Peer-reviewed article

Prevalence of female genital mutilation and associated factors among women and girls in Africa: a systematic review and meta-analysis.

Ayenew AA, Mol BW, Bradford B, Abeje G · 12 Jan 2024

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This systematic review and meta-analysis synthesised data from 155 studies across Africa to establish the prevalence and drivers of female genital mutilation (FGM). The pooled prevalence of FGM in Africa was found to be 56.4%, with significant variation across regions and countries. Key factors associated with FGM practice include family history of circumcision, Muslim religious affiliation, poverty, older age, lack of formal education, and rural residence. The review found a slight temporal decline in FGM over the study period but emphasises that substantial work remains to achieve elimination.

Key points

Pooled prevalence of FGM in Africa is 56.4% (95% CI 49.7-63.6) across 155 studies
Family history of circumcision is the strongest factor promoting FGM (AOR = 13.71)
Not attending formal education is associated with FGM practice (AOR = 3.28)
Rural residency and lower wealth index are significant associated factors (AOR = 2.27 and 1.38 respectively)
Slight temporal decline in FGM was observed over the study period (2012 onwards)

Limitations

The review excluded studies written in non-English languages, which may introduce language bias and miss important regional evidence from Africa. The review identifies prevalence and associations but does not evaluate the effectiveness of elimination interventions.

Abstract

Background Female genital mutilation (FGM) has zero health benefits. It can lead to short- and long-term risks and complications, including physical, sexual, and mental health and well-being of girls and women. It is a worldwide public health issue with more than 80% prevalence in Africa. It is a global imperative to strengthen work for the elimination, and the United Nations Sustainable Development Goal (SDG) strives to eliminate FGM and monitor the progress made. However, one of a challenge in tracking progress is establishing baseline prevalence data within regions and countries. Therefore, this review aimed to pool the prevalence of FGM in Africa and identify the promoting factors among women and girls. Methods This review was conducted according to the PRISMA checklist guideline. Both published and unpublished studies conducted from 2012 onwards were eligible. Studies written in non-English languages were excluded. To retrieve relevant studies; PubMed/Medline, Google Scholar, Science Direct, African Journals Online databases, and African Index Medicus (AIM) were searched using a combination of searching terms. The Newcastle-Ottawa Assessment Scale (NOS) tool was used to assess the quality of each included study. The Cochran's Q chi-square and I2 statistical tests were used to evaluate the heterogeneity of the included studies. The Funnel plot and Egger's regression test (p value < 0.05) were used to evaluate meh publication bias. We used STATA for analysis and the overall and subgroup pooled effect size was estimated using the random effect model with DerSimonian and Laired pooled effect method. The overall prevalence of FGM and the adjusted odds ratio (AOR) with 95%CI (confidence interval) for contributing factors were calculated and presented using a forest plot. Result This study included 155 primary studies conducted on the prevalence and/or factors associated with FGM in Africa. The pooled prevalence of FGM was 56.4% (95%CI 49.7-63.6). The primary factors promoting the practice of FGM were family history of circumcision (AOR = 13.71, 95%CI 9.11-20.62), being a Muslim religion follower (AOR = 3.51, 95%CI 2.61-4.71), poor wealth index (AOR = 1.38, 95%CI1.27-1.51), higher age (AOR = 2.95, 95%CI 2.49-3.38), not attending formal education (AOR = 3.28, 95%CI 2.62-4.12), and rural residency (AOR = 2.27, 95%CI 1.84-2.80). Conclusion The prevalence of FGM in Africa was found to be high. This study also observed a variation in FGM prevalence across regions and countries and a slight temporal decline over the study period. As the global community enters the final decade dedicated to eliminating FGM, there remains much to be done to achieve the elimination goal.