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

Abstract

AbstractBackgroundFemale Genital Mutilation/Cutting (FGM/C) is a non-medical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress towards 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.MethodsA 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 two reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalised linear mixed models (GLMM). FGM/C prevalence with 95% confidence intervals (CI), prediction intervals (PI) and FGM/C type were presented separately by women aged 15-49 years and girls aged 0-14 years.Findings161 studies met the inclusion criteria and 28 were included in the meta-analysis, of which 22 were from the WHO African region (AFR), 5 from the Eastern Mediterranean region (EMR), and 1 from the South-East Asia (SEAR) region. These studies included data from 397,683 women across 28 countries and 283,437 girls across 23 countries; the pooled prevalence estimate of FGM/C amongst women aged 15-49 years was 38.3% (95% CI: 20.8–59.5%; PI:0.48–98.8%), and 7.25% (95% CI: 3.1–16.0%; PI: 0.1-88.9%) amongst girls aged 0-14 years. Amongst included countries, this gave a total estimated prevalence of 86,080,915 women (95% CI: 46,736,701–133,693,929) and 11,982,031 girls with FGM/C (95% CI: 5,123,351–26,476,156). Somalia had the highest FGM/C prevalence amongst women (99.2%) and Mali had the highest amongst girls (72.7%). The most common type of FGM/C amongst women was “flesh removed” (Type I or II) in 19 countries, and “not sewn closed” (Type I, II, or IV) amongst girls in 9 countries. Among repeated nationally representative studies, FGM/C decreased for women and girls in 23 and 25 countries respectively, although in several countries there was a minor decrease (0-3%) or increase in prevalence. The main limitation of the study methodology is that estimates were based on the available published data, which may not reflect the actual global prevalence of FGM/C.DiscussionIn 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 minimises 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, non-comparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3.FundingNoneRegistrationCRD42020186937Author SummaryWhy was this study done?FGM/C is an extreme form of gender inequality that violates women’s and girls’ human rights, and the practice has lifelong health and economic consequences for women and girls.Previous studies on prevalence of FGM/C have used repeated nationally representative cross-sectional studies and found that FGM/C is decreasing in many countries.This study aimed to provide a baseline prevalence estimate and to understand the data gaps in prevalence required for tracking progress towards the Sustainable Development Goal (SDG) Target 5.3.What did the researchers do and find?This was a systematic review and meta-analysis of all available studies on FGM/C and it provided a thorough overview of studies published on FGM/C prevalence at a national, sub-regional, school, facility, and community level.Approximately 100 million girls and women of reproductive age have experienced FGM/C across 28 countries in three WHO regions, with a prevalence of 38% in women and 7% among girls.There were large differences between regions and countries; where some countries practiced FGM/C universally, and FGM/C appeared to be decreasing in 23 countries for women and 25 countries for girls.What do these findings mean?Current findings imply that progress towards SDG 5.3 is attainable in some countries, but much work is required in others, including Egypt, Somalia, Sudan, Indonesia, Guinea, and Mali.Evaluation of structural or community level policies and interventions in countries that had a decline in FGM/C will be beneficial for countries that have a high prevalence of FGM/C.The prevalence estimate of this study is accurate of the included countries but is an underestimate of the global prevalence due to gaps in available data across the world, which are important to resolve to understand actual progress towards SDG 5.3.