By Zeinab El Dirani, Ubah Ali and Stephen J. McCall
The act of damaging or removing female genital organs without a medical reason is known as female genital mutilation (FGM). It is performed by specific ethnicities, mainly in African countries, but also in Yemen, Iraq, Indonesia, and the Maldives.1 Religious, social norms and cultural beliefs drive the continuation of FGM. The practice is socially accepted in certain communities but sometimes performed under undue community pressure as a way of preparing girls for adulthood and marriage, as well as protecting them from sex outside marriage and preserving their virginity.2
FGM is mainly performed on children and is considered a violation of human rights, a form of child abuse, and an extreme form of gender inequality.3 The practices contribute to the perpetuation of discriminatory and unjust gender norms.3 FGM has no benefits and has severe impacts on health and wellbeing.4,5
We conducted a systematic review to examine the factors associated with FGM, using standardized systematic review methods. Data were extracted from studies that examined factors associated with FGM.
Most studies showed that higher levels of maternal and paternal education were associated with lower levels of FGM in daughters. This was notably evident if the mother was literate vs. illiterate. We looked at studies that examined whether FGM in a family member was associated with FGM in the next generation; these studies showed that if a mother, sister, or grandmother had FGM there was an increased likelihood of the daughter of the family having FGM. There was conflicting evidence between the relationship of FGM with wealth and employment across studies, which indicates that the practice of FGM is a social norm that spans all wealth domains.
Urbanization appears to be protective against FGM in most of the studies. Perhaps, women in metropolitan regions generally have a better social status and policies are more enforced. On the other hand, most studies showed FGM was associated with being Muslim or believing that FGM has religious grounds. It must be noted that religious grounds for FGM is specific to countries and ethnic groups that practice FGM.
Eliminating FGM protects women’s wellbeing and health, and ensuring that all girls have access to education is a potential mechanism to limit intergenerational continuation of FGM. This is not to say that girls of mothers who have higher education do not experience FGM; rather, education empowers women to make informed decisions and combat ‘social or cultural’ norms. Education also helps women to be more aware of their bodies, protect their future daughters, and know their fundamental human rights.
This research synthesizes the determinants of FGM from the published literature and emphasizes the need for more research on the interventions and policies that have reduced FGM in certain countries. In addition, the diversity and complexity of the factors demonstrate that breaking the cycle necessitates a holistic approach to attaining equality and equity for women.
- Farouki L, El Dirani Z, Abdulrahim S, et al. The prevalence of female genital mutilation: a systematic review and meta-analysis of national, regional, facility and school-based studies. MedRxiv 2022.
- Elamin W, Mason-Jones AJ. Female genital mutilation/cutting: A systematic review and meta-ethnography exploring women’s views of why it exists and persists. International Journal of Sexual Health 2020;32(1):1-21.
- Khosla R, Banerjee J, Chou D, et al. Gender equality and human rights approaches to female genital mutilation: a review of international human rights norms and standards. Reproductive Health 2017;14(1):1-9.
- Reisel D, Creighton SM. Long term health consequences of Female Genital Mutilation (FGM). Maturitas 2015;80(1):48-51.
- Tordrup D, Bishop C, Green N, et al. Economic burden of female genital mutilation in 27 high-prevalence countries. BMJ Global Health 2022;7(2).
Zeinab El Dirani is a Public Health professional interested in the social determinants of health. Her work focuses on mental health and evidence-based measures to improve mental health well-being.
Ubah Ali is a survivor of FGM and an activist who campaigns against female genital mutilations. Ubah is co-founder of Solace for Somaliland Girls, an organisation committed to eradicating all types of FGM across communities in Somaliland.
Stephen McCall is a Population Health researcher interested in global reproductive and maternal health. He resides in Lebanon and studies the health and well-being of vulnerable populations in the Arab region.