Female genital mutilation (FGM) is defined by the World Health Organization as any procedure that involves partial or entire removal of the external female genitalia, or other harm to the female genital organs for no medical reason. The practice is usually carried out by women who are often involved in other important aspects of their communities, such as attending childbirths. Health care providers, on the other hand, execute more than 18% of all FGM, and the tendency toward medicalization is growing (WHO Fact Sheet, 2019). At least 200 million girls and women worldwide have been subjected to FGM in 30 countries, including Ethiopia, Kenya, Somalia, Tanzania, and Uganda. They are also becoming more common in Europe, Australia, New Zealand, Canada, and the United states, mostly among immigrants from cultures where FGM is a common practice (UNFPA- UNICEF, 2019).

Out of a total population of 205 683 girls aged 0-18 originating from countries where female genital mutilation is prevalent, it is estimated that 12 to 21% of girls in France are at danger of female genital mutilation (European Institute for Gender Equality, 2018). Teixeira and Lisboa calculated that nearly 6,500 immigrant women 15 years and older had been circumcised in Portugal, while 1,830 girls under 15 years are likely to or have been circumcised, according to the study by Odukogbe et al. (2017) report. The practice is founded in traditional beliefs, values, and attitudes, and is regarded as a rite of passage into femininity and child marriage in many nations (WHO, 2016).

FGM/C is prevalent in more than 70% of African countries, according to estimates from Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Guinea, Mali, Mauritania, Northern Sudan, and Somalia. However, because of ethnicity and culture, there is a wide range of frequency between and within countries. Mali, for example, has a frequency of 92%, compared to 28% in Senegal. The most severe form of FGM (infibulations), which involves the sewing and narrowing of the vaginal hole, is estimated to have been performed on 15% of all circumcised women. However, in Djibouti, Somalia, and Sudan, this method of circumcision accounts for about 80 to 90% of all circumcisions (The European Institute for Gender Equality, 2015).

FGM is a type of gender-based violence that has been identified as a harmful practice and a violation of girls' and women's human rights. In the 28 African nations and Yemen where FGM is performed, over 125 million girls and women have had FGM, and 3 million girls are projected to be at danger of FGM each year (Unicef Anual Report, 2013). According to an Ethiopian demographic and health survey, 65% of women between the ages of 15 and 49 are circumcised. Female circumcision is most common in Somalia (99%) and least common in Tigray (24%), whereas it is most common in Wolayita (92.3%).

Clitoridoctomy is the most common kind of FGM in Ethiopia. Without having their vaginal area sowed, 96.2% of women and 96.5% of daughters have undergone some sort of circumcision. Infibulations is the most extreme type of FGM/C, involving the excision of genitalia and the closing of the vaginal hole with stitching. It has been experienced by 2.9% of Ethiopian women and 3.4% of daughters. This is because it suggests that some women who have never had infibulations want to have their daughters circumcised in the most severe way possible. Ethiopia has one of the highest rates of infant girls who are subjected to any type of female genital mutilation (Unicef Anual Report, 2013).

The study's goal was to determine the prevalence of female genital mutilation in the study area, as well as the factors that contribute to the continuation of female genital mutilation.

Study area and period

The research was carried out in Damot Gale Woreda, in the Wolayita zone of Southern Ethiopia. Damote Gale was around 302 km south of Addis Ababa, through Butajira's major road, and 138 km from Hawassa. There are 30 rural kebeles in the woreda. The population of Damot gale Woreda was estimated to be 154,610 in the 2008 E.C census (Damot Gale Wored Static Bureau, 2008). The research was carried out between the months of June and August. Area map of Damot Gale was shown in (Figure 1).

Research design

A community-based cross-sectional quantitative design was conducted at Damot Gale Woreda, Wolayita Zone.

Source population

Women residing in Damote Gala Woreda served as the study's source population.

Study population

The study population was drawn from all reproductive-age women in the household.

Sample size determination

The investigation of Woreda Damot Gale was chosen on purpose because FGM is a widely performed area. Then, at random, eight rural Kebeles from the Woreda's 30 Kebeles were chosen. The sample size was then proportionally allocated to each of the selected Kebeles based on the number of homes in each. The computed sample size was then proportionally allocated to each of the eight Kebeles based on the number of households in each Kebele. Finally, the Kebele lottery method was used to choose study subjects using family folder numbers. Women from chosen families were eligible to participate in the interview as respondents. The sample size was calculated using a single population proportion formula. According to the EDHS, the current prevalence of FGM in Southern Ethiopia was 62% (Ethiopian Public Health Institute Addis Ababa, 2019).  

d=Margin of error 5%                                 

- Z=1.96 at desired confidence level 95%                                                                                              

n = (zα/2)² P (1-P)/d ²                                    

- 10% of non-response rate

n= [1.96×1.96]0.62[1-0.62]/0.05×0.05               

n=315 then add 10% non-response rate gives

Final sample size is 347 respondents.

Sampling procedure

Damot Gale administrative Study Keble was selected by using Schematic picture below in (Figure 2).

A binary logistic regression analysis was used to evaluate the bivariate association between each independent variable and the outcome variable. For multivariate logistic regression, variables that exhibited a significant correlation on bivariate analysis with a p-value of 0.05 were employed. To reduce the impact of confounding variables and identify FGM factors, multivariate logistic regression analysis was employed. The adjusted odds ratio with 95% confidence interval and p-value of 0.05 as cut point were used to analyze the strength of the link between dependent and independent variables.

Ethical consideration

The nature and purpose of the study were explained to the respondents and Woreda administration. Following   ethical permission from the Damot Gale Woreda administrative office, the Woreda delivered an official letter to the sampled Kebeles and concerned offices. Afterall, verbal consent to participate in the study was gained from the respondents. The survey participants were given an open and honest explanation of the survey's goal, a description of the benefits, and the opportunity to ask any questions they had. They were also told that they might withdraw their agreement and quit participation at any time without fear of being labeled chauvinists. The privacy and confidentiality of the information acquired were ensured throughout the operation.

Socio-demographic characteristics of respondents

A total of 333 women took part in the survey, with a 96% response rate. Due to incompleteness, fourteen questionnaires (3.4%) were rejected. Daughters in this study ranged in age from 18 to 49 years old. The average age was 34.05 years (SD 7.9). In terms of religious affiliation, 166 respondents (49.8%) were Protestant, 111 (33.3%) were Orthodox, and 42 (12.6%) were Muslims. The ethnicity of almost all of the interviewees was Wolayita 270 (81.1%). In terms of education, 208 (62.5%) of respondents were literate, while 125 (37.5%) had no formal education. In terms of familial educational background, the vast majority of research participants were uneducated. Formal schooling was followed by 212 (63.6%) and 121 (36.4%). Husbands of respondents 143 (42.9 percent) had some level of education, while others had no formal education (Table 1).

The majority of the respondents (324, or 97.3%) were married, while some (8, or 2.4%) were divorced, and one was widowed (0.3%). Ninety-two percent (57.7%) of fathers were farmers, whereas 151% (45%) of moms worked as housewives. In terms of respondents' wealth, sixty-eight (20.4%) were judged to be in the second quintal index level, while about the same proportion (19.8%) were in the highest quintal index level. As a result, we concluded that the amount of wealth among respondents is not considerably different (Table 2).

Figure 4 depicts the frequency distribution of female genital mutilation in relation to respondents' educational status. Their educational background ranges from uneducated (no formal schooling) through grade twelve. In a nutshell, the graph showed that as educational levels rose, so did the prevalence of female genital mutilation (Figure 3).

Prevalence of the female genital mutilation

Two hundred and ninety-six (88.9%) of the total responders were circumcised, whereas just 37 (11.1%) were not circumcised. The majority of circumcisions were done on children aged 1 to 5, accounting for 171 circumcisions (51.4%). Despite the fact that all types of circumcision were used in the studied area, Clitoridoctomy 286 (85.8) is the most common kind of FGM. Traditional circumcisers 131 performed the majority of the circumcisions at home 282 (95.5%). When asked who made the decision to circumcise their daughters, the majority decided by moms 182 (54.6%), dads 139 (41.7%), and 12 (3.6%) by the daughter herself (Table 3).

Factor associated with FGM

Circumcision is regarded as a good tradition and typical practice by 154 (46.2%) of the total respondents, whereas FGM is regarded as the best practice for the cleanliness of female genitals by 24 (10.5%) of the total respondents. Eighty-one (24.3%) of the women would like to continue circumcision because they believe it is a positive custom. When asked about their plan to circumcise their daughters, the majority of respondents (84%) said they would continue the practice.

In terms of FGM treatment, around 183 (35.4%) and 66 (19.8%) of women believe that legislation enforcement and women's access to education are the best approaches to prevent FGM, respectively, whereas only one (0.3%) respondent believes that dads should take the effort to prevent FGM. Even though the  vast  majority of respondents 216 (64.9%) are aware of the dangers of female genital mutilation, nearly half of them 154 (46.2%) confirm the practice's continuation because it is seen as a positive custom 81 (24.3%) (Table 4). Qualitative data, such as uncircumcised women in a focus group discussion, backs it up.

As Figure 4 indicated in the findings of this study, out of those who face the complication of FGM, 31.8, 56.8 and 11.4% went to health institution, traditional healer and other places to cure from the defect, respectively (Figure 5).

When females were asked if they had ever heard of Female Genital Mutilation, nearly 299% (89.8%) said they had recently learned of FGM in the research region. While nearly 10% of respondents had no access to information regarding FGM, 121 (36.3%) acquire their knowledge via the radio. Furthermore, 250 (75.1%) of the women are aware of written laws against female genital mutilation. When asked about female genital circumcision and its impact on women's rights, the majority of respondents (71.5%) were unaware of the legal status of FGM, while just 28% of women believe circumcision violates women's human rights (Figure 5).

Despite the fact that several measures to prevent FGM were carried out in the research area, the prevalence of FGM remains high due to insufficient law enforcement and community resistance (Table 5). This is in line with a qualitative study in which the majority of focus group discussants stated that punishment was ineffective and that the community was resistive to anti-FGM efforts.

Analysis of factors associated to female genital mutilation

Bivariate analysis

Bivariate analysis revealed the following: maternal education (COR: 0.467, 95% CI: 0.212, 1.029), age of daughters (COR 1.92, 95% CI: 0.53, 1.25) household wealth index quintal (COR: 0.768, 95% CI: 0.550, 1.072), father's educational status (COR: 1.135, 95% CI: 0.808, 1.595), good tradition COR: 9.895, 95% CI: 2.213, 4.251). At a p-value of 0.25, knowledge of FGM health complications (COR: 0.339, 95% CI: 0.134, 0.859) and knowledge of FGM law (COR: 0.042, 95% CI: 0.005, 0.349) were candidate variables for a multivariate logistic regression model (Table 6).

Multivariate analysis

During crude analysis, factors were adjusted using multiple logistic regressions to predict variables related with Female Genital Mutilation. At a p-value of 0.05, variables such as age, maternal education, traditional FGM, and knowledge of health complications connected to FGM were significant.

The odds of experiencing FGM were nearly 45% higher in mothers who did not educate than in mothers who did [AOR: 0.454, 95% CI: 0.209, 0.984]. The odds of experiencing FGM were about two times higher in younger daughters than in elder daughters [AOR: 0.454, 95% CI: 0.209, 0.984]. Women who accept FGM because of tradition [AOR: 1.86, 95% CI: 0.42, 0.98] have 14 times higher odds of performing it than women who oppose it [AOR: 14.595, 95% CI: 3.391, 6.807]. Moreover, FGM in the household which mothers did not know about any of the health complication of FGM were 35% more at risk of performing FGM as compared to in the household in which mothers knows about the health complication of FGM [AOR: 0.356, 95% CI :0.145, 0.877] (Table 7).

The determining factor on the prevalence of FGM in this research was knowledge about the health problems of FGM. Moreover, FGM in household which mothers did not know about any of the health complication of FGM were 65% more at risk of performing FGM as compared to the household in which mothers know about the health complication of FGM. This is same percent as research finding done on school girls in Addis Ababa. Factors associated with perceived continuation of Female Genital Mutilation showed that those who have knowledge of avoiding HIV/AIDS was 60% (Uchenna et al., 2019). Knowledge of women in this study with four major complication areas such as excessive bleeding (22.2%), obstructed labor (21.9%), menstrual disturbance (17.4%) and sexual problems (25.5%) is similar with a study which is done at Gambia with higher prevalence of long-term health problems such as dysmenorrhea and vaginal pain problems related to anomalous healing such as keloid and sexual dysfunction. Women with FGM/C were also much more likely to suffer complications during delivery for example, perineal tear, obstructed labor, and episiotomy (Abeya et al., 2017). Other complications secondary to FGM according to the study conducted at Bale zone Ethiopia adds excessive bleeding at the time of the procedure, infection, urine retention and swelling of genital organ (Yirga et al., 2012; Karmaker et al., 2011).

The main other reason in this study for the higher prevalence of FGM in this study is the perception of community members about FGM practice as a tradition. The long persistence of FGM is partly ascribed to the dominant role of men played in influencing the society as a whole. In which majority of participants claimed a tradition was the main reason for a long term persistence of FGM in the study area supported due to good tradition of FGM showing that women who support FGM as a good tradition were 14 times more likely circumcised than women who oppose the practice. This is also supported by a community-based cross-sectional survey conducted in Kersa district Eastern Hararge in which societal beliefs played a major role. This was the main reason given for Genital Cutting which was to reduce “female hyperactivity” in sexual practice, and was the response of 60% of the women, while a quarter of the women responded that it was done to prevent early initiation of sexual activity (Ethiopian Public Health Institute Addis Ababa, 2019).

The authors have not declared any conflict of interests.