The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

Abstract

Background Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. Methods and findings A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was “flesh removed” (Type I or II) in 19 countries. Among girls, “not sewn closed” (Type I, II, or IV) and “flesh removed” (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. Conclusions In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. Trial registration Registration: CRD42020186937.

Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis

“…More recently there has been a surge of literature on FGM/C and health outcomes of women 4 , 41 and a few studies recently have drawn attention to psychosocial import of the practice. 42 , 43 , 44 Overall, however, very little attention continues to be paid to the link between mental health and socio-psychological and physical health consequences of FGM/C. Our review points to some areas within mental health that have been covered in studies in the SSA region.…”

Subjective health status and health literacy of African refugees and asylum seekers in Germany: a cross-sectional survey

“…Notably, there is a high prevalence of posttraumatic stress disorder (PTSD), especially among refugees from Africa, with a rate of 48.3% (Blackmore et al , 2020). Women from Ethiopia, Nigeria and Eritrea often suffer from the consequences of female genital mutilation (Arulsamy, 2022; Farouki et al , 2022). Furthermore, asylum seekers are more likely to require hospitalization compared to the host population, often for conditions that could be avoided with early and effective outpatient treatment (Bozorgmehr and Hövener, 2021; Hadgkiss and Renzaho, 2014).…”

Daughter circumcision and maternal life satisfaction: a cultural moderation effect revealed across two multicountry studies

“…Despite efforts to eradicate it, the practice persists to the present day, although with somewhat decreasing frequency over time (there is concern that the UN resolution against FGC constitutes cultural imperialism7). 8…”