A Spatial Analysis of the Prevalence of Female Genital Mutilation/Cutting among 0–14-Year-Old Girls in Kenya

Abstract

Female genital mutilation/cutting (FGM/C), also known as female circumcision, is a global public health and human rights problem affecting women and girls. Several concerted efforts to eliminate the practice are underway in several sub-Saharan African countries where the practice is most prevalent. Studies have reported variations in the practice with some countries experiencing relatively slow decline in prevalence. This study investigates the roles of normative influences and related risk factors (e.g., geographic location) on the persistence of FGM/C among 0–14 years old girls in Kenya. The key objective is to identify and map hotspots (high risk regions). We fitted spatial and spatio-temporal models in a Bayesian hierarchical regression framework on two datasets extracted from successive Kenya Demographic and Health Surveys (KDHS) from 1998 to 2014. The models were implemented in R statistical software using Markov Chain Monte Carlo (MCMC) techniques for parameters estimation, while model fit and assessment employed deviance information criterion (DIC) and effective sample size (ESS). Results showed that daughters of cut women were highly likely to be cut. Also, the likelihood of a girl being cut increased with the proportion of women in the community (1) who were cut (2) who supported FGM/C continuation, and (3) who believed FGM/C was a religious obligation. Other key risk factors included living in the northeastern region; belonging to the Kisii or Somali ethnic groups and being of Muslim background. These findings offered a clearer picture of the dynamics of FGM/C in Kenya and will aid targeted interventions through bespoke policymaking and implementations.

Evaluating changes in the prevalence of female genital mutilation/cutting among 0-14 years old girls in Nigeria using data from multiple surveys: A novel Bayesian hierarchical spatio-temporal model

“…These results agreed with findings from previous studies [11,17,[27][28][29][45][46][47]. For example, it was found that education plays an important role in a mother's decision on whether her daughter will be cut or not [27], with mother's who had higher education less likely to cut their daughters in Nigeria [11].…”

“…A study conducted in Senegal, Burkina Faso and Egypt by Farina and Ortensi found higher FGM/C prevalence among girls whose mothers had undergone FGM/C [46]. In the same spirit, studies conducted in the context of Kenya found that a woman's FGM/C status was key to her support for the continuation of the practice [28], and that daughters of women who were cut, women who supported FGM/C continuation and women who believed that FGM/C was a religious obligation, were more likely to be cut than their peers [29].…”

“…Bayesian hierarchical regression models which explicitly account for the inherent spatial and temporal autocorrelation within data, while simultaneously controlling for other linear and non-linear effects in a statistically robust framework are popular in the areas of disease mapping and ecological studies, for identifying high risk geographical locations [25,26]. To date, only a few studies have explored this powerful statistical tool in the context of FGM/C [27][28][29]. However, these studies have largely utilised data from only one single survey thereby providing only a 'snapshot' assessment.…”

Migrant Women-experiences from the Mediterranean Region

“…The Female Genital Mutilation/Cutting (FGM/C), or female circumcision, is another common form of violence against women in sub-Saharan African countries. It is a practice determining the removal of all or part of the external female genital in the absence of medical needs [ 31 ].…”

“…In Kenia, a study conducted on 0–14-year-old girls showed that daughters of cut women were highly likely to live the same experience. The likelihood of a girl being mutilated increased with the proportion of women who were cut, who supported FGM/C continuation, and who believed FGM/C was a religious obligation [ 31 ]. Achia [ 35 ], found a correlation between a woman’s current FGM/C status and her support for the continuation of the practice, among 15-49 years old women.…”