DHS COMPARATIVE

REPORTS 33

FEMALE GENITAL CUTTING: 

THE INTERPRETATION OF

RECENT DHS DATA

SEPTEMBER 2013

This publication was produced for review by the United States Agency for International Development (USAID). The report was prepared by

P. Stanley Yoder and Shanxiao Wang of ICF International.
MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about the MEASURE DHS project can 

be obtained by contacting MEASURE DHS, ICF International, 11785 Beltsville Drive, Suite 300, 

Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@measuredhs.com; 

Internet: www.measuredhs.com). 

The main objectives of the MEASURE DHS project are: 

• to provide decisionmakers in survey countries with information useful for informed policy 

choices; 

• to expand the international population and health database; 

• to advance survey methodology; and 

• to develop in participating countries the skills and resources necessary to conduct high-quality 

demographic and health surveys. 
DHS Comparative Reports No. 33 

Female Genital Cutting: 

The Interpretation of Recent DHS Data 

P. Stanley Yoder 

Shanxiao Wang 

ICF International 

Calverton, Maryland, USA 

September 2013 

Corresponding author: P. Stanley Yoder, Demographic and Health Surveys, ICF International, 11785 Beltsville 

Drive, Suite 300, Calverton, MD 20705, USA; Phone: 301-572-0840; Email: Stan.Yoder@icfi.com
Acknowledgments 

The authors would like to warmly thank our colleagues from ICF International who reviewed the 

document and made numerous helpful comments: Sunita Kishor, Erica Nybro, and Rikki Welch. Their 

suggestions greatly improved the document. 

Edited: Rikki Welch 

Document Production: Yuan Cheng 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through the MEASURE DHS project (#GPO-C-00-08-00008-00) and by the U.S. 

Centers for Disease Control and Prevention (CDC) through the contract on Communications and 

Integrated Marketing Strategies, Media Services, and Database Support to the Office on Smoking and 

Health, Health Communications Branch (#200-2008-F-26188). The views expressed are those of the 

authors and do not necessarily reflect the views of USAID or the United States Government. The authors 

gratefully acknowledge input from Samira Asma, Office on Smoking and Health, CDC, on this project. 

Recommended citation: 

Yoder, P. Stanley, and Shanxiao Wang. 2013. Female Genital Cutting: The Interpretation of Recent DHS 

Data. DHS Comparative Reports No. 33. Calverton, Maryland, USA: ICF International. 
iii 

Contents 

Tables ...............................................................................................................................................v

Figures............................................................................................................................................ vi

Preface ........................................................................................................................................... vii

Acronyms ..................................................................................................................................... viii

Executive Summary ....................................................................................................................... ix

1 Introduction ................................................................................................................................1

1.1 Purpose ............................................................................................................................. 1

1.2 Specific Objectives .......................................................................................................... 1

1.3 Terminology ..................................................................................................................... 2

1.4 Organization of Report .................................................................................................... 3

2 Estimates of FGC Prevalence ....................................................................................................5

3 The Nature of DHS Data Collected ...........................................................................................7

3.1 Specific Questions Asked in the FGC Module ................................................................ 7

3.2 The Reliability of Responses: Women’s Own Experience with FGC ............................. 9

3.3 Daughters’ Experiences with FGC ................................................................................ 10

3.4 Perceptions and Opinions about FGC ............................................................................ 11

3.5 Questions Asked of Men about FGC ............................................................................. 12

3.6 Current FGC Module (2010 to Present)......................................................................... 13

3.7 Current Tabulation Plan ................................................................................................. 14

4 National FGC Prevalence Rates for Women Age 15-49 .........................................................17

4.1 National FGC Prevalence: Most Recent DHS Surveys ................................................. 17

4.2 National FGC Prevalence: All DHS Surveys ................................................................ 19

4.3 FGC Prevalence Trends: Contrasts by Age Cohort ....................................................... 21

4.4 Changes in FGC Prevalence by Age Cohort from DHS Surveys at Different Points 

in Time ............................................................................................................................23

4.5 Changes in FGC Prevalence by Generation ....................................................................26

4.6 FGC Prevalence Disaggregated by Demographic Variables and Aspects of the 

Practice ............................................................................................................................28

4.7 FGC Prevalence and Ethnicity ....................................................................................... 28

4.8 Changes Over Time in FGC Prevalence by Ethnicity ................................................... 33
iv 

5 Female Genital Cutting as an Event: the Practice ....................................................................39

5.1 Types of Cutting ............................................................................................................ 39

5.2 Categories of Cutting in the DHS Data .......................................................................... 39

5.3 Age at Circumcision ...................................................................................................... 43

5.4 Age at Circumcision for All DHS Surveys .................................................................... 45

5.5 The Identity of the Person Performing the Circumcision .............................................. 47

6 Enduring Issues ........................................................................................................................51

References ......................................................................................................................................53

Appendix ........................................................................................................................................57
v 

Tables 

Table 1A. Check list of questions asked about the experience of FGC by respondents .................8

Table 1B. Check list of questions asked about the experience of FGC for daughters of 

respondents ..................................................................................................................10

Table 1C. Check list of questions asked about the opinions of respondents on the 

practice of FGC ............................................................................................................11

Table 2. Check list of questions asked of male respondents about the practice of FGC 

in West and East African countries in which the FGC module for women was 

used ..............................................................................................................................13

Table 3. National prevalence of FGC data by region and country for most recent DHS 

survey ...........................................................................................................................17

Table 4. National FGC prevalence for all DHS surveys with FGC data by region and 

country .........................................................................................................................20

Table 5. National FGC prevalence data by age cohort for most recent DHS survey by 

country .........................................................................................................................22

Table 6. National FGC prevalence data disaggregated by age cohorts for countries with 

more than one DHS survey with FGC data over time .................................................23

Table 7. National FGC prevalence data by ethnicity for all countries with information 

on ethnicity in the DHS................................................................................................29

Table 8. National FGC prevalence data by ethnicity for four countries with more than 

one DHS survey that showed ethnicity ........................................................................34

Table 9. Percent distribution of circumcised women by type of circumcision in most 

recent DHS survey .......................................................................................................40

Table 10. Percent distribution of circumcised women by type of circumcision with 

multiple DHS surveys ..................................................................................................42

Table 11. Percent distribution of circumcised women by age of circumcision in most 

recent DHS ...................................................................................................................43

Table 12. Percent distribution of circumcised women by age when circumcision 

occurred in countries with multiple DHS surveys .......................................................46

Table 13. Percent distribution of circumcised women by type of person who did the 

cutting for the most recent DHS survey .......................................................................48

Table 14. Percent distribution of circumcised women by type of person who did the 

cutting in countries with multiple DHS surveys ..........................................................50

Table A1. Female genital cutting module for Woman’s Questionnaire .......................................57 

Table A2. Female genital cutting module for Man’s Questionnaire ............................................59 
vi 

Figures 

Figure 1. National FGC prevalence .............................................................................................18 

Figure 2. Trends in national FGC prevalence .............................................................................21 

Figure 3. FGC prevalence by age cohort .....................................................................................25

Figure 4. Women and girls circumcised by age: Burkina Faso ...................................................27 

Figure 5. Trends in FGC prevalence by ethnicity, Kenya ...........................................................36 

Figure 6. Type of circumcision ...................................................................................................41 

Figure 7. Age at circumcision .....................................................................................................44 

Figure 8. Person who performed the circumcision ......................................................................49 
vii 

Preface 

One of the most significant contributions of the MEASURE DHS program is the creation of an 

internationally comparable body of data on the demographic and health characteristics of populations in 

developing countries. 

The DHS Comparative Reports series examines these data across countries in a comparative 

framework. The DHS Analytical Studies series focuses on specific topics. The principal objectives of both 

series are to provide information for policy formulation at the international level and to examine 

individual country results in an international context. Whereas Comparative Reports are primarily 

descriptive, Analytical Studies have a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending on the 

availability of data sets. Where possible, data from previous DHS surveys are used to evaluate trends over 

time. Each report provides detailed tables and graphs organized by region. Survey-related issues such as 

questionnaire comparability, survey procedures, data quality, and methodological approaches are 

addressed as needed. 

It is anticipated that the availability of comparable information for a large number of developing 

countries will enhance the understanding of important issues in the fields of international population and 

health by analysts and policymakers. 

Sunita Kishor 

Project Director 
viii 

Acronyms 

AIDOS Associazione Italiana Donne per le Sviluppo 

DHS Demographic and Health Surveys 

FGC Female genital cutting 

FGM Female genital mutilation 

GAMS Groupes femmes pour l’abolition des mutilations sexuelles 

MICS Multiple Indicator Cluster Surveys 

TBA Traditional birth attendant 

UNICEF United Nations Children’s Fund 

WHO World Health Organization 

 
ix 

Executive Summary

This report presents data on female genital cutting collected by the Demographic and Health 

Surveys (DHS), an international survey program funded primarily by the United States Agency for 

International Development (USAID). The report provides readers with an overview of the nature of DHS 

data on Female Genital Cutting (FGC), a summary of current FGC prevalence statistics, trends in 

prevalence, and guidelines on the appropriate ways to interpret DHS data on FGC. The report updates and 

expands on the 2004 DHS publication entitled Female Genital Cutting in the Demographic and Health 

Surveys: A Critical and Comparative Analysis that appeared as No. 7 in the DHS Comparative Reports 

series. The 2004 report described the origin and evolution of questions on FGC in some detail within the 

DHS surveys from 1989 to 2002. This report provides all DHS data on FGC since 2002, as well as 

guidance on disaggregating and interpreting these data for a better understanding of patterns and trends 

observed in DHS data on FGC. 

The report seeks to facilitate the use of DHS data on FGC by guiding the reader through the 

various ways that FGC data are collected, processed, and presented. The more specific objectives the 

document seeks to meet are: 

• Provide readers with up-to-date information on the DHS data available on FGC in ways that 

complement earlier reports; 

• Document trends over time in FGC prevalence within individual countries and provide 

guidelines for how such trends should be interpreted; 

• Present the new FGC module used by DHS and UNICEF since 2010 that provides data on all 

living daughters of respondents and suggest guidelines for how such data can best be used 

and interpreted. 

After the introduction, this report includes five chapters and an appendix. The chapters address 

the following issues: 

• The collection of data to estimate the prevalence of FGC 

• The nature of the FGC data collected by DHS and the current FGC module 

• National prevalence data on FGC for women age 15-49 in African countries 

• The practice of FGC as an event 

• Issues of interpretation 

The chapter on estimating FGC prevalence country by country focuses on countries in west and 

northeastern Africa in the household surveys conducted by DHS, since that is where FGC is most often 

practiced. The next chapter describes the nature of data on FGC collected in DHS surveys and the ways in 

which the data are analyzed and reported in DHS country reports. The way that a respondent’s daughter 

was selected varied over time (oldest, youngest, most recently circumcised). The chapter on national 

prevalence presents tables that show FGC prevalence rates for all countries in Africa plus Yemen for 

which statistics on FGC are available. The chapter on the practice of FGC reports on how FGC has been 

practiced according to respondents interviewed. The final chapter briefly discusses issues that remain 

relevant for interpreting the significance of FGC within each country involved. 

The practice of female circumcision in African countries did not attract the attention of many 

trained scholars until the 1980s, and reliable estimates of FGC prevalence were not available before the 

inclusion of questions about FGC in the DHS population-based surveys. A series of questions about FGC 
x 

was standardized for use in DHS surveys in certain countries by 1995 (Yoder et al. 2004). UNICEF began 

using an FGC module in selected countries in 2005 in their Multiple Cluster Indicator Surveys (MICS3). 

National level prevalence data on FGC from population-based surveys are now available for 27 countries 

in Africa as well as Yemen and Iraq. In addition, because female immigrants to Europe from countries in 

Africa where FGC is practiced may also have been circumcised, organizations have sought ways to 

estimate the numbers of girls and women so affected. Estimates of FGC prevalence among immigrants 

usually rely on statistics from the country of origin of the female immigrants in question, and on the 

number of immigrants and their daughters in country. Such methods provide numbers that remain 

somewhat approximate. 

Nearly all DHS surveys after 2002 that used the FGC module began with an introductory 

question asking if the respondent had ever heard of FGC or something close to that phrasing. Researchers 

and analysts have generally assumed that women know whether or not they have been circumcised, and 

that they will accurately report that knowledge in the context of a survey. Questions have been raised 

about both assumptions, but the assumptions have not been often examined. Questions have also been 

raised about the possible impact of laws passed against the practice of FGC. One way to check for an 

effect of a law against the practice of FGC is to compare the prevalence rates of age cohorts over time. If 

the law has discouraged women from admitting that they have been circumcised, then we should see a 

decrease in the FGC prevalence reported for the same age cohort from one DHS survey to the next. 

Evidence of the possible impact of such laws was found for three countries. 

Women who had heard of FGC, and who had a living daughter less than 15 years old, were asked 

questions about one or more daughters and their FGC status. Earlier DHS surveys had asked only about 

the eldest daughter, as was done in Kenya 2003. With the exception of Kenya, all DHS surveys that used 

the FGC module after 2001 asked respondents about the FGC status of a living daughter. If they had no 

daughters that had been circumcised, they were asked if they intended to circumcise any of their 

daughters. 

Since DHS data on FGC prevalence has always reported on samples of women age 15 to 49, any 

changes in prevalence rates over time reflects changes that occurred at least 10 years ago and longer. That 

is, because FGC frequently takes place about the ages of five or six, the age cohort at age 15-19 was 

likely to have been at risk for FGC five to ten years earlier. Thus, prevalence data for women 15-49, in 

most cases, is not suitable for use in the evaluation of recent interventions that promote the abandonment 

of FGC. However, data on prevalence rates of girls 0-14 years of age may be useful for the evaluation of 

more recent interventions, particularly if the age at circumcision is very young. Therefore, DHS and 

UNICEF revised their FGC module in 2010 to ask respondents about the circumcision status about each 

of their living daughters less than 15 years of age. 

The revised FGC module formulated in 2010 and used since then by DHS also revised the FGC 

questions for men. The module now includes only three questions: 1) Have you ever heard of female 

circumcision? 2) Do you think that the practice of FGC is required by your religion? 3) Should this 

practice of FGC continue or be stopped? 

Chapter 4 presents the prevalence rates by country in the form of tables and graphs for the most 

recent as well as for all DHS surveys for easy reference. Countries are grouped by geographic region to 

make visible regional patterns. The table showing data for all DHS surveys (Table 4) facilitates the 

examination of trends over time, trends that are also portrayed in Figure 1. One can detect three patterns 

of trends over time in the data from the countries in Table 4: 1) there was little or no change over time 

from 10-40 years before the survey in some countries, as seen in Sudan, Chad, and Uganda; 2) there is a 

slight decline in a few countries in the prevalence of FGC from the oldest cohort to the youngest cohort, 

with the decline being greater among the younger cohorts. Eritrea, Ethiopia, Burkina Faso, Benin, and 
xi 

Senegal fit this model; and 3) a few countries show a small but steady, nearly linear, decline in prevalence 

by age cohort, as seen in Egypt, Mauritania, Cote d’Ivoire, Nigeria, and Kenya. In Senegal the age cohort 

data show that the prevalence changed very little between about 1970 and 2000, but that there was a slight 

decrease in the 1990s. 

The national prevalence disaggregated by age cohort for all DHS surveys with FGC data from 

two or more points in time is presented in tabular form (Table 6) and in a graph for selected countries. 

The table allows us to verify if the trend over time from older to younger cohorts seen in the most recent 

survey was also evident in earlier surveys. Figure 3 shows that FGC prevalence was much lower in the 

younger age cohorts for four countries. 

The presentation of FGC prevalence by urban/rural residence and by region shows evidence of 

the distribution of FGC within a country. In the majority of countries, FGC prevalence is higher in rural 

than in urban areas. In countries with a national prevalence of less than 80 percent, marked differences by 

region are often found. Regional differences in prevalence are often a reflection of ethnic composition of 

the population. Ethnicity underlies FGC distribution by urban/rural residence and by region, since ethnic 

groups are unevenly distributed within and between regions, and FGC status so often varies with 

ethnicity. Countries with a high national prevalence have relatively small differences by ethnic group, 

whereas countries with lower overall prevalence show a wide range of FGC prevalence by ethnicity. FGC 

prevalence by ethnicity in one country may range from a low of 1% to a high of 98%. Figure 5 shows 

both the range of prevalence and trends over time in three DHS surveys in Kenya. 

The details of how, when, and where FGC occurs vary tremendously from one society and one 

country to the next. Such details may determine whether or not a girl sustains damage to her health from 

the procedure. Therefore, it is useful to consider the details of how the circumcision was conducted: at 

what age, by what type of practitioner, and what was actually done at the time. The age at cutting varies 

from a few weeks or months in some countries to 12 to 14 year olds, but in the majority of countries, girls 

are cut before the age of five. 

FGC is most often performed by elderly women who are known for playing the role of 

circumciser. In a few countries, health care professionals also perform FGC. In three countries, a 

substantial proportion of girls had been cut by health care professionals in the most recent DHS survey 

(Egypt, Sudan, Kenya). Regarding the type of circumcision, infibulation is of greatest concern because of 

the harm it may do to the health of the girl. Only in northeastern Africa do we find large proportions of 

circumcised women with infibulation. Data on the type of circumcision are presented in a table and graph 

for each country for which data are available. In several countries the survey did not include questions 

about the type of circumcision. 

The issues that remain most critical to an understanding of the practice of FGC within a country 

are the prominence of FGC nationally and the number of women cut, the regional distribution of the 

practice, any trends over time in national prevalence and age cohorts, and the use of daughter data for 

program evaluation. The proper use of data on the FGC status of daughters of respondents presents an 

enduring challenge. 

The calculation of the total number of women affected in each country involves several 

assumptions, but one can arrive at a figure with some confidence with the use of prevalence numbers and 

figures for the total female population by age. The FGC prevalence for women age 45 to 49 can be used 

as a proxy and lower limit for the prevalence of women older than 49 years of age; similarly, the 

prevalence of women 15 to 19 years of age can be used as a proxy and upper limit for girls less than 15 

years old (Yoder et al. 2013). 
xii 

Taking note of the regional distribution and any urban/rural contrast are key elements for any 

assessment of the national practice of FGC. If a national survey finds that FGC prevalence is far higher in 

rural than in urban areas, as in most countries, that fact invites us to reflect on how and why families in 

urban areas act differently toward their daughters. Whether prevalence differs markedly by region 

depends to some extent on the overall prevalence, and on the importance of the practice of FGC as a 

marker for ethnicity. The distribution of the practice may be explained in terms of either the impact of 

urbanization, the ethnic composition of the population, historical trends, or some other variable. FGC 

prevalence shows more variation by ethnicity than any other demographic variable. Programs that 

promote the abandonment of the practice will find such considerations useful for policy formulation and 

program planning. 

Because the FGC module used by both DHS and MICS since 2010 asks respondents about the 

circumcision status of each of their daughters, data on daughters are now becoming available. The survey 

respondent reports on whether or not each of her daughters was circumcised, what was done, at what age, 

and the type of person (traditional or medical personnel) who performed the procedure. The new module 

makes it possible to report on the FGC status of girls at all ages from 0-14. These data show the current

FGC status of these daughters of respondents. 

However, some of these girls will be circumcised after the date of the survey. Therefore we must 

consider the difference between current FGM/C status and final FGM/C status of daughters. Since 

relatively few women are circumcised after the age of 15, when women age 15-49 are asked whether they 

have been circumcised, it is assumed that those who report that they have not been circumcised will not 

be cut in the future. Thus our FGC data on women 15-49 years of age reports on their final (FGC) status. 

We do not make that assumption for daughters less than 15 years of age, since a certain proportion will be 

later circumcised. The question is what is the size of that proportion? 

This distinction between current and final FGC status is critical for interpreting data on daughters 

0-14 years old. We must keep in mind two limitations important for a valid interpretation of data on 

daughters: first, that the FGC prevalence of girls age 0-14 years to women age 15-49 is not valid since 

many of the 0-14 age group may not have reached the age at which circumcision takes place in that 

community/country. Second, interpretation of the prevalence of FGC among girls 0-14 should be done in 

the context of the median age of circumcision for that society. This will allow for an assessment of what 

proportion of the girls 0-14 are likely to be circumcised as they age through the cohort. 

One of the reasons for asking about the FGC status of the daughters of respondents is to obtain 

data that could be used to evaluate the impact of recent programs that promote FGC abandonment. In 

countries where most circumcision occurs in the first few years of life, such data may indeed be used for 

the evaluation of the impact of recent interventions. In countries where FGC occurs largely at the ages of 

10 and above, the current FGC status of girls will be much lower than their final FGC status, and thus 

daughter data will be less useful for recent program evaluation. Nevertheless, with proper caution, data on 

daughters can add a great amount to our understanding of how circumcision has been practiced in the last 

ten years or so. 
1 

1 Introduction 

1.1 Purpose 

This report presents data on female genital cutting collected by the Demographic and Health 

Surveys (DHS), an international survey program funded primarily by the United States Agency for 

International Development (USAID). The report provides readers with an overview of the nature of DHS 

data on Female Genital Cutting (FGC), a summary of current FGC prevalence statistics, trends in 

prevalence, and guidelines on the appropriate ways to interpret DHS data on FGC. The report updates and 

expands on the 2004 DHS publication entitled Female Genital Cutting in the Demographic and Health 

Surveys: A Critical and Comparative Analysis that appeared as No. 7 in the DHS Comparative Reports 

series. That report had provided a history of how questions on FGC were developed and how they have 

evolved over time, as well as prevalence rates for FGC in 15 countries in Africa plus Yemen for the 

period 1989 to 2002. This report provides all DHS data on FGC since 2002, as well as guidance on 

disaggregating and interpreting these data for a better understanding of patterns and trends observed in 

DHS data on FGC. 

Since its initation in 1984, the DHS project has collected high quality and nationally 

representative data on an increasing number of demographic and health indicators through more than 300 

surveys in over 90 countries. The DHS program includes both household-based and facility-based 

surveys. The standard DHS household survey includes three questionnaires—the household, woman, and 

man questionnaire. In addition, optional modules of questions on topics such as domestic violence, 

maternal mortality, and FGC have been standardized for integration into the DHS questionnaires as 

requested. Survey results are widely disseminated in the countries of origin, and all reports are available 

in hardcopy as well as on the DHS website. Survey data are also available for download from the website 

or from statcompiler.com. 

In most cases, countries seek to conduct DHS surveys every five years. Host-country institutions 

and other partners can request the inclusion of the FGC module to the woman questionnaire if FGC is 

practiced in the country. To date, FGC prevalence rates are available for more than 20 countries in fiveyear intervals. A few countries (Cameroon, Ghana, Uganda) with a very low prevalence of FGC have 

opted for asking only one or two questions rather than including the entire FGC module with about 20 

questions. The 2004 report cited above (Yoder et al. 2004) described the origin and evolution of questions 

on FGC in some detail within the DHS surveys from 1989 to 2002. 

1.2 Specific Objectives 

This report seeks to facilitate the use of DHS data on FGC by guiding the reader through the 

various ways that FGC data are collected, processed, and presented. The more specific objectives the 

document seeks to meet are: 

• Provide readers with up-to-date information on the DHS data available on FGC in ways that 

complement earlier reports; 

• Document trends over time in FGC prevalence within individual countries and provide 

guidelines for how such trends should be interpreted; 

• Present the new FGC module used by DHS and UNICEF since 2010 that provides data on all 

living daughters of respondents and suggest guidelines for how such data can best be used 

and interpreted. 
2 

1.3 Terminology 

The practice of nicking or cutting or modifying female genitalia in any way was known for 

decades as ‘female circumcision’ in English, in part because researchers found that it translated fairly well 

the local terms used for the practice, and because many societies held initiation camps for boys and for 

girls that included circumcision. The practice has long been known in French as ‘excision.’ In many West 

African societies, the practice was once an integral part of a series of ceremonies performed during a 

period of seclusion for girls reaching puberty and beyond (Gessain 1960; Jackson 1977). The collection of 

papers edited by Shell-Duncan and Hernlund on female circumcision includes an extensive discussion of 

the origins of the terms (Shell-Duncan and Hernlund 2000). Numerous anthropologists have used the term 

‘female circumcision’ over the years (Droz 2000; Shell-Duncan and Hernlund 2000; 2007; Gruenbaum 

2001). 

The interagency statement about female genital mutilation (FGM) involving all agencies 

associated with the United Nations that was published in 2008 included a very brief history of terms used 

to describe FGC (World Health Organization (WHO) 2008). The authors indicate that when the practice 

was first discussed by outside observers, the term ‘female circumcision’ was used. They go further to say 

that since the term draws a parallel with male circumcision, it “creates confusion between these two 

distinct practices” (ibid: 22). The authors state that the term “female genital mutilation” began to be used 

in the late 1990s and has advantages over “female circumcision.” One, it is clearly distinguished from 

male circumcision. Two, the term ‘mutilation’ emphasizes the severity of the act. And three, it refers to 

the fact that the practice is a violation of girls' human rights, and thus would facilitate the organization of 

actions against the practice. The WHO recommended that the term 'female genital mutilation' be generally 

adopted by United Nations agencies in 1991. That term has been used since then by the WHO. 

In the mid1990s, some researchers examining the practice found that some African colleagues 

objected to the term "mutilation" since it implied deliberate harm (Eliah 1996; Shell-Duncan and 

Hernlund 2000; Gruenbaum 2001). In their review of terms used for the practice, Shell-Duncan and 

Hernlund credit a reproductive health program in Uganda (Reproductive, Educative and Community 

Health programme: REACH) with suggesting the use of the term "female genital cutting" as more neutral 

and thus more appropriate (ibid; 6). That term (FGC) was adopted by USAID in the late 1990s and has 

been used since then for the most part. The introduction by Shell-Duncan and Hernlund to their book on 

female circumcision in Africa remains the clearest and most comprehension discussion of both the variety 

of terms used to label the practice and a cogent critique of numerous stereotypes and false assumptions 

that have appeared in the literature (Shell-Duncan and Hernlund 2000). 

Some years ago, UNICEF began using yet another term: female genital mutilation/cutting, a 

composite of FGM and FGC (UNICEF 2005). The position of UNICEF is significant because of its great 

investment in promoting the abandonment of the practice. Some donors have followed suite, while others 

have not. The programs of USAID have most often used the term FGC, but sometimes one also sees 

FGM/C. This report uses mainly FGC, but also may refer sometimes to female circumcision. The English 

questionnaire of the FGC module used by DHS asks: "Are you circumcised?" We understand the 

problematic nature of the use of each of the terms mentioned above, but we consider that the neutrality of 

"female genital cutting" recommends its general use, while the term "female circumcision" also has a 

certain utility. 

 
3 

1.4 Organization of Report 

After the introduction, this report includes five chapters and an appendix. The chapters address 

the following issues: 

• The collection of data to estimate the prevalence of FGC 

• The nature of the FGC data collected by DHS and the current FGC module 

• National prevalence data on FGC for women age 15-49 in African countries 

• The practice of FGC as an event 

• Issues of interpretation 

The chapter on estimating FGC prevalence country by country focuses on countries in west and 

northeastern Africa in the household surveys conducted by DHS, since that is where FGC is most often 

practiced. However, reports on FGC in several Asian countries and the Middle East have also been 

published. The text includes a brief discussion of the challenges presented in assessing prevalence rates in 

European and American countries where some African immigrant groups may continue the practice. 

The next chapter describes the nature of data on FGC collected in DHS surveys and the ways in 

which the data are analyzed and reported in DHS country reports. The FGC module has been used to 

collect data on four topics over time: 1) the circumcision status of the respondent herself; 2) information 

about the event for those respondents who were circumcised; 3) information about the circumcision status 

of one daughter and details about the event in cases where a respondent’s daughter was circumcised; and 

4) women’s and men’s opinions of the practice. Respondents who had at least one living daughter less 

than 15 years of age were asked questions about whether and how a daughter was circumcised. The way 

that a respondent’s daughter was selected varied over time (oldest, youngest, most recently circumcised). 

However, the FGC module currently used by differs from earlier modules in two respects: respondents are 

asked about the circumcision status of all living daughters less than 15 years old rather than about just one 

daughter, and fewer questions are asked about respondents' opinions related to FGC. 

The chapter on national prevalence presents tables that show FGC prevalence rates for all 

countries in Africa plus Yemen for which statistics on FGC are available. The text compares the FGC 

prevalence of different regions of Africa: the northeast, East Africa, northern West Africa, and southern 

West Africa. Grouping country data in this manner makes it possible to discern regional patterns in FGC 

prevalence. Most countries have had more than one DHS survey, so trends over time are shown. FGC 

prevalence is shown disaggregated by demographic variables for the most recent survey in each country. 

A table also shows FGC prevalence for each country by age cohort to see to what extent prevalence rates 

have changed over time. Finally, several tables show the distribution of FGC prevalence by ethnicity. 

The chapter on the practice of FGC reports on how FGC has been practiced according to 

respondents interviewed. The FGC module asks several questions about how FGC was done: the age of 

the girl circumcised, the type of cutting done, and the type of practitioner who did the cutting. The tables 

of the chapter show data on these topics for the most recent DHS survey and for all DHS surveys with the 

FGC module. In countries for which several rounds of DHS data are available, it is possible to identify 

changes in how FGC has been practiced over time. 

The final chapter briefly discusses issues that remain relevant for interpreting the significance of 

FGC within each country involved. Issues addressed include the relative importance of FGC nationally, 

the distribution of FGC within countries, trends over time in national prevalence data, trends over time in 

data from age cohorts, and the interpretation of daughter data for program evaluation. With the relatively 
4 

new (2010) FGC module, DHS collects information about whether or not each living daughter less than 

15 years old has been circumcised or not. This new set of questions creates a distinction between current 

FGC status and ultimate FGC status: a young girl may not have been circumcised at the time of the 

survey because she had not yet reached the proper age for the event, and thus remains at risk for FGC. 

This distinction creates challenges for the interpretation of these data on girls. 

 
5 

2 Estimates of FGC Prevalence 

The practice of female circumcision in African countries did not attract the attention of many 

trained scholars until the 1980s. To be sure, European colonialists sought to eradicate the practice in parts 

of Kenya and Sudan in the 1920s and 1930s, as well as later, but these efforts proved isolated and 

ineffective. In the late 1920s, Protestant missionaries in Kenya sought to ban FGC for medical reasons; 

clitoridectomy (the partial or total removal of the clitoris) was banned in Meru district for medical reasons 

from 1956 to 1959 during the Mau Mau rebellion and the British State of Emergency (Robertson 1996). 

British authorities banned infibulation (narrowing or nearly closing the vaginal opening) but not 

clitoridectomy in Sudan in 1946, but very few arrests were made. Mention of FGC can be found in a few 

ethnographic or sociological accounts of the 1950s and 1960s, but very few paid serious attention to the 

practice, and no one sought to estimate the size and scope of the practice in African societies. 

The study of the size and scope of FGC deserves attention for many reasons. First, we need to 

know prevalence rates to calculate the numbers of girls and women affected each year. Second, we need 

data on the distribution of the practice to be able to focus medical care and/or interventions effectively. 

Third, we need to understand how FGC is performed to better promote abandonment: on whom, by 

whom, at what age, in what manner, and organized by which groups. And finally, this information is 

crucial to assess the health consequences of the practice on girls and women soon after the cutting takes 

place, as well as later in life. 

Before national-level survey data on FGC were available, other authors proposed estimates of 

FGC prevalence for various countries in Africa. The report published in 1979 by Francis Hosken (The 

Hosken Report) is often cited as the first major effort to provide an estimate for the national prevalence of 

FGC in many African countries (Hosken 1979; Yoder et al. 2004). That report, quickly reprinted, was 

important more for the role it played in getting the attention of international agencies rather than for the 

actual numbers suggested, for researchers recognized that the estimates were often based on anecdotes 

rather than observations or surveys (Abusharaf 2000). The report gave estimates of FGC prevalence for 

28 countries. Nahid Toubia, a Sudanese surgeon and anti-FGM activist, published a report in 1993 that 

also provided prevalence estimates for FGC in African countries (Toubia 1993). 

Reliable estimates of FGC prevalence were not available before the inclusion of questions about 

FGC in the DHS population-based surveys. DHS surveys began asking female respondents questions 

about FGC first in the 1989-90 survey in northern Sudan; a series of questions about FGC was 

standardized for use in DHS surveys in certain countries by 1995 (Yoder et al. 2004). In 1997, the first 

document that provided national figures for FGC prevalence from the DHS in multiple countries was 

published (Carr 1997). The report included data on national-level FGC prevalence for six countries in 

Africa plus Yemen from surveys conducted from 1989 through 1996. UNICEF began using an FGC 

module in selected countries in 2005 in their Multiple Cluster Indicator Surveys (MICS3). Both DHS and 

MICS surveys rely on asking respondents if they themselves have been circumcised for making 

prevalence estimates. By the year 2000, statistics on the prevalence of FGC from population-based 

surveys were available for 14 African countries. National level prevalence data on FGC from populationbased surveys are now available for 27 countries in Africa as well as Yemen and Iraq. 

To date, the DHS team has provided technical assistance for national surveys that have included 

questions about FGC in 22 countries in Africa plus Yemen. DHS final reports for these countries typically 

include a separate chapter with tables and descriptive text that summarizes the survey results related to 

FGC. The chapter tables show FGC prevalence by residence, by region, by ethnicity (usually), and by a 

variety of other variables that may be associated with the practice. In addition, researchers can obtain 

access to DHS data sets to conduct their own research on FGC. 
6 

Several reports on the practice of FGC in the Middle East and South Asian countries have also 

been recently published, specifically in Indonesia, Kuwait, Malaysia, Oman, Saudi Arabia, and Iraq (Isa 

et al. 1999; Population Council 2003; Wadi 2010). Without national surveys with a representative 

samples, it is not possible to obtain valid statistics on FGC prevalence for these countries. However, a 

MICS survey was conducted in Iraq in 2011 and found an FGC prevalence of 43% in Kurdistan (MICS 

2012). 

Because female immigrants to Europe from countries in Africa where FGC is practiced may also 

have been circumcised, organizations have sought ways to estimate the numbers of girls and women so 

affected. Estimates of FGC prevalence among immigrants usually rely on statistics from the country of 

origin of the female immigrants in question, and on the number of immigrants and their daughters in 

country. One example is a study from Belgium in which the authors first used several state databases to 

estimate the numbers of immigrants in Belgium from countries where FGC is practiced, and then used the 

FGC prevalence from DHS or MICS surveys to estimate the number of women from each of these 

countries that were likely to have undergone FGC (Dubourg et al. 2011). Another example is a study 

funded by the Department of Health in England that estimated the total number of girls and women with 

FGC in England and Wales ((Forward 2007). However, such estimates are not able to take into account 

the factors of ethnicity and the fact that immigrant women are not necessarily representative of all women 

in their country of origin. Indeed, the authors noted that their inability to consider ethnicity was a 

limitation for their study. Since FGC prevalence varies by ethnicity in most countries, the ethnic origins 

of immigrants should be considered in estimating FGC prevalence. 

The branches of GAMS (Groupes femmes pour l’abolition des mutilations sexuelles) in France 

and Belgium have been active in seeking to estimate the numbers of girls at risk for FGC and support 

immigrants from West Africa (Andro and Lesclingand 2007; Dieleman 2010). Similar efforts in Italy 

have been led by AIDOS (Associazione Italiana Donne per le Sviluppo), and have led to the publishing of 

a major report on FGC in Italy (AIDOS 2000). A European Parliament Resolution of March 2009 

estimated that about 500,000 girls and women with FGC live in European Union countries, but no sources 

are given for that estimate. Finally, a Dutch agency called Pharos has recently published the results of 

their extensive study on the number of girls and women with FGC in the Netherlands (Exterkate 2013). 

 
7 

3 The Nature of DHS Data Collected 

This chapter describes the nature of the data on FGC collected by DHS surveys from 2003 to 

2010 when a modified FGC module was adopted for use in the DHS. An earlier comparative report 

described the questions on FGC used in early DHS surveys and the adoption of a standard series of 

questions that became the FGC module by 1996 (Yoder et al. 2004). As in the earlier module, the FGC 

module used from 2003 to 2010 asked questions mainly about four topics: 1) the circumcision status of 

the respondent herself; 2) information about the event for those respondents who were circumcised; 3) 

information about the circumcision status of one daughter and details about the event in cases where a 

respondent’s daughter was circumcised; 4) women’s and men’s opinions of the practice. 

3.1 Specific Questions Asked in the FGC Module 

Nearly all DHS surveys after 2002 that used the FGC module began with an introductory 

question asking if the respondent had ever heard of FGC or something close to that phrasing. The 

modules used in Egypt, Liberia, and Ghana used a slightly different approach. The surveys of 2005 and 

2008 in Egypt asked simply: “Now I would like to talk about the practice of female circumcision. Have 

you yourself been circumcised?” The 2007 Liberia DHS asked about membership in a secret society 

(Sande) rather than about circumcision, and did not use many questions from the FGC module. The 2003 

Ghana DHS asked only if FGC was practiced in the area, and if the respondent was circumcised. After the 

introductory question, respondents who said they had heard of FGC are asked: "Have you (yourself) been 

circumcised?" The answer to this question forms the basis of the calculations of FGC prevalence in each 

survey. Researchers have generally assumed that women know whether or not they have been 

circumcised, and that they will be truthful in the context of answering survey questions. 

The practice of female genital cutting takes many different forms in many countries, and 

discovering just what was done to a survey respondent many years earlier has been a challenge. DHS 

survey specialists have long recognized the ambiguities involved in finding out what was actually done at 

circumcision. Circumcised girls can get just a nick to draw blood; experience cutting away of a little 

flesh; have major cutting of the labia; have the vaginal opening sewn nearly shut; or experience other 

manipulation of the female genitalia. 

The greatest concern of FGC specialists are the cases of somehow sewing nearly shut or sealing 

shut the vaginal opening (known as infibulation), for this form of FGC has such great potential for 

harming the health of the girl or woman right after the operation as well as later (Obermeyer 2005). 

Therefore, DHS surveys ask directly if the area was sewn shut. In several surveys in French speaking 

countries, the FGC module also included a question about the effect of the circumcision on the health of 

the girl (Cameroon, Chad, Guinea, Mali, and Niger). Tables 1A, 1B and 1C identify the questions asked 

in the FGC module of each DHS survey from 2002 to 2012, including the questions on the effects of FGC 

on the health of the girl. 

Factors that may affect how the operation was done and is reported include: 1) the way the 

practice is described by elders who know what should be done; 2) the particular preferences, skill, and 

actions of the person doing the cutting; 3) the observations and memory of the respondent; and 4) the 

respondent’s understanding of the survey questions asked. DHS surveys from 2002 to 2010 asked women 

three separate questions to obtain an approximation of what was done. Women were asked if they were 

just nicked. If the answer was no, then they were asked if flesh was cut away and/or if the vaginal area 

was nearly sewn shut. 

Finally, women were asked their age at the time of circumcision and the identity of the person 

who performed the cutting. Age is important for the calculation of FGC prevalence at certain ages, and 
8 

for identifying changes over time. In some countries, for instance, recent surveys have shown that the 

median age at circumcision was decreasing in the 1980s and 1990s. The comparison of subsequent 

surveys offers an opportunity to identify such changes over time. DHS surveys in a few countries failed to 

ask about age at circumcision (Ethiopia 2005, Liberia 2007, Ghana 2003, Kenya 2003, and Uganda in 

2006 and 2011). 

The question about who conducted the procedure is asked to learn the proportion of girls 

circumcised by a traditional specialist or by a medical professional (doctor, nurse, midwife). The answer 

categories include circumciser, traditional birth attendant (TBA), and “other” as possible traditional 

providers, and doctor, nurse/midwife, and “other” as possible non-traditional providers. Data from several 

countries (Egypt, Mali, Guinea) have shown an increase in the proportion of girls cut by a health 

professional in recent years. 

Table 1A shows the topics of questions that were asked of respondents about their own 

circumcision in DHS surveys from 2002 to 2012. The table shows that most surveys began the FGC 

module with an introductory question about FGC, but a few did not (Egypt, Ghana, Liberia). The table 

also shows which surveys did not ask about type of circumcision (Egypt 2005 and 2008; Ethiopia 2005; 

Liberia 2007; Ghana 2003; Kenya 2003; Uganda 2006 and 2011). 

Table 1A. Check list of questions asked about the experience of FGC by respondents 

Country Year Introduction 

Yes/no 

FGC 

Age at 

cutting 

Type of circumcision 

Nicked 

only Cut flesh Infibulation Performer

Egypt* 2005 X X 

Egypt 2008 X X X 

Ethiopia 2005 X X 

 

Guinea 2005 X X X X X X X 

Mali 2001 X X X X X X X 

Mali 2006 X X X X X X X 

Burkina Faso 1999 X X X X X X X 

Burkina Faso 2003 X X X X X X X 

Burkina Faso 2010 X X X X X X X 

Senegal 2005 X X X X X X X 

Senegal 2010 X X X X X X X 

 

Sierra Leone 2008 X X X X X X X 

Liberia 2007 X X X X X X 

Chad 2004 X X X X X X X 

Cote d’Ivoire 2012 X X X X X 

Nigeria 2003 X X X X X X X 

Nigeria 2008 X X X X X X X 

Benin 2006 X X X X X X X 

Ghana 2003 X 

Niger 2006 X X X X X X X 

Cameroon 2004 X X X X X X X 

(Continued...)
9 

Table 1A. – Continued

Country Year Introduction 

Yes/no 

FGC 

Age at 

cutting 

Type of circumcision 

Nicked 

only Cut flesh Infibulation Performer

 

Kenya 2003 X X 

Kenya 2008 X X X X X X X 

Tanzania 2005 X X X X X X X 

Tanzania 2010 X X X X X X X 

Uganda 2006 X X 

Uganda 2011 X X 

*Sample of ever-married women age 15-49 

3.2 The Reliability of Responses: Women’s Own Experience with FGC 

As indicated above, researchers and analysts have assumed that women know whether or not they 

have been circumcised, and that they will accurately report that knowledge in the context of a survey. 

Questions have been raised about both assumptions, but the assumptions have not been often examined. 

One study on northern Ghana provides information on changes in the reported FGC status of respondents 

in two surveys. Survey research teams attached to the Navrongo Health Research Centre in northern 

Ghana conducted a longitudinal survey among women in the Kassena-Nankana district in 1995 and 2000 

that included a question about whether they had been circumcised. The same 2,391 women participated in 

both surveys, which provided an opportunity for assessing the consistency of responses about their own 

circumcision status. The results showed that about 15% of respondents (women 15-49 years old) gave 

different answers to the question on circumcision (Jackson et al. 2003). Four percent of women reported 

that they were circumcised when they had earlier stated they had not been circumcised; 11% of women 

reported they were not circumcised while they had earlier said they were circumcised. The authors 

suggest that a small number of women may not have known whether they had been circumcised or not, 

but that some of those who denied having been circumcised in the second survey may have done so 

because of the law passed in Ghana in 1994 that made it illegal to circumcise females (Jackson et al. 

2003). 

In a study conducted in northern Tanzania in a rural village south of Moshi in the Kilimanjaro 

region where more than half of women are circumcised, a total of 798 women age 15-44 were eligible to 

be interviewed (Klouman et al. 2005). Of that total, 636 (80%) were interviewed and gave a blood 

sample, and 399 (50%) of this group also agreed to a pelvic exam. The exam was done to determine if 

they had been circumcised, and what had been done. The study found that 66% of those interviewed 

(n=636) reported that they had been circumcised, while the medical exam found that 73% (n=399) had 

been circumcised. The authors suggest that some women may have been cut only minimally and at an 

early age, and thus did not realize they had been circumcised. 

It does seem important to consider the possible effect of laws passed making FGC illegal in 

countries on women's responses to the question about whether they had been circumcised. By 2012, 23 

countries in Africa had passed laws outlawing FGC, including Zambia and South Africa, where no group 

is known to practice FGC. Only seven countries where FGC is practiced in Africa do not have national 

laws that criminalize FGC: Cameroon, the Gambia, Guinea-Bissau, Liberia, Nigeria, Sierra Leone and 

Sudan. Several states within both Nigeria and Sudan have made FGC illegal, but neither country has 

passed a national law to criminalize FGC. It remains unclear, however, if these laws have been widely 

publicized or if the state has prosecuted persons who violated the law. The circumstances of each country 
10 

will be different with regard to when the law was passed, how widely the law has been advertised, the 

willingness of the state to prosecute those who violate the law, and the expectations of men and women 

regarding possible enforcement. Each of these factors may affect women's responses. 

One way to check for an effect of a law against the practice of FGC is to compare the prevalence 

rates of age cohorts over time. If the law has discouraged women from admitting that they have been 

circumcised, then we should see a decrease in the FGC prevalence reported for the same age cohort from 

one DHS survey to the next. The FGC prevalence for the 15-19 age cohort in one nationally 

representative survey should be about the same as the FGC prevalence for the 20-24 age cohort in a 

similarly representative survey five years later. This issue is discussed in some detail in the next chapter. 

3.3 Daughters’ Experiences with FGC 

Table 1B identifies the topics that were covered with questions about the circumcision of a 

daughter of the respondent. All respondents who had heard of FGC, and who had a living daughter less 

than 15 years old, were asked questions about one or more daughters and their FGC status. Earlier DHS 

surveys had asked only about the eldest daughter, as was done in Kenya 2003. With the exception of 

Kenya, all DHS surveys that used the FGC module after 2001 asked respondents about the FGC status of 

a living daughter. Respondents were first asked if any of the daughters had been circumcised, and if the 

answer was Yes, they were asked about the circumcision of the most recently cut daughter. If the answer 

was No, respondents were asked if they intended to circumcise any of their daughters. 

Table 1B. Check list of questions asked about the experience of FGC for daughters of 

respondents 

Country Year 

Eldest 

daughter 

Any 

daughter Age 

Nicked 

only Cut flesh Infibulation Performer 

Egypt* 2005 All daughters X X 

Egypt 2008 All daughters X X 

Ethiopia 2005 X X X X 

 

Guinea 2005 X X X X X X 

Mali 2006 X X X X X X 

Burkina Faso 2003 X X X X X X 

Burkina Faso 2010 All daughters X X X 

Senegal 2005 X X X X X X 

Senegal 2010 All daughters X X X 

 

Sierra Leone 2008 X X X X X X 

Liberia 2007 

Chad 2004 X X X X X X 

Cote d’Ivoire 2012 X X X X X X 

Nigeria 2003 X X X X X X 

Nigeria 2008 X X X X X 

Benin 2006 X X X X X X 

Ghana 2003 

Niger 2006 X X X X X X 

(Continued...)
11 

Table 1B. – Continued

Country Year 

Eldest 

daughter 

Any 

daughter Age 

Nicked 

only Cut flesh Infibulation Performer 

Cameroon 2004 X X X X X X 

 

Kenya 2003 X 

Kenya 2008 X X X X X X 

Tanzania 2005 X X X X X X 

Tanzania 2010 X X X X X X 

Uganda 2006 

Uganda 2011 

*Sample of ever-married women age 15-49 

The DHS surveys in Egypt in 2005 and 2008 were unique in that respondents were not asked 

what type of circumcision had been performed, but they were asked about the circumcision status of each 

of their living daughters 0-14 years of age. As will be seen in chapter four, the FGC module was modified 

in 2010 to ask fewer questions about personal opinions, and to ask about the circumcision status of each 

living daughter, one by one. The DHS surveys in Burkina Faso (2010) and Senegal (2010) were the first 

to use the new module. 

3.4 Perceptions and Opinions about FGC 

Table 1C shows which questions about personal perceptions and opinions have been asked in 

DHS surveys since 2002. DHS surveys from 2004 to 2006 in Francophone countries asked a question 

with five items about the effects of circumcision on the health of a daughter, with a Yes or No answer to 

each item. “When (daughter’s name) was circumcised, was there: a) excessive bleeding; b) difficulty in 

urination; c) swelling in the vaginal area; 4) infection of the vaginal area; 5) the wound did not heal 

properly.” The answers relied on mothers’ observations at the time of the circumcision and her memory 

of that time period. The question was dropped from the FGC module after 2006. In addition, the majority 

of FGC modules from 2004 to 2008 asked respondents: “What are the benefits to a girl in getting 

circumcised?” Six items of possible benefits were pre-coded as possible answers, with multiple answers 

possible. Social acceptance was the benefit most often cited in nearly all surveys. 

Table 1C. Check list of questions asked about the opinions of respondents on the practice of FGC 

Country Year Intention 

Health 

impact 

Advantages or 

benefits Religion +/- stop 

Egypt* 2005 X X X 

Egypt 2008 X X X 

Ethiopia 2005 X 

 

Guinea 2005 X X X X X 

Mali 2006 X X X X X 

Burkina Faso 2003 X X X X 

Burkina Faso 2010 X X 

Senegal 2005 X X X X 

(Continued...)
12 

Table 1C. – Continued

Country Year Intention 

Health 

impact 

Advantages or 

benefits Religion +/- stop 

Senegal 2010 X X 

 

Sierra Leone 2008 X X X X 

Liberia 2007 

Chad 2004 X X X X X 

Cote d’Ivoire 2012 X X 

Nigeria 2003 X X X X 

Nigeria 2008 X X X X 

Benin 2006 X X X X 

Ghana 2003 

Niger 2006 X X X X X 

Cameroon 2004 X X X X X 

 

Kenya 2003 X 

Kenya 2008 X X X X 

Tanzania 2005 X X 

Tanzania 2010 X X 

Uganda 2006 

Uganda 2011 X 

*Sample of ever-married women age 15-49 

 

In nearly all surveys, respondents were asked if FGC was required by their religion to obtain a 

measure of the importance of religion as an explanation for performing FGC. All DHS surveys with the 

FGC module (Ghana, Liberia, and Uganda did not use the module) asked if the respondents thought FGC 

should stop or be continued. The 2007 survey in Liberia asked about membership in a women’s secret 

society (Sande) that conducts FGC as part of an initiation. The 2003 survey in Ghana and the 2006 survey 

in Uganda asked only two questions about FGC. 

3.5 Questions Asked of Men about FGC 

In most West African surveys, the FGC module also included a limited number of questions for 

men. Most commonly, men age 15 to 59 were interviewed with the DHS man’s questionnaire in one-third 

of households selected for the sample. 

The standard FGC questions asked of men in the West African surveys were: 

1) Have you ever heard of female circumcision? 

2) What are the benefits for a girl of being circumcised? 

3) What are the benefits for a girl of not being circumcised? 

4) Do you think that the practice of FGC helps girls conserve their virginity? 

5) Do you think that the practice of FGC is required by your religion? 

6) Should this practice of FGC continue or be stopped? 
13 

The only country in West Africa that used the FGC module for women but did not ask such 

questions of men as part of the DHS was Senegal in 2010. In East Arica, the three surveys in Kenya and 

the 2010 survey in Tanzania did not include FGC questions for men. In Northeast Africa the DHS surveys 

in Egypt and Ethiopia 2005 did not ask FGC questions of men. The 2003 Kenya DHS asked men if the 

practice of FGC was common in their community, and if their eldest daughter had been circumcised. 

Table 2 shows which surveys from 2003 through 2012 included FGC questions for male respondents. 

Table 2. Check list of questions asked of male respondents about the practice of FGC in West and 

East African countries in which the FGC module for women was used 

Country Year 

Heard of 

FGC 

Benefits of 

being cut 

Benefits of 

not being 

cut 

Helps to 

keep 

virginity Religion +/- stop 

Guinea 2005 X X X X X X 

Mali 2006 X X X X X X 

Burkina Faso 2003 X X X X X X 

Burkina Faso 2010 X X X 

Senegal 2005 X X X X X X 

 

Sierra Leone 2008 X X X X 

Chad 2004 X X X X X X 

Cote d’Ivoire 2012 X X X 

Nigeria 2003 X X X X X X 

Nigeria 2008 X X X X 

Benin 2006 X X X X X X 

Niger 2006 X X X X X X 

Cameroon 2004 X X X X X X 

 

Tanzania 2005 X X 

If men reported that they have not heard of FGC, the interviewer described the practice and then 

asked the question again. Men who said they had never heard of FGC were not asked any further 

questions about the practice. Men who had heard of FGC were then asked about the benefits for a girl 

being circumcised, and were then asked to list benefits for a girl if she was not circumcised. Part of the 

rationale for asking men about whether FGC was required by religion is the impression held by many that 

Islam does require that girls be circumcised, and some imams have spoken in favor of the practice while 

others have urged that it be abandoned. Finally, the question about the continuation of FGC serves as a 

measure of support for FGC among men. 

3.6 Current FGC Module (2010 to Present) 

Since DHS data on FGC prevalence has always reported on samples of women age 15 to 49, any 

changes in prevalence rates over time reflects changes that occurred at least 10 years ago or longer. That 

is, because FGC frequently takes place about the ages of five or six, the age cohort at age 15-19 was 

likely to have been at risk for FGC five to ten years earlier. Thus, prevalence data for women 15-49, in 

most cases, is not suitable for use in the evaluation of recent interventions that promote the abandonment 

of FGC. However, data on prevalence rates of girls 0-14 years of age may be useful for the evaluation of 

more recent interventions, particularly if the age at circumcision is very young. Therefore, UNICEF 
14 

wanted to begin asking respondents about the circumcision status of each living daughter less than 15 

years of age. In late 2009 UNICEF contacted survey specialists at DHS to discuss ideas for a revised FGC 

module that would ask about the FGC status of all daughters. 

After a series of meetings to discuss possible revisions, DHS agreed to coordinate FGC-module 

revisions with UNICEF. Consequently, the current FGC module is essentially the same as the module 

used in the UNICEF’s MICS survey. The DHS module maintains the same questions on how 

circumcision occurred for the respondent and for her daughter(s). The module differs from the one used 

from 2001 through 2009 in several respects: a) no questions remain on the benefits or effects of the 

circumcision for daughters; b) the question on intention to circumcise a daughter has been dropped; c) the 

module asks each respondent who has at least one living daughter about the current circumcision status of 

each living daughter less than 15 years of age; d) fewer questions are asked on opinions about FGC. The 

DHS FGC module retains a question on whether the practice of FGC is required by their religion, a 

question that was never a part of the UNICEF module. 

The revised FGC module formulated in 2010 also revised the FGC questions for men. The 

module now includes only three questions: 

1) Have you ever heard of female circumcision? 

2) Do you think that the practice of FGC is required by your religion? 

3) Should this practice of FGC continue or be stopped? 

The answers to these three questions provide researchers with evidence about the general 

knowledge of FGC, about the use of religion as rationale for doing FGC, and about whether men might be 

ready to support abandonment of the practice. The answers to questions related to judgments about the 

benefits of doing FGC or not doing it, as well as the question about the effect of FGC on virginity, have 

been dropped. This was done both to save space and time, and because the answers to those questions are 

difficult to interpret. 

3.7 Current Tabulation Plan 

A new tabulation plan for reporting data on FGC was also formulated (see Appendix C). The list 

of tables and figures that is recommended for production for each country report is found below. 

Table FGC.1 Knowledge of female circumcision 

Table FGC.2 Prevalence of female circumcision 

Figure FGC.1 Percentage of women age 15-49 circumcised by ethnic group 

Table FGC.3 Age at circumcision 

Table FGC.4 Prevalence of circumcision and age at circumcision: Girls 0-14 

Table FGC.5 Circumcision of girls age 0-14 by mother’s background characteristics 

Table FGC.6 Infibulation among circumcised girls age 0-14 

Table FGC.7 Aspects of circumcision among circumcised girls age 0-14 and women age 15-49 

Working Table for Figure FGC.2 Circumcision by age: Girls and Women 

Figure FGC.2 Percentage of Women Age 15-49 and Girls Age 0-14 Circumcised by Age 

Table FGC.8 Opinions of women and men about whether circumcision is required by religion 
15 

Table FGC.9 Opinions of women and men about whether the practice of circumcision should 

continue 

One of the goals in formulating the tabulation plan for the revised FGC module was to develop a 

way to document changes in the prevalence of FGC over time. The new approach allows for a more valid 

within survey comparison of women’s and daughters ‘experience of FGC. Further, by providing 

information on a population (girls age 0-14) that is more immediately at risk of circumcision, it allows for 

a way to better document recent changes in the spread of the practice. This line of questioning produces 

data that creates a distinction between current FGC status and final FGC status for these girls. Of course 

daughters age 15 and older are eligible for the general sample and thus their FGC status will be selfreported by the respondents. This approach is discussed further in chapter 4. 

This chapter has provided an overview of the questions related to FGC that were asked in DHS 

surveys from 2003 through 2012 in African countries. The combination of tables and text reveals how 

certain questions have always been asked in surveys during this period, while other questions were asked 

in some surveys and not in others. Readers interested in a particular country can find which questions 

were asked in that country at which point in time by looking at the women's and the men’s questionnaire 

in the final country report. 

17 

4 National FGC Prevalence Rates for Women Age 15-49 

The national prevalence rates for female genital cutting in African countries and Yemen are 

derived from population-based surveys supported by the Demographic and Health Surveys (DHS) and by 

the Multiple Indicator Cluster Surveys (MICS) sponsored by UNICEF. As reported by an earlier 

Comparative Report (Yoder et al. 2004), the first survey that included questions about FGC was 

conducted in Northern Sudan in 1989-90. DHS data for FGC prevalence are now available for 23 

countries. Data on FGC prevalence are available for two or three surveys for some countries. 

Most countries that report FGC prevalence rates have used the DHS module as part of the survey. 

The decision to use the FGC module, as any module, is made by the country team that adapts survey 

questions to the needs of the country and selects the modules to use. Countries such as Ghana and 

Uganda, where the practice is highly localized and the national prevalence is low, chose to ask only two 

or three questions about FGC. Ghana did not ask any questions about FGC in the 2008 DHS survey. 

4.1 National FGC Prevalence: Most Recent DHS Surveys 

Table 3 shows the FGC prevalence for the most recent DHS survey by country. Countries are 

grouped by geographic region to facilitate comparisons and highlight regional patterns. For example, the 

countries of the northeastern part of Africa all have relatively high prevalence rates (74-91%). The 

countries of the northern portion of West Africa, with the exception of Senegal, also display high FGC 

rates (71-96%). 

Table 3. National prevalence of FGC data by region and country for most recent DHS survey 

Country Year Prevalence Number of women 

North East Africa 

Egypt 2008 91.1 5,540 

Eritrea 2002 88.7 8,754 

Sudan* 1989-90 89.2 5,860 

Ethiopia 2005 74.3 14,070 

West Africa, northern 

Guinea 2005 95.6 7,954 

Mali 2006 85.2 14,583 

Burkina Faso 2010 75.8 17,087 

Mauritania 2000-01 71.3 7,728 

Senegal 2010-11 25.7 15,688 

West Africa, southern 

Sierra Leone 2008 91.3 7,374 

Liberia** 2007 58.2 7,092 

Chad 2004 44.9 6,085 

Central African Republic 1994-95 43.4 5,884 

Cote d'Ivoire 2012 38.2 10,060 

Nigeria 2008 29.6 33,385 

Benin 2006 12.9 17,749 

(Continued...)
18 

Table 2. – Continued 

Country Year Prevalence Number of women 

Ghana 2003 5.4 5,691 

Niger 2006 2.2 9,223 

Cameroon 2004 1.4 5,391 

East Africa 

Kenya 2008-09 27.1 8,444 

Tanzania 2010 14.6 10,139 

Uganda 2011 1.4 8,674 

Yemen* 1997 22.6 10,414 

*Sample consisted of ever-married women 

** Women were asked if they had been initiated into a secret society. 
19 

In a small number of countries in Africa, the FGC prevalence rates are provided by a MICS 

survey only. The countries with only MICS data available are Djibouti, Somalia, the Gambia, Guinea 

Bissau, and Togo. In a few others, data on FGC prevalence are available from both DHS and MICS 

surveys or a combined DHS/MICS survey. Table A in the Appendix shows FGC prevalence rates from 

the most recent survey available whether from DHS or MICS. Thus as of July 2013, these are the current 

FGC prevalence rates for these countries. 

The countries listed in northeastern Africa such as Egypt, Ethiopia, and Sudan have relatively 

large populations and very high FGC prevalence rates. Those three countries alone account for more than 

50% of all women circumcised on the African continent, with Egypt at 23.5 million, Ethiopia at 15.7 

million, and Sudan at 8 million according to the most recent surveys in those countries 

4.2 National FGC Prevalence: All DHS Surveys 

Table 4 shows national prevalence rates for all of the DHS surveys for which data are available 

conducted between 1990 and 2012. Four surveys with FGC data have been conducted in Egypt, and six 

countries have had three such surveys: Mali, Burkina Faso, Cote d'Ivoire, Nigeria, Kenya, and Tanzania. 

In countries with more than two surveys with datasets available, one can see evidence of decreases in the 

national prevalence that occurred from 10 to 40 years earlier. The case of Nigeria is the exception to the 

rule. However, the increase in FGC prevalence in Nigeria from 2003 to 2008 stems partly from the use of 

a new definition for what constitutes FGC as well as differences in the data available for selecting the 

sample. Interviewers in the northeast included local forms of cutting and scraping of the vaginal walls in 

their definition of what constitutes FGC. The data bases for constituting the samples for the DHS of 2003 

and 2008 were somewhat different, so that the distribution of the samples by region was dissimilar. 

In most countries, however, the decline in FGC prevalence at a national level as measured in 

DHS surveys over 10 to 15 years was small. In Egypt FGC prevalence declined from 97% in 1995 to 91% 

in 2008; in Mali the decline was from 94% in 1995 to 85% in 2006; in Cote d’Ivoire it declined from 43% 

in 1994 to 38% in 2012; and in Burkina Faso the prevalence did not change between 1998 and 2010. 

Those changes in prevalence reflect a decrease in prevalence that occurred from about 10-40 years before 

each survey if we assume that circumcision is typically done at ages less than age 10. That is, a 35 year 

old woman interviewed in the 2010 Burkina Faso was likely circumcised around 1980. Interviewing adult 

women about their experience with FGC therefore captures patterns and changes that were actually in 

effect years earlier. 

The FGC prevalence decreased quite remarkably in Kenya between 1998 and 2008: from 37.6% 

to 27.1%, a decrease of 28% in 10 years. In fact, FGC prevalence in 1998 was presumably slightly higher 

than the 37.6% found by the DHS survey because the 1998 DHS survey did not include the three districts 

of Northeastern province bordering Somalia and the districts of Turkana, Marsabit, Isiola and Samburu in 

Eastern province. Although all of these districts are sparsely populated, Northeastern province is 

populated mainly by Kenyans of Somali origin, and prevalence in that population is around 98%. The 

population of the seven districts omitted in 1998 makes up about 8% of the total population of Kenya. 
20 

Table 4. National FGC prevalence for all DHS surveys with FGC data by region and country 

Country Year Prevalence Number of women 

North East Africa 

Egypt* 1995 97.0 14,779 

Egypt* 2000 97.3 15,573 

Egypt* 2005 95.8 19,474 

Egypt 2008 91.1 5,540 

Eritrea 1995 94.5 5,054 

Eritrea 2002 88.7 8,754 

Sudan* 1989-90 89.2 5,860 

Ethiopia 2000 79.9 15,367 

Ethiopia 2005 74.3 14,070 

West Africa, northern 

Guinea 1999 98.6 6,753 

Guinea 2005 95.6 7,954 

Mali 1995-96 93.7 9,704 

Mali 2001 91.6 12,849 

Mali 2006 85.2 14,583 

Burkina Faso 1998-99 71.6 6,445 

Burkina Faso 2003 76.6 12,477 

Burkina Faso 2010 75.8 17,087 

Mauritania 2000-01 71.3 7,728 

Senegal 2005 28.2 14,602 

Senegal 2010-11 25.7 15,688 

West Africa, southern 

Sierra Leone 2008 91.3 7,374 

Liberia** 2007 58.2 7,092 

Chad 2004 44.9 6,085 

Cote d'Ivoire 1994 42.7 8,099 

Cote d'Ivoire 1998-99 44.5 3,040 

Cote d'Ivoire 2012 38.2 10,060 

Central African Republic 1994-95 43.4 5,884 

Nigeria 1999 25.1 8,206 

Nigeria 2003 19.0 7,620 

Nigeria 2008 29.6 33,385 

Benin 2001 16.8 6,219 

Benin 2006 12.9 17,749 

Ghana 2003 5.4 5,691 

Niger 1998 4.5 7,577 

Niger 2006 2.2 9,223 

Cameroon 2004 1.4 5,391 

East Africa 

Kenya 1998 37.6 7,881 

(Continued...)
21 

Table 4. – Continued

Country Year Prevalence Number of women 

Kenya 2003 32.2 8,195 

Kenya 2008-09 27.1 8,444 

Tanzania 1996 17.9 8,120 

Tanzania 2004-05 14.6 10,329 

Tanzania 2010 14.6 10,139 

Uganda 2006 0.6 8,531 

Uganda 2011 1.4 8,674 

0.0 

Yemen* 1997 22.6 10,414 

*Sample consisted of ever-married women 

** Women were asked if they had been initiated into a secret society. 

 

4.3 FGC Prevalence Trends: Contrasts by Age Cohort 

A second source of evidence of possible changes over time comes from examining FGC 

prevalence rates by age cohort. Table 5 shows the FGC prevalence rates by five year age cohort for the 

most recent DHS survey in each country. Differences in prevalence between cohorts reflect changes in the 

rate of FGC in five year intervals over the 10-40 years preceding the survey in countries where the typical 

age at circumcision is some time before 10 years. For example, the 45-49 year old cohort in the survey 
22 

was 5-9 years old 40 years earlier, an age when FGC is conducted in some countries and has already been 

done in others. Ten years earlier the current 15-19 year old cohort was age 5-9 also. 

In a few countries where FGC is practiced on girls more than 10 years of age, the relevant time 

period for change would be from 5 to 35 years earlier. 

Table 5. National FGC prevalence data by age cohort for most recent DHS survey by country 

Age of women 

Country Year 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 

North East Africa

Egypt 2008 80.7 87.4 94.3 95.2 96.4 96.2 96.0 91.1 5,540 

Eritrea 2002 78.4 87.9 90.9 93.4 92.7 94.1 95.2 88.7 8,754 

Sudan* 1989-90 86.8 89.7 88.6 89.7 89.0 89.0 90.9 89.2 5,860 

Ethiopia 2005 62.1 73.0 77.6 78.0 81.2 81.6 80.8 74.3 14,070 

West Africa, northern

Guinea 2005 89.3 94.6 96.6 97.4 98.6 98.1 99.5 95.6 7,954 

Mali 2006 84.7 84.5 86.7 84.2 84.9 86.2 85.8 85.2 14,583 

Burkina Faso 2010 57.7 69.8 77.5 82.8 85.2 88.2 89.3 75.8 17,087 

Mauritania 2000-01 65.9 71.1 73.4 74.2 71.7 76.5 68.6 71.3 7,728 

Senegal 2010-11 24.0 24.3 26.1 24.9 29.0 26.9 28.5 25.7 15,688 

West Africa, southern

Sierra Leone 2008 75.5 89.4 95.2 94.9 96.4 96.1 95.9 91.3 7,374 

Liberia** 2007 35.9 51.1 61.3 63.4 66.7 71.2 79.0 58.3 7,092 

Chad 2004 43.4 45.8 45.2 43.5 46.2 46.1 45.9 44.9 6,085

Cote d'Ivoire 1998-99 41.2 42.7 42.4 49.0 44.5 51.4 51.0 44.5 3,040 

Cote d'Ivoire 2012 31.3 35.1 36.8 40.3 45.4 44.6 46.9 38.2 10,060 

Central African 

Republic 1994-95 34.6 42.7 44.3 44.1 47.5 51.4 53.1 43.4 5,884 

Nigeria 2008 21.7 26.4 28.9 32.8 33.9 36.4 38.1 29.6 33,385 

Benin 2006 7.9 9.9 13.6 14.3 16.3 17.0 15.8 12.9 17,749 

Ghana 2003 3.3 3.8 6.4 6.3 6.7 5.5 7.9 5.4 5,691 

Niger 2006 1.9 1.6 2.4 2.1 2.9 2.9 2.8 2.2 9,223 

Cameroon 2004 0.4 2.5 1.6 1.1 1.2 1.8 2.4 1.4 5,391 

East Africa 

Kenya 2008-09 14.6 21.1 25.3 30.0 35.1 39.8 48.8 27.1 8,444 

Tanzania 2010 7.1 11.0 11.7 19.1 21.6 22.2 21.5 14.6 10,139 

Uganda 2011 1.0 0.8 1.9 2.1 1.3 1.7 1.9 1.4 8,674 

Yemen* 1997 19.3 22.2 21.3 22.9 23.6 25.1 25.0 22.6 10,414 

*Sample consisted of ever-married women 

** Women were asked if they had been initiated into a secret society. 
23 

One can detect three patterns of trends over time in the data from the countries in the table: 1) 

there was little or no change over time from 10-40 years before the survey in some countries, as seen in 

Sudan, Chad, and Uganda. Uganda is a special case given the extremely low national prevalence and that 

the practice is limited to two small areas in the east of the country; 2) there is a slight decline in a few 

countries in the prevalence of FGC from the oldest cohort to the youngest cohort, with the decline being 

greater among the younger cohorts. Eritrea, Ethiopia, Burkina Faso, Benin, and Senegal fit this model; 

and 3) a few countries show a small but steady, nearly linear, decline in prevalence by age cohort, as seen 

in Egypt, Mauritania, Cote d’Ivoire, Nigeria, and Kenya. In Senegal the age cohort data show that the 

prevalence changed very little between about 1970 and 2000, but that there was a slight decrease in the 

1990s. 

How do we explain a significant drop in prevalence in the youngest one or two cohorts as was 

found in Ethiopia or Benin? Three explanations are possible: 1) it may be that a secular trend began about 

20 years earlier and has led to this decrease in FGC prevalence; 2) it could be the result of anti-FGC 

interventions beginning about 20 years ago; or 3) it may be the result of younger women being afraid of 

admitting they had been circumcised because of the publicity around a law passed to criminalize FGC. 

Further analysis of DHS data in a specific country, combined with an examination of the context of antiFGC programs and media campaigns to publicize laws against the practice, is needed to determine which 

of these explanations is most relevant. 

4.4 Changes in FGC Prevalence by Age Cohort from DHS Surveys at Different 

Points in Time 

For most countries where DHS surveys have included the FGC module, FGC data have been 

collected in more than one survey in the country. In Egypt, four DHS surveys have included data on the 

FGC status of respondents. In six countries, FGC data were collected in three DHS surveys each: Mali, 

Burkina Faso, Cote d'Ivoire, Nigeria, Kenya, and Tanzania. In countries with data from more than two 

time points, there is evidence of decreases in the national prevalence. 

Table 6 shows the national prevalence disaggregated by age cohort for all DHS surveys with FGC 

data from two or more points in time. As seen earlier, Table 5 showed the same data for the most recent 

DHS surveys only. This table allows us to verify if the trend over time from older to younger cohorts seen 

in the most recent survey was also evident in earlier surveys. The table can be read vertically as well as 

horizontally. 

Table 6. National FGC prevalence data disaggregated by age cohorts for countries with more than 

one DHS survey with FGC data over time 

Age of women 

Country Year 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 

North East Africa 

Egypt* 1995 98.1 98.3 97.0 95.8 96.7 97.2 96.8 97.0 14,779 

Egypt* 2000 99.1 97.4 97.2 96.7 97.4 96.9 97.9 97.3 15,573 

Egypt* 2005 96.6 95.9 95.1 95.9 95.9 96.0 96.3 95.8 19,474 

Egypt 2008 80.7 87.4 94.3 95.2 96.4 96.2 96.0 91.1 5,540 

Eritrea 1995 90.4 94.4 94.9 95.6 97.0 95.9 97.1 94.5 5,054 

Eritrea 2002 78.4 87.9 90.9 93.4 92.7 94.1 95.2 88.7 8,754 

Ethiopia 2000 70.7 78.3 81.4 86.1 83.6 85.8 86.8 79.9 15,367 

(Continued...)
24 

Table 6. – Continued

Age of women 

Country Year 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 

Ethiopia 2005 62.1 73.0 77.6 78.0 81.2 81.6 80.8 74.3 14,070 

West Africa, northern 

Guinea 1999 96.6 98.5 99.1 99.1 99.1 99.3 99.5 98.6 6,753 

Guinea 2005 89.3 94.6 96.6 97.4 98.6 98.1 99.5 95.6 7,954 

Mali 1995-96 92.5 94.2 93.9 94.8 93.9 94.2 92.4 93.7 9,704 

Mali 2001 91.2 91.3 91.9 92.1 92.3 91.2 91.0 91.6 12,849 

Mali 2006 84.7 84.5 86.7 84.2 84.9 86.2 85.8 85.2 14,583 

Burkina Faso 1998-99 64.2 70.7 75.0 73.7 74.1 76.7 74.1 71.6 6,445 

Burkina Faso 2003 65.0 76.2 79.2 79.4 81.6 83.1 83.6 76.6 12,477 

Burkina Faso 2010 57.7 69.8 77.5 82.8 85.2 88.2 89.3 75.8 17,087 

Senegal 2005 24.8 28.0 28.4 30.1 30.5 30.3 30.6 28.2 14,602 

Senegal 2010-11 24.0 24.3 26.1 24.9 29.0 26.9 28.5 25.7 15,688 

West Africa, southern 

Cote d'Ivoire 1994 35.3 42.2 47.7 47.1 43.7 44.8 44.3 42.7 8,099 

Cote d'Ivoire 1998-99 41.2 42.7 42.4 49.0 44.5 51.4 51.0 44.5 3,040 

Cote d'Ivoire 2012 31.3 35.1 36.8 40.3 45.4 44.6 46.9 38.2 10,060 

Nigeria 1999 8.8 19.6 26.4 31.3 31.0 37.9 48.3 25.1 8,206 

Nigeria 2003 12.9 17.0 20.8 19.4 22.2 22.2 28.4 19.0 7,620 

Nigeria 2008 21.7 26.4 28.9 32.8 33.9 36.4 38.1 29.6 33,385 

Benin 2001 12.1 13.4 16.9 18.4 18.3 25.1 23.7 16.8 6,219 

Benin 2006 7.9 9.9 13.6 14.3 16.3 17.0 15.8 12.9 17,749 

Niger 1998 5.0 4.8 4.3 5.3 3.8 3.3 3.3 4.5 7,577 

Niger 2006 1.9 1.6 2.4 2.1 2.9 2.9 2.8 2.2 9,223 

East Africa 

Kenya 1998 26.0 32.2 40.4 40.9 49.3 47.4 47.5 37.6 7,881 

Kenya 2003 20.3 24.8 33.0 38.1 39.7 47.5 47.7 32.2 8,195 

Kenya 2008-09 14.6 21.1 25.3 30.0 35.1 39.8 48.8 27.1 8,444 

Tanzania 1996 15.7 17.7 20.9 19.9 18.3 19.3 20.1 18.5 8,120 

Tanzania 2004-05 9.1 13.7 15.2 16.0 16.0 18.8 22.9 14.6 10,329 

Tanzania 2010 7.1 11.0 11.7 19.1 21.6 22.2 21.5 14.6 10,139 

Uganda 2006 0.5 0.8 0.3 0.8 0.8 1.0 0.4 0.6 8,531 

Uganda 2011 1.0 0.8 1.9 2.1 1.3 1.7 1.9 1.4 8,674 

*Sample consisted of ever-married women 
25 

A horizontal reading shows if any changes occurred in FGC prevalence from 10-40 years ago. 

For Egypt, no changes are seen in the survey data from 1995, 2000, or 2005. The data from 2008, 

however, show that prevalence among younger women dropped in the 2008 survey, indicating that FGC 

prevalence decreased in the late 1980s and early 1990s. The downward trend in prevalence is more 

pronounced in the 2002 survey in Eritrea than the 1995 survey. The two surveys in Ethiopia show the 

same pattern as that of Eritrea. In Guinea and Mali, the data show a drop in prevalence among the 15-19 

year olds in the more recent survey. In the Burkina Faso 2010 DHS, however, the progression from 

prevalence among the oldest to the youngest cohorts is large and linear: from 89% to 58%. Overall, the 

largest decline in prevalence among age cohorts is found in the 2008-09 Kenya survey. 

A more significant use of this table is to examine it for evidence of under-reporting of FGC over 

time. Most surveys are conducted at five year intervals. Therefore it is possible to compare the prevalence 

in equivalent age cohorts over time. The prevalence of the cohort age 15-19 in 2000 in Ethiopia, for 

example, should be about the same as the prevalence of the cohort age 20-24 in 2005. In Ethiopia, in 

2000, the 15-19 cohort has a prevalence of 71%, and the 20-24 cohort five years later (in the 2005 

Ethiopia DHS) has a prevalence of 73%. Comparisons of the other age cohorts show no or similar 

differences. This degree of variation is normal and expected as the data come from two different samples. 

However, variation in the reporting of FGC by the same age cohort as it moves through time do 

not follow the expected pattern as seen in Ethiopia in some of the other countries. The data from Mali for 

example, show a somewhat different pattern. The prevalence for each age cohort in 2001 is 1-3 

percentage points below the equivalent age cohort in 1996, five years earlier: the age cohort 15-19 in 

1996 had a prevalence of 92.5%; but in 2001 it had a prevalence of 91.3%; similarly, the 20-24 age cohort 

in 1996 had a prevalence of 94.2% but 91.9% in 2001. A difference of 1-3 percentage points is within 

acceptable statistical variation, but the prevalence for every cohort that can be compared is consistently 
26 

lower in 2001 than in 1996. The same pattern is visible in the comparison of the 2001 and the 2006 data, 

but, importantly, the differences are even greater. The 15-19 age cohort had a prevalence of 91.2% in 

2001, so we would expect about the same prevalence for the 20-24 age cohort five years later in 2006. 

However, the prevalence for the 20-24 age group in 2006 is 84.9% almost seven percentage points lower. 

Similarly, in each comparison between 2001 and 2006, the prevalence for 2006 is from about four to 

about eight percentage points less than what had been reported for the same age cohort five years earlier. 

A systematic significant decrease in the prevalence of FGC in the same age cohort when it is five 

years older does suggest under-reporting of FGC by the cohort as it ages. That appears to be the case in 

Mali, suggesting that the FGC prevalence may not have declined as much as the numbers would suggest. 

A similar pattern is also observed in Benin and Niger. Whether this pattern of under-reporting is provoked 

by fear of a law passed against practicing FGC, or in response to a campaign to abandon FGC, or some 

similar media event, is not evident from the data. To further our understanding of how such results 

appear, there is a need to examine the media discussion of FGC and/or laws concerning FGC in the 

months preceding the second or third survey in each country. 

4.5 Changes in FGC Prevalence by Generation 

As discussed in chapter 3, the tabulation plan for the DHS surveys has changed in part to allow a 

way to document changes in the prevalence of FGC over time by comparing the FGC experiences of 

mothers and daughters. However, comparing the FGC information for women age 15-49 and daughters 

age 0-14 is not as easy as it might seem. Girls, especially very young girls, who are not circumcised at the 

time of the survey, may still be circumcised in the future. A simple percentage of all girls age 0-14 who 

have been circumcised at the time of the survey will understate the magnitude of the practice for this age 

group as a whole. On the other hand, women age 15-49 who are not circumcised at the time of the survey, 

in all likelihood, will not undergo circumcision in their lifetime. This creates a situation of comparing 

apples to oranges when looking at girls’ circumcision status relative to that of women age 15-49. If such a 

comparison was to be made, reductions in the prevalence of FGC would appear larger than they actually 

were. 

A more valid approach, though not perfect, is to compare the proportion of girls currently age X 

who are circumcised, with the proportion of women who said they were circumcised by exact age X. This 

comparison is not perfect because daughters’ prevalence at each age is a current status measure based on 

their mothers’ reports, whereas, the information for women is retrospective, based on their recall of their 

own age at circumcision, and reflects their final status. Nonetheless, this approach eliminates the bias 

created by the difference in the length of time for which daughters and women have been exposed to the 

risk of circumcision. 

Accordingly, to make this comparison, DHS designed a graph that shows the percentage of girls 

and women age 15-49 circumcised by single years of age (see Figure 4 which provides an example from 

Burkina Faso). More specifically, the percentage of girls circumcised by age 5 is calculated as the 

percentage of daughters circumcised among all daughters who are age five years at the time of the survey. 

Similarly, the percentage of girls circumcised by age six is calculated as the percentage of daughters 

circumcised among all daughters who are age 6 at the time of the survey, and so on. For women, the 

percentage circumcised at each age 6, 7 ...14 is the percentage of all women age 15-49 who report being 

circumcised by that exact age. However, no year-by-year comparisons are made for women and daughters 

for ages below 5 years. This is because when asked about their age at circumcision, many women say that 

they were circumcised during infancy. Such a response is not surprising, since women who were 

circumcised during infancy are unlikely to remember the event or to know their exact ages at 

circumcision. In countries where circumcision commonly takes place soon after birth, this category of 

women can be quite large. Consequently, without more specific information, it is assumed that women 
27 

who respond that they were circumcised during infancy were circumcised before the age of 5 years and 

are grouped with women who do give specific ages of less than five years. Thus, in the figure, the plotted 

line for women begins at 5 years. 

One of the most useful pieces of information on the graph is the percentage of 14-year-old 

daughters who are circumcised compared with the percentage of women age 15-49 who were circumcised 

by age 14. Since few women are likely to be circumcised after age 14 in most countries, the percentage of 

daughters age 14 who are circumcised and women circumcised by age 14 allows a comparison of 

proportions of two different age cohorts who are likely to undergo FGC in their lifetimes. This 

information provides the overall magnitude of the practice and how it has or has not changed over the 

course of the generation. Notably, however, where circumcision takes place soon after birth, information 

on the circumcision status of daughters who are currently 14 years old is not a good indicator of recent 

changes in FGC practices given that these girls were likely to have experienced the greatest risk for 

circumcision many years earlier. In these countries, comparing the mother and daughter data for age 5 

will give a better indication of the impact of recent interventions to reduce FGC, but it will not reflect the 

overall magnitude of the practice in countries in which circumcision is practiced after age 5. 
28 

4.6 FGC Prevalence Disaggregated by Demographic Variables and Aspects of 

the Practice 

DHS surveys that use the FGC module include a separate chapter on FGC in the country final 

report. Until 2010, the percentage of women and men who had heard of FGC, as well as the FGC status of 

women, was presented in a table disaggregated by age cohort, region, urban/rural residence, education, 

religion, wealth quintile of the household, and for many countries, by ethnicity. FGC prevalence 

continues to be reported by religion because of the need for information on religion to monitor the success 

of interventions seeking to persuade religious leaders to promote abandonment of the practice. 

Since about 2010, the FGC prevalence is no longer being reported by education of the respondent 

or by the wealth quintile of the household. This change in reporting was made because it is unclear how a 

woman’s FGC status could vary by her educational attainment or current wealth status, since the FGC 

event would precede the start or even completion of education and the wealth status is a current measure 

of wealth not at the time of circumcision. Some countries do report the FGC status of daughters by the 

education of the mother, and find that mothers with higher levels of education are less likely to have their 

own daughters cut than mothers with less education. 

The presentation of FGC prevalence by urban/rural residence and by region shows evidence of 

the distribution of FGC within a country. In countries with a national prevalence of less than 80 percent, 

marked differences by region are often found. For example, the 2008-09 DHS in Kenya found an FGC 

prevalence of 0.8% in Western Province dominated by Luo, and an FGC prevalence of 98% in North 

eastern province dominated by Somalis. Regional differences in prevalence are often a reflection of ethnic 

composition of the population, as will be seen below. For more information on regional distribution of 

FGC prevalence, the maps in chapter 4 of the recent UNICEF publication show the FGC distribution in 

five countries (UNICEF 2013). 

4.7 FGC Prevalence and Ethnicity 

In many countries, ethnicity underlies FGC distribution by urban/rural residence and by region, 

since ethnic groups are unevenly distributed within and between regions, and FGC status varies with 

ethnicity in so many countries. In the majority of countries, FGC prevalence is higher in rural than in 

urban areas (ex. Senegal, Burkina Faso, Ethiopia, Kenya, Tanzania). Experts hypothesize that families in 

urban areas may be less likely to follow the requests of older relatives who would normally direct the 

circumcision rituals, but no study has been conducted to test this hypothesis. Nigeria, however, is an 

exception to this rule. In the 2003 DHS survey in Nigeria, the FGC prevalence was 28% in urban areas 

and 14% in rural areas nationally. However, most of this difference stems from the fact that the Hausa, 

who dominate the rural north of the country, do not practice FGC (prevalence was 0.4%), while 

prevalence among the Yoruba was 61% and 45% among the Igbo. Both the Yoruba and Igbo peoples are 

highly urbanized in the southern part of the country. 

DHS reports clearly show that FGC prevalence varies greatly by ethnicity except in countries 

with very high national prevalence. The Women’s core questionnaire for DHS surveys usually asks about 

the ethnicity of the respondent, though there are exceptions. For the countries of North East Africa, FGC 

prevalence by ethnicity is available only for Ethiopia. For all countries of West Africa, and for Kenya, 

information on ethnicity is available in the dataset even if the country report does not show FGC 

prevalence by ethnicity. That is, some of these countries report on FGC prevalence by ethnicity while 

others do not. The DHS surveys in Tanzania did not ask about ethnic identity. After the 2000 DHS in 

Mauritania, the government requested that no data be reported by ethnicity, including FGC prevalence. 

The DHS surveys in Uganda asked about affiliation to five broad ethnic groups. In Uganda, however, 
29 

only two small ethnic groups not included in the broad ethnic categories included as answer codes in the 

questionnaire practice FGC: the Sabiny of Eastern region and the Pokot in Karamoja region. 

Countries with a national prevalence of more than 80% have relatively small differences by 

ethnic group. Examples of such countries include Guinea, Mali, and Sierra Leone. In countries with lower 

overall prevalence, the range of FGC prevalence by ethnicity is far wider. Senegal showed a national 

prevalence of 26% in the 2010 survey, but a range of between 0.9% (Wolof) to 82% (Mandinka) by 

ethnicity. It should be noted that in many countries in West Africa such as Chad, Cote d’Ivoire, Central 

African Republic, Niger, Nigeria, and Benin, one finds ethnic groups with an FGC prevalence of 1% or 

2% and others with 65% to 80% prevalence. The 2008 DHS survey in Kenya showed a national 

prevalence of 27% but a range of FGC prevalence from 0.1% and 0.2% for Luo and Luhya, to 96% 

among the Kisii and 98% among the Somali. Thus in Kenya, some groups do not practice FGC at all, 

while among others, the practice is nearly universal. 

Table 7 shows the FGC prevalence for each ethnic group in detail in most of the countries. 

However, it is critical to remember that the names of ethnic groups in different countries are not equally 

specific. That is, some names refer to a category of related ethnic groups (Akan, Mande, Yoruba), while 

other names refer to a specific ethnic group (Wolof, Kikuyu, Bobo). In Côte d’Ivoire, for example, the 

five ethnic groups listed in the tables of the country report are ethnic groupings, not ethnic groups per se. 

In Cameroun, Chad, Côte d'Ivoire, and Nigeria, no answer codes for ethnicity were provided for coding 

on the questionnaire. Interviewers wrote the answers in the space provided in the questionnaire, and from 

50 to 100 different names were recorded in each country. During data processing, these names were 

grouped into six to ten categories as shown in the table. 

Table 7. National FGC prevalence data by ethnicity for all countries with information on ethnicity 

in the DHS 

Country Year Ethnicity Prevalence Number of women cut CCut

Guinea 2005 

Sussu 99.0 1,602 

Fulani 98.9 2,834 

Mandinka 97.1 2,080 

Kissi 97.5 412 

Toma 90.1 350 

Guerze 68.4 587 

Other/Foreigner NA 23 

Mali 2006 

Bambara 97.7 4,239 

Mandinka 98.0 1,183 

Fulani 94.3 2,122 

Sarakole/Soninke/Marka 96.9 1,838 

Songhay 28.4 1,313 

Dogon 76.0 851 

Tamachek/Tuareg 32.0 602 

Sénoufo/Minianka 92.9 1,295 

Bobo 80.6 861 

ECOWAS countries 87.1 255 

(Continued...)
30 

Table 7. – Continued

Country Year Ethnicity Prevalence Number of women cut CCut

Burkina Faso 2010 

Bobo 68.4 814 

Dioula (Jola) 72.8 142 

Fulani 83.9 1,433 

Gourmantche 64.3 1,169 

Gourounsi 60.3 773 

Lobi 83.2 423 

Mossi 78.4 8,964 

Senoufo 87.2 751 

Tuareg/Bella 22.2 317 

Dagara 69.3 412 

Bissa 83.1 670 

Other nationalities 35.7 83 

Other ethnic groups 78.4 1,107 

 

Senegal 2010 

Wolof 0.9 6,066 

Fulani 54.5 4,164 

Serer 2.2 2,353 

Mandinka 81.9 652 

Diola (Jola) 51.5 634 

Soninké 64.9 362 

Other/non-Senegalese 37.7 1,458 

Chad 2004 

Gorane 2.4 287 

Arab 95.2 769 

Ouadai 90.9 627 

Baguirmien 67.8 83 

Kanem-bornou 4.9 712 

Fitri-batha 85.6 243 

Hadjarai 93.9 452 

Lac Iro 48.8 134 

Sara 38.4 1,418 

Tandjile 1.7 402 

Fulani 12.0 67 

Mayo Kebbi 0.1 606 

Other/Foreigners 27.2 287 

Cote d'Ivoire 1998-99 

Akan 2.0 907 

Krou 13.4 335 

Northern Mande 74.6 366 

Southern Mande 69.6 313 

(Continued...)
31 

Table 7. – Continued

Country Year Ethnicity Prevalence Number of women cut CCut

Gur 66.5 442 

Others 74.7 676 

Cote d'Ivoire 2012 

 Akan 2.4 78 

 Krou 19.0 188 

 Northern Mande 66.8 830 

 Southern Mande 51.0 463 

 Gur/Voltaic 64.1 965 

 Others 60.6 1,290 

 Unknown 50.7 27 

 

Central African 

Republic 

1994-95 

Hausa 42.0 283 

Sara 35.8 342 

Mboum 3.1 405 

Gbaya 31.7 1,743 

Mandjia 71.0 581 

Banda 83.9 1,468 

Ngbaka-Bantou 5.6 453 

Yakoma-Sango 3.0 319 

Zandé-Nzakara 3.9 165 

Other 51.0 124 

Undetermined 0.0 1 

Nigeria 2003 

Fulani 0.6 463 

Hausa 0.4 2,055 

Igbo 45.1 1,037 

Kanuri 0.5 232 

Tiv 0.9 170 

Yoruba 60.7 865 

Other 15.7 2,797 

Benin 2006 

Adja 0.2 3,050 

Bariba 74.4 1,348 

Dendi 15.6 482 

Fon 0.2 7,714 

Yoa and Lokpa 53.2 578 

Bétamaribe 3.8 1,015 

Fulani 72.0 747 

Yoruba 10.0 1,959 

Other nationalities 11.9 656 

Other 23.8 79 

(Continued...)
32 

Table 7. – Continued

Country Year Ethnicity Prevalence Number of women cut CCut

Missing 11.0 164 

Niger 2006 

Arab 3.4 38 

Djerma/Songhay 2.7 1,954 

Gourmantche 65.8 70 

Hausa 0.2 4,894 

Kanuri 0.5 540 

Fulani 12.8 602 

Tuareg 0.4 1,012 

Toubou 1.4 34 

Other 15.4 80 

Cameroon 2004 

Arab 

Choa/Peulh/Maoussa/Kan

uri 12.7 433 

Biu-Mandara 0.5 591 

Adamaoua-Oubangui 0.0 589 

Bantoïde 1.4 163 

Grassfields 0.0 589 

Bamilike/Bamoun 0.2 1,328 

Coast/Ngoe/Oroko 0.0 234 

Beti/Bassa/Mbam 0.2 1,105 

Kako/Meka/Pygmé 0.0 146 

Foreigners 5.7 207 

Kenya 2008-09 

Kalenjin 40.4 1,115 

Kamba 22.9 923 

Kikuyu 21.4 1,642 

Kisii 96.1 579 

Luhya 0.2 1,373 

Luo 0.1 1,098 

Maasai 73.2 113 

 Embu 51.4 120 

Meru 39.7 415 

Mijikenda/Swahili 4.4 430 

Somali 97.6 240 

Taita/Taveta 32.2 79 

Other 38.9 315 

 
33 

Some names of ethnic groups occur in several different countries, but we should not assume that 

they share the same social practices. Ethnic groups that were once part of a larger social or political entity 

may develop a separate identity within a country. The FGC prevalence in these groups may or may not be 

similar. For example, the Gourmantché in Burkina Faso with a FGC prevalence of 64% in 2010 have a 

similar prevalence to the Gourmantché of Niger (2006) next door (66%). However, the Fulani of Guinea 

(2005) have a prevalence of 99% while the Fulani of Senegal (2010) have a prevalence of 55%. Ethnic 

groups called by the same name such as the Hausa and the Fulani live in numerous countries in West 

Africa, but the FGC prevalence within each of these groups varies widely from country to country. 

4.8 Changes Over Time in FGC Prevalence by Ethnicity 

Since FGC prevalence has declined in most countries from 1970 to 2000, and prevalence varies 

greatly by ethnic affiliation in most countries, it seemed important to examine the data to see if a decline 

in prevalence occurred equally in all ethnic groups. We expected to find wide differences in the rates of 

decline by ethnicity. However, as alluded to previously, the ethnicity of an individual, or the ethnic group 

of a survey respondent, is not as straightforward for all individuals as an outsider may expect. Several 

sources of variation should be recognized as inherent to assigning ethnicity to a respondent: 1) as noted 

earlier, some of the “ethnic groups” reported in a survey are actually categories that include a number of 

related but separate ethnic groups; 2) many individuals have a mixed ancestry ethnically, and thus may 

have some flexibility in giving their ethnic identity; 3) in the survey process, the implementing agency 

usually determines which ethnic categories will be listed as pre-coded responses to the question about 

ethnicity and any answer that does not fit into these categories is then coded as “Other.” The instructions 

given by trainers and/or supervisors about which ethnic groups belong together and should thus be 

combined, and which are separate entities, thus have an impact on the final results. 

These possible sources of variation explain how and why some countries have used a different list 

of ethnicities in subsequent surveys. If a country uses a different list of ethnic categories or ethnicities in 

subsequent surveys, it becomes extremely difficult to compare survey results. Table 8 shows FGC 

prevalence by ethnicity for the countries that used ethnic names that correspond fairly closely to actual 

groups rather than categories. Only in Guinea, Mali, Senegal, and Kenya, do the ethnic groups identified 

in the data sets correspond more or less to ethnicities recognized and consistently reported in those 

countries. Data from countries that reported ethnicity by category, or that used different ethnic groups or 

categories in successive surveys, are not included in the table. 
Table 8. National FGC prevalence data by ethnicity for four countries with more than one DHS survey that showed ethnicity 

Ethnicity Prevalence 

Number of 

women Ethnicity Prevalence 

Number of 

women Ethnicity Prevalence 

Number of 

women 

Guinea 1999 2005 

Sussu 99.5 1,336 Sussu 99.0 1,602 Fulani 99.6 2,427 Fulani 98.9 2,834 Mandinka 99.4 1,875 Mandinka 97.1 2,080 Kissi 99.7 340 Kissi 97.5 412 Toma 99.4 174 Toma 90.1 350 Guerze 89.0 492 Guerze 68.4 587 Other 73.9 15 Other 90.1 23 

Mali 1995-1996 2001 2006 

Bambara 98.9 2,814 Bambara 98.0 4,245 Bambara 97.7 4,239 Mandinka 98.9 741 Mandinka 97.9 1,177 Mandinka 98.0 1,183 Fulani 98.4 1,404 Fulani 97.2 1,797 Fulani 94.3 2,122 Sarakole /Soninke 98.6 1,228 

Sarakole /Soninke Marka 96.9 1,584 

Sarakole/Soninke Marka 96.9 1,838 

Songhay 47.8 319 Songhay 40.8 763 Songhay 28.4 1,313 Dogon 84.0 856 Dogon 78.6 938 Dogon 76.0 851 Tamachek 16.5 76 Tamachek 65.3 257 Tamachek 32.0 602 Senoufo /Minianka 95.6 859 

Senoufo/Minianka 97.2 1,063 

Senoufo/ Minianka 92.9 1,295 

Bobo 77.4 325 Bobo 90.5 489 Bobo 63.5 321 Foreigner 87.3 77 Other 95.1 323 

Ecowas countries 87.1 255 

Other 96.1 993 

other African countries 41.9 18 Other countries 55.0 5 Other 90.8 539 

(Continued...)

34 
Table 8. – Continued

Ethnicity Prevalence 

Number of 

women Ethnicity Prevalence 

Number of 

women Ethnicity Prevalence 

Number of 

women 

Senegal 2005 2010 

Wolof 1.6 5,799 Wolof 0.9 6,066 Fulani 62.1 3,684 Fulani 54.5 4,164 Serer 1.8 2,316 Serer 2.2 2,353 Mandinka 73.7 674 Mandinka 81.9 652 Diola 59.7 710 Diola 51.5 634 Soninke 78.2 402 Soninke 64.9 362 NonSenegalese 70.7 253 Non- Senegalese 57.0 318 Other 37.6 758 Other 32.3 1,140 

Kenya 1998 2003 2008-09 

Kalenjin 62.2 992 Kalenjin 48.1 831 Kalenjin 40.4 1,115 Kamba 33.0 1,008 Kamba 26.5 938 Kamba 22.9 923 Kikuyu 42.5 1,414 Kikuyu 34.0 1,886 Kikuyu 21.4 1,642 Kisii 97.0 860 Kisii 95.9 466 Kisii 96.1 579 Luhya 1.6 1,142 Luhya 0.7 1,230 Luhya 0.2 1,373 Luo 1.2 1,074 Luo 0.7 984 Luo 0.1 1,098 Maasai 88.8 113 Maasai 93.4 189 Maasai 73.2 113 Meru/Embu 54.2 564 Embu 43.6 129 Embu 51.4 120 

Meru 42.4 460 Meru 39.7 415 

Mijikenda/ Swahili 12.2 391 

Mijikenda/ Swahili 5.8 407 

Mijikenda/ Swahili 4.4 430 

Somali 62.7 16 Somali 97.0 298 Somali 97.6 240 Taita/Taveta 59.2 81 Taita/Taveta 62.1 101 Taita/ Taveta 32.2 79 Other 15.9 218 Turkana 12.2 116 Other 38.9 315 

Kuria 95.9 49 Other 17.6 111 

35 
36 

The two DHS surveys in Guinea show no change in the prevalence among the three main ethnic 

groups of the country (Fulani, Sussu, and Mandinka) and in one of the small groups (Kissi) of the forest 

area in the southeast. FGC did decline in two of the smaller ethnic groups. Prevalence among the Toma 

(1.8% of the population) decreased from 99% to 90% from 1999 to 2005, and prevalence among the 

Guerzé (3.8% of the population) declined from 89% to 68% during the same time period The Kissi, 

Toma, and Guerze, all inhabitants of the forest region, make up nearly 10% of the total population of the 

country. 

The three surveys in Mali show that five of the six largest ethnic groups in the country (Bambara, 

Fulani, Soninke, Senoufo, and Mandinka) show virtually no change in FGC prevalence in data from the 

three surveys: 1996, 2001, and 2006. FGC prevalence among these groups ranged from 96% to 99% in 

1996 and from 93% to 98% in 2006. Prevalence among the Dogon declined slightly, from 84% to 76%, 

but prevalence among the Songhay (Songhai, Sonrai) in the north dropped far more: 48% in 1996, 41% in 

2001, and 28% in 2006. The Songhay make up about 6% of the country’s population. However, the 

proportion of Songhay in the DHS sample varied somewhat, in part because in the first stage of choosing 

the sample for the survey of 1996 and 2001, the regions of Gao, Kidal, and Timbuktu were combined into 

one region for sampling purposes. In the sample of 2006, these three regions were considered separately, 

so the proportion of Songhay in the sample increased to 9% from only 6% in 2001 and 3% in 1996. The 

numbers and prevalence for the Tamachek (Tuareg, Moor) also varied greatly. It should also be noted that 

the reported prevalence for Tamachek in the 2001 survey (65.3%) is an error. Most Tamachek do not 

practice FGC, so the origin of that figure remains unclear. 
37 

The FGC prevalence specific to various ethnic groups that practice FGC in Senegal changed for 

several ethnicities in the surveys conducted in 2005 and 2010. Among the Wolof and the Serer, who 

together make up two-thirds of the total population, FGC is rare. Prevalence for both ethnicities remained 

at 1% to 2%. For Fulani, who make up one-fourth of the population, FGC prevalence declined slightly 

from 62% to 55%. For Diola and Soninke, each 4-5% of the population, FGC prevalence declined 

somewhat: Soninke from 78% to 65% and Diola from 60% to 52%. Only for Mandinka (4% of 

population) did prevalence rise: from 74% in the 2005 DHS to 82% in the 2010 DHS. Given the relative 

importance in the makeup of the population, the decrease in prevalence among the Fulani had the greatest 

impact on the overall national FGC prevalence. 

The ethnic groups of Kenya fall into three categories in relation to the practice of FGC: groups 

such as the Luo and Luhya in the west do not practice FGC at all; groups with one-third to one-half of 

their women circumcised; and groups such as the Kisii and Maasai with a prevalence of around 90% or 

higher. One sees major declines in prevalence for Kalenjin, Kamba, Kikuyu, Meru, the Mijikenda and 

Swahili, as well as the Taita and Taveta. Among the Kisii there was no change in the prevalence which 

remained at 96-97% in each of the three surveys. 

The variations in the size of a decline in prevalence by ethnicity provides some reassurance that 

the overall decline is more than a reflection of the fear of being stigmatized or of legal problems for 

having been circumcised. The three DHS surveys in Kenya showed major declines in FGC prevalence for 

the Kalenjin, the Kamba, and the Kikuyu. These three groups make up about 45% of Kenya’s population. 

The Luhya and Luo do not practice FGC and make up another 27% of the total population. Therefore, in 

Kenya, much of the overall decrease in FGC for the country can be attributed to changes among the 

Kalenjin, Kamba, and the Kikuyu. If the decline in prevalence were largely a response to a fear of legal 

problems instigated by the practice of FGC, we would see a more uniform decrease across the board. 

39 

5 Female Genital Cutting as an Event: the Practice 

The details of how, when, and where FGC occurs vary tremendously from one society and one 

country to the next. Such details may determine whether or not a girl sustains damage to her health from 

the procedure. Therefore, it is useful to consider the details of how the circumcision was conducted: at 

what age, by what type of practitioner, and what was actually done at the time. 

5.1 Types of Cutting 

Since 1996 the World Health Organization has classified FGC into four types (WH0 1997). A 

revision of 2011 identified the four types as follows: 

1) Type I: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy); 

2) Type II: Partial or total removal of the clitoris and the labia minora, with or without excision 

of the labia majora (excision); 

3) Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and 

appositioning the labia minora and/or the labia majora, with or without excision of the clitoris 

(infibulation). 

4) Type IV: All other harmful procedures to the female genitalia for non-medical purposes...” 

(WHO 2011:3). 

Although there is general agreement that any and all forms of FGC should be abandoned, it is 

also true that the most severe type of FGC—infibulation—inflicts greater harm on the physical well-being 

of girls and women than any other type. Women who are infibulated frequently experience pain and 

damage to their genitalia during pregnancy and delivery. Experts also agree that it may be difficult for a 

woman to know exactly what was done to her at the time of circumcision many years later if she had a 

mild form of FGC. Therefore, the FGC module of the DHS survey asks specifically -: Were you only 

nicked? Was flesh removed? Were you sewn shut? That sequence of questions allows us to estimate the 

proportion of women who were only slightly touched, and the proportion that was infibulated. It is this 

latter category that is of most concern from the standpoint of public health. 

5.2 Categories of Cutting in the DHS Data 

Table 9 shows the proportion of women who fall into the three main categories of types of FGC. 

In Ethiopia, women were only asked if they were infibulated. No questions were asked about the type of 

circumcision in Egypt, in the Central African Republic (CAR), in Liberia, Cameroon, Uganda, or Yemen. 

As indicated earlier, respondents in Liberia were asked only about membership in a secret society that 

includes FGC as part of initiation ceremonies. It was assumed that all members of the secret society had 

been circumcised. 

Only in northeastern Africa do we find large proportions of circumcised women with infibulation: 

82% in Sudan and 39% in Eritrea. Several neighboring countries in West Africa show rates of infibulation 

from 9% to 14%: Guinea, Mali, and Senegal. In Kenya, 13% of circumcised women are infibulated. It 

should also be noted that about 20% of women who reported that they had been circumcised said they did 

not know what was done to them in Senegal and Mauritania, and in Nigeria, the proportion of 

circumcised women who said they did not know what was done to them was almost half (46%). 

 
40 

Table 9. Percent distribution of circumcised women by type of circumcision in most recent DHS 

survey 

Type of circumcision Number of 

women 

Country Year circumcised

Nicked 

only 

Flesh 

removed 

Sewn 

closed 

Don’t 

know 

North East Africa 

Eritrea 2002 46.0 4.1 38.6 11.3 7,765 

Sudan 1989-90 14.8 2.7 82.4 0.1 5,224 

West Africa, northern 

Guinea 2005 1.7 86.5 9.3 2.58 7,607 

Mali 2006 3.0 75.8 10.2 11.1 12,426 

Burkina Faso 2010 16.6 76.8 1.2 5.4 12,949 

Mauritania 2000-01 5.5 75.3 na 19.3 5,508 

Senegal 2010-11 9.9 52.7 13.8 23.6 4,025 

West Africa, southern 

Sierra Leone 2008 3.2 82.0 2.6 12.2 6,735 

Cote d’Ivoire 2012 4.7 71.1 8.7 15.6 3,843 

Chad 2004 19.6 76.0 2.3 2.1 2,734 

Nigeria 2008 3.0 45.4 5.3 46.4 9,890 

Benin 2006 0.5 93.8 3.9 1.8 2,290 

Niger 2006 0.8 77.8 13.3 8.2 206 

East Africa 

Kenya 2008 2.3 82.7 13.4 1.6 2,284 

Tanzania 2010 0.7 90.9 2.2 6.3 1,477 

Several points about the data in Table 9 are worth noting. With the exception of Eritrea and 

Sudan, by far the largest proportion of women who had been circumcised reported they had some flesh 

removed as opposed to being nicked or infibulated. Only in Eritrea do we find a substantial proportion 

(46%) with “nicked only.” In Burkina, Chad, and Sudan, from 15-20% were ‘nicked only.’ Figure 6 

Shows the same data in a graph. 

It also seems useful to examine the type of circumcision practiced in several surveys in the same 

countries over time to assess changes in FGC practices. Table 10 shows the percent distribution of 

circumcised women by type of circumcision for the DHS surveys that asked about the type of 

circumcision in the same manner in two or more successive surveys. The number of countries is limited: 

Eritrea in the north east; Mali, Burkina Faso, Senegal, Nigeria, and Benin in West Africa, and Tanzania in 

East Africa. 
41 
42 

Table 10. Percent distribution of circumcised women by type of circumcision with multiple DHS 

surveys 

Type of circumcision Number of 

women 

Country Year circumcised

Nicked 

only 

Flesh 

removed 

Sewn 

closed 

Don’t 

Know 

North East Africa 

Eritrea 1995 61.5 4.4 34.0 0.1 4,771 

Eritrea 2002 46.0 4.1 38.6 11.3 7,765 

West Africa, northern 

Mali 1995-96 na 99.2 0.5 0.4 9,086 

Mali 2001 2.0 81.5 1.9 14.7 11,767 

Mali 2006 3.0 75.8 10.2 11.1 12,426 

Burkina Faso 2003 1.2 90.8 2.0 6.1 9,552 

Burkina Faso 2010 16.6 76.8 1.2 5.4 12,949 

Senegal 2005 0.22 82.7 11.9 5.1 4,123 

Senegal 2010-11 9.9 52.7 13.8 23.6 4,025 

West Africa, southern 

Nigeria 1999 na 88.9 3.8 7.3 2,056 

Nigeria 2003 2.0 43.5 3.9 50.6 1,445 

Nigeria 2008 3.0 45.4 5.3 46.4 9,890 

Benin 2001 7.0 84.1 3.5 5.4 1,047 

Benin 2006 0.5 93.8 3.9 1.8 2,290 

East Africa 

Kenya 1998 na 89.4 0.04 10.6 505 

Kenya 2008-09 2.3 82.7 13.4 1.6 2,284 

Tanzania 1996 na 91.9 5.2 2.9 1,476 

Tanzania 2004-05 1.9 91.3 2.0 4.8 1,510 

Tanzania 2010 0.7 90.9 2.2 6.3 1,477 

Several DHS surveys did not include all the information about type of cutting necessary to be 

included in the table. That is the case for Guinea 1999, Burkina 1999, Côte d’Ivoire 1999, and Niger 

1998. 

Eritrea shows a small increase in the proportion of women infibulated, and a larger increase in the 

proportion that gave no answer. Mali shows a small increase in the proportion with flesh removed. 

Burkina shows an increase from 1% to 17% for ‘just nicked,’ and a decrease in ‘flesh removed.’ In 

Senegal the proportion who said ‘flesh removed’ changed from 83% in the 2005 survey to 53% in the 

2010 survey; at the same time, the proportion of women saying that they don’t know what was done to 

them changed from 5% in the 2005 DHS to 24% in the 2010 DHS; it is not clear why. No changes were 

observed in the DHS surveys from Nigeria or Tanzania. 

 
43 

5.3 Age at Circumcision 

The standard FGC module has always included a question asking at what age the respondents had 

been circumcised. Knowing the age of the girl at circumcision adds to our picture of how the event 

occurred. For example, if most girls are cut by the age of two years, we cannot expect the event to have 

included much instruction about appropriate behavior or much ritual participation. Girls cut at the age or 

13 or 14 may, however, have participated in ceremonies and in learning about many topics. 

Table 11 shows the distribution of women circumcised by their age at circumcision for countries 

that include a question about age. In the region of North East Africa only two countries recorded the age 

at circumcision: Egypt and Eritrea. The two present a dramatic contrast in the timing of circumcision. In 

the 2008 survey in Egypt, 90% of circumcised women were circumcised between the ages of five and 15: 

38% between five and nine and 52% from 10 to 14. In the 2002 survey in Eritrea, 50% were circumcised 

in the first two months of life. In fact, 36% were cut during their first month of life (data not shown), 

another 10% from age two to four, and 15% from age five to nine. Nine percent reported they did not 

know their age at the time of circumcision. 

Table 11. Percent distribution of circumcised women by age of circumcision in most recent DHS 

Age at circumcision 

Country Year 0-1 2-4 5-9 10-14 15+ 

Don't 

know/ 

missing 

Number of 

women 

circumcised 

North East Africa 

Egypt 2008 0.6 1.7 38.0 52.4 1.6 5.7 5,044 

Eritrea 2002 64.7 10.4 15.0 1.1 0.1 8.7 7,765 

West Africa, northern

Guinea 2005 33.8 1.9 31.5 26.5 3.1 3.2 7,607 

Mali 2006 61.6 6.5 17.0 8.2 1.1 5.6 12,426 

Burkina Faso 2010 49.6 10.9 28.2 8.9 2.0 0.5 12,949 

Mauritania 2000-01 75.1 1.2 0.7 0.2 0.1 22.7 5,508 

Senegal 2010-11 61.7 9.5 13.8 6.0 0.7 8.3 4,025 

0.0 

West Africa, southern 0.0 

Sierra Leone 2008 22.3 0.9 13.0 35.6 19.1 9.1 6,735 

0-4 5-9 10+ 

Chad 2004 4.0 49.5 40.9 5.6 2,734 

Cote d'Ivoire 2012 52.8 18.6 26.1 2.4 3,843 

Central African Republic 1994-95 0.3 2.1 29.3 59.2 9.0 0.1 2,555 

Nigeria 2008 82.7 1.4 3.5 3.3 5.6 3.5 9,890 

Benin 2006 47.6 1.5 25.2 18.6 3.9 3.2 2,290 

Niger 2006 56.4 8.8 16.9 10.9 1.1 5.9 206 

Cameroon 2004 15.9 4.7 47.1 22.3 3.8 6.1 78 

0.0 

East Africa 0.0 

Kenya 2008-09 1.7 0.7 23.4 41.5 29.1 3.6 2,284 

Tanzania 2010 32.4 6.2 18.1 22.3 19.4 1.7 1,477 
44 

The countries in the northern part of West Africa display two patterns with regard to age at 

circumcision: smaller versus larger proportions of girls cut before their first birthday. In the 2005 survey 

in Guinea, only one-third of girls were circumcised during their first year of life, while that proportion 

varied from 50% to 75% in the other four countries. In Guinea, 36% were circumcised before the age of 

five, while in the other countries, from 60% to 76% were cut before their fifth birthday. One-third of girls 

in Guinea was cut between the ages of five and nine, and another 27% from 10 to 14. In countries where 

one-half of those circumcised are cut in the first 12 months, or two-thirds to three-fourths before the age 

of five (data not shown), it is highly unlikely that much instruction or organized group activities would 

remain part of FGC. 

Several other points about this group of countries are worth noting. In Burkina Faso, 37% of girls 

were circumcised between the age of five and 14, compared with 20% in Senegal, 25% in Mali, and 

merely 1% in Mauritania. In Burkina Faso, only 0.5% of respondents said they did not know their age at 

FGC. In Mauritania, on the other hand, 23% reported they did not know their age at circumcision. Among 

those who did report age in Mauritania, more than 97% were circumcised before their first birthday. 
45 

The countries in the southern part of West Africa display a much wider range in the age at 

circumcision. The countries with the highest percentage circumcised in the first two years of life are 

Nigeria at 83%, Niger at 56%, Cote d'Ivoire at 51%, and Benin at 48%. FGC occurs in the Central 

African Republic (CAR) much later than in the other countries in the region, with 59% of girls being cut 

between 10 and 15 years of age, and nearly 80% between 5 and 15. Cameroon is similar, with 69% 

circumcised between five and 15. However, Cameroon, with a national prevalence of only 1.4%, had only 

78 cases of women circumcised, so the percentages in the various categories are not reliable. Chad, Niger, 

and Cameroon reported that 6% of respondents did not know their age at circumcision, while the other 

countries reported lower levels. 

In East Africa, Kenya and Tanzania, show quite different patterns with regard to age at 

circumcision. In Kenya, 2% of girls were cut before the age of five, while in Tanzania, that figure was 

39%. In Tanzania, 57% of girls were circumcised before they reached 10 years of age; in Kenya, that 

figure was only 26%. Less that 4% in each country reported they did not know their age of circumcision. 

5.4 Age at Circumcision for All DHS Surveys 

Table 12 presents data on the age at circumcision for all countries that reported such data for at 

least two surveys. In Egypt, Mali, Burkina Faso, Nigeria, and Tanzania, data on age at circumcision from 

three surveys are available. Data from Egypt show that between 1995 and 2008, the median age at 

circumcision increased gradually. In the 1995 EDHS, 46% were circumcised between the ages of five to 

nine, and 43% between the ages of 10-14. By 2008, only 38% of girls were cut between five to nine years 

of age, while 52% were cut between the ages of 10-14. These changes captured between the 1995 and 

2008 surveys indicate that the median age at circumcision in Egypt rose slightly from 1960 to 1995. 

Changes between the 1995 and 2002 DHS surveys in Eritrea are shown in Table 12. Two 

apparent changes are worth pointing out: the proportion of girls circumcised before reaching two years of 

age increased from 46 in 1995 to 65% in 2002, and the proportion that reported they did not know when 

they had been cut, or were missing, declined from 28% to 9%. The question and the coding possibilities 

were identical except that in 2002, interviewers were encouraged to “Probe for a numeric answer before 

circling ‘Don’t Know.’ It would seem that the probing for a numeric answer greatly reduced the 

proportion of those reporting ‘Don’t Know.’ 
46 

Table 12. Percent distribution of circumcised women by age when circumcision occurred in 

countries with multiple DHS surveys 

Age at Circumcision 

Country Year 0-1 2-4 5-9 10-14 15+ 

Don't 

know/ 

missing 

Number of 

women 

circumcised 

North East Africa 

Egypt* 1995 0.8 1.8 46.0 42.9 1.0 7.6 14,332 

Egypt* 2005 0.3 1.8 42.5 44.9 1.3 9.1 18,657 

Egypt 2008 0.6 1.7 38.0 52.4 1.6 5.7 5,044 

Eritrea 1995 46.2 13.9 11.1 1.0 0.1 27.9 4,775 

Eritrea 2002 64.7 10.4 15.0 1.1 0.1 8.7 7,765 

West Africa, northern 

Guinea 1999 0.5 3.7 48.1 35.2 3.3 9.2 6,656 

Guinea 2005 33.8 1.9 31.5 26.5 3.1 3.2 7,607 

Mali 1995-96 30.6 10.7 24.8 15.6 1.7 16.6 9,097 

Mali 2001 54.3 6.9 20.5 13.1 1.4 3.7 11,767 

Mali 2006 61.6 6.5 17.0 8.2 1.1 5.6 12,426 

Burkina Faso 1998-99 12.5 11.9 35.3 9.3 2.2 28.8 4,649 

Burkina Faso 2003 41.4 9.3 28.9 9.1 2.1 9.1 9,552 

Burkina Faso 2010 49.6 10.9 28.2 8.9 2.0 0.5 12,949 

Senegal 2005 63.2 9.5 14.9 5.1 0.9 6.3 4,123 

Senegal 2010-11 61.7 9.5 13.8 6.0 0.7 8.3 4,025 

0.0 

West Africa, southern 0.0 

Cote d'Ivoire 1994 16.7 7.6 27.3 27.6 11.1 9.6 3,459 

Cote d'Ivoire 1998-99 51.3 3.8 17.3 18.2 8.1 1.4 1,354 

Nigeria 1999 44.9 4.6 8.0 5.8 9.6 27.1 2,073 

Nigeria 2003 74.9 0.9 4.4 5.1 11.0 3.8 1,445 

Nigeria 2008 82.7 1.4 3.5 3.3 5.6 3.5 9,890 

Benin 2001 30.2 3.8 40.0 18.6 4.4 3.0 1,047 

Benin 2006 47.6 1.5 25.2 18.6 3.9 3.2 2,290 

Niger 1998 14.1 14.7 18.8 7.2 11.4 33.8 340 

Niger 2006 56.4 8.8 16.9 10.9 1.1 5.9 206 

0.0 

East Africa 0.0 

Kenya 1998 0.0 2.7 18.9 43.1 31.9 3.5 2,965 

Kenya 2008-09 1.7 0.7 23.4 41.5 29.1 3.6 2,284 

Tanzania 1996 0.8 4.3 19.9 37.5 23.6 13.9 1,779 

Tanzania 2004-05 28.8 5.6 17.8 27.1 18.9 1.8 1,510 

Tanzania 2010 32.4 6.2 18.1 22.3 19.4 1.7 1,477 

*Sample consisted of ever-married women 
47 

The data from countries in northern West Africa demonstrate the effects that changes in the 

coding of answers may have on survey results. In Guinea, Mali and Burkina Faso, the first survey that 

collected FGC data asked about age at circumcision. If the respondent could not give a precise age in 

years, her response was coded ‘don’t know’. This approach resulted in a fairly large proportion of ‘don’t 

know’ responses: 17% in the 1996 Mali DHS and 29% in the Burkina Faso 1999 DHS. In the subsequent 

surveys in Burkina, Guinea, and Mali, the answer codes to the age question were changed: an answer 

category ‘In infancy’ was added to cover answers that did not give a precise age but that indicated a very 

early age. In addition, an instruction was added asking the interviewer to have the respondent estimate her 

age at circumcision if she did not know her exact age. As noted above for Eritrea, this change in coding 

appears to have reduced the proportion of women who reported they did not know their age. It seems 

logical to assume that many of those (who said ‘Don’t know’) were circumcised at a very early age. 

The question on age at circumcision was comparable in the second and third surveys in Burkina 

Faso and Mali as well as in the two surveys in Senegal. No difference in results can be seen in the two 

surveys in Senegal. In Mali the proportion of girls circumcised before reaching the age of two was 54% in 

2001 and 62% in 2006, while the proportion cut at age 10-14 was 13% in 2001 and 8% in 2006, 

suggesting that there might be a movement to conduct FGC at younger ages inMali. In Burkina Faso, the 

proportion of girls circumcised before reaching the age of two was 41% in 2003 and 50% in 2008. The 

age at circumcision by age cohorts in the two Burkina Faso survey indicates that the age at circumcision 

has been declining. 

The countries in the southern part of West Africa show mainly a shift towards girls being 

circumcised during their first two years of life (0-1). The largest increases can be seen in Côte d’Ivoire, 

where the proportion of girls circumcised in their first two years was 17% in 1994 and 51% in 1999. 

Similarly, the DHS in Niger showed that the proportion of circumcised women who were cut at age 0-1 

went from 14% in 1998 to 56% in 2006. 

In 1998-99 Côte d’Ivoire, 2006 Niger, and 1999 and 2003 Nigeria, an answer code ‘during 

infancy’ was added to accommodate answers that respondents often gave. That is, when respondents in a 

number of West African countries were asked about their age at circumcision, an important proportion 

gave answers that could best be translated as “during infancy.” The coding change most likely explains 

part of the dramatic increase in the proportion of girls cut before their second birthday, but not all. In 

Benin, the coding for both surveys included the same answer code (during infancy), yet the proportion of 

girls cut in their first two years changed from 30% in the 2001 survey data to 48% in the 2006 survey 

data. 

5.5 The Identity of the Person Performing the Circumcision 

In most countries, FGC is performed by elderly women who are known for playing the role of 

circumciser. In a few countries, health care professionals also perform FGC. Women were asked who 

performed their circumcision; the answers were coded as traditional provider (circumciser, traditional 

birth attendant, or other traditional) or health care professionals (doctors, nurses, midwives). The country 

reports include a table showing the percentage of women circumcised by traditional practitioners and the 

percentage cut by health care professionals. 

Table 13 shows the data on circumciser from the most recent DHS surveys for all countries that 

used the FGC module. The data from three countries stand out as different from all the rest in the 

percentage of cases of FGC that were performed by health care professionals: Egypt, Sudan, and Kenya. 

The 2008 Egypt DHS showed that 32% of FGC cases were performed by health care professionals. The 

corresponding percentage in the 1989-90 Sudan DHS was 36%, and in the 2008 Kenya DHS it was 20%. 

We should also take note of the significant role of health care professionals in performing FGC in Guinea, 
48 

Nigeria, and Yemen: in these countries, the latest DHS shows that about 1 in 10 circumcised women are 

cut by a health professional. 

Table 13. Percent distribution of circumcised women by type of person who did the cutting for the 

most recent DHS survey 

Type of person who did the cutting 

Country Year 

Health care 

professional Circumciser 

Other 

traditional 

Nonspecified Number of women 

circumcised 

North East Africa 

Egypt 2008 31.9 NA 66.4 1.7 5,044 

Eritrea 2002 0.6 84.7 8.5 6.2 7,677 

Sudan* 1989-90 35.6 NA 64.0 0.3 5,213 

West Africa, northern 

Guinea 2005 10.0 87.8 1.5 0.7 7,561 

Mali 2006 2.5 88.8 2.8 5.8 12,426 

Burkina Faso 2010 0.2 95.7 1.6 2.6 12,949 

Mauritania 2000-01 1.4 35.5 53.5 9.6 4,384 

Senegal 2010-11 NA 91.4 8.6 NA 4,025 

West Africa, southern 

Sierra Leone 2008 0.3 94.8 0.7 4.2 6,735 

Chad 2004 2.9 77.0 19.4 0.7 2,734 

Cote d'Ivoire 2012 0.3 93.8 1.1 4.8 3,843 

Nigeria 2008 8.9 63.7 9.9 17.5 9,890 

Benin 2006 0.6 84.3 11.3 3.8 2,290 

Niger 2006 0.5 92.5 1.0 6.0 206 

Cameroon 2004 4.4 80.6 12.4 2.7 75 

East Africa 

Kenya 2008-09 19.7 74.7 3.7 1.9 2,284 

Tanzania 2010 1.8 69.9 18.5 9.7 1,477 

Yemen* 1997 8.5 NA 90.8 0.6 1,544 

*Sample consisted of ever-married women 
49 

In a limited number of countries, data on who performed the circumcision are available for two or 

three surveys in the country which shows changes in the proportion of FGC procedures performed by 

health professionals and by any traditional person. Table 14 shows these data from 11 countries. The table 

shows changes in Egypt and Kenya only. In Egypt, the percentage of FGC procedures performed by 

medical staff rose from 17% in the 1995 survey to 32% in the 2008 survey, while the percentage of FGC 

operations performed by medical personnel declined to 20% in the Kenya 2008 DHS from 35% in the 

1998 DHS. In addition, slight decreases can also be seen in Nigeria and Mali: from 12.9% in 2003 to 

8.9% in 2008 in Nigeria, and from 5.2% in 1996 to 2.4% in 2001 in Mali. 
50 

Table 14. Percent distribution of circumcised women by type of person who did the cutting in 

countries with multiple DHS surveys 

Country Year 

Health 

professional Circumciser 

Other 

traditional 

Nonspecified Women 

circumcised 

North East Africa 

Egypt* 1995 17.3 NA 79.6 3.1 14,332 

Egypt 2008 31.9 NA 66.4 1.7 5,044 

Eritrea 1995 0.2 92.2 4.1 3.4 4,708 

Eritrea 2002 0.6 84.7 8.5 6.2 7,677 

West Africa, northern 

Mali 1995-96 5.2 88.2 5.7 0.8 4,694 

Mali 2001 2.4 91.4 0.7 5.5 11,674 

Mali 2006 2.5 88.8 2.8 5.8 12,426 

Burkina Faso 1998-99 0.6 86.3 0.2 12.9 4,647 

Burkina Faso 2003 0.1 88.0 1.0 10.8 9,505 

Burkina Faso 2010 0.2 95.7 1.6 2.6 12,949 

Senegal 2005 0.6 91.6 1.8 6.1 4,087 

Senegal 2010-11 NA 91.4 8.6 NA 4,025 

West Africa, southern 

Cote d'Ivoire 1994 0.9 NA NA 8.6 3,450 

Cote d’Ivoire 1998-99 0.4 92.3 1.5 5.8 1,344 

Cote d’Ivoire 2012 0.3 93.8 1.1 4.8 3,843 

Nigeria 1999 12.9 37.6 36.3 13.2 2,048 

Nigeria 2003 12.8 50.2 9.9 27.0 1,419 

Nigeria 2008 8.9 63.7 9.9 17.5 9,890 

Benin 2001 0.5 94.7 1.8 3.0 1,040 

Benin 2006 0.6 84.3 11.3 3.8 2,290 

Niger** 1998 NA NA 96.6 3.4 337 

Niger 2006 0.5 92.5 1.0 6.0 206 

East Africa 

Kenya 1998 35.0 51.1 12.1 1.8 507 

Kenya 2008-09 19.7 74.7 3.7 1.9 2,284 

Tanzania 1996 3.6 75.7 8.8 11.8 1,425 

Tanzania 2004-05 2.0 70.9 18.2 9.0 1,510 

Tanzania 2010 1.8 69.9 18.5 9.7 1,477 

*Sample consisted of ever-married women 

** “Circumciser” not included in answer categories 
51 

6 Enduring Issues 

This final chapter briefly discusses issues that remain relevant to understanding the practice of 

FGC within each country: overall prevalence, its distribution within the country, temporal trends, and the 

interpretation of daughter data. These issues will be included in efforts by government agencies and 

donors in their assessments of the importance of the practice and their understanding of trends over time. 

The issues addressed include the prominence of FGC nationally, the regional distribution of the practice, 

any trends over time in national prevalence and age cohorts, and the use of daughter data for program 

evaluation. The proper use of data on the FGC status of daughters of respondents presents an enduring 

challenge. 

DHS data on the national prevalence for FGC shows the proportion of women age 15-49 that 

have been circumcised. This proportion can be used to estimate the total number of women in all ages 

who are circumcised in the country. The calculation of the total number of women affected involves 

several assumptions, but one can arrive at a figure with some confidence. The FGC prevalence for women 

age 45 to 49 can be used as a proxy and lower limit for the prevalence of women older than 49 years of 

age; similarly, the prevalence of women 15 to 19 years of age can be used as a proxy and upper limit for 

girls less than 15 years old (Yoder et al. 2013). 

There is tremendous variation in FGC prevalence from one country to the next, sometimes in 

countries that share a border. In West Africa, according to the 2006 DHS in Mali, prevalence was 85%, 

while in Niger next door, 2% of women (2006) had been cut. In East Africa, the 2008 DHS in Kenya 

showed an FGC prevalence of 27% while across the border in Uganda, less than 1% of women had been 

cut. Knowledge of the proportion of women affected as well as the total number can be used to assess the 

importance of FGC as an issue in public health, child protection, and women’s rights. 

Taking note of the regional distribution and any urban/rural contrast are key elements for any 

assessment of the practice of FGC in most countries. If a national survey finds that FGC prevalence is far 

higher in rural than in urban areas, as in most countries, that fact invites us to reflect on how and why 

families in urban areas act differently toward their daughters. Why are mothers less likely to have their 

daughters circumcised? Whether prevalence differs markedly by region depends to some extent on the 

overall prevalence, and on the importance of the practice of FGC as a marker for ethnicity. Countries with 

a prevalence of less than 70% display marked difference in prevalence by region, while those with a 

prevalence of 80% or higher show relatively small regional differences. 

Several examples serve to illustrate these points. In the 2010 survey in Burkina Faso, with an 

overall national prevalence of 76%, prevalence in urban areas was 69% and 78% in rural areas. Regional 

variations in prevalence were also found. The Centre-Ouest (Center-West) region had a prevalence of 

54%, the Centre-Est (Center-east) a prevalence of 90%, and all other regions were in between.The 2008 

survey in Kenya found an FGC prevalence of 0.8% in Western province, 98% in North Eastern province, 

three provinces around 33%, and the others somewhat less. 

In short, an assessment of FGC in a country will consider the overall national prevalence as well 

as how the practice is distributed. The distribution of the practice may be explained in terms of either the 

impact of urbanization, the ethnic composition of the population, historical trends, or some other variable. 

FGC prevalence shows more variation by ethnicity than any other demographic variable. Programs that 

promote the abandonment of the practice will find such considerations useful for policy formulation and 

program planning. 

Evidence for changes in FGC prevalence over time is derived from the national prevalence found 

in two or more DHS for a country, or one or more DHS that show FGC prevalence by age cohort. In most 
52 

cases, it is not possible to interpret the results without performing statistical tests to determine whether or 

not the change was statistically significant. That is, what are the chances that the decline in national 

prevalence is due to chance, as determined by whether or not the confidence intervals overlap? For 

example, the small decrease in national prevalence in the 2005 to 2010 surveys in Senegal is not 

statistically significant (decrease from 28.2% to 25.7%). On the other hand, the decline in national 

prevalence in Kenya from 36% in 1998 to 27% in 2008 is statistically significant. 

As indicated earlier, the FGC module used by both DHS and MICS since 2010 asks respondents 

about each of their living daughters less than 15 years of age. The respondent reports on whether or not 

each of her daughters was circumcised, what was done, at what age, and the type of person (traditional or 

medical personnel) who performed the procedure. These questions mirror the questions asked of the FGC 

status of the respondents themselves. The new module makes it possible to report on the FGC status of 

girls at all ages from 0-14. These data show the current FGC status of these daughters of respondents. 

However, some of these girls will be circumcised after the date of the survey. Therefore we must 

consider the difference between current FGM/C status and final FGM/C status of daughters. Since 

relatively few women are circumcised after the age of 15, when women age 15-49 are asked whether they 

have been circumcised, it is assumed that those who report that they have not been circumcised will not 

be cut in the future. Thus our FGC data on women 15-49 years of age reports on their final (FGC) status. 

We do not make that assumption for daughters less than 15 years of age, since a certain proportion will be 

later circumcised. The question is, what is the size of that proportion? 

However, when mothers (respondents) are asked about the FGC status of their daughters, they 

provide information about their current status only. Some girls in the 0-4 cohorts and the 5-9 cohorts have 

not yet been circumcised at the time of the survey because they had not yet reached the proper age for the 

event, and thus remain at risk for FGC. Some of these will be cut later. Indeed, even some in the 10-14 

age cohort will be circumcised before they become 15 years old. For these girls, their current FGC status 

of not being cut will be different from their final FGC status. 

This distinction between current and final FGC status is critical for interpreting data on daughters 

0-14 years old. We must keep in mind two limitations for these data: Thus two caveats are important for a 

valid interpretation of data on the circumcision of daughters: first, that the FGC prevalence of girls age 0-

14 years to women age 15-49 is not valid since many of the 0-14 age group may not have reached the age 

at which circumcision takes place in that community/country. Second, interpretation of the prevalence of 

FGC among girls 0-14 should be done in the context of the median age of circumcision for that society. 

This will allow for an assessment of what proportion of the girls 0-14 are likely to be circumcised as they 

age through the cohort. For example, in the 2002 survey in Eritrea, more than 90% of women reported 

that they had been circumcised before the age of 10. Therefore, data on the FGC status of girls age 10-14 

in Eritrea would be fairly close to their final FGC status. 

One of the reasons for asking about the FGC status of the daughters of respondents is to obtain 

data that could be used to evaluate the impact of recent programs that promote FGC abandonment. The 

availability of more complete data on the FGC status and experience of girls can always be useful. In 

countries where most circumcision occurs in the first few years of life, such data may indeed be used for 

the evaluation of the impact of recent interventions. In countries where FGC occurs largely at the ages of 

10 and above, the current FGC status of girls will be much lower than their final FGC status, and thus 

daughter data will be less useful for recent program evaluation. Nevertheless, with proper caution, data on 

daughters can add a great amount to our understanding of how circumcision has been practiced in the last 

ten years or so. 
53 

References 

Abusharaf, R. 2006. Female Circumcision: Multicultural Perspectives. Philadelphia, PA: University of 

Pennsylvania Press. 

AIDOS. 2000. Anthropologia delle mutilazioni dei genital femminili: Una ricerca in Italia. Rome: 

AIDOS. 

Andro, A., and M. Lesclingand. 2007. “Les mutilations sexuelles féminines: le point sur la situation en 

Afrique et en France.” Population et Sociétés Numéro 438 (octobre). 

Boddy, J. 1991. “Body Politics: Continuing the Anti-Circumcision Parade.” Medical Anthropology 

Quarterly 5: 15-17. 

Boddy, J. 2007. Civilizing Women: British Crusades in Colonial Sudan. Princeton, NJ: Princeton 

University Press. 

Carr, D. 1997. Female Genital Cutting: Findings from the Demographic and Health Surveys Program. 

Calverton, MD: Macro International Inc. 

Dellenborg, L. 2007. “Multiple Meanings of Female Initiation: “Circumcision” among Jola Women in 

Lower Casamance, Senegal.” Dissertation, Department of Social Anthropology, School of Global 

Studies, Göteborg University, Göteborg, Sweden. 

Dieleman, M. 2010. Excision et migration en Belgique francophone. Rapport de recherche de 

l’Observatoire du sida et des sexualités pour le GAMS Belgique. Bruxelles: Ed. GAMS Belgique. 

Droz, Y. 2000. “Circoncision féminine et masculine en pays kikuyu.” Cahiers d’études africaines

158(XL-2): 215-240. 

Dubourg, D., F. Richard, E. Leye, S. Ndame, T. Rommens, and S. Maes. 2011. “Estimating the number of 

women with female genital mutilation in Belgium.” The European Journal of Contraception and 

Reproductive Health Care 16: 248-257. 

Eliah, E. 1996. “REACHing for a Healthier Future.” Populi (May): 12-16. 

Exterkate, M. 2013. Female Genital Mutilation in the Netherlands. Prevalence, Incidence and 

Determinants. Pharos Centre of Expertise on Health for Migrants and Refugees. Utrecht: Pharos. 

FORWARD. 2007. A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in 

England and Wales. Report for Foundation for Women’s Health, Research and Development 

(FORWARD). London, UK: FORWARD. 

Gessain, M. 1960. “Femmes Coniagui (Guinée).” In Femmes d’Afrique Noire, edited by D. Paulme, Paris: 

Mouton & Co. 

Gruenbaum, E. 2001. The Female Circumcision Controversy: An Anthropological Perspective. 

Philadelphia, PA: University of Pennsylvania Press. 

Hayford, S., and J. Trinitapoli. 2011. “Religious Differences in Female Genital Cutting: A Case Study 

from Burkina Faso.” Journal for the Scientific Study of Religion 50(2): 252-271. 
54 

Hernlund, Y., and B. Shell-Duncan, eds. 2007. Transcultural Bodies: Female Genital Cutting in Global 

Context. New Brunswick, NJ: Rutgers University Press. 

Hosken, F. 1982. The Hosken Report: Genital and Sexual Mutilation of Females. Lexington, MA: 

Women’s International Network News. 

Isa, A.R., R. Shuib, and M.S. Othman. 1999. “The Practice of Female Circumcision among Muslims in 

Kelantan, Malaysia.” Reproductive Health Matters 7(13): 137-144. 

Jackson, E.E., P. Akweongo, E. Sakeah, A. Hodgson, R. Asuru, and J.E. Phillips. 2003. “Inconsistent 

Reporting of Female Genital Cutting Status in Northern Ghana: Explanatory Factors and Analytical 

Consequences.” Studies in Family Planning 34(3): 200-210. 

Jackson, M. 1977. The Kuranko: Dimensions of Social Reality in a West African Society. New York, NY: 

St. Martin’s Press. 

Klouman, E., R. Manongi, and K.I. Klepp. 2005. “Self-reported and Observed Female Genital Cutting in 

Rural Tanzania: Associated Demographic Factors, HIV and Sexually Transmitted Infections.” Tropical 

Medicine and International Health 10(1): 105-115. 

MICS (Multiple Indicator Cluster Survey). 2012. Iraq. Multiple Indicator Cluster Survey 2011 Volume I: 

Final Report. New York, NY: Central Statistics Organization, Kurdistan Regional Statistics Office, and 

UNICEF. 

Msuya, S., E. Mbizvo, A. Hussain, J. Sundby, N. Sam, and B. Stray-Pedersen. 2002. “Female Genital 

Cutting in Kilimanjaro, Tanzania: Changing Attitudes.” Tropical Medicine and International Health 7(1): 

159-165. 

Obermeyer, C. 2003. “The Health Consequences of Female Circumcision: Science, Advocacy, and 

Standards of Evidence.” Medical Anthropological Quarterly 17(3): 394-412. 

Population Council. 2003. Female Circumcision in Indonesia. Research Report. Jakarta, Indonesia. 

Rashid, A.K., S.S. Patil, and A.S. Valimalar. 2010. “The Practice of Female Genital Mutilation among the 

Rural Malays in North Malaysia.” The Internet Journal of Third World Medicine 9(1): 10.5580/a23 

Robertson, C. 1996. “Grassroots in Kenya: Women, Genital Mutilation, and Collective Action, 1920-

1990.” Signs 3: 615-642. 

Shell-Duncan, B., and Y. Hernlund. 2000. Female “Circumcision” in Africa: Culture, Controversy, and 

Change. Boulder, Colorado: Lynne Rienner Publishers. 

Snow, R.C., T.E. Slanger, F.E. Okonofue, F. Oronsaye, and J. Wacker. 2002. “Female Genital Cutting in 

Southern Urban and Peri-Urban Nigeria: Self-Reported Validity, Social Determinants and Secular 

Decline.” Tropical Medicine and International Health 7(1): 91-100. 

Toubia, N. 1993. Female Genital Mutilation: A Call for Global Action. New York, NY: Women, Ink. 

United Nations Children’s Fund (UNICEF). 2005. Female Genital Mutilation/Cutting: A statistical 

exploration. New York, NY: UNICEF. 

United Nations Children’s Fund (UNICEF). 2013. Female Genital Mutilation/Cutting: A statistical 

overview and exploration of the dynamics of change. New York, NY: UNICEF. 
55 

WADI. 2012. Female Genital Mutilation in Iraq: An Empirical Study in Kirkuk Province. Report of 

Association for Crisis Assistance and Development Cooperation. Frankfurt: WADI. 

Winterbottom, A., J. Koomen, and G. Burford. 2009. “Female Genital Cutting: Cultural Rights and Rites 

of Defiance in Northern Tanzania.” African Studies Review 52(1): 47-71. 

World Health Organization. 1998. Female Genital Mutilation: An Overview. Geneva, Switzerland: WHO. 

World Health Organization (WHO). 2008. Eliminating Female Genital Mutilation: An Interagency 

Statement. Geneva, Switzerland: Department of Women’s Health, WHO. 

WHO. 2011. An Update on WHO’s Work on Female Genital Mutilation (FGM): Progress Report.

Geneva, Switzerland: Department of Women’s Health, WHO. 

Yoder P.S., N. Abderrahim, and A. Zhuzhuni. 2004. Female Genital Cutting in the Demographic and 

Health Surveys: A Critical and Comparative Analysis. DHS Comparative Reports No.7. Calverton, MD: 

ORC Macro. 

Yoder, P.S., S. Wang, and E. Johansen. 2013. “Estimates of Female Genital Mutilation/Cutting in 27 

African countries and Yemen.” Studies in Family Planning 44(2): 189-204. 

57 

Appendix 

Table A1. Female genital cutting module for Woman’s Questionnaire 

(Continued...)

FEMALE GENITAL CUTTING FOR WOMAN'S QUESTIONNAIRE(1) 3 January 2011

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

GC1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GC3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

GC2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEXT

SECTION

GC3 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 GC9

GC4 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GC6

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

GC5 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

GC6 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

GC7

AGE IN COMPLETED YEARS

IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, 

PROBE TO GET AN ESTIMATE. AS A BABY/DURING INFANCY . . . . . 95

DON'T KNOW . . . . . . . . . . . . . . . . . . . 98

GC8 TRADITIONAL

TRAD. CIRCUMCISER . . . . . . . . . . . 11

TRAD. BIRTH ATTENDANT . . . . . . . 12

OTHER TRAD. 16

(SPECIFY)

HEALTH PROFESSIONAL

DOCTOR . . . . . . . . . . . . . . . . . . . . . 21

NURSE/MIDWIFE . . . . . . . . . . . . . . . 22

OTHER HEALTH

PROFESSIONAL 26

(SPECIFY)

DON'T KNOW . . . . . . . . . . . . . . . . . . . 98

GC9 CHECK 213, 215 AND 216:

HAS ONE OR MORE HAS NO LIVING 

 LIVING DAUGHTERS DAUGHTERS GC16

BORN IN 1995 (5) BORN IN 1995 (5)

OR LATER OR LATER

How old w ere you w hen you w ere circumcised?

Who performed the circumcision? (4)

Have you ever heard of female circumcision? (2)

Have you yourself ever been circumcised?

Now I w ould like to ask you w hat w as done to you at that time. 

Was any flesh removed from the genital area?

Was the genital area just nicked w ithout removing any flesh?

Was your genital area sew n closed? (3)

In some countries, there is a practice in w hich a girl may have 

part of her genitals cut. Have you ever heard about this 

practice?
58 

(Continued...)

CHECK 213, 215 AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING 

DAUGHTER BORN IN 1995 (5) OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH 

THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 3 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).

GC10 BIRTH HISTORY NUMBER YOUNGEST LIVING NEXT-TO-YOUNGEST SECOND-TO-YOUNGEST

AND NAME DAUGHTER LIVING DAUGHTER LIVING DAUGHTER

OF EACH LIVING DAUGHTER BIRTH BIRTH BIRTH

BORN IN 1995 (5) OR LATER HISTORY HISTORY HISTORY

NUMBER NUMBER NUMBER

NAME _____________ NAME _____________ NAME _____________

GC11 YES . . . . . . . . . . . 1 YES . . . . . . . . . . . 1 YES . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . 2

(GO TO GC11 (GO TO GC11 (GO TO GC11

IN NEXT COLUMN; IN NEXT COLUMN; IN FIRST COLUMN

OR IF NO MORE OR IF NO MORE OF NEW

DAUGHTERS, DAUGHTERS, QUESTIONNAIRE; OR IF

GO TO GC16) GO TO GC16) NO MORE DAUGHTERS,

GO TO GC16)

GC12 AGE IN AGE IN AGE IN

COMPLETED COMPLETED COMPLETED

YEARS . . . YEARS . . . YEARS . . . 

IF THE RESPONDENT DOES NOT DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98

KNOW THE AGE, PROBE TO 

GET AN ESTIMATE.

GC13 YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . 2

DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8 DON'T KNOW . . . . . 8

GC14 TRADITIONAL TRADITIONAL TRADITIONAL

TRADITIONAL TRADITIONAL TRADITIONAL

CIRCUMCISER 11 CIRCUMCISER 11 CIRCUMCISER 11

TRAD. BIRTH TRAD. BIRTH TRAD. BIRTH

ATTENDANT 12 ATTENDANT 12 ATTENDANT 12

OTHER TRAD. OTHER TRAD. OTHER TRAD.

16 16 16

(SPECIFY) (SPECIFY) (SPECIFY)

HEALTH PROFESSIONAL HEALTH PROFESSIONAL HEALTH PROFESSIONAL

DOCTOR . . . . . . . 21 DOCTOR . . . . . . . 21 DOCTOR . . . . . 21

NURSE/MIDWIFE 22 NURSE/MIDWIFE 22 NURSE/MIDWIFE 22

OTHER HEALTH OTHER HEALTH OTHER HEALTH

PROFESSIONAL PROFESSIONAL PROFESSIONAL

26 26 26

(SPECIFY) (SPECIFY) (SPECIFY)

DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98 DON'T KNOW . . . . . 98

GC15 GO BACK TO GC11 IN GO BACK TO GC11 IN GO TO GC11 IN

NEXT COLUMN; OR, IF NEXT COLUMN; OR, IF FIRST COLUMN OF NEW

NO MORE DAUGHTERS, NO MORE DAUGHTERS, QUESTIONNAIRE; OR IF

GO TO GC16. GO TO GC16. NO MORE DAUGHTERS,

GO TO GC16.

Now I w ould like to ask you some questions about your (daughter/daughters). 

Is (NAME OF DAUGHTER) 

circumcised?

How old w as (NAME OF 

DAUGHTER) w hen she w as 

circumcised?

Who performed the circumcision? 

(4)

Was her genital area sew n 

closed? (3)
59 

Table A2. Female genital cutting module for Man’s Questionnaire 

GC16 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

NO RELIGION . . . . . . . . . . . . . . . . . 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

GC17 CONTINUED . . . . . . . . . . . . . . . . . . . 1

STOPPED . . . . . . . . . . . . . . . . . . . . . 2

DEPENDS . . . . . . . . . . . . . . . . . . . . . 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

(1) Female genital cutting module can be inserted into the woman's questionnaire wherever it is appropriate,

and questions should be renumbered accordingly.

(2) Use local term for female circumcision.

(3) This question should be adapted to reflect country-specific methods of infibulation

(that is, ways in which the vaginal orifice is narrowed or “closed”).

(4) Coding categories to be developed locally and revised based on information collected before the survey and on

the pretest; however, the broad categories must be maintained. The detailed coding categories for “health

professional” are relevant in the countries where health professionals perform a large number of circumcisions.

(5) Year of fieldwork is assumed to be 2010. For fieldwork beginning in 2011 or 2012, the year should be 1996 

or 1997, respectively.

Do you believe that female circumcision (2) is required by your 

religion?

Do you think that female circumcision should be continued, or 

should it be stopped?

FEMALE GENITAL CUTTING FOR MAN'S QUESTIONNAIRE(1)

NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP

GC1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GC3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

GC2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEXT

SECTION

GC3 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

NO RELIGION . . . . . . . . . . . . . . . . . 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

GC4 CONTINUED . . . . . . . . . . . . . . . . . . . 1

STOPPED . . . . . . . . . . . . . . . . . . . . . 2

DEPENDS . . . . . . . . . . . . . . . . . . . . . 3

DON'T KNOW . . . . . . . . . . . . . . . . . . . 8

(1) Female genital cutting module can be inserted into the man's questionnaire wherever it is appropriate, 

and questions should be renumbered accordingly.

(2) Use local term for female circumcision.

Have you ever heard of female circumcision? (2)

Do you think that female circumcision should be continued, or 

should it be stopped?

Do you believe that female circumcision (2) is required by your 

religion?

In some countries, there is a practice in w hich a girl may have 

part of her genitals cut. Have you ever heard about this 

practice?