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.
- systematic review
- maternal health
- medical demography
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Handling editor Seye Abimbola
Contributors N-BK conceived of and designed the study, interpreted the results, and was involved in conducting the literature review and drafting the article. MCE conducted the data analysis, and was involved in conducting the literature review, interpreting the results and drafting the article. OAU was involved in conducting the literature review, interpreting the results and drafting the article. PK was involved in interpreting the results and drafting the article. All authors performed critical revisions for important intellectual content and read and approved the article.
Funding Funding for this work was provided by UK Aid and the UK Government through the Department for International Development-funded project, 'Evidence to End FGM/C: Research to Help Girls and Women Thrive', coordinated by Population Council. N-B K recieved partial support through the DELTAS Africa Initiative SSACAB [grant#DEL-15-005]. The DELTAS Africa Initiative is an independent funding scheme ofthe African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence inScience in Africa (AESA) and supported by the New Partnership for Africa’sDevelopment Planning and Coordinating Agency (NEPAD Agency) with funding fromthe Wellcome Trust [grant #107754/Z/15/Z] and the UK government. The views expressed in this publication are those of the author(s) and not necessarilythose of AAS, NEPAD Agency, Wellcome Trust or the UK government. OAU is supported by the National Institute for Health Research using Official Development Assistance (ODA) funding.
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the AAS, NEPAD Agency, Wellcome Trust, the UK Government, NHS, the National Institute for Health Research, or the Department of Health and Social Care.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are open access data.
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