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Setting Female genital mutilation (FGM) is a traditional surgical modification of the female genitalia comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or nontherapeutic reasons. It can be harmful and violates girls’ and women’s human rights. FGM is a worldwide problem but mainly practiced in Africa. FGM is still widely practiced in Ethiopia despite being made a criminal offence in 2004. Objective Using data from three Ethiopian Demographic Health Surveys (EDHS) conducted in 2000, 2005 and 2016 the objective was to assess changes in prevalence of FGM and associated factors among women of reproductive age and their daughters. Methods EDHS datasets for the three surveys included data on FGM prevalence and socio-demographic factors. After weighting, the data were analysed using frequencies, proportions and the chi square test for trend. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% Confidence Intervals (CI). Levels of significance were set at 5% (P<0.05). Results There was overall decline in FGM prevalence (from 79.9% to 74.3% to 65.2%, P<0.001), especially in younger women aged 15-19 years, and in the proportion of women who believed that the practice should continue (from 59.7% to 28.3% to 17.5%, P95%, lack of school education, coming from rural areas and living in less wealthy households. Conclusion Although progress has been slow, the prevalence of FGM in Ethiopia has declined over time. Recommendations to quicken the trajectory of decline targeting integrated interventions to high prevalence areas focusing on mothers, fathers, youngsters, religious leaders and schools and ensuring that all girls receive some form of education.
This was a secondary analysis of cross-sectional studies done in the three EDHS. Ethiopia is located in the Horn of Africa and is the second most populated country in sub-Saharan Africa with almost 105 million inhabitants [14]. Life expectancy at birth is 66 years [14], whilst the GDP per capita is at USD$735 [15]. Administratively the country is divided into nine geographical regions and two administrative cities, and there are approximately 80 different ethnic groups [16]. There is a shortage of skilled health care professionals in the country, estimated at 2.8 healthcare workers per 10,000 population, and health service coverage for reproductive age women, infants and children is estimated at 59% [17]. Traditional practices, including FGM, are common and are used by 80% or more of the population, and female literacy in the country is estimated at 29% [16]. These factors all contribute to a high maternal mortality ratio of 446 per 100,000 live births and an under-five mortality rate of 60 per 1,000 live births [17]. Demographic and Health Surveys are used in most countries of the world to collect data on marriage, fertility, family planning, reproductive health, child health and HIV/AIDS so that decision makers in participating countries have improved information and analyses useful for informed policy choices [18]. The 2000 [19], 2005 [11] and 2016 [16] EDHS used the same methodology, interviewing a sample that represented the population at the national and regional levels, and for urban and rural areas. Eligible participants were women aged 15-49 years and men aged 15-59 years in randomly selected households across Ethiopia. In 2000, 2005 and 2016, the numbers of households selected were 14,642, 14,500 and 16,650 respectively and the numbers of female participants were 15,367 (2000), 14,070 (2005), and 15,683 (2016). The EDHS protocols were reviewed and approved by the Federal Democratic Republic of Ethiopia Ministry of Science and Technology and Institutional Review Board of the Inner City Fund (ICF) International [11, 16, 19]. For the purpose of this study, detailed information in the EDHS was collected on a wide range of socio-demographic factors and characteristics of FGM. The study population included all women of reproductive age (15-49 years) who were interviewed about themselves and their daughters in the 2000, 2005 and 2016 EDHS. Data variables in our analysis included: year of EDHS; number of reproductive age women aged 15-49 years completing the survey questionnaire; number of women interviewed who had ever been circumcised; number whose genital area had been sewn closed; and whether they thought circumcision should be continued or stopped; for 2016 the age at the time of circumcision and who performed the circumcision. Socio-demographic factors included: age at the time of interview; region of residence; education; religion; urban or rural residence; occupation and wealth index. Wealth index was calculated for each household based on the number and kind of common goods (for example, a television) that were owned and housing characteristics such as source of drinking water, toilet facilities and floor materials [16]. For daughters of mothers who were interviewed, data variables included: whether mothers had been circumcised or not; total number of daughters; and number of daughters who were circumcised. The sources of data were the completed EDHS questionnaires, which were extracted as .sav files for SPSS (version 25, IBM, New York, USA). The data were extracted between February and April, 2019. The three data sets from EDHS were weighted before analysis to compensate for unequal probability of selection among geographic strata to restore the representativeness of the sample using standard DHS methodology [20]. After weighting, data were analysed using OpenEpi (Open Source Epidemiological Statistics for Public Health, version 3.03) and SPSS (version 25, IBM, New York, USA). Frequencies and proportions for each variable were calculated and described. The proportions of women with FGM and factors associated with FGM in each of the three time periods were compared with the chi square test using OpenEpi. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% confidence intervals (CI). Levels of significance were set at 5% (P<0.05). Permission to access and analyse the EDHS files was obtained from the Demographic and Health Survey Program, Inner City Fund (ICF), Virginia, USA. Local ethics approval was obtained from the Chief Academic and Research Directorate Office, College of Health Sciences, Wolaita Sodo University, Sodo, Ethiopia. Ethics approval was also obtained from The Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France (EAG Number 20/19). As the data used in this study was all secondary and in the public domain, individual consent is not required.
