Female Genital Mutilation in Ethiopia's Afar Region: Patterning, Drivers, and Decision-Making.

Purpose: To explore the patterning, practices, and drivers of female genital mutilation (FGM) in Ethiopia's Afar region.

Methods: This article draws on mixed-methods research conducted in 2022 in 18 rural communities in three districts of Ethiopia's Afar region. Survey data were collected from 1,022 adolescents and their caregivers. Qualitative interviews were conducted with approximately 270 adults and adolescents.

Results: The survey found that FGM remains practically universal (97% of sampled adolescent girls), and infibulation remains the norm (87% of girls). Most adolescent girls and caregivers reported that FGM is required by religion and should continue. When queried about the main reason for FGM, however, most cited culture rather than religion. Female caregivers and adolescent girls were more likely to report that FGM has benefits than risks; the reverse was true for male caregivers. Qualitative evidence suggests that even girls who are not reported as infibulated generally, and that the social benefits of FGM--especially regarding controlling girls' sexuality and facilitating their marriageability--are perceived to outweigh health risks. Where there are shifts in type of FGM, it is largely due to efforts of religious leaders who preach against infibulation and for "milder" types--and the growing scope of fathers to input into mothers' FGM decision-making and advocate for less invasive types.

Discussion: Eliminating FGM requires focusing on contexts where the practice is most invasive and progress is not yet visible. Given complex intrahousehold and intragenerational dynamics, this will necessitate engaging whole communities with sustained multipronged approaches to shift social norms.