Towards the elimination of FGM by 2030: A statistical assessment

Female genital mutilation: trends, economic burden of delay and basis for public health interventions

BACKGROUND

The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions.

METHODS

Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19.

RESULTS

For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted.

CONCLUSION

Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

Prevalence of female genital mutilation and associated factors among daughters aged 0-14 years in sub-Saharan Africa: a multilevel analysis of recent demographic health surveys

Background

Female genital mutilation (FGM) is a harmful traditional practice involving the partial or total removal of external genitalia for non-medical reasons. Despite efforts to eliminate it, more than 200 million women and girls have undergone FGM, and 3 million more undergo this practice annually. Tracking the prevalence of FGM and identifying associated factors are crucial to eliminating the practice. This study aimed to determine the prevalence of FGM and associated factors among daughters aged 0-14 years.

Methods

The most recent Demographic Health Survey Data (DHS) datasets from sub-Saharan African countries were used for analysis. A multilevel modified Poisson regression analysis model was applied to identify factors associated with FGM. Data management and analysis were performed using STATA-17 software, and the pooled prevalence and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported. Statistical significance was set at p ≤ 0.05.

Results

The study included a weighted sample of 123,362 participants. The pooled prevalence of FGM among daughters aged 0-14 years in sub-Saharan Africa was found to be 22.9% (95% CI: 16.2-29.6). The daughter's place of birth (AOR = 0.54, 95% CI: 0.48-0.62), mother's age (AOR = 1.72, 95% CI: 1.4-2.11), father's education (AOR = 0.92, 95% CI: 0.87-0.98), mother's perception about FGM (AOR = 0.42, 95% CI: 0.35-0.48), FGM as a religious requirement (AOR = 1.23, 95% CI: 1.12-1.35), mother's age at circumcision (AOR = 1.11, 95% CI: 1.01-1.23), residing in rural areas (AOR = 1.12, 95% CI: 1.05-1.19), and community literacy level (AOR = 0.90, 95% CI: 0.83-0.98) were factors associated with FGM.

Conclusion

The high prevalence of FGM among daughters aged 0-14 years in sub-Saharan Africa indicates the need for intensified efforts to curb this practice. Addressing the associated factors identified in this study through targeted interventions and policy implementation is crucial to eradicate FGM and protect the rights and well-being of girls.

Spatial Clustering in Temporal Trends of Female Genital Mutilation Risk: Leveraging Sparse Data in Ethiopia, Kenya, and Somalia

Female genital mutilation (FGM) is a harmful practice rooted in gender inequality. Its elimination is part of national and international agendas including the Sustainable Development Goals of the United Nations. Understanding its geographical evolution is crucial for targeted programming. However, due to sparse data, it is challenging to establish international comparability and statistical reliability. Data on FGM is observed at different points in time and periodicity across countries and in contexts with varying age-risk patterns, all of which can be a source of inaccurate and biased estimates. We perform an exemplary analysis, drawing on survival and complex survey analysis in Ethiopia, Kenya, and Somalia. This novel approach addresses measurement challenges specific to FGM data and produces an internationally comparable indicator-the probability of not experiencing FGM by age 20. We pinpoint the onset of statistically significant FGM decline at the subnational level from cohorts born in the 1970s until the 1990s. In the same period, we observe no decline in FGM risk across regions clustered around international borders and increasing subnational inequalities within countries. Our methods thus provide crucial insights into the geographical pattern of temporal trends in FGM risk.

Estimating excess mortality due to female genital mutilation

Globally, over 200 million women and girls have been subjected to Female Genital Mutilation (FGM). This practice, illegal in most countries, often happens in unsanitary conditions and without clinical supervision with consequent bleeding and infection. However, little is known about its contribution to the global epidemiology of child mortality. We matched data on the proportion of girls of a given age group subject to FGM to age-gender-year specific mortality rates during 1990-2020 in 15 countries where FGM is practised. We used fixed-effects regressions to separate the effect of FGM on mortality-rates from variation in mortality in that country in that year. Using our estimated effect, we calculated total annual excess mortality due to FGM. Our estimates imply that a 50% increase in the number of girls subject to FGM increases their 5-year mortality rate by 0.075 percentage point (95% CI [Formula: see text]-[Formula: see text]). This increased mortality rate translates into an estimated 44,320 excess deaths per year across countries where FGM is practised. These estimates imply that FGM is a leading cause of the death of girls and young women in those countries where it is practised accounting for more deaths than any cause other than Enteric Infections, Respiratory Infections, or Malaria.

Mental Health Disorders in Circumcised Reproductive-age Women, Legal Dimensions and Prevention Strategies: A Narrative Review

OBJECTIVE

 Female genital mutilation/cutting (FGM/C) can affect women's lives through various physical, psychological, social and even sexual mechanisms. According to the World Health Organization guidelines for managing the health effects of FGM/C, further research into its psychological effects and preventative measures is required. In this study, a comprehensive review of the mental health consequences of circumcised women of reproductive age has been conducted with a special focus on providing preventive solutions.

METHODS

 A comprehensive search of the Web of Science, PubMed(MEDLINE), Proquest, Scopus and Google scholar was carried outfrom 2000 to 2022. The second stage of search was conducted in grey literature. To facilitate a systematic approach to search the literature, the PECO framework, was adopted.

RESULTS

 The result of this narrative review study showed that, the most common mental health disorder in reproductive age circumcised women were depression, anxiety and post-traumatic stress disorder. Some studies found a significant relationship between parents' education level and circumcised girls, so that parents of the circumcised women had a low level of education. Two studies considered religious beliefs, tradition, cleanness, sexual desire control and virginity as the reasons for FGM/C.

CONCLUSION

 All forms of FGM/C may be harmful to one's health. Women, who have undergone widespread forms of circumcision, are more likely to develop mental disorders. As the psychosocial effects of circumcision can affect the sexual experience of circumcised women, addressing this issue, emphasizing its legal aspects, and providing preventative solutions can improve physical, mental, social, and even sexual health in circumcised women.

New estimations of child marriage: Evidence from 98 low- and middle-income countries

The Sustainable Development Goals include a target on eliminating child marriage, a human rights abuse. Yet, the indicator used in the SDG framework is a summary statistic and does not provide a full picture of the incidence of marriage at different ages. This paper aims to address this limitation by providing an alternative method of measuring child marriage. The paper reviews recent data on nuptiality and captures evidence of changes in the proportion married and in the age at marriage, in 98 low- and middle-income countries (LMICs). Using data collected from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys, survival analysis is applied to estimate (a) age-specific marriage hazard rates among girls before age 18; and (b) the number of girls that were married before age 18 in 2020. Results show that the vast majority of girls remain unmarried until age 10. Child marriage rates increase gradually until age 14 and accelerate significantly thereafter at ages 15-17. By accounting for both single-year-age-specific child marriage hazard rates and the age structure of the population with a survival analysis approach, lower estimates in countries with a rapid decrease in child marriage and higher estimates in countries with constant or slightly rising child marriage rates relative to the direct approach are obtained.

The effect of female genital mutilation/cutting (FGM/C) on girls/women's mental health: a case-control study in Kurdistan Region of Iraq

Female genital mutilation/cutting (FGM/C) is a violation of human rights and is associated with a range of health effects and consequences. It is common in Kurdistan region of Iraq. Therefore, the present study aimed to investigate the effect of female genital mutilation/cutting on girls and women's mental health in Iraqi Kurdistan. The present case-control study was carried out on 145 girls and women with FGM/C and 145 girls and women without FGM/C in the city of Halabja, in the east of Iraqi Kurdistan, in 2020. Mental health status of the participants was measured using the 28-item version of General Health Questionnaire. Chi-square test was used in order to compare mental health and its dimensions in both groups. The multivariate logistic model with odds ratio was applied to determine the relationship of independent variables with the outcome variable (mental health status). In total, almost 72% (n = 104) of girls and women with FGM/C and 56% (n = 81) of girls and women without FGM/C presented the symptoms of mental health disorders and this difference was statistically significant (P-value = 0.005). Also, the prevalence of depression and somatic disorders among girls and women with FGM/C was higher than among girls and women without FGM/C and this difference was significant (P-value < 0.05). Based on the results of multivariate logistic regression, the variables of having a history of FGM/C (AOR = 2.14, 95% CI: 1.29-3.54), and being in an age group of 30-40 years (AOR = 2.01, 95% CI: 1.07-3.76) had a significant effect on presenting the symptoms of mental problems. A significant percentage of women and girls with a history of FGM/C had symptoms of mental disorders. FGM/C was a risk factor for a higher chance of presenting symptoms of mental disorders. We need to try to reduce and eradicate FGM/C by educating the public about the health consequences of FGM/C and enacting restrictive laws and monitoring proper implementation of them.

Changes in the prevalence and trends of female genital mutilation in Iraqi Kurdistan Region between 2011 and 2018

Background

Female genital mutilation (FGM) is commonly practiced in Iraqi Kurdistan Region, where there are extensive efforts to combat the practice over the last decade. This study aimed to determine the trends and changes in the FGM prevalence in Iraq between 2011 and 2018 and assess their associated factors.

Methods

Secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018 was carried out to calculate the prevalence and the relative changes in the prevalence of FGM for 2011 and 2018 by governorate. The change in the prevalence was compared with the changes in other exposure variables such as age, education level, wealth, and area of residence over the same period.

Results

The prevalence of FGM in 2018 was high in Erbil and Suleimaniya governorates (50.1% and 45.1%). The prevalence of FGM decreased remarkably from 2011 to 2018 in all governorates of the Iraqi Kurdistan Region. The decrease in the prevalence was statistically significant in Erbil and Suleimaniya. FGM prevalence declined remarkably in all age, education level, residence area groups, and most economic level groups. Such decline was associated with a significant increase in the education level, wealth, and urban residence. The decline was highest in the younger age groups, with a relative change of − 43.0% among 20–24 years and − 39.2% among 15–19 years. The decline was also highest in those with secondary and higher education (relative change = −32%). The decline was higher in rural areas than in urban areas (relative change = −35.3% and − 27.4%, respectively). The decline was higher among the poorest and second wealth quintile (relative change = −38.8% and − 27.2%, respectively).

Conclusion

The trend of FGM in Iraqi Kurdistan Region declined remarkably and significantly from 2011 to 2018. Further decline is predicted because of having lower rates and a higher decline in the younger age groups. However, the rates remained high in Erbil and Suleimaniya governorates that need further intensifying the preventive measures. The education level of women plays a primary role in decreasing the prevalence and should be considered in future efforts to ban the practice.