Female Genital Mutilation in Ethiopia's Afar Region: Patterning, Drivers, and Decision-Making.

PURPOSE: To explore the patterning, practices, and drivers of female genital mutilation (FGM) in Ethiopia's Afar region. METHODS: This article draws on mixed-methods research conducted in 2022 in 18 rural communities in three districts of Ethiopia's Afar region. Survey data were collected from 1,022 adolescents and their caregivers. Qualitative interviews were conducted with approximately 270 adults and adolescents. RESULTS: The survey found that FGM remains practically universal (97% of sampled adolescent girls), and infibulation remains the norm (87% of girls). Most adolescent girls and caregivers reported that FGM is required by religion and should continue. When queried about the main reason for FGM, however, most cited culture rather than religion. Female caregivers and adolescent girls were more likely to report that FGM has benefits than risks; the reverse was true for male caregivers. Qualitative evidence suggests that even girls who are not reported as infibulated generally, and that the social benefits of FGM--especially regarding controlling girls' sexuality and facilitating their marriageability--are perceived to outweigh health risks. Where there are shifts in type of FGM, it is largely due to efforts of religious leaders who preach against infibulation and for "milder" types--and the growing scope of fathers to input into mothers' FGM decision-making and advocate for less invasive types. DISCUSSION: Eliminating FGM requires focusing on contexts where the practice is most invasive and progress is not yet visible. Given complex intrahousehold and intragenerational dynamics, this will necessitate engaging whole communities with sustained multipronged approaches to shift social norms.

"People will talk about her if she is not circumcised": Exploring the patterning, drivers and gender norms around female genital mutilation in Ethiopia's Somali region.

Over the past decade there has been a burgeoning literature on social norms and the need to understand their context-specific patterning and trends to promote change, including to address the harmful practice of female genital mutilation (FGM), which affects around 200 million girls and women globally. This article draws on mixed-methods data collected in 2022 and 2023 with 1,020 adolescents and their caregivers, as well as key informants, from Ethiopia's Somali region to explore the patterning, drivers, and decision-making around FGM. Findings indicate that almost all Somali girls can expect to undergo FGM before age 15, and that infibulation is near universal. Critically, however, we find that respondents' understanding of infibulation is rooted in traditional practice, and many girls are now "partially" infibulated-an invasive procedure that girls nonetheless see as an improvement over the past. These shifts reflect religious leaders' efforts to eliminate traditional infibulation--and the health risks it entails--by promoting "less invasive" types of FGM as a requirement of Islam. We also find evidence of emergent medicalization of the practice, as mothers-who are the primary decision-makers-seek to further reduce risks. Adult and adolescent respondents agree that FGM is a deeply embedded social norm, but distinguish between FGM as a perceived religious requirement, and infibulation as a cultural requirement. For girls and women, the importance of FGM is framed around social acceptance, whereas boys and men focus on FGM as a requirement for marriage as it allows families to control girls' sexuality. The article concludes by reflecting on the implications of our findings for programming in high-prevalence contexts. Key conclusions include that FGM interventions should not rely on empowering individuals as "champions of change" but rather prioritize engagement with whole communities, and should be open in the short term to incremental harm-reduction approaches.