Female genital mutilation/cutting: changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia

Figures & data

Table 1 Socio-demographic characteristics of the sample population

	n	%
Sex
Male	561	44.4
Female	703	55.6
Ethnicity
Mandinka	503	40.3
Wollof	126	10.1
Fula	266	21.3
Serahuleh	23	1.8
Jola	126	10.1
Serere	61	4.9
Other	143	11.5
Occupation
HP	475	36.9
Student	813	63.1
Area of residence
Urban	690	55
Rural	566	45
	n	Mean
Mean age, years	1,256	27.9

Abbreviation: HP, health professional.

Table 2 Knowledge according to occupation, gender, and ethnicity

	Occupation
	Total		HP		Students		P-value
	%	95% CI	%	95% CI	%	95% CI
FGM/C is a deeply rooted cultural practice in Gambian society	96.5	(95.5, 97.5)	97.3	(95.8, 98.8)	96.1	(94.7, 97.4)	0.272
FGM/C is practiced by both Muslims and Christians in The Gambia	66.7	(64.0, 69.3)	72.9	(68.7, 77.1)	63.2	(59.8, 66.6)	,0.01
FGM/C is mandatory by religion	24.6	(22.1, 27.0)	22.9	(18.9, 26.8)	25.5	(22.4, 28.6)	0.304
There are specific laws that ban the practice of FGM/C in The Gambia	41.3	(38.5, 44.1)	38.1	(33.5, 42.7)	43.0	(39.5, 46.6)	0.099
FGM/C violates human rights	77.9	(75.6, 80.3)	77.8	(73.9, 81.7)	78.0	(75.0, 80.9)	0.948
FGM/C is a rite of passage for girls into womanhood	41.3	(38.5, 44.1)	49.5	(44.8, 54.3)	36.7	(33.2, 40.1)	<0.01
FGM/C consequences on health
No consequences	1.5	(0.8, 2.2)	2.0	(0.6, 3.4)	1.2	(0.4, 2.0)	0.301
Reduction of sexual feelings is a consequence on health of FGM/C	33.0	(30.3, 35.9)	25.1	(20.8, 29.4)	37.3	(33.8, 40.9)	<0.01
Transmission of infected diseases is a consequence on health of FGM/C	78.5	(76.1, 80.9)	70.8	(66.3, 75.3)	82.6	(79.9, 85.4)	0.01

	Gender
	Total		Men		Women		P-value
	%	95% CI	%	95% CI	%	95% CI
There are specific laws that ban the practice of FGM/C in The Gambia	41.3	(38.5, 44.1)	32.4	(28.0, 36.8)	46.2	(41.9, 50.5)	<0.01
FGM/C violates human rights	77.9	(75.6, 80.3)	76.5	(72.4, 80.5)	83.4	(80.5, 86.6)	0.01
FGM/C is a rite of passage for girls into womanhood	41.3	(38.5, 44.1)	40.3	(35.7, 45.0)	36.6	(32.5, 40.8)	0.106
FGM/C consequences on health
Difficulty during childbirth is a consequence on health of FGM/C	65.0	(62.2, 67.8)	64.1	(59.6, 68.7)	68.4	(64.4, 72.4)	0.161

	Ethnicity
	Total		Mandinka		Wollof		Fula		Serahuleh		Jola		Serere		P-value
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
There are specific laws that ban the practice of FGM/C in The Gambia	41.3	(38.5, 44.1)	37.0	(32.0, 42.1)	38.2	(28.7, 47.7)	46.9	(39.9, 54.0)	20.0	(19.9, 38.0)	36.1	(26.5, 45.7)	45.8	(31.6, 60.1)	0.01
FGM/C violates human rights	77.9	(75.6, 80.3)	75.5	(71.0, 79.9)	81.4	(73.8, 89.0)	82.5	(77.1, 87.8)	80.0	(62.0, 98.0)	76.3	(67.8, 84.8)	79.2	(67.5, 90.8)	<0.01
FGM/C is practiced by both Muslims and Christians in The Gambia	66.7	(64.0, 69.3)	65.7	(60.8, 70.7)	73.5	(64.9, 82.1)	70.6	(64.2, 77.1)	50.0	(27.5, 72.5)	72.2	(63.2, 81.1)	62.5	(48.6, 76.4)	0.11
FGM/C is mandatory by religion	24.6	(22.1, 27.0)	24.2	(19.8, 28.7)	5.9	(1.3, 10.5)	25.8	(19.6, 32.0)	25.0	(5.5, 44.5)	27.8	(18.9, 36.8)	7.8	(2.9, 12.7)	<0.01
FGM/C consequences on health
Reduction of sexual feelings is a consequence on health of FGM/C	33.0	(30.3, 35.9)	33.7	(28.8, 38.6)	30.4	(21.4, 39.4)	33.5	(26.8, 40.2)	50.0	(27.5, 72.5)	32.0	(22.6, 41.3)	27.1	(14.4, 39.8)	0.492
Affects the health and welfare of women and girls	7.2	(5.7, 8.8)	5.8	(3.4, 8.3)	6.9	(1.9, 11.8)	7.7	(4.0, 11.5)	15.0	(0.0, 31.1)	5.2	(0.7, 9.6)	6.3	(0.0, 13.2)	0.775
There are no consequences of FGM/C on health	1.5	(0.8, 2.2)	1.7	(0.3, 3.0)	0	–	1.0	(0.0, 2.5)	10.0	(0.0, 23.5)	3.1	(0.0, 6.6)	0.0	–	0.122
Difficult penetration during sex is a consequence of FGM/C on health	12.7	(10.7, 14.6)	12.8	(9.3, 16.3)	9.8	(4.0, 15.6)	11.9	(7.3, 16.4)	5.0	(0.0, 14.8)	15.5	(8.2, 22.7)	14.6	(4.5, 24.7)	0.53

Note: Results are based on ‘yes’ answers.

Abbreviations: FGM/C, female genital mutilation/cutting; CI, confidence interval; HP, health professional.

Table 3 Attitudes according to occupation, gender, and ethnicity

	Occupation
	Total		HP		Students		P-value
	%	95% CI	%	95% CI	%	95% CI
What is your opinion of the practice of FGM/C?
It is a good practice	14.5	(12.5, 16.5)	11.8	(8.8, 14.8)	16.0	(13.4, 18.6)	0.128
It is a harmful practice	71.6	(69.1, 74.1)	74.1	(70.1, 78.2)	70.1	(66.9, 73.3)
It is neither good nor bad	13.9	(12.0, 15.9)	14.1	(10.8, 17.3)	13.9	(11.4, 16.3)
What do you think of families that practice FGM/C?
They are practicing a good tradition	13.6	(11.7, 15.6)	12.6	(9.4, 15.7)	14.2	(11.8, 16.7)	0.709
They are subjecting themselves to unnecessary pain and suffering	71.8	(69.2, 74.3)	72.8	(68.7, 77.0)	71.2	(68.0, 74.3)
They are doing what is expected of them	14.6	(12.6, 16.6)	14.6	(11.3, 17.9)	14.6	(12.1, 17.1)
Do you think that girls who have not undergone FGM/C should be discriminated against in your community?	10.5	(8.8, 12.2)	12.7	(9.6, 15.8)	9.3	(7.2, 11.3)	0.059
Is it a good idea for men to be concerned about the debate on FGM/C?	90.0	(88.3, 91.7)	90.4	(87.6, 93.2)	90.0	(87.6, 91.9)	0.724
Do you think that the practice of FGM/C should continue?	25.4	(22.9, 27.8)	23.5	(19.5, 27.6)	26.4	(23.2, 29.5)	0.282
Do you think health personnel/health workers have a role to play in preventing FGM/C?	93.7	(92.3, 95.1)	94.1	(91.8, 96.3)	93.5	(91.8, 95.2)	0.706
What do you think of “medicalizing” FGM/C?
It makes the practice safer	28.7	(26.1, 31.3)	23.4	(19.3, 27.5)	31.7	(28.3, 35.0)	0.01
It is a way of encouraging FGM/C	22.8	(20.3, 25.2)	24.1	(20.0, 28.2)	22.0	(19.0, 25.0)
It should be stopped at all levels	48.5	(45.7, 5.14)	52.4	(47.7, 57.3)	46.3	(42.7, 49.9)
If you have a daughter in the future, do you intend to circumcise her?	24.4	(22.0, 26.8)	21.3	(17.4, 25.2)	26.1	(23.0, 29.2)	0.061
Will you support the proposal of introducing initiating girls without cutting as an alternative rite of passage?	72.2	(69.7, 74.8)	74.3	(70.1, 78.5)	71.1	(67.9, 74.4)	0.241

	Gender
	Total		Men		Women		P-value
	%	95% CI	%	95% CI	%	95% CI
What is your opinion of the practice of FGM/C?
It is a good practice	14.5	(12.5, 16.5)	20.3	(16.9, 23.7)	9.4	(7.2, 11.6)	<0.01
It is a harmful practice	71.6	(69.1, 74.1)	64.7	(60.7, 68.8)	77.4	(74.2, 80.5)
It is neither good nor bad	13.9	(12.0, 15.9)	14.9	(11.9, 17.9)	13.2	(10.7, 15.8)
What do you think of families that practice FGM/C?
They are practicing a good tradition	13.6	(11.7, 15.6)	17.8	(14.5, 21.0)	10.2	(7.9, 12.6)	<0.01
They are subjecting themselves to unnecessary pain and suffering	71.8	(69.2, 74.3)	66.9	(62.9, 70.9)	75.6	(72.3, 78.9)
They are doing what is expected of them	14.6	(12.6, 16.6)	15.4	(12.3, 18.4)	14.2	(11.5, 16.8)
Would you support any legislation that bans the practice of FGM/C in The Gambia?	75.4	(73.0, 77.8)	68.2	(64.2, 72.1)	81.1	(78.2, 84.1)	<0.01
Is it a good idea for men to be concerned about the debate on FGM/C?	90.0	(88.3, 91.7)	90.5	(88.0, 93.0)	90.1	(87.8, 92.3)	0.813
Do you think that the practice of FGM/C should continue?	25.4	(22.9, 27.8)	29.5	(25.6, 33.4)	21.3	(18.1, 24.4)	<0.01
In your opinion, why should FGM/C be stopped?
Because it affects the health and welfare of women and girls	67.2	(64.4, 70.0)	63.4	(59.1, 67.6)	70.4	(66.9, 74.0)	<0.01
Because it violates the human rights of women and girls	16.7	(14.5, 18.8)	13.8	(10.7, 16.8)	18.8	(15.8, 21.9)
I do not support a ban on FGM/C	16.2	(14.0, 18.3)	22.9	(19.2, 26.6)	10.7	(8.3, 13.1)
Do you think health personnel/health workers have a role to play in preventing FGM/C? (Yes)	93.7	(92.3, 95.1)	93.0	(90.8, 95.2)	94.3	(92.5, 96.1)	0.354
What do you think of “medicalizing” FGM/C?
It makes the practice safer	28.7	(26.1, 31.3)	35.6	(31.5, 39.8)	23.3	(20.0, 26.6)	<0.01
It is a way of encouraging FGM/C	22.8	(20.3, 25.2)	20.2	(16.8, 23.7)	24.6	(21.2, 27.9)
It should be stopped at all levels	48.5	(45.7, 5.14)	44.2	(39.9, 48.5)	52.2	(48.2, 56.1)
If you have a daughter in the future, do you intend to circumcise her?	24.4	(22.0, 26.8)	31.1	(27.3, 35.3)	19.1	(16.1, 22.1)	<0.01
Will you support the proposal of introducing initiating girls without cutting as an alternative rite of passage?	72.2	(69.7, 74.8)	71.7	(67.8, 75.6)	73.2	(69.7, 76.6)	0.575

	Ethnicity
	Mandinka		Wollof		Fula		Serahuleh		Jola		Serere		P-value
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
What is your opinion of the practice of FGM/C?
It is a good practice	17.3	(13.4, 21.2)	4.0	(1.3, 7.8)	14.2	(9.5, 18.9)	5.3	(0.0, 15.6)	14.0	(6.9, 21.1)	6.1	(0.0, 12.9)	<0.01
It is a harmful practice	66.5	(61.6, 71.3)	91.1	(85.5, 96.7)	71.1	(65.0, 77.2)	73.7	(53.3, 94.1)	74.2	(65.2, 83.1)	79.6	(68.2, 91.0)
It is neither good nor bad	16.2	(12.4, 20.0)	5.0	(0.7, 9.2)	14.7	(9.9, 19.5)	21.1	(2.2, 39.9)	11.8	(5.2, 18.4)	14.3	(4.4, 24.2)
What do you think of families that practice FGM/C?
They are practicing a good tradition	14.3	(10.7, 17.9)	5.9	(1.3, 10.6)	14.7	(9.9, 19.5)	5.3	(0.0, 15.6)	12.9	(6.0, 19.8)	6.1	(0.0, 12.9)	<0.01
They are subjecting themselves to unnecessary pain and suffering	67.3	(62.5, 72.1)	89.1	(83.0, 95.2)	72.5	(66.5, 78.6)	68.4	(46.9, 89.9)	72.0	(62.9, 81.2)	85.7	(75.8, 95.6)
They are doing what is expected of them	18.4	(14.4, 22.4)	5.0	(0.7, 9.2)	12.8	(8.3, 17.3)	26.3	(5.9, 46.7)	15.1	(7.7, 22.4)	8.2	(0.4, 15.9)
Would you support any legislation that bans the practice of FGM/C in The Gambia?	72.0	(67.4, 76.6)	87.1	(80.6, 93.7)	74.9	(69.0, 80.8)	78.9	(60.1, 97.8)	78.5	(70.1, 86.9)	87.8	(78.5, 97.0)	<0.01
Do you think that the practice of FGM/C should continue?	33.1	(29.0, 37.5)	10.0	(5.8, 16.7)	27.0	(21.9, 32.8)	22.7	(10.1, 43.4)	24.6	(17.8, 32.9)	15.8	(8.5, 27.4)	<0.01
Do you think that girls who have not undergone FGM/C should be discriminated against in your community?	12.6	(9.2, 16.1)	3.0	(0.0, 6.3)	9.5	(5.5, 13.4)	5.3	(0.0, 15.6)	14.0	(6.9, 21.1)	12.2	(3.0, 21.5)	0.041
Do you think it is a good idea for religious leaders to preach against FGM/C?	60.4	(55.4, 65.5)	82.2	(74.7, 89.7)	68.7	(62.4, 75.0)	68.4	(46.9, 89.9)	63.4	(53.6, 73.3)	67.3	(54.1, 80.6)	<0.01
Do you think the practice of FGM/C can ever be eliminated in The Gambia?	52.6	(48.0, 57.2)	68.1	(59.2, 75.7)	55.7	(49.4, 61.8)	59.1	(38.7, 76.7)	55.0	(46.1, 63.6)	79.3	(67.2, 87.7)	<0.01
Do you think health personnel/health workers have a role to play in preventing FGM/C?	92.0	(89.2, 94.8)	98	(95.3, 100.0)	94.3	(91.2, 97.4)	94.7	(84.4, 100.0)	90.3	(84.3, 96.4)	95.9	(90.3, 100.0)	0.163
What do you think of “medicalizing” FGM/C?
It makes the practice safer	33.7	(29.3, 38.1)	18.6	(11.6, 25.7)	36.0	(29.9, 42.0)	22.7	(4.8, 40.7)	29.9	(21.6, 38.3)	16.7	(6.6, 26.7)	<0.01
It is a way of encouraging FGM/C	20.0	(16.3, 23.7)	26.3	(18.3, 34.3)	20.7	(15.5, 25.8)	40.9	(19.9, 62.0)	28.2	(20.0, 36.4)	27.8	(15.7, 39.8)
It should be stopped at all levels	46.3	(41.6, 50.9)	55.1	(46.1, 64.1)	43.4	(37.1, 49.7)	36.4	(15.8, 57.0)	41.9	(32.9, 50.9)	55.6	(42.2, 68.9)
If you have a daughter in the future, do you intend to circumcise her?	31.3	(26.5, 36.1)	6.9	(1.9, 11.9)	28.0	(21.9, 34.0)	10.5	(0.0, 24.7)	26.9	(17.8, 36.0)	16.3	(5.9, 26.8)	<0.01
Will you support the proposal of introducing initiating girls without cutting as an alternative rite of passage?	70.1	(65.4, 74.8)	76.2	(67.9, 84.6)	73.9	(68.0, 79.9)	68.4	(46.9, 89.9)	69.9	(60.5, 79.3)	79.6	(68.2, 91.0)	0.568

Note: Results are based on ‘yes’ answers.

Abbreviations: FGM/C, female genital mutilation/cutting; CI, confidence interval; HP, health professional.

Table 4 Practices according to occupation, gender, and ethnicity

	Total		HP		Students		P-value
	%	95% CI	%	95% CI	%	95% CI
Is FGM/C practiced in your family/household?	71.5	(68.9, 74.0)	75.4	(71.4, 79.4)	69.3	(66.0, 72.5)	0.022
As a health care provider, have you ever carried out FGM/C on a girl?a	5.9	(4.5, 7.2)	10.5	(7.9, 13.7)	–	–	–
In your practice as a health care provider, have you ever seen a girl with complications after FGM/C?a	52.8	(50.0, 55.6)	62.6	(58.1, 67.2)	–	–	–

	Total		Men		Women		P-value
	%	95% CI	%	95% CI	%	95% CI
Is FGM/C practiced in your family/household?	71.5	(68.9, 74.0)	72.9	(69.2, 76.7)	70.6	(67.1, 74.0)	0.366
As a health care provider, have you ever carried out FGM/C on a girl?a	10.5	(7.6, 13.4)	6.2	(3.5, 10.8)	12.0	(8.5, 16.7)	0.047
In your practice as a health care provider, have you ever seen a girl with complications after FGM/C?a	62.6	(58.1, 67.2)	53.1	(45.8, 60.2)	69.7	(63.6, 75.2)	<0.01

	Mandinka		Wollof		Fula		Serahuleh		Jola		Serere		P-value
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Is FGM/C practiced in your family/household?	89.6	(86.9, 92.4)	23.4	(15.9, 30.9)	85.0	(80.6, 89.4)	90.9	(78.6, 100.0)	79.5	(72.3, 86.7)	43.3	(30.7, 56.0)	<0.01
As a health care provider, have you ever carried out FGM/C on a girl?a	10.6	(6.7, 16.3)	9.5	(3.8, 22.1)	7.0	(3.2, 14.4)	0.0	(0.0, 32.4)	10.6	(4.6, 22.6)	0.0	(0.0, 13.3)	0.49
In your practice as a health care provider, have you ever seen a girl with complications after FGM/C?a	59.1	(51.5, 66.4)	69.0	(54.0, 80.9)	61.9	(51.2, 71.6)	87.5	(52.9, 97.8)	63.8	(49.5, 76.0)	72.0	(52.4, 85.7)	0.498

Notes:

a Only working health professionals’ responses were considered. Results are based on ‘yes’ answers.

Abbreviations: FGM/C, female genital mutilation/cutting; CI, confidence interval; HP, health professional.