Introduction: Even if FGM has been declined dramatically in the world, the rate of decline is far below the rate needed to achieve SDG in Ethiopia. FGM remains as a serious public health concern in Ethiopia and the prevalence has varied across and within countries. Therefore, this study aimed to assess the trends and geographic variation of FGM practice in Ethiopia based on EDHSs.
Methods: The study used the data from the three DHSs conducted in Ethiopia. Trend and Logistic based decomposition analysis technique was used for analyzing the change in FGM practice overtime and factors contributing to the change in FGM practice. STATA 14 was used for data management and analysis. The Bernoulli model was fitted using spatial scan statistics version 9.6 to identify hotspot areas and ArcGIS version 10.6 to explore the spatial distribution FGM.
Results : The prevalence of FGM practice was decreased from 79.9% in 2000 to 70.4% in 2016. The decomposition analysis indicated that about 95% of the overall decrease in FGM practice was due to the difference in the change in the behavior of FGM practice among urban residents, orthodox and Muslim followers, self-employed, education, and media exposure were significant factors contributed to the change in FGM over the study period. The SaTScan analysis identified 141 most likely clusters (LLR=711.9, p<0.001) in 2000, 175 (LLR=576.4, p<0.001) in 2005, and 220 (LLR= 243.6, p<0.001) in 2016 which was located in Somali, Somali, Harari, and border areas of Somali consistently over the three surveys.
Conclusions: These results showed that FGM practice has been declined in Ethiopia. The decrease in FGM practice could be attributable to the difference in the change in effects of residence, media exposure; religion, region, and educational status. The spatial analysis provides further insight into differences in FGM practice within the country and highlights primary and secondary clusters. This could enable efficient and timely spatial targeting of hotspot areas of FGM practice to achieve the goals of eliminating FGM practice in Ethiopia by 2025 and the government should scale up the public health programs to improve the rate of reduction.