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.