Kandala, Ngianga-Bakwin, Ezejimofor, Martinsixtus C., Uthman, Olalekan A. and Komba, Paul Nzinga (2018) Secular trends in the prevalence of female genital mutilation/cuttings among girls: a systematic analysis. BMJ Global Health, 3 (5). e000549. doi:10.1136/bmjgh-2017-000549 ISSN 2059-7908.

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Abstract

Background
Current evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C over sustained periods (ie, 1990–2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among girls aged 0–14 years and examine geographical variations in low-income and middle-income countries.

Methods
Analysis on the shift in prevalence of FGM/C was undertaken using the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data sets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poisson regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017.

Findings
We included 90 DHS and MICS data sets for 208 195 children (0–14 years) from 29 countries spread across Africa and two countries in Western Asia. The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. The percentage decline in the prevalence of FGM/C among children aged 0–14 years old was highest in East Africa, followed by North and West Africa. The prevalence decreased from 71.4% in 1995 to 8.0% in 2016 in East Africa. In North Africa, the prevalence decreased from 57.7% in 1990 to 14.1% in 2015. In West Africa, the prevalence decreased from 73.6% in 1996 to 25.4% in 2017. The results of the trend analysis showed a significant shift downwards in the prevalence of FGM/C among children aged 0–14 years in such regions and subregions of East Africa, North Africa and West Africa. East Africa has experienced a much faster decrease in the prevalence of the practice (trend=−7.3%, 95% CI −7.5% to −7.1%) per year from 1995 to 2014. By contrast, the decline in prevalence has been much slower in North Africa (trend=−4.4%, 95% CI −4.5% to −4.3%) and West Africa (trend=−3.0%, 95% CI −3.1% to −2.9%).

Conclusion
The prevalence of FGM/C among children aged 0–14 years varied greatly between countries and regions and also within countries over the survey periods. There is evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions. There is a need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive.

Item Type:	Journal Article
Subjects:	G Geography. Anthropology. Recreation > GN Anthropology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Female circumcision, Female circumcision -- Prevention, Female circumcision -- Developing countries, Health surveys
Journal or Publication Title:	BMJ Global Health
Publisher:	BMJ Publishing Group
ISSN:	2059-7908
Official Date:	8 October 2018
Dates:	Date Event 8 October 2018 Published 8 October 2018 Available 13 July 2018 Accepted
Volume:	3
Number:	5
Article Number:	e000549
DOI:	10.1136/bmjgh-2017-000549
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	12 October 2018
Date of first compliant Open Access:	12 October 2018
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Population Council http://dx.doi.org/10.13039/100005974 DEL-15-005 African Academy of Sciences http://viaf.org/viaf/126099153 DEL-15-005 NEPAD Planning and Coordinating Agency http://viaf.org/viaf/231953619 107754/Z/15/Z Wellcome Trust http://dx.doi.org/10.13039/100010269
Related URLs:	Other

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