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. 2018 Nov 6;3(5):e000549.
doi: 10.1136/bmjgh-2017-000549. eCollection 2018.

Secular trends in the prevalence of female genital mutilation/cutting among girls: a systematic analysis

Ngianga-Bakwin Kandala  1   2 , Martinsixtus C Ezejimofor  1   3 , Olalekan A Uthman  4 , Paul Komba  1
Affiliations

Secular trends in the prevalence of female genital mutilation/cutting among girls: a systematic analysis

Ngianga-Bakwin Kandala et al. BMJ Glob Health. .

Abstract

Background: Current evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C over sustained periods (ie, 1990-2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among girls aged 0-14 years and examine geographical variations in low-income and middle-income countries.

Methods: Analysis on the shift in prevalence of FGM/C was undertaken using the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data sets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poisson regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017.

Findings: We included 90 DHS and MICS data sets for 208 195 children (0-14 years) from 29 countries spread across Africa and two countries in Western Asia. The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. The percentage decline in the prevalence of FGM/C among children aged 0-14 years old was highest in East Africa, followed by North and West Africa. The prevalence decreased from 71.4% in 1995 to 8.0% in 2016 in East Africa. In North Africa, the prevalence decreased from 57.7% in 1990 to 14.1% in 2015. In West Africa, the prevalence decreased from 73.6% in 1996 to 25.4% in 2017. The results of the trend analysis showed a significant shift downwards in the prevalence of FGM/C among children aged 0-14 years in such regions and subregions of East Africa, North Africa and West Africa. East Africa has experienced a much faster decrease in the prevalence of the practice (trend=-7.3%, 95% CI -7.5% to -7.1%) per year from 1995 to 2014. By contrast, the decline in prevalence has been much slower in North Africa (trend=-4.4%, 95% CI -4.5% to -4.3%) and West Africa (trend=-3.0%, 95% CI -3.1% to -2.9%).

Conclusion: The prevalence of FGM/C among children aged 0-14 years varied greatly between countries and regions and also within countries over the survey periods. There is evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions. There is a need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive.

Keywords: epidemiology; maternal health; medical demography; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Location of included studies. FGM/C, female genital mutilation or cutting.
Figure 2
Figure 2
Secular trends in prevalence of female genital mutilation or cutting among children.
See this image and copyright information in PMC

References

    1. UNICEF, 2018. At least 200 million girls and women alive today living in 30 countries have undergone FGM. https://data.unicef.org/topic/child-protection/female-genital-mutilation (accessed 20 Feb 2018).
    1. UNICEF. Female genital mutilation/cutting: a global concern. New York: UNICEF, 2016: 1–4.
    1. Leye E, Mergaert L, Arnaut C, et al. . Towards a better estimation of prevalence of female genital mutilation in the European Union: interpreting existing evidence in all EU Member States. Genus 2014;70:99–121.
    1. Alison Macfarlane B, Stat F. Female genital mutilation in England and Wales: updated statistical estimates of the numbers of affected women living in England and Wales and girls at risk Interim report on provisional estimates. Northampton Square. London: City University London, 2014:1–24.
    1. Macfarlane A, Dorkenoo E. Prevalence of female genital mutilation in England and Wales: national and local estimates. London, London: City University, 2015:1–32.

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