Background: In Sudan, the prevalence of Female genital mutilation (FGM)
is declining, likely as a result of an ongoing changing attitude towards
FGM as more Sudanese women believe the practice should be discontinued
amid growing awareness about its health dangers. This study examined the
geographical variation of attitude shifts toward the abandonment of FGM,
as well as a wide range of potential correlates towards the continuation
of FGM (pro-FGM).
Methods: We conducted cross-sectional analyses of the successive DFID
Sudan opinion poll data sets (DFIDSOP) collected from 2012 to 2014,
based on 4,741 individuals (age range: 18–75 in 2012/13 and 18-97 for
2014). We used Bayesian geo-additive mixed models to map the spatial
distribution and determine the odds ratios (OR) of positive attitude
surrounding FGM continuation, accounting for individual, household and
state associated risk factors.
Results: During 2012/2013 and 2014 in Sudan, the overall percentage of
people with a positive attitude towards FGM continuation (Yes, FGM
practice should continue) was 27.5% and 18.3% respectively. In
multivariable Bayesian geo-additive regression analyses, there was a
striking geographical variation within the country and between the two
surveys. Factors that were consistently associated with a higher pro-FGM
attitude in both samples are: education (no education) [OR & 95%
Credible Region (CR): 2.15(1.03, 3.80) in 2012/13] and primary/interim
education [OR & 95% CR: 2.07(1.29, 3.18) in 2014] compared with
higher education, trust in local government (people with some trust)
[OR & 95% CR: 1.59(1.05, 2.64); in 2014] and people with little
trust in 2014 [OR & 95% CR: 2.10(1.03, 4.04)] or people with
little trust [OR & 95% CR: 1.47(1.03, 2.03) in 2012/13] compared
with people with no trust at all, identity (African identity [OR &
95% CR: 3.16(1.24, 6.48) in 2012/13] ) and tribal identity [OR &
95% CR: 3.23(1.75, 6.34) in 2014] compared with Sudanese identity and
the state of residence (living in Sinnar, Red sea, and White Nile in
2012/13 and living in South Darfur, West Darfur and White Nile in 2014)
compared with the Northern state.
Other factors associated with a higher pro-FGM attitude in each sample
were: in 2012/13, household income (501-1000STG) [OR & 95% CR:
1.43(1.03, 2.36) compared with people with income
Conclusions: The results demonstrate a significant decline and changing
attitudes in Sudan towards FGM, which can help accelerate the ongoing
reduction of the practice, with high risk estimates for a positive
attitude towards the continuation of FGM in rural settings by
un-educated people with a strong tribal identity. The notable decrease
in the practice of cutting observed between the 2006 and 2010 Sudanese
Household Surveys and the resulting shift in attitude make a compelling
case that attitudes and the practise of FGM can be changed.
Hamilton, A.; Kandala, N.G. Geography and correlates of attitude toward Female Genital Mutilation (FGM) in Sudan: what can we learn from successive DFID Sudan opinion poll data? University of Warwick, Warwick, UK (2014) 32 pp.
Geography and correlates of attitude toward Female Genital Mutilation (FGM) in Sudan: what can we learn from successive DFID Sudan opinion poll data?