than 1 per cent. Nevertheless, it is believed to indicate the beginning of change.

Attitudes towards FGM/C are slowly changing as more and more women oppose its continuation.

In almost all countries that have conducted more than one survey during the past decade, data indicate that opposition to the practice is increasing. These results are reinforced by the fact that support for the discontinuation of the practice is particularly high among younger women. As FGM/C is deeply ingrained in the social fabric, and in most countries has been practised for a very long time, any increase in opposition, even a small one, represents a significant indication of change.

There are various reasons for the increasing levels of opposition. Higher educational attainment among women, for example, is closely associated in most countries with a significant increase in disapproval of the practice. In countries where specific laws prohibit FGM/C, this legislation, coupled with awareness-raising programmes and social support, has contributed significantly to the strong opposition to female genital mutilation.

Strategies to end FGM/C must be accompanied by holistic, community-based education and awareness-raising.

As a social behaviour, the practice of FGM/C derives its roots from a complex set of belief systems. DHS attempt to measure these beliefs and perceptions through a number of attitudinal questions. The analysis of attitudinal data is crucial in designing programmatic interventions that can help change the beliefs that perpetuate the practice. In many ways, bringing an end to FGM/C requires changing community norms and societal attitudes that discriminate against women and subjugate their rights to those of men. In its study of the association between women’s attitudes towards FGM/C and empowerment indicators, this study shows the close link between women’s ability to exercise control over their lives and their belief that FGM/C should be ended. Programmatic interventions must aim to promote the empowerment of women and girls through awareness-raising campaigns and increasing their access to education, as well as their access to and control of economic resources. Accelerating social change and creating the necessary preconditions will enable women to realise the full extent of their rights and may help them conclude that the practice of FGM/C can end.

Programmes must be country specific and adapted to reflect regional, ethnic and socioeconomic variances.

The case study of the tiers of prevalence indicates that the practice of FGM/C differs significantly between and within countries. Any strategy to end FGM/C must address the specific situation for each country and reflect regional and ethnic differences. Strategies to end the practice should take one form for communities that practise FGM/C universally and uniformly and be adapted for communities where it is not widespread or is practised sporadically. Furthermore, as the section on attitudes illustrates, FGM/C is practised for a wide variety of cultural reasons. For some communities, it is related to rites of passage. In others, it is considered aesthetically pleasing. Some practice it for reasons related to morality and sexuality. Research into why and how FGM/C is practiced among a given group or region is essential for the design of culturally appropriate, effective programmatic interventions.

Detailed segregation of data by socio- economic variables can significantly enhance and strengthen advocacy efforts at the country level.

Advocacy efforts are instrumental in influencing behaviour change and awareness. In many situations, however, advocacy can be severely hampered by the lack of systematic and accurate data. In the field of FGM/C, the link between advocacy efforts and accurate data is particularly strong due to the availability of such instruments as DHS and MICS. In many countries where FGM/C occurs, detailed information on the prevalence and circumstances of the practice by socio-economic variables is routinely used to inform advocacy efforts and strengthen communication messages.

Programmatic interventions to end FGM/C should continue to draw upon the available measurement tools and use data to better tailor their advocacy messages. By examining the different factors and variables that surround the practice, this study attempts to identify girls most at risk and thus take the first step towards ensuring their protection. FGM/C is no longer a cultural practice alone, removed from the scrutiny of international attention and human rights concerns. Rather, it has become a phenomenon that cannot be independently evaluated without looking at the social and economic injustices surrounding women and girls. Any approach that aims to end FGM/C must incorporate a holistic strategy that addresses the multitude of factors that perpetuate it.