Community gender systems and a daughter’s risk of female genital mutilation/cutting: Multilevel findings from Egypt

Abstract

We tested a feminist social-ecological model to understand community influences on daughters' experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15-49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. However, an integrated multilevel-level framework is lacking. We theorized that a more favorable community-level gender system, including stronger gender norms opposing FGMC and expanded extrafamilial opportunities for women in the village or neighborhood, would be associated with a daughter's lower risk of FGMC and would strengthen the negative association of a mother's opposition to FGMC with her daughter's risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women's opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems framework of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and structural opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters, may be needed for sustainable declines in the practice.

Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

“…Consistent negative association has been reported between women’s education, FGM/C intention and its perpetration [ 26 – 30 ]. The common pathways for the negative association include the fact that education enlightens women to appreciate the consequences of FGM/C on females’ sexual and reproductive health [ 28 ] including mental health implications [ 31 ].…”

“…The common pathways for the negative association include the fact that education enlightens women to appreciate the consequences of FGM/C on females’ sexual and reproductive health [ 28 ] including mental health implications [ 31 ]. Education in effect empowers women to oppose all forms of violence against women and protect their children from experiencing FGM/C and abuse of all forms [ 30 , 32 ]. Meanwhile, Hayford et al [ 33 ] observed that daughters of women with primary or higher education experienced FGM/C in Burkina Faso, Cote d’voire, Guinea and Mali.…”

Factors associated with female genital mutilation among women of reproductive age and girls aged 0–14 in Chad: a mixed-effects multilevel analysis of the 2014–2015 Chad demographic and health survey data

“…The contextual factors were place of residence (urban or rural), community literacy level-proportion of women who can read and write (low, medium, high) and community socio-economic status-proportion of women in the richest household quintile (low, medium, high). The selection of these variables was influenced by their associations with FGM in previous studies [11,12,[14][15][16].…”

Why we need population data on gender norms, and why this is important for population health

“…As another example, female genital mutilation/cutting is often tied to gender norms regarding femininity, purity, cleanliness and control of female sexuality. As a collective practice, it serves to support and affirm normative expectations of women being sexually modest and appealing 14. Further, this practice is associated with detrimental health effects, including greater odds of contracting sexually transmitted diseases15 and adverse obstetric outcomes 16…”