Fewer younger women are undergoing female genital mutilation, study findsBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4754 (Published 25 July 2013) Cite this as: BMJ 2013;347:f4754
The practice of female genital mutilation is becoming less widespread in countries with low prevalence of the practice, prompting the children’s charity Unicef to say there are strong signs it will become a “vestige of the past.”
A statistical report on the 29 countries in Africa and the Middle East where the practice is most prevalent shows that in some countries the practice is declining rapidly.1 Researchers used 70 household surveys conducted over a 20 year period, as well as carrying out new surveys, to look at the changing landscape surrounding female genital mutilation.
Researchers asked women and girls aged 15 to 19 years whether they had undergone the procedure, which in most cases takes place before the age of 10. They asked the same question of women aged 45 to 49. In all countries, fewer younger women had undergone the procedure than older women.
In Liberia 85% of the women aged 45 to 49 who were questioned had undergone the procedure, compared to 44% of women and girls in the younger age group. In Burkina Faso 89% of older women had been cut, compared to 58% of younger women. In Kenya the figures were 49% and 15%, respectively.
However, in some countries there was little change. In Somalia 99% of the older age group had undergone female genital mutilation, compared to 97% of younger women and girls. In Djibouti the figures were 94% and 90%, respectively, and in Guinea they were 100% and 89%.
Claudia Cappa, the report’s author, said that Kenya had witnessed an “incredible decline” in the practice but it was important not to make generalisations across the whole country.
She said, “It’s very much located in certain groups. Some ethnic groups have never practised it but in others it is at a rate of 100%.”
Cappa said that there were many reasons for the practice dying out. In Kenya, for example, the population has become more urbanised and educated.
“Women [who are urbanised] are exposed to women from non-practising communities. They become more aware of the risks and more aware that it’s fine for girls not to have it done,” she said.
In 24 out of the 29 countries studied in the report legislation was in place outlawing female genital mutilation, Cappa said, but laws had to be accompanied by a change in social attitudes.
The report also looked at attitudes towards female genital mutilation and found that in most countries (23 out of 29) more than 50% of women and girls think the practice should stop. Boys and men were asked about their attitudes to the practice in 16 countries. In 12 countries more than 50% of men said that it should stop. In Chad, Guinea, and Sierra Leone more men than women were opposed to the practice.
Cappa said that men and women do not talk about female genital mutilation. “It’s always been seen as a women’s issue and it’s always been handled by women. Couples don’t discuss it,” she added.
Female genital mutilation is generally undertaken by traditional practitioners but in some countries it is performed by doctors. In Egypt, where 91% of all women have been cut, more than 70% of girls were cut by a doctor—however, this often took place in the girl’s own home rather than in a clinic or hospital. But Cappa said that medicalisation of the practice was not an answer.
She said, “FGMC [female genital mutilation/cutting] is not just a health issue—it’s a violation of a child’s right to health, to being integral, and to self determination. It’s a clear form of gender discrimination—a desire to preserve a woman’s virginity and control her sexuality.”
Cite this as: BMJ 2013;347:f4754
bmj.com Clinical Review: Female genital mutilation: the role of health professionals in prevention, assessment, and management (BMJ 2012;344:e1361, doi:10.1136/bmj.e1361).