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

Abstract

Female genital mutilation/cutting (FGM/C) is considered a public health and human rights concern, mainly concentrated in Africa, and has been targeted for elimination under the sustainable development goals. Interventions aimed at ending the practice often rely on data from household surveys which employ complex designs leading to outcomes that are not totally independent, thus requiring advanced statistical techniques. Combining data from multiple surveys within robust statistical framework holds promise to provide more precise estimates due to increased sample size, and accurately identify ‘hotspots’ and allow for assessment of changes over time. In this study, rich datasets from six (6) successive waves of the Nigeria Demographic and Health Surveys and Multiple Indicator Cluster Surveys undertaken between 2003 and 2016/17, were combined and analyzed in order to better assess changes in the likelihood and prevalence of FGM/C among 0-14-year old girls in Nigeria. We used Bayesian hierarchical regression models which explicitly accounted for the inherent spatial and temporal autocorrelations within the data while simultaneously adjusting for variations due to different survey methods and the effects of linear and non-linear covariates. Parameters were estimated using Markov chain Mote Carlo techniques and model fit assessments were based on Deviance Information Criterion. Results show that prevalence of FGM/C among 0–14 years old girls in Nigeria varied over time and across geographical locations and peaked in 2008 with a shift from South to North. A girl was more likely to be cut if her mother was cut, supported FGM/C continuation, or had no higher education. The effects of mother’s age, wealth and type of residence (urban-rural) were no longer significant in 2016. These results reflect the gains of interventions over the years, but also echo the belief that FGM/C is a social norm thus requiring tailored all-inclusive interventions for the total abandonment of FGM/C in Nigeria.

Variations in the Prevalence of Female Genital Mutilation Among Reproductive-aged Women in Nigeria Across Three Generations

“…18 Some researchers argued that the practice of FGM continues because of social and family pressure to adhere to tradition, and this is passed on from generation to generation, whose result leaves girls and women to suffer the consequences indefensibly. 19 Other studies have also argued that the practice of FGM is sustained from generation to generation because the procedure is deeply rooted in social norms, cultural beliefs, and tradition or because of its strong association with ethnicity and religion, particularly among the Muslim community. 17,19 Although the practice of FGM in Nigeria is widespread and varies with geopolitical zone, state, and ethnic group, 13 several studies have reported that the highest prevalence of FGM is in the southern geopolitical zone of Nigeria, among the Yoruba and Igbo ethnic groups.…”

“…19 Other studies have also argued that the practice of FGM is sustained from generation to generation because the procedure is deeply rooted in social norms, cultural beliefs, and tradition or because of its strong association with ethnicity and religion, particularly among the Muslim community. 17,19 Although the practice of FGM in Nigeria is widespread and varies with geopolitical zone, state, and ethnic group, 13 several studies have reported that the highest prevalence of FGM is in the southern geopolitical zone of Nigeria, among the Yoruba and Igbo ethnic groups. 4,16,20,21 This is consistent with our study findings.…”

Somalian women with female genital mutilation had increased risk of female sexual dysfunction: a cross-sectional observational study

“…It has been widely practiced in several African and Asian countries for cultural, traditional, hygienic, and religious beliefs affecting about 125 million girls under fifteen 4 . It was reported that women who underwent FGM had psychosocial disabilities, sexual embarrassment, and low quality of life, impacting their psychological and physical well-being 5 .…”

“…It was reported that women who underwent FGM had psychosocial disabilities, sexual embarrassment, and low quality of life, impacting their psychological and physical well-being 5 . Thus, in addition to violating a fundamental human right, FGM also leads to anxiety, depression, and social isolation 3 , 4 . Furthermore, it is also associated with short-term and long-term complications, including bleeding, infection, dermoid cysts and abscesses, chronic pelvic pain, recurrent urinary tract infections, difficulties in menstruation, maternal and fetal issues, and dyspareunia 6 .…”

Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey

“…Regarding the statistical approach used in this paper, there are many potential advantages of this approach over more conventional approaches like discrete-time Cox models with time varying covariates and fixed or random districts effects; or standard 2-level multilevel modelling with unstructured spatial effects [22,23]. In the conventional models, it is assumed that the random components at the contextual level (province in our case) are mutually independent.…”