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BACKGROUND: The morbidity and mortality associated with Female Genital Mutilation (FGM) have been clearly documented. Controlling and eventually eradication this practice is very important. Despite a loud call from the WHO and other international organisations, there are extensive nationalities and societies from both developed and developing countries still practising FGM. Understanding the current magnitude and associated factors in Tanzania may bring more light for possible interventions intended to control FGM. This study is timely for this aim.
OBJECTIVE: To determine the prevalence of female genital mutilation and its associated factors among adolescent girls and young women in Tanzania.
METHODS: Secondary data analysis was conducted on data from the 2022 Tanzanian Demographic and Health Survey. The weighted sample included in this study was 2965 adolescent girls and young women aged 15-24 years. Data analysis was performed using Stata 18.0 software. The strength of the association was assessed using the adjusted odds ratio (aOR) along with its corresponding 95% confidence interval (CI).
RESULTS: The overall prevalence of FGM among adolescent girls and young women in Tanzania was 4.9% (95% CI = 3.37, 6.97). The prevalence varied significantly across the zones, ranging from < 1% in both Zanzibar and Southern zones to 19.7% in the Northern zone. Moreover, the results revealed that factors associated with FGM were rural areas (aOR = 2.09, 95% CI = 1.80, 5.44); no education (aOR = 11.59, 95% CI = 4.97, 27.03); poor (aOR = 2.41, 95% CI = 1.20, 4.83); unskilled manuals (aOR = 3.76, 95% CI = 1.97, 7.15); continued FGM (aOR = 3.86, 95% CI = 1.62, 9.18); FGM required by religion (aOR = 8.5, 95% CI = 3.15, 22.96) and watching television at least once a week (aOR = 0.20, 95% CI = 0.70, 1.56) among adolescents and young women in Tanzania.
CONCLUSIONS: Female genital mutilation among adolescent girls and young women aged 15-24 years in Tanzania has decreased slightly between 2015/16 and 2022 from 5.9% to 4.9% respectively. This was mostly associated with education level, place of residence, occupation, wealth index, mass media exposure, attitudes towards FGM. More tailored programs focusing on high prevalence zones targeting adolescent girls and young women are needed to end female genital mutilation by 2030.

OBJECTIVE: 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.
CONCLUSIONS: 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.

BACKGROUND: Due to its economic burden and change of focus, there is no gainsaying of the potential impacts of the COVID-19 pandemic on the progress of several female genital mutilation (FGM) interventions across the various countries. However, the magnitude of the potential changes in likelihood and prevalence should be more accurately explored and quantified using a statistically robust comparative study. In this study, we examined the differences in the likelihood and prevalence of FGM among 15-49 years old women before and after the pandemic in Nigeria.
METHODS: We used advanced Bayesian hierarchical models to analyse post-COVID-19 datasets provided by the Multiple Indicator Cluster Surveys (MICS 2021) and pre-COVID-19 data from the Demographic and Health Surveys (DHS 2018).
RESULTS: Results indicated that although there was an overall decline in FGM prevalence nationally, heterogeneities exist at state level and at individual-/community-level characteristics. There was a 6.9% increase in prevalence among women who would like FGM to continue within the community. FGM prevalence increased by 18.9% in Nasarawa, while in Kaduna there was nearly 40% decrease.
CONCLUSIONS: Results show that FGM is still a social norm issue in Nigeria and that it may have been exacerbated by the COVID-19 pandemic. The methods, data and outputs from this study would serve to provide accurate statistical evidence required by policymakers for complete eradication of FGM.

There is limited evidence on how to engage health workers as advocates in preventing female genital mutilation (FGM). This study assesses the feasibility, acceptability, appropriateness and impact of a person-centered communication (PCC) approach for FGM prevention among antenatal care (ANC) providers in Guinea, Kenya and Somalia.
Between August 2020 and September 2021, a cluster randomised trial was conducted in 180 ANC clinics in three countries testing an intervention on PCC for FGM prevention. A process evaluation was embedded, comprising in-depth interviews (IDIs) with 18 ANC providers and 18 ANC clients. A qualitative thematic analysis was conducted, guided by themes identified a priori and/or that emerged from the data.
ANC providers and clients agreed that the ANC context was a feasible, acceptable and appropriate entry point for FGM prevention counselling. ANC clients were satisfied with how FGM-related information was communicated by providers and viewed them as trusted and effective communicators. Respondents suggested training reinforcement, targeting other cadres of health workers and applying this approach at different service delivery points in health facilities and in the community to increase sustainability and impact.
These findings can inform the scale up this FGM prevention approach in high prevalence countries.

A deeper understanding of the factors associated with female genital mutilation remains important in the fight against this practice, particularly in developing countries. This study focused on young women (15-35 years) and pooled analysis using DHS data (2015-2019) for selected sub-Saharan African countries was done. The weighted study sample was 26289 and the data were analysed using univariate, bivariate and multivariate regression analysis. The results are based on information at the time of the survey. The overall prevalence of FGM among young women from the selected countries was 71.5%. Sierra Leone had the highest prevalence (83.7%), followed by Tanzania (80.8%), Ethiopia (73.0%), and Gambia (72.4%). The prevalence in Senegal and Guinea were both below 60%. We found that age, level of education, age at first marriage, parity, employment status, media exposure, and type of place of residence were statistically associated with FGM. This calls for targeted interventions focusing on increasing awareness, education, and empowerment for young women with low socio-economic status.
Une compréhension plus approfondie des facteurs associés aux mutilations génitales féminines reste importante dans la lutte contre cette pratique, en particulier dans les pays en développement. Cette étude s\'est concentrée sur les jeunes femmes (15-35 ans) et une analyse groupée utilisant les données DHS (2015-2019) pour certains pays d\'Afrique subsaharienne a été réalisée. L\'échantillon pondéré de l\'étude était de 26 289 et les données ont été analysées à l\'aide d\'une analyse de régression univariée, bivariée et multivariée. Les résultats sont basés sur les informations disponibles au moment de l\'enquête. La prévalence globale des MGF parmi les jeunes femmes des pays sélectionnés était de 71,5 %. La Sierra Leone avait la prévalence la plus élevée (83,7 %), suivie par la Tanzanie (80,8 %), l\'Éthiopie (73,0 %) et la Gambie (72,4 %). La prévalence au Sénégal et en Guinée était inférieure à 60 %. Nous avons constaté que l\'âge, le niveau d\'éducation, l\'âge au premier mariage, la parité, la situation professionnelle, l\'exposition aux médias et le type de lieu de résidence étaient statistiquement associés aux MGF. Cela nécessite des interventions ciblées axées sur la sensibilisation, l’éducation et l’autonomisation des jeunes femmes ayant un statut socio-économique faible.

BACKGROUND: There is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for FGM prevention.
METHODS: A cluster randomised trial was conducted in 2020-2021 in 180 antenatal care (ANC) clinics in Guinea, Kenya and Somalia. At baseline, all clinics received guidance and materials on FGM prevention and care; at month 3, ANC providers at intervention sites received PCC training. Data were collected from clinic managers, ANC providers and clients at baseline, month 3 and month 6 on primary outcomes, including delivery of PCC counselling, utilisation of level one materials, health facility preparedness for FGM prevention and care services and secondary outcomes related to clients\' and providers\' knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models.
RESULTS: Providers in the intervention arm were more likely to deliver PCC for FGM prevention compared with those in the control arm, including inquiring about clients\' FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p<0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p<0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p<0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p<0.001) FGM should be prevented. They were more confident in their FGM-related knowledge (AOR: 7.0, 95% CI: 1.5 to 32.3; p=0.012) and communication skills (AOR: 1.8; 95% CI: 1.0 to 3.2; p=0.035). Intervention clients were less supportive of FGM (AOR: 5.4, 95% CI: 2.4 to 12.4; p<0.001) and had lower intentions of having their daughters undergo FGM (AOR: 0.3, 95% CI: 0.1 to 0.7; p=0.004) or seeking medicalised FGM (AOR: 0.2, 95% CI: 0.1 to 0.5; p<0.001) compared with those in the control arm.
CONCLUSIONS: This is the first study to provide evidence of an effective FGM prevention intervention that can be delivered in primary care settings in high-prevalence countries.
UNASSIGNED: PACTR201906696419769 (3 June 2019).

Female genital mutilation is widely recognised as a practice that causes grave, permanent damage to the genital anatomy and function. The literature has documented its impact on physical, sexual, emotional, and mental wellbeing, and this has informed the development of guidelines and recommendations for managing women with female genital mutilation. There has, though, been little, if any, focus on how women with female genital mutilation experience menopause. A literature search did not return any published research on the topic and there are currently no clinical guidelines for managing the menopause in women who have undergone female genital mutilation. This review calls attention to this gap by exploring the clinical implications that the loss of natural hormones has on the vulvovaginal tissues, as well as on urogenital and sexual function. Psychological aspects of the experience of women with female genital mutilation going through menopause are also explored, as well as common barriers they face in accessing adequate healthcare. Finally, we offer a set of recommendations for clinical practice, including the need to improve current care pathways, and potential directions for future research.

Female genital mutilation or cutting (FGM/C) is a practice involving the partial or complete removal of the external female genitalia for non-medical reasons. To facilitate attitude changes, the ecological model of behavior change considers multiple levels of influence and their relationships with environmental and behavioral factors. The combined effects of migration and cultural adaptation result in a transformative process that leads to decreased support for FGM/C. This qualitative study aimed to gain knowledge from FGM/C field professionals regarding the factors promoting behavioral changes in migrant communities in Geneva, Switzerland. Between September and October 2023, we conducted semi-structured interviews using a reflexive thematic analysis. Our qualitative research is reported in accordance with the COREQ criteria. A data analysis was performed using NVivo 14 software. Four influential dimensions were identified, each with associated factors. The first dimension, the social level, includes (1) the impact and implementation of anti-FGM/C laws. The second dimension, the community level, encompasses four factors such as (2) religion, (3) a multifaceted examination of social aspects, (4) navigating language barriers and raising awareness, and (5) cultural adaptation processes. The third dimension, the interpersonal level, includes factors such as (6) changing views on the marriage prerequisite. Finally, the fourth dimension, the personal level, is associated with (7) women\'s experiences and perspectives regarding FGM/C. The findings highlight seven environmental factors, both within and across dimensions of the ecological model, that interact with human behavior to enable an adaptive cultural process. This process influences changes in attitudes and behaviors regarding FGM/C.

Female genital mutilation and cutting (FGM/C) is a human rights violation and a form of gender-based violence. Yet it is estimated that more than 230 million women and girls globally and over half a million women and girls living in the United States have been subjected to FGM/C or are at risk. Due to rising rates of immigration to the United States, it is more likely that health care providers will encounter patients subjected to FGM/C. In this column, I review clinicians\' knowledge of and experience in delivering care to women with FGM/C, patient experiences, the role of clinical guidelines, screening, research gaps, laws, and data. I conclude with recommendations from professional organizations related to the reproductive health needs of women affected by FGM/C during pregnancy and birth.