Published on Investing in Health

Ending Female Genital Mutilation (FGM) across generations

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The attention given to female genital mutilation (FGM) as a harmful practice has grown in recent years. Yet, while ending the practice is a target under the Sustainable Development Goals, it remains common in many countries.

FGM has potentially life-threatening health consequences for girls, especially when the cutting is severe (infibulation). The practice has been linked to infections, infertility, and childbirth complications, among others. Cases of girls dying after being cut have been documented. The practice may also affect a girls’ newborn due to complications at birth.

Last week,the World Bank held an event ahead of the International Day of Zero Tolerance for FGM on February 6. The event featured a powerful documentary about Jaha Dukureh, a survivor of FGM who led a campaign to end the practice in The Gambia. Jaha was able to share her message about the negative impacts of the practice and the need to end it with the audience. In addition, a photo exhibit entitled The Face of Defiance, which benefited from a grant from Wallace Global Fund, celebrated other survivors and campaigners against FGM.

Several presentations of on-going analytical work were made at the event, with a focus on the drivers of the practice and what can be done to end it. One presentation was based on work I did with a colleague using Demographic and Health Surveys for six African countries. We looked at the transmission of FGM from one generation to the next in two separate ways: through support among women for the practice, and through decisions by mothers on whether to have their daughters cut. The main findings, summarized in a short brief, are as follows:

  • The role of social norms and community pressures in the perpetuation of the practice is large. Daughters living in an area where the practice is common face much higher risks of being cut. Similarly, community prevalence strongly affects support for the continuation of the practice
  • The personal experience of mothers also makes a substantial difference for the transmission of the practice across generations. The risk of cutting for daughters increases dramatically if the mother was herself cut. It also increases if the mother was married as a child.
  • The risk for daughters of being cut and overall support for the practice tend to be at the margin higher among poorer households as identified by quintiles of wealth.
  • Educating girls should help reduce the prevalence of FGM. First, mothers with a secondary education are less likely to have their daughters cut. They are also less likely to support the continuation of the practice. In addition, secondary education for girls would help reduce child marriage and improve earnings and thereby wealth for households. Through these indirect effects as well, better educational attainment for girls should contribute to a reduction in FGM.
  • One piece of good news is that the likelihood for mothers of having their daughters cut is lower among younger age groups, although differences by age in support for the practice are smaller.
Overall, the results suggest that apart from targeted interventions aiming to change community and individual practices related to FGM, investments in girls’ education may also play a positive role, provided however that girls reach and ideally complete their secondary education.

However, aiming to end FGM simply by investing in girls’ education would take too much time, and education only is not enough on its ownThere is a need for urgent action to end the practice. Molly Melching, the Founder and CEO of Tostan, shared lessons from her organization’s work, including a recent evaluation of a three-year program implemented in four countries from 2014 to 2016. The evaluation suggests that targeted campaigns and interventions  at the level of communities can make a substantial difference in social norms and attitudes towards FGM as well as other issues related to women’s empowerment in communities.

Finally, the World Bank released a brand new Compendium on international and national legal frameworks on FGM. Knowledge of the law is an important empowerment tool to end FGM. The Compendium provides a survey of the key international and regional instruments as well as domestic legislation as they relate to the prohibition.

The title of the event last week was Ending FGM: The role of laws, education, and social norms. We will need to tackle all three with targeted interventions as well as broader investments in women and girls to end the practice within a generation.


Quentin Wodon

Lead Economist, Education Sector, World Bank

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