Article Text
Abstract
Background The majority of women who undergo female genital mutilation/cutting (FGM/C) live in Africa. Although the UN Sustainable Development Goals call for intensified efforts to accelerate the abandonment of FGM/C, little is known about where in Africa the declines in prevalence have been fastest and whether changes in prevalence differ by women’s socioeconomic status.
Methods We use data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys for 23 African countries, collected between 2002 and 2016, and covering 293 170 women. We reconstruct long-term cohort trends in FGM/C prevalence spanning 35 years, for women born between 1965 and 1999. We compute absolute and relative changes in FGM/C prevalence and differentials in prevalence by women’s education and urban-rural residence. We examine whether socioeconomic differences in FGM/C are converging or diverging.
Findings FGM/C prevalence has declined fastest (in relative terms) in countries with lower initial prevalence, and more slowly in countries with higher initial prevalence. Although better-educated women and those living in urban areas tend to have lower prevalence, in some countries the opposite pattern is observed. Socioeconomic differentials in FGM/C have grown in the majority of countries, particularly in countries with moderate-to-higher overall prevalence.
Conclusions The documented relationship between absolute and relative FGM/C prevalence rates suggests that in settings with higher initial prevalence, FGM/C practice is likely to be more entrenched and to change more slowly. There is substantial variation between countries in socioeconomic differentials in prevalence and their changes over time. As countries change from higher to lower overall prevalence, socioeconomic inequalities in FGM/C are increasing.
- child health
- maternal health
- public health
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Footnotes
Handling editor Sanni Yaya
Contributors EB, BW, EC and VC conceived and designed the study. EB and BW coordinated and monitored the study. EB collected and harmonised the data. EB and BW carried out the analysis with input from EC and VC. EB and BW wrote the first manuscript draft and all authors contributed to the subsequent drafts and approved the final version.
Funding This study was funded by STICERD.
Disclaimer The funders had no role in the study design, data collection, data analysis, data interpretation or manuscript preparation. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the United Nations.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. For each country, we either use data from the Demographic and Health Survey (DHS) or the Multiple Indicator Cluster Survey (MICS). Data are available at no cost for legitimate academic research at: https://www.dhsprogram.com/Data/http://mics.unicef.org/surveys.