Secular trends in the prevalence of Female Genital Mutilation/Cuttings among girls: a systematic analysis

Kandala, Ngianga-Bakwin, Ezejimofor, Martinsixtus, Uthman, Olalekan A. and Komba, Paul (2018) Secular trends in the prevalence of Female Genital Mutilation/Cuttings among girls: a systematic analysis. BMJ Global Health, 3 (5). e000549. ISSN 2059-7908

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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 (i.e.1990-2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among the 0-14 years girls, and examine geographic variations in low-and middle-income countries (LMICs).

Methods: Analysis on the shift in prevalence of FGM/C was undertaken using the DHS and MICS datasets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poison regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017.

Findings: We included 90 DHS and MICS datasets 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 survey periods. The percentage decline in the prevalence of FGM/C among the 0 to 14-year-old children was highest in East Africa, followed by North and West Africa. The prevalence decreased by 787% in East Africa, from 71.4% in 1995 to 8.0% in 2016. In North Africa, the percentage 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 sub-regions 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%).

Interpretation: The prevalence of FGM/C among children aged 0-14 years varied greatly between countries and regions and, also within countries over 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.

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