Peer-reviewed article

Targeting a future generation free from female genital mutilation: A mixed-methods quasi-experimental study of an awareness intervention in central Tanzania.

Kimario LB, Isack MN, Temba BZ, Msoka AC, Mmbaga BT · 26 May 2026

Abstract

Female genital mutilation (FGM) persists in Tanzania, with the Dodoma Region having the country's second-highest prevalence. This study evaluated a community-based educational intervention aimed at increasing FGM awareness and encouraging its abandonment among young adults (15-19 years) in Chamwino District, Dodoma, an important yet often overlooked group for fostering intergenerational change. We conducted a mixed-methods study with a primary quasi-experimental component: a single-arm, baseline-to-endline survey with a multi-stage cluster sample of 452 young adults who completed follow-up from schools and hospitals. Secondary components included a clinical audit of 3,770 delivering mothers to determine FGM prevalence and in-depth interviews with ten young adult mothers who had undergone FGM. The primary outcome was the change in the mean awareness score, analyzed using a paired t-test, with linear regression estimating associations with participants' demographics. Changes in binary secondary outcome measures were analyzed using McNemar's test, and the association between them was assessed with the chi-square test. The mean awareness score increased by 15.04 percentage points from 44.08% (SD = 15.85) at baseline to 59.12% (SD = 16.85), p < .001. At endline, 96.5% believed FGM is harmful, 50.9% reported its continuation, 97.6% knew it violates the human rights of girls and women, and 95.8% expressed a desire for abandonment. About 7.3% of women self-reported positive FGM status at baseline, while 16.6% were observed in 9-months. Qualitative analysis yielded three themes: 1) The hidden system, 2) Blood and lies, and 3) Intergenerational revolt. This theory-informed, community-engaged intervention significantly improved awareness and attitudes among more than 1,700 community members. However, qualitative findings revealed a persistent "hidden system" and a "critical power gap" among young adults, indicating awareness alone is insufficient. Sustainable abandonment requires integrating awareness campaigns with strategies that address structural power dynamics.