Country‑Level Factors Associated With FGM Decline: A Secondary Analysis of 30 Countries with Population-based FGM Data Surveys

Abstract

Background: Female genital mutilation (FGM) is a harmful traditional practice, performed for non-medical reasons, with physical, reproductive, and psychological health consequences that may last a lifetime.1 Globally, more than 230 million women have undergone some form of FGM. While national-level FGM prevalence has declined in many countries over recent decades, the country-level social, legal, and development factors most strongly associated with these declines remain poorly understood. The existing research has focused on individual- and community-level determinants of FGM within specific countries, leaving a critical gap in cross-national, ecological analyses that examine associations between country-level changes in structural indicators and changes in FGM prevalence over time. This study addresses that gap.Methods: This study employed a secondary data analysis with an ecological design. Data from 30 countries with at least one nationally representative, population-based survey on FGM were analyzed. The primary outcome was the proportional change in FGM prevalence among women aged 15–49 years between the earliest and most recent available national survey. Independent variables included country-level changes over the same time period in: attitudes toward FGM continuation among women and men, presence and duration of national anti-FGM legislation, the Gender Inequality Index (GII), female gross school enrollment, internet access, mobile phone use, and GDP per capita. Baseline perceived religious justification for FGM at the time of the first survey was also examined; change data existed for only 9 countries and was therefore treated as a baseline measure rather than a change indicator. Bivariable analyses included Pearson correlation coefficients and simple linear regression models for each predictor. A multivariable linear regression model was constructed including the two strongest predictors. All analyses were conducted in R, and six publication-quality figures were generated to visualize key findings. Results: The dataset included 30 countries overall. Change analyses were limited to 28 countries with survey data available at two time points, 25 (89.3%) showed some degree of decline in FGM prevalence. The five countries with the greatest proportional declines were Ghana (−76%; from 10.2% to 2.4%), Kenya (−61%; from 37.6% to 14.8%), Niger (−56%; from 4.5% to 2.0%), Uganda (−50%; from 0.6% to 0.3%), and the Central African Republic (−49%; from 43.4% to 22.0%). Three countries showed no meaningful decline or a slight increase: Nigeria (+3%, 2003-2018), Guinea-Bissau (+5%, 2010-2019), and Somalia (+1%, 2006-2020). The strongest bivariable correlations with greater FGM decline were longer duration of anti-FGM law (r = −0.34, n=17, p = 0.185) and greater improvement in the Gender Inequality Index (r = −0.27, n=19, p = 0.267). No predictor reached conventional statistical significance (p < 0.05) in simple linear regression. A multivariable model including the Gender Inequality Index (GII) improvement and law duration explained 35.3% of the variance in FGM decline (R² = 0.353, adjusted R² = 0.192) among the 11 countries with complete data on both variables, with an overall model p-value of 0.175. Conclusion: FGM prevalence has declined in the large majority of countries with available survey data, though the magnitude and pace of decline vary across settings. Longer anti-FGM legal duration and greater improvements in gender equality were the most consistent country-level correlates of greater FGM decline, though no predictor reached statistical significance possibly explained by low sample size. Results should be considered descriptive and hypothesis-generating. Future research with larger samples and longitudinal data is needed.