Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

Figures & data

Figure 1 Conceptual framework showing factors associated with female genital mutilation.

Table 1 Female Genital Mutilation by Background Characteristics in Ethiopia, Findings from 2000 to 2016 EDHS

Percentage of Participants Who Had Been Circumcised
	2000 EDHS (N=15,367)		2005 EDHS (N=14,070)		2016 EDHS (N=7248)
Age (Mean ± SD)	28.13 ±9.64		28.90 ±9.44		28.14 ± 9.16
Characteristics	FGM%	Total (%)	FGM%	Total (%)	FGM%	Total (%)
Age (years)
15–19	70.72	3710 (24.14)	64.22	3566 (23.21)	51.64	1523 (21.01)
20–24	78.34	2859 (18.61)	75.26	2547 (18.10)	63.3	1194 (16.47)
25–29	81.42	2585 (16.82)	79.59	2517 (17.89)	73.44	1356 (18.71)
30–34	86.15	1841 (11.98)	79.55	1808 (12.85)	82.21	1124 (15.50)
35–39	83.56	1716 (11.17)	82.86	1602 (11.39)	80.77	939 (12.95)
40–44	85.84	1392 (9.06)	84.23	1187 (8.44)	77.16	610 (8.42)
45–49	86.79	1264 (8.22)	83.68	1143 (8.12)	81.53	502 (6.93)
Religion
Orthodox	76.77	7763 (50.52)	70.71	6920 (49.19)	58.79	3157 (43.56)
Catholic	66.87	175 (1.14)	77.69	173 (1.23)	73.71	52 (0.72)
Protestant	71.87	2433 (15.83)	71.57	2654 (18.87)	73.23	1674 (23.09)
Muslim	91.80	4456 (29.00)	90.28	4009 (28.49)	84.87	2288 (31.56)
Traditional	66.85	503 (3.27)	49.16	189 (1.34)	62.14	55 (0.76)
Others	73.46	37 (0.24)	74.35	123 (0.87)	20.86	22 (0.30)
Occupation
Working	79.57	5657 (36.82)	76.13	9266 (65.86)	72.94	3516 (48.51)
Not working	80.11	9705 (63.18)	76.78	4804 (34.14)	67.96	3732 (51.49)
Age at first marriage
Early (<18)	82.21	8585 (55.87)	79.07	7475 (53.13)	78.53	3364 (62.05)
≥18	77	6781 (44.13)	73.28	6595 (46.87)	63.31	2058 (37.95)
Marital status
Never in union	70.91	3688 (24)	65.17	3516 (24.99)	51.53	1826 (25.19)
Married/ Had partner	82.63	9789 (63.70)	80.75	9066 (64.44)	77.2	4711 (64.99)
Divorced/ Widowed/ separated	83.40	1890 (12.30)	75.67	1487 (10.58)	73.53	711 (9.82)
Wealth index
Poorest	75.92	2885 (21.1)	74.81	2428 (17.26)	75.56	1127 (15.55)
Poorer	76.63	806 (5.9)	78.03	2643 (18.78)	73.15	1284 (17.71)
Middle	80.47	2731 (19.9)	76.91	2732 (19.42)	77.14	1408 (19.43)
Richer	79.21	2553 (18.7)	78.79	2646 (18.81)	73.56	1445 (19.93)
Richest	72.36	4684 (34.3)	73.89	3621 (25.73)	58.51	1984 (27.37)
Educational level
No education	80.44	11,551 (75.17)	79.22	9271 (65.89)	81.02	3406 (46.99)
Primary	78.42	2425 (15.78)	72.61	3123 (22.20)	66.34	2505 (34.56)
Secondary	77.68	1304 (8.49)	68.43	1482 (10.53)	50.89	889 (12.27)
Higher	85.46	87 (0.56)	58.11	194 (1.38)	50.74	448 (6.19)
Residence
Urban	79.79	2791 (18.17)	72.53	2499 (17.76)	55.49	1665 (22.97)
Rural	79.94	12,576 (81.83)	77.15	11,571 (82.24)	74.81	5583 (77.03)
Region
Central regions	79.48	14,011 (91.18)	73.77	12,405 (88.17)	70.28	6345 (87.54)
Peripheral regions	87.74	552 (3.59)	87.76	801 (5.69)	89.85	378 (5.22)
Metropolitans	82.04	804 (5.23)	68.71	864 (6.14)	57.47	525 (7.24)
Community media access
Low	80.44	14,681 (95.54)	74.18	10,063 (71.52)	72.97	4575 (63.12)
High	66.55	686 (4.46)	74.46	4007 (28.48)	65.93	2673 (36.88)
Community poverty
Low	75.47	9587 (62.39)	74.11	8989 (63.96)	68.43	4837 (66.73)
High	69.10	5780 (37.61)	74.51	5071 (36.04)	74.28	2411 (33.27)
Community women educational level
Low	80.44	11,551 (75.17)	77.28	9271 (65.89)	81.02	3406 (46.99)
High	78.32	3816 (24.83)	68.42	4799 (34.11)	60.94	3842 (53.01)

Figure 2 Trend of female genital mutilation in Ethiopia using 2000, 2005, and 2016 EDHS data.

Table 2 Findings of the Multilevel Logistic Regression to Identify the Factors Associated with Female Genital Mutilation in Ethiopia Using Data from 2016 EDHS

Background Characteristics	COR (95% CI)	AOR (95% CI)
Religion
Orthodox	1.00	1.00
Catholic	1.86 (0.72,4.82)	1.79(0.69,4.65)
Protestant	1.16 (0.90,1.51)	1.14(0.87,1.48)
Muslim	6.51(5.04,8.39)***	5.48(4.23,7.09)***
Traditional	0.68(0.14,3.34)	0.61(0.13,2.88)
Others	1.06(0.29,3.82)	1.06(0.29,3.88)
Educational level
No education	1.00	1.00
Primary	0.88(0.71,1.09)	0.87(0.71,1.09)
Secondary	0.56(0.43,0.73)***	0.57(0.44,0.74)***
Higher	0.39(0.29,0.54)***	0.40(0.29,0.54)***
Respondent’s age (Years)
15–19	1.00	1.00
20–24	1.72(1.36,2.18)***	1.72(1.36,2.18)***
25–29	2.32(1.78,3.03)***	2.36(1.80,3.09)***
30–34	3.67(2.72,4.96)***	3.73(2.76,5.05)***
35–39	4.42(3.22,6.07)***	4.55(3.31,6.25)***
40–44	4.03(2.84,5.72)***	4.11(2.90,5.85)***
45–49	4.94(3.31,7.38)***	5.06(3.38,7.57)***
Occupation
Working	1.00	1.00
Not working	1.20(1.02,1.41)*	1.20(1.02,1.41)*
Age at first marriage(years)
Early (<18)	1.00	1.00
≥18	0.80(0.66,0.96)*	0.80(0.66,0.96)*
Marital status
Never in union	1.00	1.00
Married/ Living with partner	1.43(1.14,1.80)**	1.41(1.12,1.77)**
Divorced/ Widowed/ separated	1.32(0.96,1.79)	1.33(0.97,1.83)
Wealth index
Poorest	1.00	1.00
Poorer	0.71(0.52,0.97)*	0.86(0.58,1.09)
Middle	1.04(0.75,1.44)	1.18(0.85,1.63)
Richer	1.03(0.74,1.45)	1.17(0.83,1.66)
Richest	0.89(0.63,1.26)	1.13(0.74,1.73)
Residence
Urban	1.00	1.00
Rural	5.35(3.34,8.56)***	2.57(1.50,4.38)**
Region
Central regions	1.00	1.00
Peripheral regions	5.75(3.71,8.92)	3.04(1.96,4.70)***
Metropolitans	5.30(3.04,9.22)	3.43(2.00,5.86)***
Community media access
Low	1.00	1.00
High	1.05(0.91,1.22)	1.15(0.98,1.35)

Notes: Significant levels at p-value: ***< 0.001; **< 0.01; *< 0.05.

Table 3 Community-Level Variance Two Level Mixed Effects Logit Models Predicting Female Genital Mutilation, Ethiopia, 2016

Random Effects	Null Model	Final Model
Community variance (SE)	2.22*** (0.10)	1.85*** (0.09)
ICC (%)	60	51
PCV (%)	Reference	30.5
Model Fit Statistics
Log-likelihood	−3453.6586	−3046.5592
AIC	6911.317	6149.118

Note: Significant levels at p-value: ***< 0.001.

Abbreviations: PCV, proportional change in variance, was calculated for successive models with reference to null model to look at relative contribution of each model to explain FGM; ICC, intra-community correlation coefficient; AIC, Akaike Information Criterion; SE, standard error.