Prevalence and determinants of female genital mutilation: current insights from ten at-risk countries in Sub-Saharan Africa
Female genital mutilation (FGM) refers to all harmful procedures that involve the partial or total removal of the external female genitalia, or any other injury to the female genital organs, performed for non-medical reasons . The World Health Organization (WHO) estimates that FGM has affected more than 200 million girls and women worldwide [ – ]. Furthermore, an estimated 3 million girls are at risk of FGM annually; as the majority of these girls have their genitalia cut before the age of 15 years . FGM is conducted in various forms, including flesh removal, infibulation and symbolic ‘nicking’ of the genitals, and spicing of the fore female genital parts [ , , ]. Studies including WHO reports indicate that the negative health effects of FGM include psychological trauma, reduced sexual desire and enjoyment, malformation of the genitals, bleeding on the scar during delivery, and even death [ – ]. Additionally, the experience of FGM has been reported to hinder women from seeking healthcare services and openly communicating with healthcare providers [ – ]. The burden is disproportionately distributed across the globe, with a higher concentration in developing regions of the world particularly in Sub-Saharan Africa (SSA), the Middle East, and Asia [ , – ]. In SSA, FGM is more common in the western, northern and eastern parts of the region . The reasons for practicing FGM are commonly rooted in religious and cultural beliefs . In 2023, for example, the reported top ten African countries with populations at-risk of FGM were Guinea (94.5%), Mali (88.6%), Sierra Leone (83.0%), Eritrea (83.0%), Burkina Faso (75.8%), Gambia (72.6%), Mauritania (66.6%), Ethiopia (65.2%), Guinea Bissau (52.1%), and Côte d’Ivoire (36.7%) . Several factors have been hypothesised to be associated with FGM including types of place of residency, low education level, and husband/partner roles [ , , – ]. Fear of being physically and/or socially expelled from the community for refusing FGM is also known to ‘push’ women into FGM . For instance, in some societies, women who have not undergone genital mutilation may face social exclusion and are often perceived as less credible or respected compared to women who have undergone the practice . Interestingly, some SSA countries have made FGM an illegal practice [ , – ], however, the journey toward eradicating this practice is fraught with challenges. The intricate cultural, historical, and social factors that influence FGM vary widely among communities, leading to inconsistencies in its determinants [ , – ]. This lack of uniformity complicates efforts to implement effective interventions, as deeply rooted traditions and beliefs continue to perpetuate the practice despite legal prohibitions [ , – ]. This underscores the need for ongoing research to monitor the practice of FGM effectively. Although FGM has been the focus of numerous studies, significant gaps persist in fully understanding the complex socio-cultural determinants that shape its prevalence, acceptance, and persistence. Existing research often highlights prevalence rates and general health outcomes [ , , ], but these studies are typically limited to small, localised samples that do not capture the wider diversity of socio-economic, religious, and interpersonal factors that perpetuate FGM. Moreover, many of these studies lack a multi-dimensional examination of the deeper societal and interpersonal influences that sustain FGM across different communities. This study aims to address this gap by exploring a range of under-examined variables, such as individual awareness of FGM, religious motivations, and nuanced attitudes toward the continuation or cessation of female mutilation. It also investigates broader beliefs about gender roles, such as wife-beating tolerance, and their influence on FGM acceptance, offering insights into how social norms shape personal and communal decisions. Furthermore, by including variables, such as the age and educational level of partners, media exposure, and household decision-making roles related to healthcare and finances, this study provides a layered understanding of the factors influencing FGM. For example, analysing whether higher levels of education or frequent media engagement correlate with decreased support for FGM can help identify critical leverage points for targeted interventions. By focusing on this range of variables within a broader sample scope, this study contributes crucial evidence to guide policy development, inform culturally sensitive programs, and guide the design of effective interventions tailored to both community norms and individual empowerment. Specifically, the study aims to explore the prevalence and determinants of FGM in SSA by utilising nationally representative data from the Demographic and Health Surveys (DHS). The analysis focused on the ten countries identified as having the highest risk of FGM based on prior research findings . This approach will enable a comprehensive understanding of the socio-cultural factors and prevalence rates associated with FGM in these high-risk contexts. Theoretical framework for Understanding the determinants of FGM in SSA Understanding the determinants of FGM in SSA requires a comprehensive approach that considers multiple, interconnected factors at various levels of influence. The Social Ecological Model (SEM) provides an ideal framework for exploring these determinants, as it accounts for the complex interplay between individual, interpersonal, community, institutional, and societal factors that perpetuate or mitigate the practice . At the individual level, personal knowledge, beliefs, and attitudes are pivotal in shaping engagement with FGM . Education and awareness of the profound health risks and human rights violations associated with FGM are crucial in influencing individual decisions . Empowering individuals with knowledge, particularly regarding the immediate and long-term consequences of FGM, can significantly reduce participation in the practice, thereby challenging its perpetuation . At the interpersonal level, familial and social dynamics are key drivers in the persistence of FGM . In many communities, the practice is enforced through social pressure and the desire to conform to deeply embedded cultural or religious norms [ , – ]. The influence of family members and peers often acting as custodians of tradition can compel individuals, particularly women and girls, to undergo or perpetuate FGM . These influences are often so entrenched that FGM is viewed as an essential rite of passage or prerequisite for social acceptance, rendering it resistant to change . At the community level, local customs, norms, and collective beliefs sustain FGM practices . In numerous African societies, FGM is regarded as a ritual of womanhood, a key to ensuring marriageability, and a means to achieve social standing  Community leaders ranging from elders to religious figures wield significant power in either reinforcing or challenging these practices [ , , ]. As such, they are crucial actors in fostering cultural transformation, and their involvement is indispensable in any effort aimed at reducing FGM prevalence . At the institutional level, the roles of healthcare systems, educational institutions, and religious organisations are critical in either perpetuating or combating FGM . Some institutions inadvertently sustain FGM through inadequate education or by failing to provide comprehensive alternative practices . However, these institutions also have the potential to be agents of change, offering medical support, promoting alternatives to FGM, and supporting legal reforms. Education within these institutions can serve as a transformative tool, dispelling myths surrounding FGM and shifting attitudes towards more progressive practices. At the societal level, broader structural factors such as national legal frameworks, economic development, and media representation shape societal attitudes towards FGM . Legal prohibitions, enforced by national governments, alongside the advocacy of international organisations and NGOs, play an instrumental role in reshaping cultural perceptions and driving the shift towards the abandonment of FGM . Furthermore, economic and development factors contribute by addressing the underlying socio-economic conditions that perpetuate harmful practices . Mass media campaigns and advocacy efforts are increasingly pivotal in changing public attitudes, helping to reshape societal norms and push for the institutionalisation of gender equality . While the SEM provides a comprehensive framework for examining the multi-dimensional and interconnected determinants of FGM in SSA, it is important to acknowledge that the DHS variables do not fully capture all the levels of influence outlined in the model. Nevertheless, the SEM still offers valuable insights into the complex factors that drive FGM. By applying this framework, we can better understand the main drivers of FGM in the selected sample and inform targeted policies, design effective interventions, and develop advocacy initiatives aimed at eradicating FGM, advancing gender equity, and protecting human rights. Data and methods Study design The study analysed secondary data of 129,182 women drawn from the most recent Demographic and Health Surveys (DHS) conducted between 2014/15 and 2021. The final analysis included FGM top 10 at-risk countries with available data . However, Eritrea, Ivory Coast and Guinea Bissau were excluded due to the unavailability of the outcome variable (in the case of Guinea Bissau) and the lack of the most current dataset for Ivory Coast and Eritrea. Hence, Chad, Nigeria and Liberia were included as the replacement to three pre-mentioned countries which were dropped from the study. The countries included in the final analysis are Guinea, Mali, Sierra Leone, Burkina Faso, Gambia, Mauritania, Ethiopia, Nigeria, Chad and Liberia. As indicated in Table . The survey is conducted after every five years by country’s Bureau of Statistics, with financial support from United States Agency for International Development (USAID). The survey uses two stages stratified sampling techniques. The first stage involved stratification of the clusters in rural/urban settings based on most current census. The second stage involved clustering and from the clusters selection of households to be interviewed during the survey . The procedures for the survey are documented elsewhere in country-specific DHS final reports. In addition, we were granted approval to access the data after submitting our concept note to the DHS custodian. Study population and sample The study population composes a weighted sample of 129,182 women aged 15–49 years who are regular residents of the chosen households or have spent the night in the selected households. All individuals with missing FGM information were excluded from the study as depicted in Fig. . Dependent and independent variables The outcome variable for the study, is female genital mutilation status which was generated by asking the question: “if respondent is mutilated or not” with values 1 for “yes” and 0 for “no”. All missing and “I do not know” responses on the dependent variable were excluded from the analysis. The independent variables in this analysis include age (15–19,20–24, 25–29, 30–34, 35–39,40–44, 45–49 years), age at marriage/cohabiting (before 15 years, between 15 and 19 years, 20–29, 30–49 years, never marriage/cohabited), educational level(no formal education, primary education, secondary and beyond), types of place residence(urban/rural), respondent’s currently working status (yes/no), wealth quintile of households ( poorest, poorer, middle, rich, richest), ever heard female genital mutilation(yes,/no), frequency of watching/listening to mass media (not at all, less than once per week, at least once a week), wife beating attitude(yes/no), FGM required by your religion (yes/no, no religion and I don’t know), Female mutilation: continue or be stopped (no/yes, it depends, age of husband/partner (15–29, 30–49 and 50+), Highest education level husband/partner(no formal education, primary education, secondary and beyond, I don’t know), Who decides respondent’s healthcare (respondent alone, husband and respondent, husband/partner alone, others), Who decides use of respondent’s earning/home purchases (respondent alone, husband and respondent, husband/partner alone, others). These variables were selected based on their significant association with FGM as reported from previous studies [ , , – ]. However, our study enhances the existing body of literature by employing a larger and more representative sample derived from the ten countries most at risk for FGM in SSA, as identified in previous research. This approach allows for a more comprehensive analysis of the prevalence and determinants of FGM in these high-risk areas . Furthermore, our study incorporates variables that have been relatively underexplored, such as household decision-making power, to deepen our understanding of the determinants of FGM. This inclusion allows our study to offer new insights that enrich the ongoing conversation about FGM and its associated factors, highlighting the multifaceted nature of this issue. Data analysis The data were thoroughly cleaned to identify and correct errors, all missing cases were dropped values as data were missing complete at random, and remove duplicates before proceeding to the final analysis. Additionally, certain variables were re-categorized according to previous literature to enhance interpretation and facilitate comparability across studies. Descriptive analysis was performed to understand the distribution of variables across categories, with results presented in Table as frequencies and percentages. Bivariable analysis using Chi-square and modified Poisson Regression was performed to determine the association between independent variables and outcome of interest. All variables from the chi-square were entered in the multivariable modified Poisson Regression final model. The model was used to identify factors associated with Female Genital Mutilation. We did not include age at marriage/cohabitation and age of husband/partner in the final model due to multi-collinearity however, we maintained respondent’s age due to its importance in women’s practices regarding FGM in African contexts. All data used in the analysis were weighted to account for complex sampling design used during the survey including the cluster sampling. A cut point of p-value less than 0.05 was set to determine a significant variable. 

Understanding the determinants of FGM in SSA requires a comprehensive approach that considers multiple, interconnected factors at various levels of influence. The Social Ecological Model (SEM) provides an ideal framework for exploring these determinants, as it accounts for the complex interplay between individual, interpersonal, community, institutional, and societal factors that perpetuate or mitigate the practice . At the individual level, personal knowledge, beliefs, and attitudes are pivotal in shaping engagement with FGM . Education and awareness of the profound health risks and human rights violations associated with FGM are crucial in influencing individual decisions . Empowering individuals with knowledge, particularly regarding the immediate and long-term consequences of FGM, can significantly reduce participation in the practice, thereby challenging its perpetuation . At the interpersonal level, familial and social dynamics are key drivers in the persistence of FGM . In many communities, the practice is enforced through social pressure and the desire to conform to deeply embedded cultural or religious norms [ , – ]. The influence of family members and peers often acting as custodians of tradition can compel individuals, particularly women and girls, to undergo or perpetuate FGM . These influences are often so entrenched that FGM is viewed as an essential rite of passage or prerequisite for social acceptance, rendering it resistant to change . At the community level, local customs, norms, and collective beliefs sustain FGM practices . In numerous African societies, FGM is regarded as a ritual of womanhood, a key to ensuring marriageability, and a means to achieve social standing  Community leaders ranging from elders to religious figures wield significant power in either reinforcing or challenging these practices [ , , ]. As such, they are crucial actors in fostering cultural transformation, and their involvement is indispensable in any effort aimed at reducing FGM prevalence . At the institutional level, the roles of healthcare systems, educational institutions, and religious organisations are critical in either perpetuating or combating FGM . Some institutions inadvertently sustain FGM through inadequate education or by failing to provide comprehensive alternative practices . However, these institutions also have the potential to be agents of change, offering medical support, promoting alternatives to FGM, and supporting legal reforms. Education within these institutions can serve as a transformative tool, dispelling myths surrounding FGM and shifting attitudes towards more progressive practices. At the societal level, broader structural factors such as national legal frameworks, economic development, and media representation shape societal attitudes towards FGM . Legal prohibitions, enforced by national governments, alongside the advocacy of international organisations and NGOs, play an instrumental role in reshaping cultural perceptions and driving the shift towards the abandonment of FGM . Furthermore, economic and development factors contribute by addressing the underlying socio-economic conditions that perpetuate harmful practices . Mass media campaigns and advocacy efforts are increasingly pivotal in changing public attitudes, helping to reshape societal norms and push for the institutionalisation of gender equality . While the SEM provides a comprehensive framework for examining the multi-dimensional and interconnected determinants of FGM in SSA, it is important to acknowledge that the DHS variables do not fully capture all the levels of influence outlined in the model. Nevertheless, the SEM still offers valuable insights into the complex factors that drive FGM. By applying this framework, we can better understand the main drivers of FGM in the selected sample and inform targeted policies, design effective interventions, and develop advocacy initiatives aimed at eradicating FGM, advancing gender equity, and protecting human rights. 

Study design The study analysed secondary data of 129,182 women drawn from the most recent Demographic and Health Surveys (DHS) conducted between 2014/15 and 2021. The final analysis included FGM top 10 at-risk countries with available data . However, Eritrea, Ivory Coast and Guinea Bissau were excluded due to the unavailability of the outcome variable (in the case of Guinea Bissau) and the lack of the most current dataset for Ivory Coast and Eritrea. Hence, Chad, Nigeria and Liberia were included as the replacement to three pre-mentioned countries which were dropped from the study. The countries included in the final analysis are Guinea, Mali, Sierra Leone, Burkina Faso, Gambia, Mauritania, Ethiopia, Nigeria, Chad and Liberia. As indicated in Table . The survey is conducted after every five years by country’s Bureau of Statistics, with financial support from United States Agency for International Development (USAID). The survey uses two stages stratified sampling techniques. The first stage involved stratification of the clusters in rural/urban settings based on most current census. The second stage involved clustering and from the clusters selection of households to be interviewed during the survey . The procedures for the survey are documented elsewhere in country-specific DHS final reports. In addition, we were granted approval to access the data after submitting our concept note to the DHS custodian. 

The study analysed secondary data of 129,182 women drawn from the most recent Demographic and Health Surveys (DHS) conducted between 2014/15 and 2021. The final analysis included FGM top 10 at-risk countries with available data . However, Eritrea, Ivory Coast and Guinea Bissau were excluded due to the unavailability of the outcome variable (in the case of Guinea Bissau) and the lack of the most current dataset for Ivory Coast and Eritrea. Hence, Chad, Nigeria and Liberia were included as the replacement to three pre-mentioned countries which were dropped from the study. The countries included in the final analysis are Guinea, Mali, Sierra Leone, Burkina Faso, Gambia, Mauritania, Ethiopia, Nigeria, Chad and Liberia. As indicated in Table . The survey is conducted after every five years by country’s Bureau of Statistics, with financial support from United States Agency for International Development (USAID). The survey uses two stages stratified sampling techniques. The first stage involved stratification of the clusters in rural/urban settings based on most current census. The second stage involved clustering and from the clusters selection of households to be interviewed during the survey . The procedures for the survey are documented elsewhere in country-specific DHS final reports. In addition, we were granted approval to access the data after submitting our concept note to the DHS custodian. 

The study population composes a weighted sample of 129,182 women aged 15–49 years who are regular residents of the chosen households or have spent the night in the selected households. All individuals with missing FGM information were excluded from the study as depicted in Fig. . 

The outcome variable for the study, is female genital mutilation status which was generated by asking the question: “if respondent is mutilated or not” with values 1 for “yes” and 0 for “no”. All missing and “I do not know” responses on the dependent variable were excluded from the analysis. The independent variables in this analysis include age (15–19,20–24, 25–29, 30–34, 35–39,40–44, 45–49 years), age at marriage/cohabiting (before 15 years, between 15 and 19 years, 20–29, 30–49 years, never marriage/cohabited), educational level(no formal education, primary education, secondary and beyond), types of place residence(urban/rural), respondent’s currently working status (yes/no), wealth quintile of households ( poorest, poorer, middle, rich, richest), ever heard female genital mutilation(yes,/no), frequency of watching/listening to mass media (not at all, less than once per week, at least once a week), wife beating attitude(yes/no), FGM required by your religion (yes/no, no religion and I don’t know), Female mutilation: continue or be stopped (no/yes, it depends, age of husband/partner (15–29, 30–49 and 50+), Highest education level husband/partner(no formal education, primary education, secondary and beyond, I don’t know), Who decides respondent’s healthcare (respondent alone, husband and respondent, husband/partner alone, others), Who decides use of respondent’s earning/home purchases (respondent alone, husband and respondent, husband/partner alone, others). These variables were selected based on their significant association with FGM as reported from previous studies [ , , – ]. However, our study enhances the existing body of literature by employing a larger and more representative sample derived from the ten countries most at risk for FGM in SSA, as identified in previous research. This approach allows for a more comprehensive analysis of the prevalence and determinants of FGM in these high-risk areas . Furthermore, our study incorporates variables that have been relatively underexplored, such as household decision-making power, to deepen our understanding of the determinants of FGM. This inclusion allows our study to offer new insights that enrich the ongoing conversation about FGM and its associated factors, highlighting the multifaceted nature of this issue. 

The data were thoroughly cleaned to identify and correct errors, all missing cases were dropped values as data were missing complete at random, and remove duplicates before proceeding to the final analysis. Additionally, certain variables were re-categorized according to previous literature to enhance interpretation and facilitate comparability across studies. Descriptive analysis was performed to understand the distribution of variables across categories, with results presented in Table as frequencies and percentages. Bivariable analysis using Chi-square and modified Poisson Regression was performed to determine the association between independent variables and outcome of interest. All variables from the chi-square were entered in the multivariable modified Poisson Regression final model. The model was used to identify factors associated with Female Genital Mutilation. We did not include age at marriage/cohabitation and age of husband/partner in the final model due to multi-collinearity however, we maintained respondent’s age due to its importance in women’s practices regarding FGM in African contexts. All data used in the analysis were weighted to account for complex sampling design used during the survey including the cluster sampling. A cut point of p-value less than 0.05 was set to determine a significant variable. 

Socio demographic characteristics of the study respondents A total sample of 129,182 women were included in this analysis. Of these, nearly quarter (21.9%) were aged 15–19 years, with a mean age of 29 years, almost half (48%) of the women had no formal education, and more than half (60.3%) resided in rural areas., Over a quarter (25.5%) had never been married. More than half (54.7%) were working, and only 21.8 were from the wealthiest households. More than three quarters (84.6%) had heard about FGM with over third (33.1%) claimed that FGM required by religion. More than half 53.9% of respondents stated that FGM should be stopped. More than half (50.4%) supported a with wife beating. Regarding their partners, more than half (61.2%) were aged 30–49 years and 53.2% had no formal education. Almost half 40.6%) of women reported limited exposure to mass media. Additionally, more than half (57.5%) reported that their husband made decisions about their healthcare independently. Only slightly more than a quarter (30.3%) responded that they made major financial decisions jointly with their husbands such as large purchases/or use of respondent’s earnings. As summarized in Table . Prevalence of FGM across top 10 at-risk SSA countries The prevalence of FGM varies significantly across the top 10 at-risk countries in SSA. As presented in Fig. , Guinea stands at the highest with 94.5%, followed by Mali at 88.62%, and Sierra Leone at 83.04%. The Gambia has a prevalence of 72.59%, while Ethiopia records 65.21%. Mauritania follows closely with 63.91%, and Burkina Faso has a prevalence of 56.11%. Chad shows a notable decrease with 38.48%, while Liberia has a lower rate at 31.84%. Nigeria, with the lowest prevalence in the list, stands at 19.48%. Overall, the combined total prevalence of FGM across these countries is 53.5%, reflecting a stark regional issue that requires continued attention and intervention. Prevalence by types of FGM in top 10 at-risk SSA countries In the sample involving 129,182 women aged 15–49 years from the top 10 at-risk SSA countries, the prevalence of different types of FGM reveals significant variations. The most common type of FGM, accounting for 57.9%, involves the removal of flesh. A smaller proportion, 20.1%, underwent other forms of FGM. Additionally, 12.84% of the women experienced procedures where no flesh was removed, while 9.17% had the sewn closed form of FGM. These findings highlight the diverse and harmful practices of FGM across these regions, which have long-lasting physical and psychological effects on women (Fig. ). Determinants of FGM in top 10 FGM at-risk countries in SSA Of all women of reproductive age (15–49 years), more than half (53.5%) reported having undergone FGM. Age was significantly associated with FGM, as age increased the prevalence of FGM also increased, 43.3% of women aged 15–19 years, 49.6% aged 20–24 years, 54.8% aged 25–29 years, 56.5% aged 30–34 years, 60.1 aged 35–39 years, 61.3% aged 40–44 years and 63% aged 45–49 years. Education level was also significantly linked to FGM as women with no formal education reported 61.7% undergoing FGM, 52.4% and 41.8% with, primary education and secondary and beyond respectively having ever undergone FGM. Additionally, FGM prevalence differed based on place of residence, with 51.2% of rural women and 55% of urban women reported ever had undergone FGM We found significant association between age at marriage/cohabiting and undergoing FGM, 41.6% of never married women had undergone FGM, more than half (55.9%) of those who married/cohabiting before 15 years reported to have undergone FGM. Also, a significant percent (58%) among those married/cohabiting between 15 and 29 years, reported having had undergone FGM and again 58.6% of those who married between 30 and 49 years, reported to have had undergone FGM. Furthermore, FGM prevalence decreased as wealth increased, ranging from 57.9% among women from the poorest households to 49.5% among those from the richest households. Among women who had not heard of FGM, only 1.5% had undergone the procedure, while 63.0% of those who heard about FGM reported to have undergone it. Awareness of FGM was significantly associated with the likelihood of undergoing the procedure. Regarding religious beliefs, 51.1% Of women who said FGM was not required by religion had undergone FGM while significant proportion (88.5%) of those who believed FGM was a religious requirement had undergone FGM. Of all women who said they had no religion, 58% had undergone FGM, of all women who said they do not know if FGM is required by religion, 59% had undergone FGM. Of all women who said FGM should continue, 90.6% had undergone FGM, those who said FGM should be stopped, 46.8% had undergone FGM and of those who were undecided or said “it depends”, 57% had undergone FGM. Media exposure was also linked to FGM prevalence. Of those who said they do not all watch/listen to mass media, 52.4% had undergone FGM, those who said they watch/listen at less than once per week, 54.4% had undergone FGM and among those who said they at least once a week 54.2 had undergone FGM. Age, education level, age at marriage/cohabitation, type of place of residence and wealth quintile were found to be significantly associated with having undergone FGM. As indicated in Table below. Determinants of FGM based on the multivariable model Older women were more likely to have undergone FGM, with adjusted prevalence ratios (APRs) increasing from 2.69 (95% CI: 2.66–2.75) among women aged 20–24 to 2.86 (95% CI: 2.80–2.92) for those aged 45–49. Educational attainment also played a significant role; women with no formal education had a higher likelihood of FGM compared to those with secondary education or higher (APR = 2.53, 95% CI: 2.51–2.56). Rural residency was associated with a higher prevalence of FGM (APR = 2.59, 95% CI: 2.56–2.61), as was unemployment (APR = 2.56, 95% CI: 2.54–2.58) and living in poorer households (APR = 2.66, 95% CI: 2.62–2.69). Women unaware of FGM had a greater likelihood of undergoing the practice compared to those who had heard about it (APR = 1.43, 95% CI: 1.37–1.51). Belief that FGM is required by religion was also linked to higher prevalence (APR = 1.94, 95% CI: 1.92–1.95). Women uncertain about whether FGM should stop or continue showed similar prevalence rates to those supporting continuation (APR = 1.94, 95% CI: 1.92–1.95). Agreement with wife-beating correlated with higher FGM prevalence (APR = 2.76, 95% CI: 2.74–2.79). Husband or partner characteristics also influenced prevalence. Women whose husband or partner had primary education were more likely to have undergone FGM compared to those whose partners had no formal education (APR = 2.59, 95% CI: 2.56–2.63). Access to media was another factor; women who engaged with mass media at least once a week had slightly higher prevalence rates compared to those who did not (APR = 1.07, 95% CI: 1.05–1.09). Lastly, decision-making autonomy in healthcare was linked to FGM prevalence; women whose husband or partner solely made decisions about their healthcare were more likely to have undergone FGM compared to those who made decisions independently (APR = 1.07, 95% CI: 2.48–2.54), as summarized in Table . 

A total sample of 129,182 women were included in this analysis. Of these, nearly quarter (21.9%) were aged 15–19 years, with a mean age of 29 years, almost half (48%) of the women had no formal education, and more than half (60.3%) resided in rural areas., Over a quarter (25.5%) had never been married. More than half (54.7%) were working, and only 21.8 were from the wealthiest households. More than three quarters (84.6%) had heard about FGM with over third (33.1%) claimed that FGM required by religion. More than half 53.9% of respondents stated that FGM should be stopped. More than half (50.4%) supported a with wife beating. Regarding their partners, more than half (61.2%) were aged 30–49 years and 53.2% had no formal education. Almost half 40.6%) of women reported limited exposure to mass media. Additionally, more than half (57.5%) reported that their husband made decisions about their healthcare independently. Only slightly more than a quarter (30.3%) responded that they made major financial decisions jointly with their husbands such as large purchases/or use of respondent’s earnings. As summarized in Table . 

The prevalence of FGM varies significantly across the top 10 at-risk countries in SSA. As presented in Fig. , Guinea stands at the highest with 94.5%, followed by Mali at 88.62%, and Sierra Leone at 83.04%. The Gambia has a prevalence of 72.59%, while Ethiopia records 65.21%. Mauritania follows closely with 63.91%, and Burkina Faso has a prevalence of 56.11%. Chad shows a notable decrease with 38.48%, while Liberia has a lower rate at 31.84%. Nigeria, with the lowest prevalence in the list, stands at 19.48%. Overall, the combined total prevalence of FGM across these countries is 53.5%, reflecting a stark regional issue that requires continued attention and intervention. 

In the sample involving 129,182 women aged 15–49 years from the top 10 at-risk SSA countries, the prevalence of different types of FGM reveals significant variations. The most common type of FGM, accounting for 57.9%, involves the removal of flesh. A smaller proportion, 20.1%, underwent other forms of FGM. Additionally, 12.84% of the women experienced procedures where no flesh was removed, while 9.17% had the sewn closed form of FGM. These findings highlight the diverse and harmful practices of FGM across these regions, which have long-lasting physical and psychological effects on women (Fig. ). 

Of all women of reproductive age (15–49 years), more than half (53.5%) reported having undergone FGM. Age was significantly associated with FGM, as age increased the prevalence of FGM also increased, 43.3% of women aged 15–19 years, 49.6% aged 20–24 years, 54.8% aged 25–29 years, 56.5% aged 30–34 years, 60.1 aged 35–39 years, 61.3% aged 40–44 years and 63% aged 45–49 years. Education level was also significantly linked to FGM as women with no formal education reported 61.7% undergoing FGM, 52.4% and 41.8% with, primary education and secondary and beyond respectively having ever undergone FGM. Additionally, FGM prevalence differed based on place of residence, with 51.2% of rural women and 55% of urban women reported ever had undergone FGM We found significant association between age at marriage/cohabiting and undergoing FGM, 41.6% of never married women had undergone FGM, more than half (55.9%) of those who married/cohabiting before 15 years reported to have undergone FGM. Also, a significant percent (58%) among those married/cohabiting between 15 and 29 years, reported having had undergone FGM and again 58.6% of those who married between 30 and 49 years, reported to have had undergone FGM. Furthermore, FGM prevalence decreased as wealth increased, ranging from 57.9% among women from the poorest households to 49.5% among those from the richest households. Among women who had not heard of FGM, only 1.5% had undergone the procedure, while 63.0% of those who heard about FGM reported to have undergone it. Awareness of FGM was significantly associated with the likelihood of undergoing the procedure. Regarding religious beliefs, 51.1% Of women who said FGM was not required by religion had undergone FGM while significant proportion (88.5%) of those who believed FGM was a religious requirement had undergone FGM. Of all women who said they had no religion, 58% had undergone FGM, of all women who said they do not know if FGM is required by religion, 59% had undergone FGM. Of all women who said FGM should continue, 90.6% had undergone FGM, those who said FGM should be stopped, 46.8% had undergone FGM and of those who were undecided or said “it depends”, 57% had undergone FGM. Media exposure was also linked to FGM prevalence. Of those who said they do not all watch/listen to mass media, 52.4% had undergone FGM, those who said they watch/listen at less than once per week, 54.4% had undergone FGM and among those who said they at least once a week 54.2 had undergone FGM. Age, education level, age at marriage/cohabitation, type of place of residence and wealth quintile were found to be significantly associated with having undergone FGM. As indicated in Table below. 

Older women were more likely to have undergone FGM, with adjusted prevalence ratios (APRs) increasing from 2.69 (95% CI: 2.66–2.75) among women aged 20–24 to 2.86 (95% CI: 2.80–2.92) for those aged 45–49. Educational attainment also played a significant role; women with no formal education had a higher likelihood of FGM compared to those with secondary education or higher (APR = 2.53, 95% CI: 2.51–2.56). Rural residency was associated with a higher prevalence of FGM (APR = 2.59, 95% CI: 2.56–2.61), as was unemployment (APR = 2.56, 95% CI: 2.54–2.58) and living in poorer households (APR = 2.66, 95% CI: 2.62–2.69). Women unaware of FGM had a greater likelihood of undergoing the practice compared to those who had heard about it (APR = 1.43, 95% CI: 1.37–1.51). Belief that FGM is required by religion was also linked to higher prevalence (APR = 1.94, 95% CI: 1.92–1.95). Women uncertain about whether FGM should stop or continue showed similar prevalence rates to those supporting continuation (APR = 1.94, 95% CI: 1.92–1.95). Agreement with wife-beating correlated with higher FGM prevalence (APR = 2.76, 95% CI: 2.74–2.79). Husband or partner characteristics also influenced prevalence. Women whose husband or partner had primary education were more likely to have undergone FGM compared to those whose partners had no formal education (APR = 2.59, 95% CI: 2.56–2.63). Access to media was another factor; women who engaged with mass media at least once a week had slightly higher prevalence rates compared to those who did not (APR = 1.07, 95% CI: 1.05–1.09). Lastly, decision-making autonomy in healthcare was linked to FGM prevalence; women whose husband or partner solely made decisions about their healthcare were more likely to have undergone FGM compared to those who made decisions independently (APR = 1.07, 95% CI: 2.48–2.54), as summarized in Table . 

This study aimed at assessing the prevalence and determinants of FGM in the ten countries most at risk of FGM in SSA. The overall pooled prevalence of 53.5% underscores that FGM remains a significant public health issue in the region, warranting urgent attention. Notably, our analysis reveals considerable variability in the burden across different countries, with Guinea exhibiting the highest prevalence at 94.5%, while Nigeria reports the lowest at 19.48%. This discrepancy highlights the necessity for tailored, country-specific interventions rather than a uniform approach to combat FGM across SSA. The disparities in FGM prevalence can be attributed to the distinct socio-cultural, legal, and systemic contexts in each country. In Guinea, FGM remains deeply entrenched in cultural traditions and is increasingly medicalised, with healthcare providers playing a dual role in perpetuating and potentially addressing the practice. A formative study conducted in Guinea revealed that healthcare providers, often part of FGM-practicing communities, align with prevailing beliefs and norms, contributing to the practice’s medicalisation while also highlighting the systemic barriers to comprehensive health sector responses . The study recommended incorporating FGM-specific content into clinical training, enhancing accountability to legal standards, and fostering multi-sectoral approaches to promote FGM abandonment. These findings point to the critical role healthcare providers can play as change agents when supported by robust systemic interventions. Furthermore, the reported prevalence aligns closely with the 56.4% found in a systematic review and meta-analysis involving twelve SSA countries, reinforcing the pressing nature of this issue and the need for targeted action . Additionally, our analysis revealed that the most commonly practiced type of FGM in SSA is flesh removal. This finding aligns with results from other studies . The prevalence of this specific type of FGM underscores the need for targeted educational and intervention programs that address the cultural beliefs and practices surrounding flesh removal, ultimately aiming to reduce its incidence and promote women’s health and rights. Older women exhibited a higher likelihood of having undergone FGM, with a marked increase in prevalence observed in the 45–49 age group compared to those aged 20–24. This trend may be indicative of generational differences, reflecting the fact that older cohorts were born and raised during periods when cultural practices surrounding FGM were more deeply ingrained in societal norms. These practices were often seen as vital to social cohesion, marriageability, and cultural identity. As time progresses, however, societal attitudes toward FGM are evolving, and these traditional ties are weakening, particularly among younger generations. The decline in the prevalence of FGM, especially among younger women, aligns with broader shifts in attitudes and a growing movement towards women’s rights and health. In many sub-Saharan African communities, increasing awareness about the harmful health and psychological impacts of FGM, alongside efforts to promote gender equality, has led to a gradual rejection of the practice. These changing norms suggest that younger women, who are more likely to benefit from education and advocacy campaigns, may be less susceptible to the pressures of tradition. This generational shift reflects a broader societal change in which FGM is increasingly viewed as an outdated and harmful practice that contradicts efforts to protect and empower women . Therefore, it is likely that older women face a higher risk of undergoing FGM compared to their younger counterparts. This pattern aligns with findings from other studies conducted in various parts of Sub-Saharan Africa, suggesting that the persistence of traditional practices may be more pronounced in older generations. As cultural norms evolve, younger women may benefit from increasing awareness and changing attitudes towards FGM, further highlighting the need for targeted interventions that address the specific challenges faced by different age groups [ , , ]. Educational level emerged as a significant factor, with women without formal education showing a higher likelihood of undergoing mutilation compared to those with secondary education or higher. This disparity may be linked to a lack of awareness about the harmful effects of FGM among women with limited education . In contrast, education is associated with enhanced knowledge and understanding of the risks linked to FGM, a trend corroborated by findings from other studies [ , , , ]. This underscores the importance of educational initiatives aimed at raising awareness about FGM and its implications, particularly for women in communities where traditional practices are still prevalent . Empowering women through education can play a pivotal role in reducing the prevalence of FGM and promoting informed choices about their health and rights . Similar findings are reported in other studies done elsewhere in SSA [ , , , ]. Increased efforts must be directed toward enhancing women’s education levels, as this is vital for effectively ending FGM in Sub-Saharan Africa [ , , ]. Furthermore, women living in rural areas exhibited a prevalence of FGM that was 2.59 times higher than that of their urban counterparts. This disparity may reflect the persistence of traditional practices and cultural norms that are more deeply entrenched in rural communities. Similar findings have been reported in other studies across Sub-Saharan Africa [ , , , ], indicating that geographical location plays a significant role in the prevalence of FGM. The implications of these findings highlight the need for targeted interventions that address the unique challenges faced by rural populations, including enhanced education and community engagement to challenge and change harmful cultural practices . However, contradictory findings are reported in other studies  indicating that women from rural setting are less likely to undergo FGM compared to their counter parts from urban areas. This inconsistency highlights the complexity of FGM dynamics and underscores the importance of considering local cultural, social, and economic factors when designing interventions. It suggests that while rural areas may often exhibit higher prevalence rates, urbanization and increased access to education and healthcare can alter these patterns. Therefore, it is essential for future research to explore the nuanced factors influencing FGM practices in various settings, ultimately informing more effective and context-specific strategies to combat this practice. Furthermore, women who were unemployed demonstrated a significantly higher likelihood of undergoing FGM, with an adjusted prevalence ratio of 2.56 compared to their employed counterparts. This association likely reflects broader socio-economic factors, as unemployment is often associated with limited access to education, healthcare, and social support systems. These challenges may leave unemployed women more vulnerable to traditional practices like FGM, as they may lack the resources or networks to resist societal pressures or seek alternative options. Additionally, unemployment may be linked to lower social mobility, reinforcing the perpetuation of harmful cultural practices within certain communities , which in turn may perpetuate traditional practices such as FGM. This finding underscores the need to address the socio-economic vulnerabilities faced by unemployed women, as targeted interventions that empower them through employment and education could play a crucial role in reducing the prevalence of FGM. Similar findings are reported in other studies done in SSA . Additionally, women who expressed uncertainty about whether FGM should be continued or abandoned had a prevalence ratio of 1.94 for being mutilated compared to those who actively supported the practice. This finding resonates with results from previous studies, which indicate that women who hold ambivalent attitudes toward FGM are often more likely to undergo the procedure themselves. This highlights the complex interplay between beliefs and practices surrounding FGM; women who are uncertain may feel societal pressures that reinforce the continuation of the practice. These insights suggest the need for targeted educational initiatives that not only inform communities about the harmful effects of FGM but also empower women to challenge and change prevailing norms . Our analysis also found that women from the poorest households were more likely to undergo FGM compared to those from wealthier households. This disparity may stem from the economic dependency of women on men, as well as rigid societal structures that limit their autonomy. In economically disadvantaged households, women may have fewer resources, less educational attainment, and limited social support, which can reduce their ability to challenge or refuse FGM. These socio-economic constraints, combined with deep-rooted cultural norms, make it more difficult for women in poorer households to resist the pressures to conform to traditional practices . Such dependence not only reinforces traditional practices but also reflects broader socio-economic inequalities that contribute to the perpetuation of FGM. These findings highlight the urgent need for interventions that address both economic empowerment and the dismantling of harmful cultural norms, enabling women to make informed choices about their bodies and health . Similar findings are reported in other studies done elsewhere in SSA [ , , ]. Women who engaged with mass media at least once a week reported a prevalence ratio of 1.07 for undergoing FGM compared to those who never consume mass media. These results are surprising, as exposure to mass media typically provides access to messages that oppose FGM and enhance awareness of its negative consequences. This paradox may suggest that while mass media can disseminate information against FGM, it might also inadvertently reinforce traditional narratives or social pressures within certain contexts [ , – ]. For instance, media messages might emphasise cultural identity or inadvertently validate practices perceived as community traditions. To better understand these dynamics, further research is needed to analyse the content and framing of media messages, the types of media consumed, and the socio-cultural contexts of media audiences in regions with persistently high FGM prevalence. Such studies could uncover insights into how media consumption interacts with attitudes and practices related to FGM. The decision-making authority regarding a woman’s healthcare significantly influences whether she undergoes FGM. Women whose healthcare decisions are made by their husbands or partners had a prevalence ratio of 2.51 for undergoing FGM compared to those who make their own healthcare choices. This finding aligns with results from other studies, reinforcing the importance of women’s empowerment as a crucial strategy in the fight against FGM . By promoting autonomy in healthcare decision-making, we can help reduce the prevalence of FGM and enhance women’s overall health and well-being. Empowering women to take control of their health decisions is essential for challenging and changing the societal norms that perpetuate this harmful practice. In line with the Social Ecological Model (SEM)  the findings of this study underscore the multifaceted and interconnected nature of the factors that sustain the practice of FGM in SSA, highlighting the need for a comprehensive approach to its eradication. The socio-ecological model serves as a valuable lens to understand the various layers of influence that perpetuate this harmful practice. Based on our findings and supported by the SEM, FGM is not merely an individual behaviour but a deeply ingrained social and cultural norm that is shaped and reinforced by broader societal, economic, and institutional structures. At the individual level, age and educational attainment are significant predictors of FGM prevalence, with older women and those with no formal education being disproportionately affected. This suggests that a lack of education and awareness plays a crucial role in the perpetuation of FGM, emphasising the need for targeted educational interventions to inform individuals about the risks and human rights implications of the practice. Furthermore, the cultural traditions and social norms that uphold FGM are often more entrenched in rural communities, where access to education, healthcare, and alternative practices is limited. In these contexts, FGM may be viewed as a rite of passage, religious thing or a necessary cultural practice, making it particularly resistant to change [ , , , ]. The study also highlights the strong link between FGM and socioeconomic status, with women from poorer households or those who are unemployed being more likely to undergo FGM. This underscores the intersectionality of social disadvantage, where economic hardship, lack of opportunities, and social isolation increase the vulnerability of women to harmful cultural practices. These findings stress the importance of addressing the issue of FGM on multiple levels. While individual education and awareness-raising are critical, efforts to reduce FGM must also focus on transforming community norms and practices [ , , – ]. This involves engaging local leaders, religious figures, and other influential community members in dialogue to shift perceptions and challenge the social pressures that perpetuate FGM . Additionally, improving access to education, healthcare, and economic opportunities is essential for breaking the cycle of poverty and reducing vulnerability to FGM. Structural interventions, such as legal frameworks that protect women and girls, must also be strengthened to create an environment where the practice of FGM is no longer tolerated or normalised. Ultimately, a holistic approach that addresses the individual, community, and societal factors contributing to FGM is required to effectively eliminate the practice and protect the rights of women and girls across SSA. Recommendations and implications for policy, research and practice Governments in Sub-Saharan Africa must prioritise strengthening legal frameworks that explicitly prohibit female genital mutilation (FGM). This could entail enacting and enforcing comprehensive laws that impose penalties on those who facilitate or perform the practice . Advocacy campaigns are also essential to raise awareness about these laws, underscoring their significance in protecting women’s rights and health. Moreover, FGM prevention should be integrated into national health policies. This integration can involve educational initiatives that highlight the health risks associated with FGM within maternal and child health programs, as well as broader community health initiatives. Policymakers should allocate resources to train healthcare providers to effectively identify and address FGM-related health issues. Investment in education and awareness campaigns targeting high-risk communities is crucial . These campaigns should focus on the health implications of FGM, promote gender equality, and challenge the cultural norms that sustain the practice. By fostering community awareness, it is possible to cultivate a more informed public that is willing to reject harmful practices. Community engagement is vital for instigating change regarding FGM . Engaging local communities in discussions about the practice can provide insights into their beliefs and values. Community-based programs should empower women and girls through education and support networks, enabling them to advocate for their rights. Additionally, training community leaders as champions against FGM can further encourage cultural shifts toward abandoning the practice . Enhancing educational opportunities for girls, particularly in rural areas, is another key intervention . Initiatives such as scholarships, mentorship programs, and awareness campaigns that highlight the importance of education can help reduce the prevalence of FGM, as educated women are less likely to undergo the practice. Future research should include longitudinal studies that explore the causal relationships between socio-demographic factors and FGM prevalence. Such research can help identify specific factors that lead to changes in mutilation practices over time. Additionally, investing in qualitative research is critical for understanding the lived experiences of women and communities affected by FGM. By exploring personal narratives and cultural contexts, researchers can inform more effective intervention strategies and policies. Evaluating the effectiveness of current anti-FGM interventions is also necessary. Understanding which strategies work and under what circumstances can guide future programming and resource allocation, ensuring that efforts are focused on approaches with proven impact. Strengths and limitations of the study This cross-sectional study benefits significantly from the use of nationally representative data sourced from the Demographic and Health Surveys (DHS), encompassing a robust sample of 129,182 women aged 15–49 years. This large sample size allows for the generation of national estimates, enhancing the generalizability of the findings and providing a comprehensive understanding of FGM status across diverse socio-demographic groups. The employment of sample-weighted data further ensures that the results reflect the broader population, reducing biases that might arise from unweighted analyses. However, the study’s cross-sectional design presents limitations in establishing cause-effect relationships. While the analysis offers valuable insights into the associations between socio-demographic characteristics and FGM status, the nature of cross-sectional data limits the ability to draw definitive conclusions about the directionality of these relationships. It is crucial to acknowledge that the associations observed may be influenced by underlying cultural or temporal factors that are not captured in this snapshot of data. Additionally, the reliance on secondary data introduces constraints regarding the availability of certain known variables, such as ethnicities or tribes within which FGM is performed. This limitation restricts the analysis to only those variables present in the dataset, potentially overlooking important nuances in FGM practices. Furthermore, the use of self-reported data on a sensitive topic like FGM raises concerns about the accuracy of responses. Participants may be prone to over-reporting or underreporting their mutilation status due to social desirability or stigma, which can affect the reliability of the results. As a result, caution should be taken in interpreting these findings with respect to causation. Another methodological limitation of this study is the variation in the years of the most recent DHS surveys across African countries. This discrepancy arises from differences in national survey schedules, funding availability, and logistical challenges. The timing of these surveys often reflects country-specific priorities, resource constraints, and the demand for updated data to inform policies and programs. Additionally, surveys are sometimes timed to align with national development plans or international reporting requirements. These differences in survey years may introduce temporal heterogeneity, which has been acknowledged as a limitation of the study . 

Governments in Sub-Saharan Africa must prioritise strengthening legal frameworks that explicitly prohibit female genital mutilation (FGM). This could entail enacting and enforcing comprehensive laws that impose penalties on those who facilitate or perform the practice . Advocacy campaigns are also essential to raise awareness about these laws, underscoring their significance in protecting women’s rights and health. Moreover, FGM prevention should be integrated into national health policies. This integration can involve educational initiatives that highlight the health risks associated with FGM within maternal and child health programs, as well as broader community health initiatives. Policymakers should allocate resources to train healthcare providers to effectively identify and address FGM-related health issues. Investment in education and awareness campaigns targeting high-risk communities is crucial . These campaigns should focus on the health implications of FGM, promote gender equality, and challenge the cultural norms that sustain the practice. By fostering community awareness, it is possible to cultivate a more informed public that is willing to reject harmful practices. Community engagement is vital for instigating change regarding FGM . Engaging local communities in discussions about the practice can provide insights into their beliefs and values. Community-based programs should empower women and girls through education and support networks, enabling them to advocate for their rights. Additionally, training community leaders as champions against FGM can further encourage cultural shifts toward abandoning the practice . Enhancing educational opportunities for girls, particularly in rural areas, is another key intervention . Initiatives such as scholarships, mentorship programs, and awareness campaigns that highlight the importance of education can help reduce the prevalence of FGM, as educated women are less likely to undergo the practice. Future research should include longitudinal studies that explore the causal relationships between socio-demographic factors and FGM prevalence. Such research can help identify specific factors that lead to changes in mutilation practices over time. Additionally, investing in qualitative research is critical for understanding the lived experiences of women and communities affected by FGM. By exploring personal narratives and cultural contexts, researchers can inform more effective intervention strategies and policies. Evaluating the effectiveness of current anti-FGM interventions is also necessary. Understanding which strategies work and under what circumstances can guide future programming and resource allocation, ensuring that efforts are focused on approaches with proven impact. 

This cross-sectional study benefits significantly from the use of nationally representative data sourced from the Demographic and Health Surveys (DHS), encompassing a robust sample of 129,182 women aged 15–49 years. This large sample size allows for the generation of national estimates, enhancing the generalizability of the findings and providing a comprehensive understanding of FGM status across diverse socio-demographic groups. The employment of sample-weighted data further ensures that the results reflect the broader population, reducing biases that might arise from unweighted analyses. However, the study’s cross-sectional design presents limitations in establishing cause-effect relationships. While the analysis offers valuable insights into the associations between socio-demographic characteristics and FGM status, the nature of cross-sectional data limits the ability to draw definitive conclusions about the directionality of these relationships. It is crucial to acknowledge that the associations observed may be influenced by underlying cultural or temporal factors that are not captured in this snapshot of data. Additionally, the reliance on secondary data introduces constraints regarding the availability of certain known variables, such as ethnicities or tribes within which FGM is performed. This limitation restricts the analysis to only those variables present in the dataset, potentially overlooking important nuances in FGM practices. Furthermore, the use of self-reported data on a sensitive topic like FGM raises concerns about the accuracy of responses. Participants may be prone to over-reporting or underreporting their mutilation status due to social desirability or stigma, which can affect the reliability of the results. As a result, caution should be taken in interpreting these findings with respect to causation. Another methodological limitation of this study is the variation in the years of the most recent DHS surveys across African countries. This discrepancy arises from differences in national survey schedules, funding availability, and logistical challenges. The timing of these surveys often reflects country-specific priorities, resource constraints, and the demand for updated data to inform policies and programs. Additionally, surveys are sometimes timed to align with national development plans or international reporting requirements. These differences in survey years may introduce temporal heterogeneity, which has been acknowledged as a limitation of the study . 

This study underscores the high prevalence of female genital mutilation (FGM) across ten Sub-Saharan African countries, with a pooled prevalence of 53.5%. The findings highlight significant socio-demographic disparities in FGM prevalence, demonstrating that older women are more likely to be subjected to the practice, with prevalence ratios increasing consistently with age. Educational attainment plays a pivotal role, as women with no formal education are significantly more likely to undergo FGM compared to those with secondary education or higher. Moreover, the study reveals a strong association between rural residency and higher FGM prevalence, emphasising the cultural and regional variations that influence the practice. Employment status and household wealth also contribute to these disparities, with unemployed women and those from poorer households being more likely to experience FGM. These results illustrate the complex interplay of socio-economic, educational, and cultural factors that perpetuate FGM, underscoring the need for targeted interventions that address these determinants to reduce the prevalence of the practice and protect the rights and well-being of women and girls. These insights emphasise the need for targeted interventions that address the socio-economic and educational factors influencing FGM prevalence. Efforts to eradicate this harmful practice must consider the specific contexts and vulnerabilities of at-risk populations, particularly in rural areas and among less educated women. Future policies should focus on empowering women through education and economic opportunities, while also engaging communities in dialogue to shift cultural norms surrounding FGM. The findings of this study serve as a crucial foundation for ongoing research and advocacy aimed at eliminating FGM and protecting women’s health and rights in the region. 

