974a UNICEF Nigeria Ethnographic study report_low res

An

Ethnographic Study

of the Practice of Female Genital Mutilation in Nigeria

Federal Ministry of Women Affairs

An Ethnographic Study of the Practice of Female Genital Mutilation in Nigeria

© Government of the Federal Republic of Nigeria and United Nations Children’s Fund Abuja, May 2024

ISBN: 978-978-784-129-7

Cover photograph: © UNICEF/UN0413794/Owoicho

An

Ethnographic Study of the Practice of Female Genital Mutilation in Nigeria

Chapter 4: Findings and discussions

4.1 Objective 1: Assess the knowledge of and attitudes towards FGM 40

4.1.1 Assess what people know (knowledge of FGM) 40

4.1.2 Assess what people feel (attitudes related to FGM) 56

4.2 Objective 2: Explore FGM prevalence and behaviours 59

4.2.1 Assess what people do across the study states 59

4.3 Objective 3: Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence 62

4.3.1 Perception of social networks

4.3.2 Perception of FGM prevalence (descriptive norms) 64

4.3.3 Approval of FGM by self and others (injunctive norms) 64

4.3.4 Perceived social benefits and sanctions of FGM 65

4.4 Objective 4: Describe the decision-making process and context in families 68

4.4.1 Female agency and female decision-making power

4.4.2 Gender role beliefs

4.5 Objective 5: Track individual and social change over time

4.5.1 Key success factors of the FGM abandonment campaign

4.5.2 Challenges of the FGM abandonment campaign

Chapter 5: Cultural analysis

Figure 1: The three components of the ACT Framework – ascertain, consider the context and track and triangulate

Figure 2: Study locations (state level)

Figure 3: Target respondents in FGDs and one-on-one interviews

Figure 4: Process of sampling

Figures Tables

Table 1: ACT Framework subconstructs aligned with the study’s objectives

Table 2: The study matrix for the ethnographic study of FGM in Nigeria

Table 3: Number and variety of study areas in the five states

Table 4: Number of FGDs and interviews of different stakeholder groups at the various levels of the study

Table 5: UNJP and non-programme study locations

Table A1.1: Number and variety of study areas in the five states

Table A1.2: Number of FGDs and in-depth and key informant interviews held with stakeholder groups at the various levels of the study 94

Table A2.1: Work plan of activities and deliverables and tentative timeline

Foreword

As we navigate the complex landscape of gender equality and women’s rights, the scourge of female genital mutilation (FGM) remains a stark reminder of the deep-rooted inequalities that persist in our society. It is with great resolve and a sense of urgency that I introduce this groundbreaking ethnographic study on the practice of FGM in Nigeria.

FGM not only violates the fundamental human rights of girls and women, but also perpetuates harmful gender norms and inequalities. The findings presented in this study underscore the urgent need for concerted action to eliminate this harmful practice. Drawing on the Sustainable Development Goals and the commitment expressed in Goal 5.3 to eradicate FGM and all harmful practices by 2030, this study serves as a vital tool in our collective efforts towards achieving this global imperative.

Commissioned by the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) in collaboration with the National Technical Working Group on FGM, co-led by the Federal Ministries of Health and of Women Affairs, this study represents a significant milestone in our journey towards ending FGM in Nigeria. It offers invaluable insights into the barriers to and enablers of behaviour change in relation to FGM, as well as gender considerations crucial to effective eradication programming.

The utilization of the ACT Framework, a monitoring and evaluation tool developed by UNICEF, UNFPA and Drexel University, has allowed for a comprehensive examination of the knowledge, attitudes, behaviours and social dynamics surrounding FGM in Nigeria. Through a participatory and consultative approach involving a diverse range of stakeholders, from caregivers to health-care professionals and traditional circumcisers to government officials, this study provides a nuanced understanding of the complex drivers of FGM and the societal norms that sustain it. It captures the voices and perspectives of those most affected by FGM, ensuring a comprehensive understanding of FGM’s impact on individuals and communities.

As the first of its kind in Nigeria, this study serves as a foundational cornerstone for informing evidence-based interventions and policies aimed at combating FGM. By highlighting the prevalence, trends and social dynamics surrounding FGM practices in key states and communities, this study lays the groundwork for strategic and targeted approaches to achieve meaningful change, particularly for at-risk girls.

I extend my deepest appreciation to the researchers, stakeholders and participants who have contributed to this vital endeavour. It is my hope that the insights gleaned from this study will catalyse a renewed commitment to ending FGM in Nigeria and ensuring the health, dignity and rights of all girls and women across our nation.

Barister Uju Kennedy Ohanenye Honourable Minister of Women Affairs

Preface

In the pursuit of our shared vision for a world free from the scourge of FGM by 2030, as expressed in the Sustainable Development Goals, particularly Goal 5.3, I am honoured to present this ethnographic study on the practice of FGM in Nigeria. This study represents a crucial step towards understanding and addressing the multifaceted dimensions of FGM in Nigeria.

Addressing the multifaceted dimensions of FGM in Nigeria is imperative, given recent evidence from 2024, which reveals a stark reality: over 230 million girls and women worldwide have undergone FGM – a 15 per cent increase compared to data released eight years ago, equating to 30 million more affected individuals. While there has been some progress, with half of the advancements of the past 30 years achieved in the last decade alone, the evidence also underscores the urgency of the situation. To reach our targets, progress must accelerate at a rate 27 times faster than that which we have seen in the past decade, necessitating immediate and unprecedented action.

Nigeria, unfortunately, holds the unenviable position of being the third highest country globally in terms of the number of women and girls who have undergone FGM. Shockingly, 15 per cent of women aged 15–49 years have experienced this harmful practice, with a prevalence rate among young girls aged 0–14 years of 8 per cent. Even more distressing is the fact that 86 per cent of individuals are subjected to this practice before the age of 5. These statistics underscore the gravity of the situation and call for a collective commitment to bring an end to FGM once and for all.

As we confront the challenge of ending FGM in Nigeria by 2030, this study serves as a beacon of hope. By delving into the social norms, prevalence and trends of FGM in key states and communities, this study provides invaluable insights for designing evidence-based interventions and policies to combat this harmful practice. It offers actionable recommendations to enhance the effectiveness of FGM abandonment efforts. From strengthening monitoring and evaluation structures to fostering community ownership and challenging social norms, the recommendations outlined in this study provide a road map for transformative change.

I extend my sincere gratitude to all those who have contributed to this study, from the researchers and participants to our partners and stakeholders. Together, let us redouble our efforts to end FGM in Nigeria and create a future where every girl and woman can live free from harm and discrimination.

Cristian Munduate Dr. Gifty Addico Representative, UNICEF Representative, UNFPA

Acknowledgements

The research study that is detailed in An Ethnographic Study of the Practice of Female Genital Mutilation in Nigeria was led by the Government of Nigeria, in close collaboration with UNICEF, UNFPA and the UNFPA–UNICEF Joint Programme on the Elimination of Female Genital Mutilation (UNJP) Strategic Technical Assistance for Research (STAR) Initiative. This initiative was carried out within the framework of the UNFPA–UNICEF Joint Programme on the Elimination of Female Genital Mutilation: Accelerating Change in Nigeria, generously funded by the governments of Austria, France, Iceland, Italy, Luxembourg, Norway, Spain (Spanish Agency for International Development Cooperation), Sweden, the United Kingdom, the United States of America and the European Union (through the Spotlight Initiative Africa Regional Programme). The UNJP is jointly implemented by UNICEF, UNFPA and the federal and state ministries of Women Affairs and Health.

The federal ministries of Women Affairs and Health, under the able leadership of their respective ministers, Bar. Uju Kennedy Ohanenye and Prof. Ali Pate, along with their respective state counterparts through the National Technical Committee on FGM and the state- and local-government-level technical committees of the five UNJP focus states (Ebonyi, Ekiti, Imo, Osun and Oyo) played an instrumental role in facilitating and supporting the stakeholder activities of the study and providing technical oversight. Special acknowledgment goes to Dr John Ovuoraye (Director of Gender Adolescents School Health and Elderly Division, Federal Ministry of Health), Funke Oladipo (Director of Women, Federal Ministry of Women Affairs) and Friya Kimde (Director of Gender, Federal Ministry of Women Affairs).

Heartfelt gratitude goes to the relevant federal and state government ministries of Justice, the National Human Rights Commission, the National Orientation Agency, civil society organizations and international non-governmental organizations for their invaluable contributions to the finalization and validation of this study across various sectors, including education, health, justice, social welfare, human rights and child protection.

Special thanks to Ipsos, the research organization and the team of researchers, including Pushpendra Mishra, Ayodele Lawani and Irene Obi, for their unwavering dedication in conducting this research and ensuring the development of a robust, reliable and high-quality resource to inform and enhance the quality of programming and the effectiveness of policies.

Lastly, we acknowledge the exceptional support and coordination provided by the UNICEF and UNFPA Nigeria country office teams, including UNICEF’s Ibrahim Sesay (Chief of Child Protection), Amandine Bollinger, Mona Aika, Hadiza Ibrahim Abba, Benjamin Mbakwem, Aderonke Olutayo, Victor Atuchukwu, Denis Onoise, Faith Nyam and Phydelia Abbass; and the UNFPA team led by Koessan Francis Kuawu, Babatunde Adelekan, Karima Bungudu, Lanre Alabi and Kareem Olushola. Special recognition is extended to Manahil Siddiqi (Technical Coordinator of FGM Research, STAR Initiative to End Harmful Practices); UNICEF and Catherine Mueller and Zubaida Abubakar of UNICEF and UNFPA for their invaluable technical input and recommendations.

Abbreviations and acronyms

ACT ascertain, consider the context, track and triangulate

CBO community-based organization

FGD focus group discussion

FGM female genital mutilation

IDI in-depth interview

KII key informant interview

LGA local government area

NDHS Nigeria Demographic and Health Survey

NGO non-governmental organization

NPC National Population Commission [Nigeria]

NTC National Technical Committee on FGM

PWAN Partners West Africa Nigeria

SDG Sustainable Development Goal

TBA traditional birth attendant

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

UNJP UNFPA–UNICEF Joint Programme on the Elimination of Female Genital Mutilation

USAID United States Agency for International Development

VAPP Violence Against Persons (Prohibition) [Act, 2015]

WHO World Health Organization

Executive summary

Female genital mutilation (FGM) constitutes an extreme form of discrimination against women and girls, reflecting deep-rooted inequalities between sexes and a violation of human rights. Presently, addressing FGM remains a global concern. Sustainable Development Goal (SDG) 5.3 expresses a commitment to eliminate FGM and all harmful practices by 2030. Achieving SDG 5.3 requires a comprehensive and multisectoral approach, creating collaborations between national governments, international organizations, civil societies and other local stakeholders.

Towards achieving the set global target in the Federal Republic of Nigeria, where FGM prevalence is high, the United Nation’s Children’s Fund (UNICEF) in collaboration with the Federal Ministry of Women Affairs commissioned Ipsos Nigeria to conduct an ethnographic study of FGM practice in the country. The study was designed to provide insight into the barriers to and enablers of behaviour change around the practice of FGM in Nigeria, and included gender considerations in programming to eradicate FGM. Specifically, it aimed to measure social norms around FGM practice, as well as its prevalence and trends. The study focused on the five states in which the UNFPA–UNICEF Joint Programme on the Elimination of Female Genital Mutilation (UNJP) is being implemented – Ekiti, Ebonyi, Imo, Osun and Oyo – and communities with the highest rates of FGM prevalence in girls aged 0–14 years.

Being the first of its kind in Nigeria, the study is positioned as a baseline study, providing foundational data for enhancing the effectiveness of ongoing FGM programming and decision-making and for paving the way for a strategic and targeted approach to achieving desired outcomes, particularly for at-risk girls. Furthermore, it furnishes valuable data to shape Phase IV of the UNJP, concentrating on expediting and amplifying initiatives to decrease and ultimately eliminate FGM.

To gain insight into the deep-rooted drivers of FGM and inform evidence-based interventions, the study utilizes the ACT Framework,1 a tool to monitor and track changes in social norms that was produced by UNICEF, the United Nations Population Fund (UNFPA) and Drexel University (Philadelphia). This study aims to address objectives such as assessing knowledge and attitudes towards FGM, examining FGM-related prevalence and behaviours, identifying perceived social benefits and consequences, describing decision-making processes in families and, over time, documenting changes in FGM practices.

1 The ACT Framework is derived from three guiding principles and activities: (i) assess what people know and ascertain norms and outcome expectancies, (ii) consider the context and (iii) track change and triangulate data and analyses. See UNJP (n.d.) for more detail.

Implemented in three phases –inception, data collection, and data analysis and reporting – this study utilized interviews and archival research methods.

The study was executed in the above-mentioned UNJP project states from November 2022 to October 2023. Adopting a participatory and consultative approach, it engaged a diverse group of participants. Target respondents included adolescent girls, caregivers, male youths, FGM survivors, community gatekeepers, programme implementers, government officials, health workers, traditional circumcisers and media people.

Implemented in three phases – inception, data collection, and data analysis and reporting – this study utilized interviews and archival research methods. At the core of an ethnographic study is observation of respondents and practices in their natural environment. With respect to the context of this study, which centres on the conduct of a harmful practice that is prohibited by law, ethical principles of doing no harm and protecting the well-being, safety and dignity of all study participants were prioritized. Observation in this study was thus limited to very detailed interviews and discussions on the practice of FGM with diverse groups of participants in their natural environments. Generally, this study employed a cross-sectional research design, blending desk research, secondary data analysis and primary data collection through qualitative participatory methods like focus group discussions (FGDs), key informant interviews (KIIs) and in-depth interviews (IDIs). A total of 40 FGDs and 147 KIIs and IDIs were undertaken as part of this study.

Key findings

Study Objective 1: Assess knowledge of and attitudes towards FGM

Awareness of FGM

This study assessed the awareness of FGM in Nigeria, which was defined as a respondent’s consciousness of the practice and understanding of it, as well as cognizance of actions associated with it. The study found that respondents were largely aware of FGM practice. All 12 IDI respondents in each of the five states in the study – mothers-in-law and grandmothers of a girl child, circumcised girls or women and their husbands – reported being aware of the term FGM as well as its practice. Similarly, FGDs also revealed high levels of awareness of FGM. Of 32 adolescent girls interviewed in each state, an average of 67 per cent expressed awareness of FGM. Respondents expressed their awareness of localized FGM, as they were able to articulate terms associated with FGM in their local language, with some linguistic variations observed. In spite of the differences observed, the overall awareness of FGM was high across all states, aligning with the 2018 Nigeria Demographic and Health Survey (NDHS), which recorded the highest level of awareness in the South East (77.3 per cent) and the South West (73.2 per cent) geopolitical zones of the country, and also among urban residents (NPC and ICF, 2019).

Knowledge of the types and methods of FGM

The study examined respondents’ knowledge of the types of FGM practised in Nigeria, utilizing the World Health Organization’s (WHO’s) classification of four categories: Type I, clitoridectomy; Type II, excision; Type III, infibulation; and Type IV, other harmful procedures to the female genitalia (WHO, n.d.). Despite a general recognition that FGM involves cutting or mutilation, the respondents exhibited limited awareness of the specific types as outlined by WHO. This lack of clarity was evident at both individual and community levels with descriptions often falling short of the formal categorizations. Inconsistency across states emerged, with respondents referring to different types of FGM practices. Notably, the study recorded a growing trend in the adoption of Type IV FGM, which takes diverse forms in different communities. In some instances, respondents described the use of seemingly harmless procedures, such as pressing, massaging with hot water or using petroleum jelly. The study emphasizes a gap in understanding the diverse forms of FGM, echoing findings from the 2018 NDHS, which reported a lack of knowledge about types of FGM among women in Nigeria, possibly due to the absence of awareness of standardized categorization (NPC and ICF, 2019).

Respondents displayed knowledge of the methods of FGM practised in their communities, distinguishing between traditional practices by traditional birth attendants (TBAs) and circumcisers and medical procedures conducted by health workers like nurses, midwives and doctors. Interestingly, there was acknowledgement that FGM is mostly conducted by unqualified doctors.

Knowledge of medical and traditional FGM practices

While respondents lacked clear awareness of WHO-defined types, they acknowledged the practice of cutting by either a medical or traditional method. Traditional practices involved cutting with razors, and medical methods included the use of forceps and massages, with some medical practitioners implicated in promoting Type IV FGM (WHO, n.d.). The location at which FGM was conducted varied, with traditional FGM being conducted at home and medical FGM being conducted in a health centre or at the practitioner’s home. Despite the roles of health-care facilities and professionals in FGM, no health-care worker taking part in this study confirmed direct participation in medicalized practices. The study highlights the importance of Nigeria’s national protocol for managing FGM in health care, which emphasizes the need for an immediate response to complications for survivors.

Knowledge of justification for FGM practices

The respondents generally recognized the risks of FGM practices, such as pain, severe bleeding, infection and obstetric complications. However, their knowledge was often poorly categorized, with difficulties in identifying specific physical or

While respondents lacked clear awareness of WHO-defined types, they acknowledged the practice of cutting by either a medical or traditional method.

This study explored the knowledge of law and its implementation in relation to FGM in Nigeria.

psychological risks. Most respondents acquired their awareness of FGM risks through campaigns and community initiatives rather than direct experience. Health-care professionals and focal persons who had directly encountered the practice emphasized the sexual and obstetric challenges faced by women who have undergone FGM. Some respondents highlighted an indirect link between FGM and infidelity in marriage, suggesting that women’s diminished sexual urge due to FGM might lead to their partners seeking other sexual partners. Notably, prior to learning about the risks, many respondents viewed FGM as a cultural practice rather than a harmful one, emphasizing the role of knowledge quality in shaping community perceptions. Some respondents mentioned the need for unlearning misconceptions about FGM to drive more informed narratives and decisions.

Knowledge of the law around FGM

This study explored the knowledge of law and its implementation in relation to FGM in Nigeria. FGM is recognized as a harmful practice and the Violence Against Persons (Prohibition) Act – the VAPP Act – criminalizes it. The VAPP Act, introduced in 2015, has been domesticated by most states (35 out of 37), with varying levels of awareness and implementation. Lagos and Ekiti states are excluded from the 35 states that have domesticated the VAPP Act, but Lagos has the Protection Against Domestic Violence Law (2007) and Ekiti the Gender-Based Violence (Prohibition) Law (2019), along with other supporting provisions (PWAN, 2023). Following domestication, the law has been gazetted in 30 states, including four of the five study states.

Although respondents were aware of the VAPP Act, their knowledge of the specific provisions of the Act was generally poor. The study also highlighted inconsistencies in the enforcement of the law, with limited examples of individuals being prosecuted. Community-level laws against FGM pronounced by traditional rulers exist, but enforcement is rarely observed. Responsibility for law enforcement is perceived differently across states and communities, with a general sense of outsourcing the responsibility to government, leadership and the justice system.

Knowledge of anti-FGM campaigns

The study investigated the knowledge and engagement of respondents in anti-FGM campaigns in Nigeria, with a focus on interventions by initiatives like the UNJP. Various strategies, including awareness campaigns, capacity-building, circumciser conversion outreach, oath-taking ceremonies and health initiatives, have been employed to combat FGM. Respondents showed varying levels of awareness, with key informants who were involved in abandonment programmes reporting higher exposure to campaigns than community members who participated in the in-depth interviews. The study underscores the importance of organizations like UNICEF, UNFPA, the United States Agency for International Development (USAID), WHO, ActionAid and state government agencies in sponsoring and implementing

interventions. Despite these efforts, there is a disconnect on the part of respondents in recognizing the role played by state governments. This suggests a lack of visibility and points to a need for continued collaborative efforts to achieve widespread abandonment of FGM in the targeted states.

Attitudes towards FGM

The respondents revealed a complex landscape of attitudes towards FGM, emphasizing the predominant belief that FGM is driven by cultural factors and tradition rather than gender, power or control. A positive shift in attitudes is noted among traditional circumcisers, TBAs, men and boys, but pockets of opposition and indifference exist, particularly in areas with limited interventions. A few respondents in communities where UNJP is not implemented expressed approval of FGM, citing a lack of clear evidence of harm. Furthermore, the study highlights a crucial gap in the ownership of FGM abandonment initiatives at the community level, with participants, rather than embracing a sense of ownership of these efforts, viewing their role more as employment-related. Overall, the findings underscore the importance of continued interventions to challenge cultural norms and foster community ownership of sustainable FGM abandonment.

Study Objective 2: Ascertain FGM prevalence and behaviours

This ethnographic study examined FGM-related behaviours and respondents’ perceptions of prevalence across the study states, utilizing both secondary data from the 2018 NDHS (NPC and ICF, 2019) and first-hand perspectives of respondents. The prevalence of FGM varies among states, with Imo having the highest reported rate and Oyo and Ebonyi the lowest. Caregivers estimated that, on average, 1 out of every 10 girls aged 0–4 years in their community has experienced FGM; for the 5–14 age group, the perceived prevalence is higher. Traditional circumcisers noted a shift towards a decrease in circumcisions, attributed to anti-FGM campaigns. Despite this positive trend, covert FGM practices persist, particularly in Ekiti and Osun, driven by societal resistance to change. Sensitivity surrounding the direct questioning of FGM practices is acknowledged, prompting questions about community perceptions. The adoption of Type IV FGM, perceived as less harmful, is noted but is nevertheless indicative of ingrained practices. Support for FGM abandonment is evident and is accompanied by efforts to address livelihood issues for affected circumcisers. However, challenges remain, particularly in states not yet reached by interventions, demonstrating the complexity of achieving comprehensive FGM abandonment.

The respondents revealed a complex landscape of attitudes towards FGM, emphasizing the predominant belief that FGM is driven by cultural factors and tradition rather than gender, power or control.

This study explored the perceptions around the prevalence of FGM through a participatory FGD involving 120 caregivers of adolescent girls (80 mothers and 40 fathers).

Study Objective 3: Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence

Perception of social networks

The study examined the social dynamics that influence decisions around FGM by conducting a social network mapping exercise. Respondents, particularly fathers, identified key individuals in their social networks whose thoughts and opinions hold sway in decisions related to FGM. The family-level decision-making process primarily revolves around parents, with fathers often having a significant say. However, the role of mothers, especially as primary caregivers, remains crucial. In south-western states like Oyo and Osun, fathers often pointed to their wives as being directly involved in deciding on FGM for their daughters, emphasizing a negotiation of power in the household. However, in Ekiti, fathers cited other family members – including the father’s parents and brothers – and friends as also being involved. In the south-eastern states, particularly Ebonyi, fathers declared themselves as sole decision makers, while in Imo, opinions varied, with some fathers involving their wives and others identifying their traditional rulers as having a significant level of influence on their decisions. These findings highlight the complexity of power dynamics, gender roles and negotiations in households and communities concerning decisions around FGM.

Perception of FGM prevalence (descriptive norms)

This study explored the perceptions of FGM prevalence through a participatory FGD involving 120 caregivers of adolescent girls (80 mothers and 40 fathers). The descriptive norms regarding FGM prevalence reveal a notable shift in social perceptions. On average, caregivers perceived that only 1 out of 10 girls aged 0–4 years had undergone FGM in their communities, indicating a decline in prevalence. However, the perceived prevalence for the older cohort (5–14 years of age) was higher, with an average of 5 out of 10 girls perceived as having undergone FGM. The gender breakdown of caregivers and specific state variations indicates a complex landscape. Notably, Imo State reported a higher perceived prevalence in the younger age group compared to other states, while the older age group had varying averages across states. The findings align with a U-Report opinion poll, 2 where a significant percentage of respondents expressed support for FGM abandonment, signalling a positive shift in attitudes and social norms.

2 U-Report is a social messaging tool and data collection system developed by UNICEF in 2011 to engage citizens, especially young people, in programme priorities, emergency response and advocacy actions.

Approval of FGM by the self and others (injunctive norms)

Of the 120 caregivers, 20 per cent personally approved of FGM, with fathers showing a higher self-approval rate (23 per cent) than mothers (19 per cent). In terms of social network approval, 18 per cent indicated approval. Fathers in Ekiti State, however, had a notably higher self-approval rate (63 per cent). Overall, percentages were low and caregivers attributed their disapproval to factors like support for abandonment of FGM, government intervention and awareness of the risks involved. Caregivers emphasized that societal pressure to continue FGM was absent, as their social networks did not find it beneficial. Unanimous disapproval was reported in Osun, Imo and Ebonyi states, while Oyo mothers reported a higher social network approval rate (44 per cent).

Perceived social benefits and sanctions of FGM

The practice of FGM is deeply rooted in social norms that are associated with historical social benefits such as respect and inclusion. However, the study revealed a shift in perception, with caregivers reporting a lack of substantial benefits for parents or children. Many now see abandoning FGM as beneficial, emphasizing the protection of girls’ rights and health. Social benefits previously associated with FGM are diminishing, and respondents highlighted the positive impact of abandonment on women’s health and on the workload of health-care providers. While some circumcisers may resist abandonment due to financial losses they may suffer, efforts to discourage FGM received support from various quarters. Furthermore, most respondents did not know about any social sanctions for not conducting FGM. The handful of respondents who could identify social sanctions for continuing with FGM practices listed fines and community punishments.

Study Objective 4: Describe the decision-making process and power context in families

Female agency and female decision-making power

This study investigated the dynamics of decision-making regarding FGM in households and communities. The results underscore the prevailing perception that it is predominantly men who make decisions related to FGM, with financial responsibilities for the practice often falling on them. The participation of women in decision-making is found to be conditional, influenced by factors such as their ability to be respectful, trustworthy and exhibit love. A significant proportion of respondents believe that women lack the ability to make decisions for themselves and their children, revealing societal norms that limit women’s agency. Despite some women expressing confidence in their decision-making abilities, there is an overarching sense that women face challenges in exercising decision-making power in the context of FGM, reflecting broader gender dynamics and cultural norms.

Of the 120 caregivers, 20 per cent personally approved of FGM, with fathers showing a higher self-approval rate (23 per cent) than mothers (19 per cent).

Key success factors of FGM abandonment programmes include collaboration, government involvement, engagement of community leaders and men targeted as advocates for behaviour change.

Gender role beliefs

The study examined the impact of gender roles on the practice of FGM. Gender role beliefs were explored through a gender box exercise, revealing traditional expectations of men as providers and women as caregivers. Non-compliance with these roles results in social consequences such as disrespect and disharmony. The study highlights a shift in participation in FGM, with communities punishing participation rather than non-participation, reflecting changing attitudes towards the practice. Additionally, compliance structures, such as monitoring teams, have been established, but their effectiveness is yet to be verified.

Study Objective 5: Track individual and social change over time

The study aimed to track individual and social change over time in the context of FGM abandonment programmes across different states in Nigeria. The focus was on documenting changes in engagement, programme activities and societal attitudes towards FGM. The findings indicated various anti-FGM initiatives involving government bodies, non-governmental organizations and community-level activities. The media plays a crucial role in disseminating information about abandoning FGM, with radio jingles being a significant source of awareness.

The study suggests that respondents are exposed to a moderate level of FGM abandonment programmes. Respondents generally perceive these programmes as effective, with reported reductions in FGM prevalence. The use of legal frameworks, such as the VAPP Act and others against FGM, is seen as a positive enabler for the campaign.

Key success factors of FGM abandonment programmes include collaboration, government involvement, engagement of community leaders and men targeted as advocates for behaviour change. Challenges include financial constraints, communication difficulties, hard-to-reach communities and resistance from those who view FGM as an essential cultural practice.

Recommendations

The recommendations of this study highlight key actions to enhance the effectiveness of efforts to encourage the abandonment of FGM in Nigeria:

• Create effective monitoring and evaluation structures

Establish robust platforms for monitoring and evaluating FGM practices and responses nationwide. This includes gathering information at community, local government and state levels to support evidence-based decision-making.

• Establish reporting mechanisms

Create adoptable reporting structures for community members in project states and communicate these to the target communities for proper utilization to encourage robust reporting and tracking of FGM incidents.

• Encourage states to create awareness of and implement the gazetted VAPP Act

Advocate for the implementation of the VAPP Act where it has been domesticated. This would make the law more accessible to the public, and promote awareness and understanding of the FGM provisions in the Act.

• Strengthen community actors’ capacity

Provide technical and material support to community-based organizations (CBOs), focal persons and FGM champions. Develop standard operating procedures to assist them in identifying and processing violators of FGM laws and facilitate the documentation of convictions and prosecutions.

• Scale up interventions in hard-to-reach areas

Design and implement programmes specifically tailored for hard-to-reach communities, ensuring that FGM abandonment efforts are inclusive and no woman or girl is left behind. Collaborate with CBOs and state governments for effective outreach.

• Ensure continual anti-FGM engagement

Across communities in project states, continual programming should be encouraged through activities and messaging to reinforce efforts to abandon FGM, increase awareness and eventually eliminate resistance to change.

• Build alliances with men and boys

Design activities that will empower men and boys with the requisite knowledge and skills to act as behaviour change agents, leveraging their powers and privileges in support of the abandonment of FGM in their respective homes and communities.

• Empower women and girls

Equip women and girls with education and skills to enhance their participation in decision-making at household and community levels. While women can gain economically valuable skills that can enhance their participation in decisionmaking at household and community levels, girls can gain life skills that can improve their understanding of their rights to bodily autonomy. Both women and girls can be encouraged to take up leadership roles by empowering them with key leadership skills.

• Strengthen collaboration across sectors

Enhance collaboration with health-care workers and the justice system to actively monitor trends and prevalence of FGM. Strengthen partnerships to facilitate the implementation of the VAPP Act across states.

This country-level study in Nigeria, focusing on Ebonyi, Ekiti, Imo, Osun and Oyo states, aimed to measure social norms, prevalence and trends pertaining to FGM, using the ACT Framework.

• Challenge social and cultural norms

Address social and cultural norms hindering FGM abandonment by scaling up interventions, conducting regular campaigns and fostering social mobilization activities. Reinforce messages to counteract persistent norms driving the practice.

• Focus on emerging trends

Investigate and understand emerging trends in FGM, particularly the shift to Type IV FGM. Conduct studies to gain insight into these evolving dynamics and to inform the design of targeted interventions and programming.

• Encourage community ownership

Foster a sense of responsibility and engagement at the state and community levels. Encourage direct involvement of individuals in the FGM abandonment programme by sharing a long-term vision that aligns with community needs and aspirations, and promotes commitment and ownership.

• Support the enforcement of laws and policies

The state governments and regulatory bodies should be supported to effectively advance the implementation of existing legal frameworks on FGM, as this will deter abusers and protect women and girls from FGM practices.

Conclusion

This country-level study in Nigeria, focusing on Ebonyi, Ekiti, Imo, Osun and Oyo states, aimed to measure social norms, prevalence and trends pertaining to FGM, using the ACT Framework. Despite high levels of awareness of FGM, the study revealed limited detailed knowledge of FGM types and of laws regulating FGM practices, including the VAPP Act. Perceived prevalence rates indicated a decline in FGM, although the emergence of Type IV FGM was noted. Support for abandonment remained high, unaffected by social pressures. Decision-making, influenced by parents and community leaders, reflected changing societal attitudes and a lack of identified social benefits for FGM continuation. The study’s success lies in providing evidence-based insights for strategic interventions that support effective programming and decision-making to safeguard girls at risk of FGM.

Chapter 1: Introduction

1.1 Background

Female genital mutilation (FGM) is a harmful traditional practice that involves the partial or complete removal of the external genitalia of females or other harm to their genital organs for non-medical reasons (UNICEF, 2016). FGM has no health benefits and can cause numerous physical and psychological complications for girls and women. Some of the immediate risks include severe pain and shock during the procedure; excessive bleeding; wound infections; urinary problems, including difficulty urinating and urinary tract infections; problems with menstruation; and injury to nearby genital tissue. Long-term risks include chronic pain; development of cysts and abscesses; increased risk of urinary and vaginal infections; infertility; sexual dysfunction; complications during childbirth, such as prolonged labour, tears and stillbirths; and psychological trauma, including depression and anxiety (Anzaku et al., 2018). Furthermore, FGM is considered a severe violation of human rights and of the physical integrity of girls and women.

FGM is predominantly practised in Africa, Asia and the Middle East, where the majority of countries record high rates of prevalence. It is estimated that over 200 million girls and women worldwide have undergone FGM, with 31 countries in these regions having the highest prevalence (UNICEF Data, 2024). Within Africa, FGM is prevalent in several countries, but particularly in Egypt, Ethiopia, Nigeria and Sudan, which account for two thirds of all girls who have undergone FGM globally, thus contributing significantly to the overall prevalence of the practice (International Center for Research on Women, n.d.; Obianwu et al., 2018). Each country has its own prevalence rate, cultural practices and reasons for performing FGM, although the harmful effects are consistent across regions.

The prevalence of FGM in Nigeria is significant, with approximately 19.9 million Nigerian women having undergone a procedure (28 Too Many, 2016; UNICEF Nigeria, n.d.-b). This amounts to 20 per cent of women aged 15–49 and 19.2 per cent of girls aged 0–14 who have undergone FGM, according to the 2018 NDHS (NPC and ICF, 2019). Typically, FGM is performed on infants in Nigeria, and the majority of survivors aged 15–49 (86 per cent) underwent the procedure before the age of 5. Furthermore, all four types of FGM3 are practised in Nigeria, but Type II (excision),

3 The World Health Organization (WHO) classifies FGM into four different categories: Type I, clitoridectomy; Type II, excision; Type III, infibulation; and Type IV, other harmful procedures to the female genitalia. See WHO (n.d.) for more information on these categories.

The literature on FGM prevalence also indicates different trends for different age groups, with an increase among girls aged 0–14 from 16.9 per cent in 2013 to 19.2 per cent in 2018, and a decrease among women aged 15 and above from 25 per cent to 20 per cent over the same period.

which involves the removal of flesh from the genital area, is the most common (NPC and ICF, 2019). However, Type I (clitoridectomy) appears to be increasing in prevalence (UNFPA, 2021).

The South East and South West zones have the highest prevalence rates, ranging from 35.0 per cent to 30.0 per cent among women aged 15–49. The South-South (17.7 per cent), North East (6.1 per cent), North West (20.2 per cent) and North Central (9.9 per cent) zones have lower but still notable prevalence rates (NPC and ICF, 2019). Among the states looked at in closer detail in this study, namely Oyo, Osun and Ekiti in the South West zone and Imo and Ebonyi in the South East zone, FGM prevalence 4 also varies. According to the 2018 NDHS, a higher percentage of women in Ekiti (44.6 per cent) and Imo (37.9 per cent) expressed the desire to continue the practice, compared to lower percentages in Ebonyi (7.3 per cent), Osun (10.2 per cent) and Oyo (5.7 per cent). It is important to note that the prevalence rates in these states may change over time due to various factors, such as increasing awareness, education and implementation of interventions to combat FGM.

The literature on FGM prevalence also indicates different trends for different age groups, with an increase among girls aged 0–14 from 16.9 per cent in 2013 to 19.2 per cent in 2018 and a decrease among women aged 15 and above from 25 per cent to 20 per cent over the same period (NPC and ICF, 2014, 2019). In addition, FGM is performed at different stages of a girl’s life. Infant FGM is common, and FGM is also often associated with an event for older girls and women, who may undergo the procedure during a cultural festival or before a marriage ceremony. For instance, FGM is commonly carried out on older girls and women during the ‘Aju’ festival or, in Ebonyi State, when the woman is about to marry (Odo et al., 2020).

The practice of FGM is deeply rooted in gender inequality and to some degree in religious belief (Obianwu et al., 2018; UNFPA Nigeria, 2021). Generally, it is seen as a necessary step in raising girls, protecting them, preparing them for womanhood and ensuring their eligibility for marriage. It is typically driven by the following reasons:

1. FGM is often seen as a means to preserve virginity and purity and to control female sexuality and ensure premarital virginity. Furthermore, some cultural beliefs associate intact genitals with purity, modesty and the preservation of family honour.

2. In some cultures, FGM is equivalent to social acceptance and marriageability. In such communities, it is perceived as a necessary cultural tradition for girls to follow to be considered marriageable and/or a prerequisite for a smooth transition into adulthood and as a way to secure a husband.

3. Some families may not adhere to the culture of or reasons for practising FGM, but they may well succumb to social pressure to conform, usually driven by fear

4 Reported prevalence of FGM rates among girls aged 0–14 years in the states that were examined in this study are as follows: Imo (62.8 per cent), Ekiti (30 per cent), Osun (17.5 per cent), Oyo (8.2 per cent) and Ebonyi (5.2 per cent) (NPC and ICF, 2019).

of being stigmatized, socially excluded or accused of immorality. In scenarios like this, families may subject girls to FGM.

In select cases, religion is referenced as a reason for FGM; however, it is not a valid reason for practising FGM, as according to the 2018 NDHS, 78 per cent of those women (16,227 respondents) who had heard of FGM believed that FGM is not required by their religion (NPC and ICF, 2019).

Efforts to eliminate FGM in Nigeria have been made through various programmes, laws and policies. Various stakeholders, including government, non-governmental organizations (NGOs) and community-based organizations (CBOs), are working towards eliminating FGM (UNFPA, 2021). Target 5.3 of the SDGs is to eliminate all harmful FGM practices by 2030 (United Nations Department of Economic and Social Affairs, 2015). To achieve this, Nigeria has been part of the UNJP since 2014, which has partnered with federal ministries and state-level departments in selected states with high FGM prevalence, including Ebonyi, Ekiti, Imo, Lagos, Osun and Oyo (UNFPA, 2021). This programme aims to strengthen legal frameworks through policy development and implementation, improve access to health care and social services, support girls’ education and raise community awareness about the dangers and complications of FGM.

Additional FGM eradication efforts are seen in Nigeria’s enactment of federal laws such as the Violence Against Persons (Prohibition) Act of 2015 (VAPP Act), which considers FGM a criminal offence. Additionally, there are state laws, policies and public community declarations against FGM. Despite these efforts, enforcement of laws and behavioural changes have been limited (Obianwu et al., 2018; UNICEF Nigeria, n.d.-a). More work is needed, especially in terms of enforcement and sustained interventions, to achieve the goal of eliminating FGM and to promote the health, well-being and rights of girls and women in Nigeria.

1.2 Purpose of study

Based intimately on societal norms and, to a lesser extent, religious expectations, FGM practices in Nigeria have become deeply entrenched. Despite substantial efforts targeted at eradicating these harmful practices, the sociocultural infrastructures supporting FGM have proven substantial and resilient (Obianwu et al., 2018). This has necessitated a more nuanced understanding of the perspectives of communities where FGM practice is prevalent.

The interdependence of societal behaviours necessitates consideration of entire communities, as people’s decisions and actions correspond with the expectations and perceived societal norms held by important figures in their lives. This propensity for societal norms to remain stable over generations and function almost autonomously necessitates a thorough understanding of the sociocultural norms

Additional FGM eradication efforts are seen in Nigeria’s enactment of federal laws such as the Violence Against Persons (Prohibition) Act of 2015 (VAPP Act), which considers FGM a criminal offence.

The objective of this undertaking is not merely exploratory; it aims to generate valuable knowledge that facilitates effective programming strategies and informs decisionmaking processes with regard to FGM, particularly in Phase IV of the UNJP.

surrounding FGM, the key drivers of this practice and how these influence the response of individuals and communities vis-à-vis FGM.

While several studies have been conducted on this issue, their limited scope and depth mean that their findings cannot be generalized. Therefore, the purpose of this ethnographic study was to provide comprehensive and methodical evidence on FGM practices using the ACT (assess and ascertain, consider the context and track and triangulate) Framework5 constructs (see Figure 1) related to FGM knowledge, attitudes and beliefs, behaviours, decision-making, social networks and individual and social-level change. The study was carried out in the five UNJP implementation states and focused on communities where the rate of prevalence of FGM in girls aged 0–14 years is high and/or increasing.

A• Access what people know, feel and do

• Ascertain normative factors: descriptive norms, injunctive norms and outcome expectancies

C• Consider context, specifically gender and power

• Collect information on social support and networks

T• Track individual and social change over time

• Triangulate all data and analyses

Figure 1: The three components of the ACT Framework – ascertain, consider the context and track and triangulate

Source: UNJP, n.d.

The objective of this undertaking was not merely exploratory; it aimed to generate valuable knowledge that facilitates effective programming strategies and informs decision-making processes with regard to FGM, particularly in Phase IV of the UNJP. The ultimate goal here was a targeted, strategic approach to reducing and ultimately ending FGM.

1.3 Study objectives

In response to the study objectives, the ACT Framework was broadly adopted at the construct level and adapted at the subconstruct level as it related to the specific study objectives. The different study objectives were aligned with the relevant ACT Framework construct and subconstructs as presented in Table 1.

5 The ACT Framework is derived from three guiding principles and activities: (i) assess what people know and ascertain norms and outcome expectancies, (ii) consider the context and (iii) track change and triangulate data and analyses. See UNJP (n.d.) for more information.

Table 1: ACT Framework subconstructs aligned with the study’s objectives

Assess what people know and feel

Assess what people do

Ascertain normative factors (social norms)

Consider the gender and power context

Track individual and social change over time

Objective 1: Assess knowledge about FGM and attitudes towards FGM (assess what people know and feel)

Objective 2: Explore FGM prevalence, behaviours and decision-making across states and regions of Nigeria

Objective 3: Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence

Objective 4: Describe the decision-making process and context in families that support, or do not support, the practice, with consideration of female agency, decision-making power, gender role beliefs and spousal communication

Objective 5: Document what changes, if any, have taken place with regard to the practice of FGM, including engagement in programme activities, reach of programme messages and encouragement to abandon FGM

1.4 Study coverage

The study took place in five states that are also part of the UNJP intervention. These are Oyo, Oson and Ekiti in the South West geopolitical zone and Imo and Ebonyi in the South East geopolitical zone (see Figure 2).

The ethnographic study took place in five states that are also part of the UNJP intervention. These include Oyo, Oson and Ekiti in the South West geopolitical zone, and Imo and Ebonyi in the South East geopolitical zone.

Source: Authors

Figure 2: Study locations (state level)

Oyo

Osun Ekiti

Imo

Ebonyi

Despite meticulous planning and execution, a few limitations were encountered in this ethnographic study. These limitations have some effects on the results and their interpretation.

1.5 Study limitations

Despite meticulous planning and execution, a few limitations were encountered in this study. These limitations had some effects on the results and their interpretation, as explained in the points below.

1. Methodology: An elemental component of ethnographic research involves observing the study participants in their natural environment, which allows for a deeper understanding of their culture, behaviours, experiences, perspectives and interactions. Regretfully, the sensitivity of this study, the illegality of FGM under prevailing laws (the VAPP Act and state laws) and the difficulty of naturally observing the targeted behaviour restricted the ability to observe community members as a core methodological approach.

2. Participants’ responses: Although participatory and projective techniques were employed to gain rich information during FGDs and IDIs, an inherent limitation of the study was the potential for misreporting stemming from the sensitivity of the topic, discomfort among the participants or fear of legal repercussions due to the prohibition of FGM.

3. Adapting the ACT Framework: The ACT Framework, which is a macro-level monitoring and evaluation tool designed to measure and track changes in social norms related to FGM, comprises both quantitative and qualitative indicators. In this study, however, the focus was primarily on qualitative aspects, leading to limited capture of quantitative indicators, which could only be partly tackled through analysis of secondary data.

4. Tracking changes: With the adaptation of the ACT Framework to align with the objectives of this qualitative study and its cross-sectional approach, tracking changes was not possible due to the absence of baseline values. In establishing itself as a baseline study, this study relied on the current data it extracted.

5. Sensitivity of the study: In many contexts, discussing FGM practices can be taboo and invoke a sense of shame or fear due to societal pressures and expectations. The deeply sensitive nature of FGM and the associated personal experiences and traumas attached to it may have made respondents uncomfortable, which may have limited their honest and open participation and introduced an inherent bias. Furthermore, during the pilot, it became apparent that younger adolescents were oblivious of the subject matter, possibly due to its sensitive nature. To mitigate this, the study guides were reviewed to ensure age- and information-sensitive questions.

Chapter 2: Research uptake

Research uptake is a process in which research findings are assessed, evaluated and utilized for practical applications to inform policymaking, practice and behaviour change. Hence, the findings of this ethnographic study highlight the social norms, cultural dynamics and religious beliefs underpinning FGM practices and also identify the driving forces that perpetuate these harmful rituals. They create a rich knowledge base. Furthermore, the study aims to ensure that the results significantly influence decision-making processes that lead to the abolition of FGM in Nigeria. Therefore, to ensure a wider use of the detailed insights of this study, it is recommended that the findings be disseminated widely to stakeholders (influential and traditional leaders, men and boys, health professionals, the media, etc.) through stakeholder-specific research briefs. Specifically, these research results can be shared in the following various ways:

• Communicate the findings of this study to government agencies, NGOs and development partners through workshops and other learning platforms. The findings of this study link the perceived reduction in FGM to the influence of various anti-FGM activities conducted by these stakeholders. The value of their efforts in achieving the goal of eliminating FGM should be communicated, as well as the importance of improved collaboration in programme implementation.

• Engage traditional leaders at the state-level forums at which they meet to present study findings, particularly those related to their communities. Considering that the study highlights poor implementation of FGM laws and policies, which falls within their purview, their collaboration in addressing concerns, especially with regard to implementation and enforcement of existing laws on FGM, should be sought through dissemination.

• Engage men and boys through a town hall meeting or community gathering. The findings of this study should be communicated to them via such a platform, highlighting the implications of their lack of support for ending FGM. Specifically, their support as active agents in eliminating FGM can be sought by leveraging the key role they play as decision makers at household and community levels.

• Community platforms where only women participate (such as the August meeting in South East zone), or any other gathering of women, should be used to reach caregivers and survivors of FGM with the findings of the study. Through this, their commitment to continuously stand up for change to end FGM can be obtained.

• Disseminating the findings of this study to health-care workers can be conducted through workshops and seminars. Their role in educating caregivers and discouraging the practice of FGM is highlighted in this study. Further support can be sought from them for the dissemination of relevant information through a variety of platforms, such as prenatal and postnatal clinic days, using tailored education and communication materials.

• Dissemination of the study findings to the general public is important. This can be achieved through an activity designed to launch the research study report at national and project-state levels. Production of a concise form of the report that highlights key findings and recommendations can further aid the dissemination and spread of the study.

• The dissemination of this study can take place throughout the year by presenting its findings at research symposiums and conferences. It can be supported by other studies on FGM in the country to drive further discourse and learning.

Importantly, it is envisaged that the research findings of this study can be used to develop evidence-based policies and programmes, support the roll-out of national strategies and initiatives and offer stakeholders valuable insights into community engagement:

• Evidence-based policies and programmes: The study provides an evidencebased foundation for the development and implementation of impactful programmes geared towards the reduction and, ultimately, the abolition of FGM practices in Nigeria. This in-depth understanding will serve as significant leverage to inform decision-making processes, leading to the design of strategic, welltargeted interventions that keep the welfare of children, particularly those most at risk, at the forefront. Additionally, based on the thorough analysis of primary and secondary data, recommendations have been generated to identify more efficient and sustainable approaches to combat FGM.

• Supporting national strategies: The findings of this study will support the dissemination of the National Policy and Plan of Action for the Elimination of Female Genital Mutilation in Nigeria (2021–2025) by providing critical evidence to support the effective roll-out of the initiatives led by the Federal Ministry of Health and the Federal Ministry of Women Affairs. Moreover, the results will be invaluable for monitoring and evaluating the implementation of the action plan, thereby facilitating informed planning for the next phase of the UNJP to end FGM.

• Formative and focused on learning: Distinctly formative in nature, this study has been designed to offer stakeholders – UNICEF, UNFPA and the Government of Nigeria – valuable insights regarding the effectiveness of community engagement approaches, the practical implementation and enforcement of prohibitive laws and communication strategies for social behaviour change, especially for promoting normative change.

Chapter 3: Study approach and methodology

3.1 Study approach

The approach of this study was participatory and consultative in nature, aimed at achieving the study objectives. In collaboration with the National Technical Committee on FGM (NTC), efforts were harmonized to conduct this research. The NTC, which included experts from UNFPA, UNICEF West and Central Africa Regional Office, UNICEF Headquarters, consultants on social behavioural change communication, the UNICEF FGM team and the Strategic Technical Assistance for Research Initiative to End Harmful Practices, provided essential advice and oversight on the study approach, tools, protocol, selection of study participants, legal implications, policies and regulations. Their review of study documents and deliverables ensured that the study was robust and methodically sound in its execution.

Guided by the ACT Framework (Sood et al., 2020), the study had a broad scope, incorporating a social-ecological perspective. This framework, which measures and tracks changes in social norms related to FGM, facilitated the understanding of the individual-level factors of knowledge, attitudes and practices within the context of their wider environment. The study encompassed various elements, including gender and power, and considered multiple levels of influence.

3.2 Methodology

This study employed a qualitative, cross-sectional research design that seamlessly integrated desk research and secondary data analysis with primary data collection through qualitative participatory methods and analysis. To gain a deeper understanding and effectively document the prevailing knowledge, attitudes and practices related to FGM, as well as associated social, religious and cultural beliefs, a range of distinct yet complementary methods were employed. These included focus group discussions (FGDs), key informant interviews (KIIs) and in-depth interviews (IDIs).

To enhance the credibility of the findings, data were triangulated by drawing on various sources of information to corroborate the findings. This comprehensive approach not only enriched the knowledge and understanding of the findings but also fed into the generation of informed and applicable recommendations.

3.3 Study matrix

The study matrix includes the study objectives, ACT Framework constructs, key information areas and/or indicators, data collection methods and data sources. These are summarized in Table 2.

Table 2: The study matrix for the ethnographic study of FGM in Nigeria

Assess what people know Assess knowledge about FGM and attitudes towards FGM

Assess what people feel

Assess what people do Explore FGM prevalence, behaviours and decisionmaking across states and regions of Nigeria

• Awareness of FGM

• Awareness of FGM as a harmful traditional practice

• Knowledge of the types of FGM and their risks

• Knowledge of the laws around FGM

• Beliefs about FGM (as a function of gender, power and/or control, identity, religion, health and human rights)

• Attitudes towards those that do not practise FGM

• Support for FGM abandonment

• Sense of ownership in abandoning FGM and willingness to support those who abandon FGM

• Intention to practise FGM

• Willingness of men to marry women who have not undergone FGM

• Self-efficacy in abandoning FGM

• Prevalence of FGM among 0–4-year-old girls

• Behaviour shift towards abandoning FGM

• Public support for those who abandon FGM

• Desk review

• Secondary data analysis

• Primary data collection

• NDHS

• FGDs: Priming questions, body mapping, free listing and gender boxes

• Interviews: KII and/ or IDI vignettes

• Secondary data analysis

• Primary data collection

• NDHS

• FGDs: Priming questions, 2×2 tables

• Interviews: KII and/ or IDI vignettes, social network mapping

ACT

Framework constructs

Ascertain normative factors (social norms)

Consider the context, especially gender and power

Study objectives

Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence

Describe the decisionmaking process and context in families that support, or do not support, the process, with consideration of female agency, decisionmaking power, gender role beliefs and spousal communication

Track individual and social change over time

Document what changes, if any, have taken place with regard to the practice of FGM, including engagement in programme activities, reach of programme messages and encouragement to abandon FGM

Key information areas/ indicators

• Perceived prevalence and perceived changes in prevalence

• Perception of others’ expectations

• Existence of benefits and sanctions

• Willingness to apply benefits and sanctions to others

• Expectation of experiencing benefits and sanctions

• Female agency

• Female decision-making power

• Gender role beliefs

• Spousal communication and social support

Data Collection methods Sources

• Desk review

• Primary data collection

• Trends in the prevalence of FGM among 0–4-year-old girls

• Reach of messages related to FGM, encouraging others to abandon FGM

• Primary data collection

• Secondary data analysis

• FGDs: Priming questions, social network mapping, 2×2 tables

• Interviews: IDI vignettes

• NDHS

• FGDs: Priming questions, gender boxes

• Interviews: KII and/ or IDI vignettes

• Desk review

• Secondary data analysis

• Primary data collection

• NDHS

• FGDs: Priming questions

• Interviews: KII and/ or IDI vignettes

The FGDs were held with adolescent girls, their caregivers (mother and father) and male youths in the selected communities. Each group consisted of six to eight participants.

3.4 Data collection methods

The methodology implemented in this study embraces various methods, including participatory approaches to elicit comprehensive insight into FGM practices.

3.4.1 Focus group discussions

The FGDs were held with adolescent girls, their caregivers (mother and father) and male youths in the selected communities. Each group consisted of six to eight participants. The FGDs were guided by priming questions to address the five objectives of the study with various participatory activities embedded within the FGDs, as explained below.

Priming questions

Priming questions were overarching questions that were utilized to address all the study objectives:

• Objective 1: Assess knowledge about FGM and attitudes towards FGM (assess what people know and feel).

• Objective 2: Explore FGM prevalence, behaviours and decision-making across states and regions of Nigeria.

• Objective 3: Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence.

• Objective 4: Describe the decision-making process and context in families that support, or do not support, the process, with consideration of female agency, decision-making power, gender role beliefs and spousal communication.

• Objective 5: Document what changes, if any, have taken place with regard to the practice of FGM, including engagement in programme activities, reach of programme messages and encouragement to abandon FGM.

Activity 1: Body mapping with adolescent girls

The body mapping activity, which was conducted only with adolescent girls, used a visual aid (a picture of a typical girl child in their community) to enquire of these adolescents about what happens to the senses and parts of the body of girls when they undergo FGM, as well as what girls do and think when undergoing the practice. While conducting this activity, respondents were questioned in more depth to understand the reasons for their individual responses. This activity helped in understanding the immediate physical and psychosocial risks of FGM and in learning more about awareness levels, types of FGM and beliefs related to FGM.

This activity was used to respond to Objective 1 (assess knowledge about FGM and attitudes towards FGM (assess what people know and feel)).

Activity 2: Social network mapping with caregivers

This activity was conducted with caregivers (mothers and fathers of adolescent girls) who completed a social network map to identify and provide an understanding of their specific social networks at the family, peer and community levels. This activity was aimed at not only identifying the caregivers’ social networks, but also providing an understanding of the beliefs about and opinions on FGM held by these networks and the extent to which these influence the caregivers’ decision to practice FGM or not. This was a prerequisite for the subsequent 2×2 tables activity.

Activity 3: 2×2 tables with caregivers

This participatory activity helped identify injunctive and descriptive norms and beliefs, and also assess the influence of these on FGM behaviours. It also helped in understanding caregivers’ expected outcomes for abandoning or continuing FGM practices. For this activity, a social network map was completed and used as a reminder for participants when responding to questions about others’ perceptions, behaviours and expectations. Individual participants in a group completed two 2×2 tables: one for descriptive norms (or empirical expectations), referred to as ‘behaviours’ and the other for injunctive norms (or normative expectations), referred to as ‘approval’. The results were tallied for each table and then compared using probing questions that also enquired about outcome expectancies, social benefits and sanctions for continuing and/or abandoning FGM.

This activity was used to respond to Objective 3 (identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence).

Activity 4: Free listing with caregivers and male youths

This activity involved listing, categorizing and ranking reasons for practising FGM, or not. It led to an understanding of personal, cultural, social, religious, gender, legal and moral norms that impact FGM practice.

This activity was used to respond to Objective 1 (assess knowledge about FGM and attitudes towards FGM (assess what people know and feel)).

The ‘vignette story completion’ technique was used to conduct interviews with FGM champions, CBOs, girls and women who have undergone FGM and their husbands, mothers-in-law, grandmothers of girls, community health workers, TBAs and traditional circumcisers.

Activity 5: Gender boxes with adolescent girls, their caregivers and male youths

For this activity, participants in the FGD were divided into two groups to respond to probing questions about the expected qualities, roles and behaviours of a ‘typical’ man and a ‘typical’ woman in their community. This helped measure FGM knowledge, beliefs and attitudes in a gender-based context and in understanding female agency and decision-making power.

This activity was used to respond to Objective 1 (assess knowledge about FGM and attitudes towards FGM (assess what people know and feel)) and Objective 4 (describe the decision-making process and context in families that support, or do not support, the process, with consideration of female agency, decision-making power, gender role beliefs and spousal communication).

3.4.2 Key informant interviews and in-depth interviews

Interviews were conducted to provide a comprehensive understanding of the reasons and factors that drive FGM. The ‘vignette story completion’ technique was used to conduct interviews with FGM champions, CBOs, girls and women who have undergone FGM and their husbands, mothers-in-law, grandmothers of girls, community health workers, TBAs and traditional circumcisers. The technique facilitated exploration into social expectations while focusing on fictional characters. The content of the interviews was divided into three parts, each exploring a different aspect of FGM norms and practices.

The first part of the interview enquired about the intention to practise FGM, or not; the second part enquired about the decision not to practise FGM and the social benefits and social sanctions the family might face; and the third part enquired about the participants’ and understanding, expectations and behaviours of themselves in relation to FGM as well as what they thought the understanding, expectations and behaviours of others – especially those in their community – was. Additionally, facilitators probed responses to identify obstacles to achieving an FGM-free community and existing community resources that could be leveraged to abandon the practice and eventually eliminate FGM.

Information from this activity helped identify beliefs about FGM, attitudes towards girls who have not undergone FGM or are in FGM-free communities, the decisionmaking process around FGM, support for abandoning FGM, the intention to practise FGM, outcome expectancies and types of social support available. The information gathered from these KIIs and IDIs was instrumental in achieving an in-depth analysis to respond to all study objectives except Objective 2 (explore FGM prevalence, behaviours and decision-making across states and regions of Nigeria), which was achieved through secondary data analysis.

3.5 Target respondents and sample size

3.5.1 Target respondents

The selection of respondents for this study was intentional and purposeful to ensure that a comprehensive landscape of information on FGM practices across the target states was collected. These targeted respondents ensured our study would capture a nuanced understanding of FGM practices and norms in the study area from a variety of perspectives and experiences. The target respondents were different for FGDs and for one-on-one interviews (KIIs and IDIs).

Focus group discussion respondents

1. Adolescent girls: This group is particularly crucial because these girls are directly at risk of FGM. Their insights provided first-hand experience of their understanding and perceptions of FGM practices and the effects of these.

2. Caregivers (mothers and fathers): Parents or caregivers play a significant role in the continuation or discontinuation of FGM. Their views helped in understanding the family dynamics and decision-making processes associated with FGM practice.

3. Male youths: Engaging young males provided perspectives on how the next generation perceives FGM, giving insights into potential future changes or reinforcement of societal norms, especially as UNJP was also engaging men and youths in FGM elimination activities. This is also an important category of people according to NDHS, as a substantial number of men are responsible for making, in most cases, final family-related decisions, including health-related decisions for their wives and children (NPC and ICF, 2019).

One-on-one interviewees

1. FGM champions: These are individuals who are actively advocating against FGM in their communities. Their experiences offered helpful insights into advocacy strategies and the challenges faced.

2. Community health workers, TBAs and traditional circumcisers: Their insights were essential to understand the linkage between health services and FGM practices.

3. CBOs: These organizations, working at the grassroots level, offered a valuable understanding of community dynamics and intervention strategies.

4. UNJP funders (UNICEF and UNFPA): The representatives of these agencies were integral to understanding the programmatic and strategic nuances of anti-FGM interventions. Their insights helped provide a broader picture of the organizational efforts and challenges in combating FGM.

5. Government officials: Government officials at local, state and national levels were included in the study. Their perspectives were essential in understanding

The selection of respondents for this study was intentional and purposeful to ensure that a comprehensive landscape of information on FGM practices across the target states was collected.

The inclusion of such diverse stakeholders in the study ensured a comprehensive and holistic understanding of FGM practices, from narratives at the grassroots level to inputs from decision makers at the policy level, thereby painting a detailed picture of the subject.

the legal and policy frameworks that are in place to combat FGM and the obstacles to their implementation, as well as the interplay between these frameworks and societal traditions and norms.

6. Media professionals: This group is instrumental in sensitizing, informing and raising awareness about harmful practices like FGM. They have been advocating for the abandonment of FGM, and their viewpoints were critical to understanding how media narratives about FGM are formed and diffused and the potential impact these narratives can have on shaping community attitudes and compelling societal change. Furthermore, their outreach methods and the challenges they encounter in their work provided further insights into effective media advocacy in the drive to abolish FGM.

The inclusion of such diverse stakeholders in the study ensured a comprehensive and holistic understanding of FGM practices, from narratives at the grassroots level to inputs from decision makers at the policy level, thereby painting a detailed picture of the subject. A summary of the diverse participant categories differentiated into social-ecological categories is provided in Figure 3.

Individual level

• Adolescent girls (aged 10–14 years and 15–19 years)

Household level

• Mothers of adolescent girls

• Fathers of adolescent girls

• Mothersin-law and grandmothers of girls

Community level

• Traditional rulers and community gatekeepers

• Male community members

• Community health workers, TBAs and traditional circumcisers

Government and CBOs

• FGM champions

• CBOs

• FGM focal person at LGA level

• FGM focal person at state level

• Federal Ministry of Health

• Federal Ministry of Women Affairs

• Other stakeholders from UNICEF and UNFPA

• Media professionals

Figure 3: Target respondents in FGDs and one-on-one interviews

Source: Authors

3.5.2 Sample size

The study team visited one community or ward in a total of 15 local government areas (LGAs), three in each state (see Table 3). A total of 40 FGDs and 147 (against the planned 154) one-on-one KIIs and IDIs were conducted during this study. Table 4 provides a summary breakdown of the distribution and numbers of FGDs and interviews conducted.

Table 3: Number and variety of study areas in the five states

The study team visited one community or ward in a total of 15 local LGAs, three in each state.

Table 4: Number of FGDs and interviews of different stakeholder groups at the various levels of the study

Focus group discussions

3.6 Sampling methodology

For this study, a systematic sampling methodology was implemented in three crucial stages to ensure a comprehensive and representative understanding of FGM practices across the regions of interest to enhance the credibility and comprehensiveness of the study findings (see Figure 4).

Stage 1: Selection of states

Five UNJP implementation states – Ekiti, Osun and Oyo (South West) and Ebonyi and Imo (South East) – were intentionally selected for this study due to their significance and prevalence regarding FGM.

Stage 1: State Stage 2: LGAs and communities Stage 3: Target respondents

Figure 4: Process of sampling

Source: Authors

Stage 2: Selection of LGAs and communities

In each of these five states, three LGAs were selected – a UNJP-implementing LGA and two LGAs (one urban and one rural) not in the UNJP – using a simple random sampling technique. Subsequently, in each LGA, one community was selected. This was carried out in consultation with the UNJP team, including state government representatives, to effectively focus the study. See Table 5 for the final selection.

For this study, a systematic sampling methodology was implemented in three crucial stages to ensure a comprehensive and representative understanding of FGM practices across the regions of interest to enhance the credibility and comprehensiveness of the study findings.

As the study aimed to capture a broad spectrum of perspectives, respondents with diverse sociodemographic characteristics were selected, including varying age groups, education levels, employment status and socioeconomic backgrounds.

Table 5: UNJP and non-programme study locations

State Type of LGA

South West zone

UNJP

Ekiti

Osun

Oyo

Non-UNJP

UNJP

Non-UNJP

UNJP

Non-UNJP

South East zone

UNJP

Ebonyi

Imo

Non-UNJP

UNJP

Non-UNJP

Urban or rural LGA Community

Urban Ikere Uro

Urban Irepodun/Ifelodun Iyin

Rural Oye Ilupeju

Urban Ife East Iyafoworogi

Urban Iwo Iwo

Rural Odo Otin Agbeye

Urban Iseyin Ekunle

Urban Ibadan North-West Ayeye

Rural Afijio Ilora

Semi-urban Afikpo South Owutu

Semi-urban Ikwo Ndufu Echara

Rural Ohaozara Okposi

Rural Ideato South Ugbelle

Rural Mbaitoli Nkwo Orodo

Semi-urban Nkwerre Owerri Nkworji

Stage 3: Selection of target respondents

The recruitment of the target respondents in the chosen communities pivoted around a screening/recruitment checklist. As the study aimed to capture a broad spectrum of perspectives, respondents with diverse sociodemographic characteristics were selected, including varying age groups, education levels, employment status and socioeconomic backgrounds.

3.7 Quality check to mitigate bias

Quality assurance and control mechanisms were meticulously established and implemented to uphold the quality of this study and to mitigate potential bias. Hence, quality control mechanisms were integrated at three levels:

1. Data collection phase: The field teams were meticulously trained on the study protocol, ethical parameters and various research methodologies to ensure the authenticity of the recorded data, and that they precisely reflected the

responses, facts and events stated by the participants. Also, singular method biases were minimized by leveraging diverse data collection techniques, such as FGDs, IDIs and KIIs. Furthermore, audio recordings were safely transferred to a shared drive folder with restricted access.

2. Data entry phase: Data were digitized, transcribed and systematically entered into a spreadsheet and coded as per explicit guidelines. The methods used were standardized and consistent, aiming for the best quality of data entry.

3. Data validation phase: After data entry, a thorough data-checking process was executed, in which data were cleaned, verified, cross-checked and validated using both automated systems and manual procedures, thus enhancing the reliability of the study’s conclusions.

3.7.1 Quality of deliverables

As an integral part of Ipsos processes, internal quality assurance of all formal deliverables was conducted before the submission of first drafts to UNICEF and the NTC. This process ensured that the deliverables met the normative criteria, including defensible design, independence and impartiality, and also offered valuable recommendations. From a technical perspective, the deliverables were made clear, reliable and valid by leveraging suitable research methods. The quality assurance checks ensured that the final report was of high technical quality, was reader friendly and followed a consistent structure and style. Furthermore, clear connections between findings, conclusions and recommendations were ensured.

The quality assurance checks ensured that the final report was of high technical quality, was reader friendly and followed a consistent structure and style.

Chapter 4: Findings and discussions

4.1 Objective 1: Assess the knowledge of and attitudes towards FGM

The ACT Framework posits that gaining factual knowledge about FGM and understanding the inherent risks of the practice are important for challenging myths, enabling value and promoting attitudinal shifts in FGM practices, all of which aid the abandonment and elimination of FGM practices. In conducting this study, awareness and knowledge of FGM was assessed comprehensively by enquiring about participants’ knowledge of FGM, their awareness of FGM as a harmful practice and its associated risks and knowledge of the types of FGM, their risks, the laws on FGM and the interventions pertaining to FGM in the respective states. All of these were assessed using diverse tools adopted for this study, as described in the previous chapter. The analysis of the findings is informed by the triangulation of responses given by the study respondents.

4.1.1 Assess what people know (knowledge of FGM)

Awareness of FGM

Awareness of FGM in this study was measured by seeking information on respondents’ familiarity with FGM and their recognition of it. Through the different tools utilized for data collection, different categories of respondents indicated their awareness of FGM. From a state-level perspective, data show that respondents from the south-western states (Ekiti, Osun and Oyo) showed high levels of awareness of FGM. In FGDs conducted in Oyo State, which comprised adolescents, youths and caregivers (mothers and fathers), all categories of respondents expressed awareness of FGM. In Ekiti State, all respondents had an awareness of FGM, except for adolescents, of which only 65 per cent of the 31 adolescents interviewed indicated that they were aware of it. A similar pattern was found in Osun State, where out of 62 participants, 76 per cent were aware of FGM; among respondents who were unaware of it were younger adolescents and fathers.

To ensure that respondents were very familiar with FGM, the terms used for it in their various local languages were explored. Their understanding of its framing in

their different local contexts and their ability to communicate the local terminology relating to FGM were noted. The similarity in language used across states in the same region was noted from the terms shared by respondents. The two study states located in south-eastern Nigeria (Ebonyi and Imo) are Igbo-speaking communities. Similarities in language and culture in the region were expected; however, it was observed that some linguistic variances exist in the local terms used for FGM. Respondents in Ebonyi referred to FGM as ‘ ibi amimi ’ or ‘ibi ugwu ’, while in Imo it is referred to as ‘ ibi ubu ’, ‘ ikwa nwanyi ugwu ’, ‘ ikwa ugwu ’ or ‘ ichi nwanyi nma’. A similar circumstance was noted in the south-western region, where Ekiti, Osun and Oyo states have similar languages based on the Yoruba language. However, some linguistic variations also exist there. In Ekiti State, FGM is referred to as ‘ idabe’, ‘ dida be omo obirin’ or ‘abe dida omo obirin’, while in Oyo State it is called ‘ dida abe fun omo obirin’, ‘ ilakiko’ or ‘abedida’. Furthermore, Osun respondents share a slightly different variant, ‘ didabe fun obirin’ or ‘ idabe fun obinrin’.

Across all the states, most respondents were aware of FGM, which is consistent with the 2018 NDHS, which reported high awareness of FGM among respondents. Of women respondents between 15–49 years of age, 60.8 per cent were noted to have heard of FGM. Across this percentage, women in the south-east (77 per cent), the south-west (73 per cent) and in urban areas (69 per cent) expressed more awareness and knowledge about FGM than others (NPC and ICF, 2019).

Knowledge of FGM

The level of knowledge respondents had of FGM was not only ascertained by their awareness of the term, but also by exploring their understanding of the various types of FGM they were familiar with, the risks of FGM, the laws and legislation on FGM and their knowledge of interventions to end FGM and accompanying actions targeted against the practice of FGM in their local contexts. Responses were assessed to determine the respondents’ relative positions based on the entirety of their FGM knowledge filtered through the lens of the factors stated above. The findings are based on the convergence of the diverse forms of data from this study.

a) On the types of FGM

WHO’s classification of FGM in 1995, which was revised in 2007 into four broad categories, informs the criteria for measuring respondents’ knowledge of the types of FGM occurring in their local contexts. The four broad categories, which correspond to the amount of tissue damaged and health risks, include Type I, clitoridectomy; Type II, excision; Type III, infibulation; and Type IV, which represents all other harmful procedures to the female genitalia for non-medical purposes (UNICEF Data, 2024).

An assessment of all responses shows that, for the respondents, FGM is largely categorized as involving cutting or other forms of mutilation. There was no clear-cut knowledge of the diverse forms of cutting as set out in the WHO categorization.

Across all the states, most respondents were aware of FGM, which is consistent with the 2018 NDHS, which reported high awareness of FGM among respondents.

At the community level, respondents largely lacked detailed knowledge of the different types of FGM.

What I know about FGM is that it’s a cut given to girls, especially young girls. It can be done to a baby, and they can be using sharp something to cut part of the female genital.

FGM LGA focal person, Ebonyi State

At the community level, respondents largely lacked detailed knowledge of the different types of FGM. For example, a CBO in Ugbelle under a UNJP LGA describes only three types of FGM as: “(i) Clitoridectomy: this is the partial removal of the clitoral gland; (ii) excision: it is the partial or total removal of the clitoris and the labia; and (iii) massaging then cutting: massaging with hot water and applying Vaseline.”

While respondents were able to share an idea of what procedures different types of FGM may entail, those who responded, at best, lacked detailed knowledge of the types as formally categorized.

Across the states, inconsistency is observed regarding the naming of the type of FGM being practised, compared with the types used in the WHO categorization. The different types of FGM respondents alluded to are essentially ‘partial cutting’ to ‘full cutting’, practices that, according to them, had been conducted in their communities/state. The lack of awareness of how a type of FGM is framed was noted, even by community respondents.

In this south-west part of the country they usually refer to removal of the clitoris either partially or totally, they are not aware of other methods of FGM … without our intervention and campaign showing the pictorial to them, I think some of the communities we have been to are now becoming aware that female genital mutilation is more than removal of only [the] clitoris.

FGM state focal person, Oyo State

An emerging trend is the growing adoption of Type IV FGM, which is expressed in various forms across the diverse communities that were part of this study. While respondents lack awareness of the categorization of FGM, their responses on the types and ways that FGM is being practised in their communities indicate that Type IV FGM is popular.

Like in the FCT [Federal Capital Territory], people around the Lubge and Kuje site … use pressing. Then around Kwali, they massage with hot water to shrink the clitoris, yes. And then there’s this one that they call ‘yankan gishiri’ where they cut and put salt there.

KII respondent, national

Particularly in the south-eastern region, respondents noted that mutilative procedures and implements perceived to be harmless are being used to cause changes to female genitalia. In describing what forms of FGM are being practised in

the south-east, respondents made particular mention of cutting as a severe form of FGM, while the other forms were seen as less harsh.

It is conducted by either doing the severe one, which [was] practised in the olden days by using a razor blade, a sharp knife or hot iron to cut off the female genitals permanently … or partially or sewing the genitals. The other type is using rub or Vaseline, or hot-water-soaked … towel to press down or massage the genitals.

Community health worker, Mbaitoli, Imo State

In Imo State, for example, the study records the use of substances such as hot water, petroleum jelly, engine oil and dusting powder (medicated mentholated powder developed to be used as a desiccant) to massage or press the female genitalia into a desired form. Responding to this, the state focal person in Imo said confidently: “I know what they practise in Imo State is the Type IV. The use of Vaseline and hot water.” It is observed that the drive for this form of FGM is the need to ‘beautify’ the woman’s vagina.

Within the family or parental realm, there may be a sense of satisfaction stemming from the misguided belief that this act serves as a form of enhancement. In the Igbo language, this concept is encapsulated by the phrase ‘a ni’ acho mma’, signifying the notion of embellishing the infant. However, this perspective raises questions about the rationale behind such enhancement, especially since the genitalia in question are a naturally endowed feature.

Media professional, Imo State

UNFPA’s review of the patterns and types of FGM in Nigeria shows that across national studies conducted between 2003 and 2018, Type II FGM, commonly known as excision, was practised extensively in Nigeria (UNFPA, 2021). Referring to the level of knowledge of types of FGM, the 2018 NDHS revealed that 44.1 per cent of women surveyed lacked knowledge of the type of FGM they were subjected to (NPC and ICF, 2019). This current study found that while respondents had knowledge of FGM as essentially involving the cutting of the female genitalia, there was a lack of clear knowledge as to the type of cutting that was adopted. The findings align with those of the 2018 NDHS in confirming that there is a low level of knowledge of the types of FGM among respondents in Nigeria.

b) On the methods of FGM

While there is a lack of clear-cut knowledge of the four types of FGM, there is a great deal of knowledge regarding the methods of FGM practised in the communities in the study. These include traditional methods used by TBAs and circumcisers and medical methods employed by a range of health workers in public or private clinics. According to respondents, the medical practitioners who were engaged in FGM in their communities were nurses, midwives and doctors. When probed further about

UNFPA’s review of the patterns and types of FGM in Nigeria shows that across national studies conducted between 2003 and 2018, Type II FGM, commonly known as excision, was majorly practised in Nigeria.

While medical practitioners are known to engage in what appears to be Type II FGM, it is understood that, in places where medicalization had occurred, Type IV FGM was usually reinforced through the counsel of a medical practitioner.

their knowledge of the use of medical methods, a TBA from Iwo in Osun State noted that these were mostly employed by unqualified doctors: “The unqualified doctors who are in every local government, they suddenly became doctor-circumcisers without training.”

c) On knowledge of the practices adopted in medical and traditional FGM

Further enquiry aimed to ascertain what types of FGM were practised by means of traditional and medical methods. Apart from the fact that the data showed that in both the traditional and medical approaches a cut is made, the analysis revealed no clear alignment with WHO’s four FGM categories (UNICEF Data, 2024). According to a health worker who shared his knowledge of the methods, there are significant differences in the tools and processes used in traditional methods and those used in medical methods: “[T]hey [medical practitioners] normally use … forceps, holding the vagina; they massage, then they cut the part.” The traditional method, on the other hand, involves cutting the flesh around the vagina with either a razor blade or another sharp object, according to other study participants.

The implements utilized in these two methods are different across communities. In Osun State, examples of tools used in the traditional method include sharp objects and snail fluid: “[T]he common method is through the local surgical knife (abe olola) and snail water that they apply before cutting the clitoris.” Aside from the snail fluid, which purportedly acts as an analgesic, palm oil is also mentioned as being used in FGM. Cotton wool is dipped in the oil and then placed on the cut. Noteworthy is the understanding shared by respondents that the traditional FGM method comprises the various types of FGM. For example, a traditional method of FGM employed by a TBA can involve the removal or partial removal of the clitoris (Type I) of the female child or massaging the genitalia (Type IV).

For traditional methods, some normally put a knife on fire and leave it to heat very well and they will use it to cut off the baby’s clitoris. Some partially remove … it, some massages with hot water so the clitoris will not be itchy, some use Vaseline to massage it, pressing it with hands and also dustin[g] powder so that the child will not be having much feelings or urge.

Health-care provider, Imo State

The complicity of some medical practitioners in promoting Type IV FGM in the forms highlighted above was noted. While medical practitioners are known to engage in what appears to be Type II FGM, it is understood that, in places where medicalization had occurred, Type IV FGM was usually reinforced through the counsel of a medical practitioner.

The medical people basically … will tell the parents to go and continue with Type IV because the part needs to heal up and they began to use hot water to massage it and that process further kill[s] the clitoris off. They conduct it by

cutting the clitoris and they tell the parents of the girl to continue the process by massaging with hot water.

CBO representative, Ekiti State

The places where traditional and medical procedures are performed were further explored with respondents. It was reported that traditional FGM is conducted in the home of the TBA, the circumciser or the parents of the girl, whereas medical FGM is done, among other locations, at a health centre or the home of the health practitioner or parents of the girl. A TBA from Odo Otin, a non-UNJP LGA in Osun State, validated this: “Now there are people who perform in the hospital … The two legs will be held down separately, someone will hold her arms for the process to be done. The nurses and the doctors are the [ones] performing it.”

Respondents were asked about whether practitioners of the traditional and medicalized forms of FGM were trained to conduct the procedure. Some respondents were of the opinion that practitioners of both forms had received training.

The medical professionals are trained; even the traditional circumcisers also receive trainings.

TBA, Osun State

Analysis from the KIIs shows that, particularly in the south-western states of Osun and Oyo, traditional FGM is the remit of a lineage of cutters called ololas, who are locally authorized and trained for this purpose. In the IDIs conducted across the five states, 24 of 60 respondents constituting various categories across diverse LGAs indicated that FGM is performed in a hospital or a medical facility, while 36 indicated that it is either performed in the home of the circumciser or the home of the girl child. The number of respondents indicating the hospital as a location where FGM is performed was particularly high in Ekiti State, at 11 out of 12 respondents. By contrast, results for Ebonyi State show only one mention of a hospital being a place where FGM is performed.

Evident from the above is the fact that health-care facilities and health-care professionals continue to play a role in the practice of FGM. However, no healthcare worker in this study confirmed participation in the medicalized practice of FGM. While a few respondents felt that the professional training of doctors, nurses and midwives qualified them to perform FGM, respondents across the various communities were largely unable to determine if the persons that conducted medical FGM were trained to do so and what the quality of the training was like. Alluding to this, a respondent from a CBO in Ikere, Ekiti State, responded: “I don’t think they are trained in the medical profession to start cutting clitoris, but they are making use of their traditional knowledge, and since they know where to cut and the likes, they are cutting them.”

It was reported that traditional FGM is conducted in the home of the TBA, the circumciser or the parents of the girl, whereas medical FGM is done, among other locations, at a health centre or the home of the health practitioner or parents of the girl.

As reported by UNFPA Nigeria (2021), with no proven benefits, FGM results in health complications that could be immediate, including bleeding, infection, pain and trauma to the urogenital system, and even death.

However, it is noteworthy that, under the UNJP, a national protocol for the clinical management of FGM has been designed in collaboration with the Federal Ministry of Health. This serves as a guideline for health-care professionals, detailing how to care for survivors of FGM. To support the use of this guideline, health-care workers have been trained in immediate response and complication management of FGM survivors who are brought to a medical facility. This training uses modules that are predesigned for prophylaxis and management of women and girls subjected to FGM in the immediate period after the act is done.

d) Knowledge of the risk of FGM

The practice of FGM results in acute, intermediate and late complications, which are assessed as risks that have both physical and psychosocial consequences (WHO, 2024). As reported by UNFPA Nigeria (2021), with no proven benefits, FGM results in health complications that could be immediate, including bleeding, infection, pain and trauma to the urogenital system and even death. The long-term sequelae, such as obstetric, genitourinary, sexual and psychological complications, have also been documented (ibid.). Community members’ understanding of FGM as a harmful practice with known associated risks and negative effects was assessed. Respondents generally noted risks such as pain and severe bleeding in the immediate period, as well as infection that could lead to HIV/AIDS. Obstetric risks that FGM poses for women and girls and the sexual and psychological consequences suffered by women as a result of FGM were duly highlighted by respondents. A review of responses from the husbands of women who have undergone FGM shows that out of 10 husbands who participated in IDIs, only two lacked knowledge of the risks associated with FGM. These two participants framed their understanding of the risks as consequences of not conducting FGM. The immediate and long-term effects, such as pain felt during the procedure and difficulty experienced in childbirth, were known to the respondents, but most of them could not correctly identify or categorize physical or psychological risks of FGM. According to one respondent: “Psychological risk is infection; immediate risk is fear; long-term risk is prolonged labour, anybody that is being circumcised finds it difficult to deliver easily.”

In expressing their knowledge of the risks associated with FGM, most respondents at the community level indicated that the risks they shared were learned risks and not generally ones they had direct or close experience of. This implies that the risks respondents associate with FGM are ones that they have learned about from FGM campaigns and initiatives in their communities.

They said that it causes problem[s] during childbirth for a woman that is circumcised.

CBO representative, Afikpo South, Ebonyi State

Only a few respondents mentioned that their knowledge of the risks of FGM was gained directly from a personal experience or an encounter with someone who had suffered such risks. These respondents included focal persons and health-care workers who would have engaged with survivors of FGM in their professional capacity. Comparative experiences largely informed the opinion of these respondents.

With the knowledge and experience I have in this midwifery profession, oftentimes we discovered that circumcised girls usually have difficulties in their sexual life because the part that was circumcised would have formed a scar and will not be able to expand for better penetration during intercourse, which will make them feel pain instead of pleasure during intercourse.

With my experience as a midwife, I discovered that circumcised women find it difficult during delivery because the elasticity of their genitals will have been reduced and will not expand enough for [the] baby to come out. The genitals have been scarred and will not allow proper dilation, and this will result in the woman having multiple tears and ruptures in the process to the extent that we will need to sedate such [a] woman in order to repair such lacerations. Focal person, Iseyin, Oyo State

The analysis of other risks indirectly linked to FGM revealed an association between FGM and infidelity in marriage, as observed by the study’s respondents. According to the respondents, this occurs when a woman suffers a lack of sexual drive because of FGM and is therefore unable to respond or meet her partner’s sexual needs. This results in partners becoming unfaithful by adopting other sex partners and potentially exposing themselves to infection.

Previous studies that focused on some of the states targeted in this study indicate significant knowledge of the risks or side effects of FGM practices. According to Ibekwe et al. (2012), 63.8 per cent of 320 female respondents in Ebonyi State expressed awareness of the side effects of FGM (ibid.). In another study in Imo State, out of 380 female respondents, 42.6 per cent were aware of the physical and other health risks, 42.9 per cent of the emotional health risks and 27.6 per cent of the social health risks (Okhiai et al., 2011).

Noteworthy is that, prior to their learning of the risks associated with FGM, most respondents did not consider it a harmful practice, instead seeing it as a part of their culture. Generally, the poor quality of knowledge of FGM risks can be considered a factor that led to the adoption of the practice by society. Some respondents noted that, apart from being aware of FGM, their poor knowledge about the practice has largely driven their communities’ narratives of it. On learning about the risks of FGM, many of them had to go through a process of unlearning the misconceptions they had been socialized to believe about FGM.

The analysis of other risks indirectly linked to FGM revealed an association between FGM and infidelity in marriage, as observed by the study’s respondents.

Studies exploring reasons for performing FGM highlight diverse influences, all of which include culture and tradition.

I, sitting with you here, was circumcised and that doesn’t make me promiscuous, and we have those that are not circumcised that are promiscuous. Because I now have the knowledge, I didn’t circumcise my daughter and I tell our nursing mothers during my health talk that they need to seek more knowledge because I do wash the private part of the baby well so that it will not be itching her.

Community health worker, Osun State

e) On the justification for practising FGM

Studies exploring reasons for performing FGM highlight diverse influences, all of which include culture and tradition. Specific beliefs that drive FGM practices are noted in the literature. Keredei (2022), in her study of the effects of FGM on women and girls in Nigeria, notes that FGM practice is anchored on beliefs of preservation of chastity and purification, family honour, hygiene, aesthetics, protection of virginity, prevention of promiscuity, increasing the sexual pleasure of the husband, enhancing fertility and increasing matrimonial opportunities. Other studies previously conducted on FGM highlight similar reasons given across communities in Nigeria (Orji and Babalola, 2006). Although many studies posit that FGM is perceived as a rite of passage into womanhood (Mberu, 2017), this was not given as a popular reason by the respondents in this study. An analysis of responses across diverse groups of respondents, such as adolescent girls, caregivers, men, boys and other actors, provides no variance.

Equally relevant is respondents’ knowledge of why FGM is (or was) being conducted. Discouraging promiscuity among girls and women was the most frequent reason given across all states and communities.

One day, I asked my mother: “Why did this thing happen to us?” And she said: “My daughter, I have to tell you the truth … they said if you are not circumcised, you will be doing harlot work. That anywhere you see men, your body will be shaking to [have] sex.”

FGM champion, Ebonyi State

A few respondents highlighted the aesthetic value of FGM as a reason for why it was performed, pointing to a need for the female vagina to look ‘sightly’. A male respondent’s comment validates this: “I was told that if the clitoris is not being cut off, the clitoris might be longer than the penis.” Similarly, a female respondent linked the appearance of the vagina to marriageability: “The reason is that the female genitalia will keep growing and if it is not cut off it keeps growing; if you are not circumcised, nobody will want to marry you.” Some respondents said they were told that FGM kept the female genitalia healthy: “We were told that if a girl is not mutilated, her genitalia will be itching her.” Others associated it with fertility or marriageability.

The Yoruba and the Ekiti people believe that when it is not cut, a woman will be promiscuous. They believe that if the clitoris grows beyond normal, it could hit the baby during delivery.

Media practitioner, Ekiti State

Some are of the belief that if a female child is not circumcised she will be giving birth to stillbirth [stillborn babies] when she starts bearing children; some believe that they would not enjoy sex with their partners, while others believe they would be promiscuous if not circumcised.

FGM champion, Osun State

According to [the] Ikere community, they said that is the way they’ve been doing it and, for some of them, if they do not do it, they won’t be able to get [a] husband. Some won’t be able to give birth and for some, if they give birth, the child will die. For others, it is their own traditional, family rites that they perform. So, these are the common reasons they practise it in [the] Ikere community and even Ekiti at large.

CBO representative, Ekiti State

Essentially, popular opinion holds that the practice of FGM is largely a way of controlling female sexuality. This and the reasons outlined above are used to reinforce the myths that drive the practice of FGM – and the threat that women and girls who do not have FGM will suffer the consequences.

Knowledge of the law

Globally, FGM is understood to be a harmful practice that threatens the wellbeing of women and girls and, by implication, society at large. Criminalizing FGM became a critical step for reducing FGM prevalence in Nigeria, alongside a range of other strategies. In May 2015, Nigeria introduced the Violence Against Persons (Prohibition) Act (VAPP), which directly prohibits the practice of FGM, thereby condemning it as a crime (Eshemokha, 2020). The introduction of the VAPP Act further strengthened efforts in support of the abandonment of FGM in Nigeria. The Act is an improvement on the penal and criminal code in relation to violence, as it addresses the elimination of violence in private and public spaces in all forms (including physical, sexual, psychological and domestic forms, as well as harmful traditional practices) and prohibits discrimination. An attempt to commit an offence listed in the Act is, in itself, considered an offence. The Act provides maximum compensation and protection for victims through the protection of their rights and provisions for the punishment of offenders (Mberu, 2017).

Under the VAPP Act, female circumcision or genital mutilation was prohibited throughout the country, thereby turning FGM, along with other forms of violence, into an offence in Nigeria. To make the provisions of the VAPP Act applicable in other states, beyond the Federal Capital Territory, states are expected to domesticate this law to enable enforcement in their jurisdictions. This includes all five target states

Essentially, popular opinion holds that the practice of FGM is largely a way of controlling female sexuality.

This study found that so far, 34 federal states have domesticated the law (although two of these states do not specifically use the VAPP Act).

in this study. The five states and their year of domestication of the VAPP Act are: Ebonyi (2018), Ekiti (2019),6 Oyo (2020), Osun (2021) and Imo (2021). This is further replicated in LGAs and communities in the different states.

Similarly to the VAPP Act, the Child’s Right Act (2003) also contains provisions that protect children throughout the country from various forms of violence. While the VAPP and Child’s Right acts inform frameworks that can address FGM practice, the VAPP Act most directly applies to FGM.

This study found that so far, 34 federal states have domesticated the law (although two of these states – Ekiti and Lagos – do not specifically use the VAPP Act). Only four of the five study states have gazetted the law. The act of gazetting the law is a way of officially informing the general public that the state has passed the law and making available a documented version containing all the provisions of that law. Contradictory evidence was given by a national respondent who reported that of the five study states, only Ekiti State had gazetted the VAPP Act. This contradicts evidence from the literature findings, mainly that Ekiti State implements the Ekiti State Gender-Based Violence (Prohibition) Amendment Law (2019), a law that is similar to the VAPP Act and includes some provisions of that Act (PWAN, 2023).

The VAPP law has been shared most especially in the FCT [Federal Capital Territory]. Anytime I go for programming in the state, I also encourage the states to share copies of their state law. But you know the challenge we have is that in those states that have domesticated the law, the law has not been gazetted. Only three states have gazetted the law. These states are Sokoto, FCT, Ekiti. For the states that have gazetted their laws, they can use it in court without any blink, compared to other states that have only domesticated it. No lawyers will say they cannot use their law. This is why most people are not accessing justice in female genital mutilation.

National KII respondent

This study explored the level of knowledge that all respondents, except adolescent girls, had of laws in their states and communities. Through data analysis, the status of these across the states – and the implications of this for the scale and quality of knowledge provided by the participants – varied. Most KII and IDI respondents indicated their awareness of the existence of a law on FGM, while fewer FGD respondents indicated a similar awareness. A closer look at the results showed that of the 12 IDI respondents in each of the five states, all respondents in Osun, 11 in Ekiti, 9 in Ebonyi and 6 in Oyo states were aware of the law. Limited awareness of the law was found in Imo State, where 2 out of 12 respondents reported knowledge of any existing laws on FGM. While awareness of the existence of a law was expressed by these respondents, knowledge of the provisions of the law was mostly poor. For example, most of the respondents were able to share that the law makes provision

6 In Ekiti State, the domestication of the VAPP Act is the Gender-Based Violence (Prohibition) Amendment Law.

for a jail term, but they were not able to share the conditions or particular actions associated with the jail term or its duration.

I know that there [are] federal government and state laws, but I can’t quote it. In the community, the women’s group have a law. KII respondent, Ebonyi State

No particular differences were noted between the awareness of respondents in LGAs where the UNJP has implemented interventions and those where it has not. In Imo State, for example, where 10 out of the 12 respondents in the IDIs indicated that they were unaware of the law on FGM, further review of their location showed that the respondents represent a range of communities, comprising Ugbelle (a UNJP community in Ideato South), and Nkwo Orodo (in Mbaitoli) and Owerri Nkworji (in Nkwerre), which are both non-UNJP LGAs and communities. The KII data from Imo State showed a large degree of inconsistency in the respondents’ knowledge of the provisions of the law. Many respondents who were key stakeholders in the FGM abandonment campaign gave conflicting information regarding the provisions of the law when it was enacted and the punitive measures it contains. For example, in the case of Imo State, the VAPP Act was initially introduced in 2021, but was later repealed by the government as a result of pressure from the public. Although Imo State reinstated the Act in 2021, awareness of whether it was in force was low among respondents. One respondent highlighted the fact that Imo State law contains the toughest punitive measures on FGM, but other respondents from the state were completely unaware of this.

It is quite interesting [that] of all the laws in the states, both the national [law] and [those] for the other states, Imo seems to have the strongest penalty. You know, for FGM, for example, if you perpetrate the act [you get] 14 years imprisonment and if the person dies within one year of the act being performed, it is life imprisonment for the [perpetrator]. They even go further to say if you present yourself – you know, to be cut, you are … compelled to be cut – you are also liable to be sanctioned. The other states are between 200,000 to 500,000 naira and three years to five years imprisonment, but Imo is 14 years, with life imprisonment if the procedure leads to death within one year of the act being carried out.

National KII respondent

The quality and depth of knowledge of the law demonstrated by implementers of anti-FGM programmes and actors in the justice system is critical to prosecution and the achievement of justice. Respondents expressed that law enforcement agents, such as the police and the judiciary, have a notably low level of awareness and knowledge of the content of existing FGM laws at both state and federal levels.

Recently, we were engaged in some discussion with some magistrates – or let me call them ‘the judiciary’ – and we were trying to tell them about some of these laws that exist in the state which talk about violence (and FGM law is

The quality and depth of knowledge of the law demonstrated by implementers of anti-FGM programmes and actors in the justice system is critical to prosecution and the achievement of justice.

Notwithstanding the existence of these laws at state and community levels, respondents had no experience or examples of the punitive measures being implemented.

one of them). These magistrates were like they were not even aware of some of these laws … that is a very big issue because when a law enforcement agency arrests [a perpetrator], they still have to take the case to the judiciary. They have to pronounce punishment for the person. But when the judiciary or the person that needs to pronounce judgement does not even know about the law, it is actually a huge challenge. So maybe … the state can make these laws in print form, give it to the magistrates, make people aware – which is where the National Orientation Agency comes in, so that everyone that needs to, will be aware of it.

CBO representative, Osun State

Media practitioners engaged in this study had a better knowledge of the law across most of the study states than other groups of respondents. In some states, like Ekiti, there was a greater awareness of state-level law on FGM than there was of federal law. Similarly, reference by this group to the existence of laws at community level was also noted.

a) Knowledge of community-level laws and their implementation

The existence of community-level laws on FGM is noted in this study. Within communities, especially LGAs that have experienced interventions by UNJP and others, there are local FGM laws that discourage the practice. These laws and their accompanying sanctions are usually community-based edicts pronounced by traditional rulers who hold a high level of authority in their communities.

I witnessed a pronouncement of such declarations by the Alaafin [traditional ruler] of Oyo. He declared during the council meeting the end of FGM practice. He mentioned the sanctions [and] directed all his council members, as well as women that were being part of it, to inform others when they go back.

National KII respondent

In Ebonyi State, respondents noted the existence of by-laws that address FGM practice; these provide for a range of punishments for violators, from a fine of goats to the payment of 100,000 Nigerian naira. In Osun State, a similar claim is made of communities having their own by-laws that differ from the state laws, with sanctions that include the performance of community service and a fine of a gallon of palm oil. Respondents from these communities expressed a good understanding of the core principles of existing local laws and punitive actions.

Notwithstanding the existence of these laws at state and community levels, respondents had no experience or examples of the punitive measures being implemented. Across the states, there was consensus among the respondents that the punitive measures were untested as no one known to them had been arrested or punished. Some associated this with a decline in FGM practice in their communities, while others were of the opinion that FGM is covertly practised and therefore difficult to detect and prosecute, even at the community level.

Nobody has been ever caught breaking the law till now because it seems they have cautioned themselves. I am not saying outright that people are not doing it again, but it is not as widely done as before; it could be done in secret, but [I] am sure because we have engaged one another that even if we are not there and a neighbour suspects that such act is being practised anywhere then they should report to us and up ‘til today we have not had any feedback.

CBO representative, Osun State

Unverified claims of ongoing practices of FGM in Ekiti and Osun states (with the knowledge of the government) were made by two respondents in this study. But even in the reported cases, there was no prosecution. For some respondents, the lack of people being punished for practising FGM makes them question the effectiveness of existing laws on FGM. Alluding to this, a respondent in Oyo shared: “I cannot say categorically that the law is being adopted or not because I have not seen anyone been punished by law for practising FGM.” Making an example of someone is considered by some to be a factor that will not only improve confidence in the law, but also aid in moving FGM practice from reduction to elimination. According to a respondent in Ekiti State: “If a few parents are apprehended, that will be a lesson for other parents; other parents will not want to try it.”

b) Perceptions of responsibility for enforcement

As part of the assessment of respondents’ knowledge of the law, the study enquired about their perceptions of the persons currently responsible for the implementation and enforcement of laws in their communities and states. Analysis shows that there was no clarity among respondents on who is responsible for enforcing the provisions of the law. It is noted that at the national level, the VAPP Act is placed under the office of the National Agency for the Prohibition of Trafficking in Persons as the service provider. At the state level, that responsibility lies with the Ministry of Justice and the Ministry of Women Affairs, among others. Respondents in this study communicated that in their local communities, persons responsible for enforcement could vary from the king (or Baale) to the women’s group, town union leaders or CBOs, among others. Essentially, respondents saw the responsibility for enforcement as belonging to government, leadership, the justice system, the police who address criminal matters and legal practitioners.

Noteworthy across the states is the sense of outsourcing of the responsibility for enforcing the law and collective accountability of FGM abandonment by most respondents interviewed. To give some perspective, only six respondents across the states felt that the responsibility of law enforcement was theirs, as well as that of other members of society.

It is the responsibility of everyone, but more [so] of the law enforcement agencies that we have around us. It is their responsibility to ensure that it is enforced, but every one of us is responsible for this. We have to make people

Analysis shows that there was no clarity among respondents on who is responsible for enforcing the provisions of the law.

The fact that respondents do not see themselves as key actors in the enforcement of the law highlights a gap in the sense of ownership that they should have for FGM abandonment at community and state levels.

aware of this law – the content, the fines, the consequences – then we can start talking about how to use it to prosecute so that the law enforcement agencies can now enforce those laws.

CBO representative, Osun State

To reinforce the importance of collective responsibility for the law and its implementation, one of the community respondents in Oyo State shared a personal story of how she and her spouse were held accountable by a health worker who saved their daughter from FGM.

Since everybody is aware that this act [FGM] is not good, then it is the responsibility of everybody to enforce the law. Both the mother of the child and the father, and the one who circumcises children have a responsibility.

My husband insisted that my little girl child must be circumcised. When I told him no, he asked me where I got such information. I planned to run away with my child, but … when we got to the woman who was to perform the circumcision, she was surprised to see that it was a girl child that we wanted to circumcise. The woman happens to be a senior nurse. The woman turned to me and asked where I did antenatal. So, I responded that it was at the general hospital. She asked me what I was told at the hospital, and I told her, [and] that I said the same thing to my husband, but he insisted. “I knew that when we get to you, that you will send us away. That was the only reason why I chose to come with him.” The nurse said that had it been that she didn’t know my husband and my mother-in-law, she would have reported him. The nurse spoke to my husband saying that if she had known that it was a girl child we were bringing to her that she would have turned us down. She said we are supposed to pay a fine of 500,000 Nigerian naira and also [would] have been locked up had it been that we went to an unknown person for the circumcision.

FGM champion, Oyo State

The fact that respondents do not see themselves as key actors in the enforcement of the law highlights a gap in the sense of ownership that they should have for FGM abandonment at community and state levels.

Knowledge of anti-FGM campaigns

Over the past decades, several types of FGM interventions have been conducted through different initiatives and organizations in the country. The key types of intervention include awareness creation, capacity-building, campaigns, circumciser conversion outreach, oath taking, health interventions and behaviour change interventions. The UNJP has remained at the forefront of the FGM abandonment campaign, particularly across the five study states, employing different strategies.

Through this study, respondents’ knowledge of the anti-FGM campaign in their respective states and communities was explored. Respondents expressed

awareness of anti-FGM activities in communities, alluding to events related to this. At the national level, the role of the National Technical Working Group on FGM in campaigning against FGM practice was noted. At the state level, public declarations organized by UNICEF were highlighted by most participants as a form of campaign organized in different communities in each state. Another intervention that respondents had knowledge of was dialogue with communities, religious groups and market women. In the south-eastern states, reference was made to interventions incorporated into the annual women’s August meetings where people have been taught about the risks of FGM and the criminalization of the practice.

During our last year’s August meeting, they made it [clear] to the women that anybody that circumcise[s] her daughter will be dealt [with] severely. We are even being educated that anybody that circumcises [their] daughter will be sanctioned … The pregnant women, when they go for antenatal, [are] usually [told] at the health centres not to circumcise any female child and they should report anybody that circumcise[s] their female child to them.

FGM champion, Afikpo South, Ebonyi State

The health centre provides an avenue for reaching women in communities with antiFGM campaign messages. Women attending prenatal and postnatal activities at community health centres reported having received information on FGM.

Respondents’ level of exposure to anti-FGM activities was moderate. For example, it could be deduced from the responses that over half of the respondents had been exposed to anti-FGM interventions. Key informants confirmed attending or being exposed to FGM abandonment programmes and activities. A difference was, however, noted among participants in the IDIs across the five states. Essentially, 34 out of 60 IDI respondents indicated exposure to an FGM abandonment campaign, while only 12 out of the 60 respondents said they had physically participated in one.

Of the 12 IDI respondents in each state, 11 in Ebonyi, 9 in Oyo, 6 in Imo, 5 in Ekiti and 3 in Osun reported having been exposed to an FGM abandonment campaign.

While data from the KIIs indicate a high level of exposure and participation in the FGM abandonment campaign, the results from the IDIs point to moderate exposure and very low participation. The difference in the category of respondents – IDIs and KIIs – is noteworthy: the KIIs consisted of key stakeholders who actively participated in FGM-related programmes as part of their responsibilities, whereas the IDIs comprised community members who were active participants in FGM abandonment activities. Respondents generally agreed that community enlightenment through seminars, door-to-door sensitization visits to households in the community, the media and town-hall meetings were some of the ways that the FGM campaigns were being conducted in their communities. While the details of the events were not memorable, the core message of abandonment of FGM registered with respondents who had attended such events.

The health centre provides an avenue for reaching women in communities with anti-FGM campaign messages.

To understand the prevalence of FGM and behaviours that encourage or discourage its practice, this study assessed respondents’ opinions on their beliefs about FGM, exploring its relationship to gender, power and control and also to identity, religion, health and human rights.

The names of the organizations sponsoring or organizing such events were mostly known and communicated. Respondents mentioned sponsoring organizations such as UNICEF, UNFPA, the United States Agency for International Development (USAID), WHO, ActionAid and state government agencies (e.g., the National Orientation Agency) as notable sponsors and implementers of these interventions. The role of the state government as a sponsor or implementer of these interventions was, however, mostly not visible to nor acknowledged by the respondents.

Reports such as the Nigeria UNFPA–UNICEF Joint Programme on FGM/C Baseline Study by Günther Lanier (2015) and UNICEF (2021) describe the scale of interventions conducted in communities across Nigeria. Of particular relevance are the public community declarations against FGM practice made by traditional and religious leaders. In the UNJP implementation states, such declarations were made in 943 out of 950 communities (UNICEF, 2021). Respondents made note of these activities and others that they had attended in their communities.

Considering that the five study states are also the states with the highest prevalence of FGM, this analysis shows that most study communities do not have a lack of organizations that are willing and interested in tackling the FGM challenge at all levels and in all its ramifications. In addition to UNJP, several other organizations are active in UNJP and non-UNJP communities and states, working collectively to achieve the abandonment of FGM.

4.1.2 Assess what people feel (attitudes related to FGM)

To understand the prevalence of FGM and behaviours that encourage or discourage its practice, this study assessed respondents’ opinions on their beliefs about FGM, exploring its relationship to gender, power and control and also to identity, religion, health and human rights. Employing a comparative approach, it explored the attitudes of respondents who had undergone FGM, as well as those who had not. It further explored respondents’ willingness to support FGM abandonment and publicly defend those who abandon FGM. Similarly, respondents’ sense of ownership of community-based FGM abandonment projects was assessed. Finally, respondents’ behavioural intent and self-efficacy pertaining to decision-making about FGM abandonment were also assessed.

Utilizing the FGDs, a free-listing exercise was conducted across different respondent categories and across the five study states to gain insight into the beliefs of adolescent girls, caregivers, men and boys in communities. A key question in the free-listing exercise was whether respondents perceived FGM practice as a function of gender, power and control, identity, religion, health and human rights. A cross-cutting summary of responses from this exercise shows that FGM was not perceived as being linked with any of these.

The 2018 NDHS, in particular, notes that of all the women surveyed (16,227) who had heard of FGM, 78 per cent believed that FGM is not required by their religion (NPC and ICF, 2019). That finding was validated in this study, as respondents did not associate FGM with religion. Respondents mostly viewed it as being driven by culture. This, and the belief that FGM practise discourages promiscuity, are the most important drivers of FGM practice. Noteworthy are responses from caregiver mothers in Afijio (Oyo State), who linked FGM practice to health, and caregiver fathers in Irepodun (Ekiti State), who associated it with biblical instruction. Besides these groups of respondents, who are from non-UNJP states, other respondents in the FGDs, and in this study generally, shared a strong cultural leaning in their understanding of why FGM is practised, even where the core reasons are to prevent promiscuity or encourage marriageability or fertility, for example, which are still linked to cultural beliefs.

People will always stick to what they call ‘tradition’, that they cannot forego their tradition at this point in life; that it is what they inherited from their fathers. And when you see most of the girls sticking to doing it, it’s because their mothers did it, their grandmothers did it. Why is it in her time that somebody will now come up to say I won’t do it? So, the challenge of tradition. FGM champion, Ebonyi State

A review of the responses in this study indicates the lack of association of FGM with power and control. A woman’s lack of autonomy over her body, however, should be regarded as a form of powerlessness. While there are many reasons for the adherence of some societies to FGM, the power that a society has over the female body and the need to use this power to control and restrict it in accordance with a repressive social construct is noted. A few respondents in this study drew attention to the notion of power and control as it relates to the practice of FGM.

Power, you are right. Some people feel the female child is to be subdued, so they are not supposed to be heard, so let’s remove this part of their body.

Some people see it as norm, they do not have any particular reason for doing it, they just know their great-grandmother did it and they have to do it also.

They see it as [a] norm. Some people also think it has health benefits when [a] female child itches.

CBO representative, Osun State

To measure behaviour change, respondents were asked to share their opinion on the continuation (or discontinuation) of FGM. The study engaged traditional circumcisers and TBAs, the core actors in FGM, to understand their feelings on FGM. These respondents were asked if they support the abandonment of FGM, despite its threat to the benefits they have been deriving from it as practitioners. Data analysis shows that, on the whole, they support the abandonment of FGM.

Through the 2×2 table exercise executed as part of the FGD, respondents communicated their personal disapproval of FGM, as well as their interest in

A review of the responses in this study indicates the lack of association of FGM with power and control.

While FGM abandonment interventions recorded across the states are targeted at changes in behaviour and shifts in values at the community level, responses in the states show a pattern of participation in these activities, but not ownership.

supporting efforts to abandon FGM. The position is further corroborated in the results from the KIIs and IDIs. Participants in the KIIs felt that there had been a shift in the feelings and beliefs of people in their communities in the past year, and prior to that, towards the practice of FGM. In assessing what people feel, the majority of respondents, through the diverse forms of data collection, indicated their support for the discontinuation of FGM. The opinions of men and boys were tested to determine if they upheld values that could encourage the continued practice of FGM. Key questions on the likelihood of them marrying women who had not undergone FGM were put to them. Responses revealed that many of them felt that circumcision was not a criterion for choosing a marriage partner. To reinforce their position, this group argued that people have become better informed. “What men want is a good woman,” reported one respondent. Another said: “Men want a woman who can give him kids.”

Pockets of opposition and indifference characterized the responses of a few respondents in the south-western states. For example, in the 2×2 table activity in an FGD session with caregivers (mothers) in Ilora, Afijio (a non-UNJP LGA in Oyo State), 7 out of 8 respondents indicated their approval for the continuation of FGM. A similar pattern was observed in Ilupeju (a non-UNJP LGA in Ekiti State), where in a FGD of six mothers, all indicated their support for the continuation of FGM. According to them, their indifference is based on the lack of clear evidence that FGM practice is bad for women and the society. Communities where opposition to the eradication of FGM was noted are mostly those that have not experienced interventions from UNJP or other organizations.

While FGM abandonment interventions recorded across the states are targeted at changes in behaviour and shifts in values at the community level, responses in the states show a pattern of participation in these activities, but not ownership. Respondents working in communities evaluated their role from an employee perspective and not from the point of view of ownership. Respondents who confirmed that they play a role in FGM-abandonment activities included those working in CBOs, FGM champions, media practitioners who create and spread news through print and visual media, state government employees who support the FGM campaign as community mobilizers and persons who engage in sensitization activities. Beyond incorporating FGM messages in antenatal and postnatal care, which are delivered to women in health centres, health-care workers are engaged in monitoring newborns to ensure that their parents act in compliance with antiFGM legislation.

4.2 Objective 2: Explore FGM prevalence and behaviours

4.2.1 Assess what people do across the study states

As part of this objective, the prevalence of FGM in the study states was examined primarily by analysing secondary data from the 2018 NDHS (NPC and ICF, 2019). Imo State had the highest reported prevalence of FGM among girls aged 0–14 years, with a rate of 62.8 per cent, followed by Ekiti at 30 per cent and Osun at 17.5 per cent. Conversely, Oyo and Ebonyi states had the lowest prevalence of FGM, at 8.2 per cent and 5.2 per cent, respectively.

Although direct questions about respondents’ present practices of FGM were not asked due to the sensitivity of the subject and the laws prohibiting FGM, respondents were asked about their perceptions of FGM prevalence in their communities in order to capture data on social norms. The results revealed that the perception of caregivers (mothers and fathers of adolescent girls) was, on average, that only 1 out of every 10 girls aged 0–4 years had undergone FGM in their communities. However, for the older cohort of girls aged 5–14 years, the perceived prevalence was higher, with caregivers estimating that approximately 5 out of every 10 girls had undergone FGM.

Engagement with traditional circumcisers, the core actors in FGM, to understand their perspective on the prevalence of FGM in their areas, revealed a shift that was attributed to the anti-FGM campaigns. According to them, prior to the implementation of the FGM abandonment campaign and legal interventions, more girls would have undergone FGM. With the spread of the FGM campaign, traditional circumcisers held the view that only half or less than half of the girls would now have undergone FGM.

Despite the positive perspective that FGM practice is declining, the reality is that FGM still exists in pockets. In the states of Ekiti and Osun, two respondents drew attention to covert forms of FGM practice in some communities. Further probing showed that the claims appear to be based on anecdotal evidence.

Parents now sneak to circumcise since there is a law against it. The families sneak and say that it should be kept a secret. The circumcision is usually completed in minutes … The government is threatening people with sanctions and parents are sneaking to the circumciser’s place. There [is] a lot of secret circumcision. Unless people are not having babies anymore … if they are, circumcision will still be ongoing. It is bitter, but it is the truth. You cannot put an end to it, it is only the olola [the circumciser] who can help end FGM.

TBA, Iwo, Osun State

Engagement with traditional circumcisers, the core actors in FGM, to understand their perspective on the prevalence of FGM within their areas, revealed a shift that was attributed to the anti-FGM campaigns.

There

is evidence that mutilation of the female genitalia has essentially shifted from cutting to other forms that are perceived to be less harmful.

According to a respondent in Ekiti State, her position is informed by the hostility she experiences from community members who still strongly support the practice of FGM.

When you are sensitizing them in the community, it’s very rare before you’ll see someone that will say it [FGM] is not good, they will even tell you the story of how they even mutilated their own grandchildren and even give you reasons why everyone should be mutilated. So that’s why I [said that] eight [out of 10 girls will undergo or have undergone FGM]. Even in the marketplace when you are asking them, they’ll almost beat you up in the marketplace if one isn’t careful, because it’s as if you are standing against their livelihood, against their culture, against so many things. So that’s the way they’ll see it. It’s always a big argument in the market and it will turn to conflict sometimes and we’ll just need to excuse ourselves.

CBO representative, Ekiti State

Attention was drawn to the covert practice of FGM in the south-western states, despite interventions and laws put in place to address it. A few examples were given of people in rural communities who, owing to the lack of reach of the programme, still make requests for the genital mutilation of their female children.

Recently someone came around and said she wanted to do circumcision for her child. I was of the impression that it was a male child until she said it is her female child, and I said we don’t do such here.

CBO representative, Osun State

In discussing the type of FGM practised, the increasing use of Type IV FGM as a replacement for the other types of FGM, which require cutting, is noteworthy in the south-eastern states. The underlying sentiment is that this form of FGM is not harmful and therefore does not call for attention and action, unlike the acts of excision or infibulation.

A lot of people said they have stop[ped] mutilation, but many still [do it]. They make use of Vaseline to press the genitals; some use methylated spirits; some use dusting [talcum] powder … that is the method people are using.

FGM champion, Afikpo South, Ebonyi State

There is evidence that mutilation of the female genitalia has essentially shifted from cutting to other forms that are perceived to be less harmful. In the south-eastern states, especially in Imo, the practice of Type IV FGM is prevalent. Questions aimed at probing who performs Type IV FGM procedures failed to yield relevant responses, especially from respondents such as mothers and grandmothers. Perhaps, because this form is perceived to be less harmful, the people who subject the girl child to this are not framed as violators. For example, a respondent, in discussing the medical methods of FGM, suggested that nurses’ advice to parents to use warm water and petroleum jelly to press the genitalia of their female children is not considered a form

of mutilation: “They don’t mutilate. They will advise you to use Vaseline after you use warm water to press the female genitals and rub it with Vaseline and within some time it will go.”

The increase in the adoption of Type IV FGM is shifting the profile of violators from traditional circumcisers to mothers, grandmothers and anybody who can bath the baby, for example, a neighbour or a nurse. These categories of people have the space and agency to, for example, make use of hot water, petroleum jelly, talcum powder or other substances to massage the genitalia of the baby in a form of mutilation.

Notwithstanding the dynamics and the perceived change in prevalence, support for FGM abandonment and the people committed to it is not lacking. Furthermore, some respondents in this study have taken it upon themselves to advocate for alternative livelihood options for circumcisers whose income has been affected by the ban on FGM. The loss of income has been validated by circumcisers who feel that they have been stripped of their livelihood and ignored, with no adequate provision having been made for an alternative source of income.

The government is not even interested in us at all. All they are saying is do not circumcise female children. They are wicked. They are buying farm implements, motorcycles and the like for others. We were told to stop the job. We spoke to our people to stop the job. If you ask someone to stop his or her job, you should make provision for a means of livelihood for them. They [the government] have said they will imprison them [if they don’t stop].

TBA, Osun State

Findings of this study show that in the south-western states of Oyo and Ekiti, measures have been put in place to provide other means of livelihood for local circumcisers following the loss of income as a result of the ban on FGM. According to a respondent in Oyo, “[L]ocal circumcisers were empowered with pepper grinders, sewing machines and other things so they could stop [practising] FGM and local circumcision generally.” Whether these interventions are sufficient to dissuade them from continuing to practice FGM has not been established.

Overall, the study found that respondents support the abandonment of FGM. Across diverse categories of respondents, there was mostly a negative response to questions aimed at ascertaining whether they approved of the continuation of FGM.

Findings of this study show that in the south-western states of Oyo and Ekiti, measures have been put in place to provide other means of livelihood for local circumcisers following the loss of income as a result of the ban on FGM.

Most fathers in this study mentioned their wife, children, parents and siblings as the people whose thoughts mattered most at the family level.

4.3 Objective 3: Identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence

One of the objectives of this study was to identify perceived social benefits and consequences of practising FGM (or not) and perceptions around prevalence. In line with this, the study focused on ascertaining relevant normative factors influencing FGM, while also probing the expectations of respondents’ social networks to continue with or abandon FGM.

4.3.1 Perception of social networks

A key step in addressing Objective 3 was conducting a social network mapping exercise to identify the key social networks that influence respondents’ decisionmaking and choices, particularly in relation to FGM. During FGDs with groups of caregivers (mothers and fathers), respondents were engaged in a participatory social network mapping exercise and asked to identify people whose thoughts and opinions regarding FGM mattered to them. Their choices were classified as being family, peer group or community relationships. Most fathers in this study mentioned their wife, children, parents and siblings as the people whose thoughts mattered most at the family level. At the peer group level, friends were mentioned, while at the community level, community and religious leaders were mentioned in line with the respondents’ religious affiliation.

While different groups of people (spouse, siblings, extended family members, in-laws, parents, mothers and grandmothers) were highlighted as people whose opinion mattered regarding FGM, it is evident that the decision architecture that determines a girl’s FGM status orbits around her parents and, in a few cases, in the structure of leadership in the community they live in.

Specifically, of the eight men participating in the social network mapping exercise in each of the south-western states of Oyo and Osun, six from each group indicated that their wife was directly involved in the decision to arrange FGM for their daughter. The situation in Ekiti, however, was different, as no man indicated that his wife was involved. Of the eight father caregivers, four identified their father as directly involved; two, their brother; one, his mother; and another, his friend.

It is the father that makes the final decision for a girl to undergo FGM because it is not possible for the mother to do it without the father’s consent. In the olden days, the grandfathers [made] decisions at times when they come visiting.

FGM champion, Osun State

The situation in the south-east also reflected a variance in responses. All seven fathers in Ebonyi State declared themselves the sole decision makers, thus implying that they did not rely on anyone at family, peer or community level to come to a decision. In Imo State, however, four of the eight fathers engaged in the exercise indicated that their wives were directly involved; two declared their traditional ruler (the Eze) as being involved; one declared himself as the sole decision maker; and one identified his son as being involved in the decision to arrange FGM for his daughter.

Further discussion on these findings revealed that in some states spousal opinion is important to a parent’s decision regarding FGM for girls, implying that there is, to an extent, negotiation between the man (father) and the woman (mother) in the household. Consistently, from the FGDs and the IDIs across the states, it was clear that men are mostly prioritized for decision-making and women’s opinions are prioritized, whether the wife, a mother or a sister. While most respondents acknowledged that power was centralized in men, a few respondents challenged the notion of female powerlessness. They indicated that the power held by men and by women in relationships are perceived differently, and that these differences can be leveraged when making decisions.

In Igbo land, they say it is the man, but if you are married you may know that at times the man will have a say and the woman will too. The man can say, ‘bark’, and nothing will happen; the woman will gradually walk you into doing what she wants … [regarding FGM], they believe that it is a man, but it is not so in all cases; some women lead the family. I tell you it is the woman, the husband can say don’t do that, but the child is always with the woman.

Media practitioner, Ebonyi State

Irrespective of the perception that power in decision-making is the domain of the man across all households, gender roles matter and play a role in decisions regarding FGM. The woman’s role as the carer of the child places her in a position to participate in decisions around exposing her daughter to FGM. Respondents recognized the dynamics of relationships and the power that mothers and grandmothers have to make decisions about a child’s well-being.

It is the mother. The reason why I said it is the mother is because it is the mother who goes to the clinic for immunization and postnatal lectures. The mothers are closer to the health practitioners. There are health tips we give them when they come to the hospital. It is the mothers that are closer to us. The fathers are not close to us.

Health worker, Oyo State

The issue of female genital mutilation. It’s not even the men. It’s the old women.

Media respondent, Ekiti State

Irrespective of the perception that power in decision-making is the domain of the man across all households, gender roles matter and play a role in decisions regarding FGM.

These findings align with the U-Report opinion poll conducted in 2021, where 15 per cent of 10,458 female and male respondents reported that they thought a lot of people were practising FGM, while 30 per cent believed no one was practising FGM in their community.

4.3.2 Perception of FGM prevalence (descriptive norms)

As part of the participatory FGDs, 120 caregivers (80 mothers and 40 fathers) of adolescent girls shared their perceptions regarding the prevalence of FGM among girls aged 0–4 years and 5–14 years in their respective communities. The findings indicated a change in social norms (descriptive norms) overall. Caregivers perceived that, on average, only 1 girl out of 10 in the younger cohort (aged 0–4 years) had undergone FGM in their community. In contrast, for the older cohort (aged 5–14 years), the perceived prevalence was higher, with an average of 5 out of 10 girls having undergone FGM.

Closer examination of the responses from specific study states and from caregivers of different genders helped separate out the results. No girls aged 0–4 had undergone FGM in the communities of the 80 mothers interviewed across the five study states, except for in Imo. In Imo State, the reported average number of girls who had undergone FGM was 6 out of 10. Of the 40 fathers interviewed, those in Imo and Ebonyi states believed that, on average, only 1 out of 10 girls aged 0–4 years had undergone FGM, while those in Ekiti State reported a higher average of 5 out of 10. When looking at the older age group (aged 5–14 years), caregivers in all states acknowledged the occurrence of FGM in this age group, with varying averages across the states, ranging from 2 to 7 girls out of 10, and Imo State reporting a prevalence rate of 10 out of 10.

These findings align with the U-Report opinion poll conducted in 2021,7 where 15 per cent of 10,458 female and male respondents reported that they thought a lot of people were practising FGM, while 30 per cent believed no one was practising FGM in their community. Furthermore, U-Report demonstrated that 81 per cent of 9,815 female and male respondents were in favour of FGM abandonment and that 84 per cent of 11,043 female and male respondents did not plan to cut their current or future daughters or sisters (UNICEF, n.d.).

4.3.3 Approval of FGM by self and others (injunctive norms)

Reflecting on the group of people whose thoughts and opinions matter in decisionmaking regarding FGM and who can influence decisions and actions, it was critical to ascertain what their position on FGM was. For this, a participatory exercise was conducted for the caregivers on self approval and others’ approval of FGM.

7 U-Report is a social messaging tool and data collection system developed by UNICEF in 2011 to improve citizen engagement, inform leaders and foster positive change. SMS polls and alerts are sent out, collecting real-time responses which are subsequently analysed and published.

The analysis revealed that, out of 120 caregivers, 20 per cent personally approved of FGM, while 18 per cent indicated that their social networks also approved of it. Notably, fathers exhibited a higher self-approval rate (23 per cent) than mothers (19 per cent). Upon enquiry as to the reasons for these low percentages, the key reasons were reported as “circumcision is not practised again” or “most people don’t do it again” or “government asks us not to do it again” or “we should stop it because it’s dangerous”. Caregivers emphasized that there was no pressure to persist with FGM in their social networks because there was no endorsement of the continuation of the practice. Their opinions were supported, mostly, because the people in their social networks no longer found FGM socially or personally beneficial.

On examination of the responses from specific study states, it was found that all mothers and their respective social networks in Osun, Imo and Ebonyi states, as well as all fathers and their social networks in Osun State, unanimously disapproved of FGM. In contrast, fathers in Ekiti State reported a higher proportion of self approval of FGM, with 63 per cent of eight fathers expressing approval. In addition, mothers in Oyo State reported a higher percentage of their social networks approving of FGM, with 44 per cent of 16 mothers acknowledging this stance.

4.3.4 Perceived social benefits and sanctions of FGM

FGM is understood to be a social convention (social norm) and, consistent with this, there is social pressure to conform to the norm. Social norms are the linked behavioural drivers of FGM (Kihara and Koigi, 2022; UNFPA and UNICEF, 2022). It is not uncommon to expect that people will conform to what others do or have been doing in a bid to be accepted socially and to avoid communal rejection. The fear of being rejected by a community or being deprived of the comfort of community acceptance – and the unique benefits such acceptance guarantees – are strong factors in perpetuating FGM practice.

In the olden days, it [was] said that if a girl doesn’t undergo FGM she will not [enjoy] some rights. Maybe between her fellow adolescents or youths she won’t talk where and when others are talking; when she grows and marr[ies] then joins [the] women[‘s] group, she won’t have that audacity. Maybe when others speak and she wants to react, she will be shunned and told that she is not equal to the task.

Health-care provider, Imo State

Studies show that in communities where FGM is practised, social benefits could be tied to respect and inclusion in certain social activities in the community. For those who do not conform, what follows are disrespect, stigma and discrimination, which are expressed in exclusionary practices, not just for the woman or girl but for her family too (Mberu, 2017). The current study engaged respondents to ascertain whether social benefits linked to FGM still exist or whether they have been replaced by new benefits aimed at perpetuating the practice of FGM.

Studies show that in communities where FGM is practised, social benefits could be tied to respect and inclusion in certain social activities within the community.

Respondents mentioned that, for many parents, FGM, irrespective of its harmful effects, was a practice adopted for the benefit of their girl child.

Enquiries were made about whether positive social effects (rewards and benefits) can be enjoyed by parents who arrange FGM for their daughters or whether there is no substantial external benefit. Across the states engaged, most respondents indicated that no social benefits are accrued for either the parents or the child. Only 7 out of 114 caregivers across five states reported social benefits for continuing FGM. These caregivers were in Oyo and Ekiti states. The benefits they identified for continuing FGM included preservation of culture, family pride and reduction of promiscuity.

It is good because it is our culture.

FGD respondent, Oye, Ekiti State

Promiscuity will be no more in our society.

FGD respondent, Ibadan North-West, Oyo State

Respondents mentioned that, for many parents, FGM, irrespective of its harmful effects, was a practice adopted for the benefit of their girl child.

The reason why they do it is just for the girl child, it’s just like they are preparing the girl child for the future, for marriage – so that the girl child can give birth, can have [a] husband and whatever unpleasant thing[s] surround her can go away, and the likes.

CBO representative, Ekiti State

The other 107 (of 114) caregiver respondents felt that, on the contrary, parents could enjoy the immediate reward of not subjecting their child to suffering and pain. Similar responses were expressed by young girls themselves. In an era where the benefits of FGM no longer have value or relevance for many, it is now to the great benefit of society as a whole, and of women and girls in particular, that the practice be abandoned.

There are lot of benefits. The parents would not experience any stigma and the girls would no longer have to experience those pains during and after mutilation.

FGM Champion, Osun State

The benefits are many, first of all, girls are not mutilated, they are whole, they are not stigmatized, they can reach their full potential, no medical complications. The major benefit is that their lives are protected. They have all the rights to their body. So, their body is protected.

KII, UNFPA representative, Imo State

The success factor now is those primips [first pregnancies] that delivered without [an] episiotomy because they are not circumcised. If they go home, they will tell some of their friends that they delivered their baby without [an]

episiotomy because my mummy said I was not circumcised when I was born.

Health-care provider, Imo State

As expressed by these respondents, for the woman the benefits are measured by the satisfaction she will experience as a first-time mother who will most likely have safe and uncomplicated childbirth.

How the continuation or discontinuation of FGM affects other groups of people in society was also highlighted. Health-care providers find the abandonment of FGM beneficial to them as it reduces workload, produces better health outcomes for women and allows for a more fulfilling work experience.

I’m a midwife now. Those people that didn’t undergo circumcision, during their childbearing, I don’t give them [an] episiotomy. They deliver freely. But for those [whose] mothers circumcised [them], if they come for childbirth, their vagina will be very tight, so you must do [an] episiotomy. Even some we give bilateral, both sides will be given [an] episiotomy before the baby, the head of the baby will pass. From my experience as a midwife, when I have a pregnant woman in labour, during vagina examination if I find out that the lady was not circumcised, I feel very happy, because the work would be very easy for me. But if the person is circumcised, I find it to be very difficult. After delivering the baby with [an] episiotomy, I will come back and stitch the episiotomy. So, what I’m trying to tell you now is that this abandonment of FGM to me helps in childbearing.

Health-care provider, Imo State

It is noted that the continued practice of FGM may benefit other groups like circumcisers. Some respondents, particularly in Ekiti and Osun states, alluded to the fact that circumcisers reap social benefits from FGM as they make a living from the practice of it. They indicated that the resource benefit extends to the ‘human waste’, i.e., the excised body parts, which are purportedly utilized for ritual benefits by circumcisers.

I think it’s the cutters, because they benefit from them. … according to some people in Ikere [Ekiti State] then – we had a stakeholder meeting in Ikere for women groups – and some were saying that whatever they are cutting, the clitoris or any part they are cutting, they normally use it to do rituals. They were so quiet about it, that they’ll take it to the traditional rulers as part of their … sacrifice … something like that. So they were so quiet about it when they were saying that.

CBO representative, Ekiti State

Local circumcisers represent the only clear group of beneficiaries of FGM practice, and abandoning it poses a real risk to their survival.

It is noted that the continued practice of FGM may benefit other groups like circumcisers.

Critical to this study was to gain an understanding of how socially prescribed roles and expectations of men and women manifested in their support for or abandonment of FGM.

Anyone who takes someone’s means of livelihood is not a good person. Circumcision is a means of livelihood. They are paid after circumcision, and they get fed through the job. People … are paying maybe 2,500 or 5,000 [naira].

TBA, Osun State

A few local circumciser respondents did not hesitate in exercising their dissenting voice on FGM abandonment efforts. For them, FGM was designed to benefit the girl child and therefore should not be discouraged.

Female circumcision is beneficial to the female child; it discourages prostitution and waywardness. If you are soliciting discontinuation of FGM, what you have experienced is a good thing. How many people among the circumcised are complaining?

TBA, Osun State

Regarding social sanctions, most respondents do not know about these for conducting FGM. A handful of respondents identified fines and community punishments as social sanctions for practising FGM.

[At the] public declaration in Owerri West, the traditional rulers came in mass and declared that anybody caught mutilating a female child will give them tubers of yam, goat, kola nuts, big jar of wine, and the person will be taken to the market square and shamed publicly.

Focal person, Imo State

4.4 Objective 4: Describe the decisionmaking process and context in families

Understanding the decision-making process and social context in families that support or do not support FGM was important to this study. To address this objective, the effect of female agency, decision-making power and gender role beliefs on FGM was explored. Realities around spousal communication and social support and how they relate to discussions around FGM were also investigated. The existence of sanctions and social benefits relating to FGM and the willingness to apply them were also explored.

4.4.1 Female agency and female decision-making power

Critical to this study was to gain an understanding of how socially prescribed roles and expectations of men and women manifested in their support for or abandonment of FGM. In exploring these roles in relation to FGM, an important factor was understanding the decision-making architecture prevalent in households.

Respondents were engaged with to determine whose role it was to make decisions in the home. Generally, men were perceived to make the decisions in the home and, by extension, in the community and society too. Thus, decision-making was not something that was ascribed to women. A review of the IDIs conducted across the five study states shows that out of 60 IDI respondents, 53 believed that, when it came to FGM, men always made the final decision. Allied to the man’s decisionmaking role is the expectation that he be the provider of resources for conducting FGM. In other words, he is the one to pay the hospital or circumciser’s bill.

The woman’s role in decision-making around the child’s welfare, particularly with respect to FGM, was explored. IDI respondents indicated that, mostly, a woman’s opinion is not required or prioritized in decisions about FGM. Of the 60 IDI respondents, only 24 believed that a mother’s opinion would be requested or considered with regard to whether FGM should be conducted. A further 26 respondents believed that a mother’s opinion can be requested or considered conditionally. The conditionality attached to a mother’s participation in decisionmaking is predicated on her ability to be respectful, trustworthy, loving and convincing and is dependent on the dynamics existing in the marriage and the family.

The man will force the woman to do that because he is the man and because they don’t have a better understanding about FGM, like the risk, and because he feels … if the child is not mutilated, she might be promiscuous. But in recent days there is always an understanding when it comes to FGM.

KII, Afikpo South, Ebonyi State

The study found that while some respondents believed that there is a space for women to make decisions for themselves and their children, a larger number believed that the power to decide whether a child should be touched or not (essentially, what happens to the child) is exercised by men. In addition, 37 of the 60 IDI participants were of the opinion that women lacked the ability to make decisions for themselves and their children.

Considering respondents’ lack of confidence in women’s decision-making abilities, women themselves were further engaged with to determine their own perception of their capacity or ability to make decisions relating to their children. Of the 30 women engaged in IDIs across the five study states, only 14 believed that they have the agency and ability to make decisions about their children. Just over half the group, 16 women, did not believe that women have the ability to make such decisions. The reason given for their responses was that decision-making is not a culturally enabled role for women. While the findings may highlight women’s lack of agency to make decisions, they also point to the fact that women lack the space to exercise decision-making power at household and community levels. Essentially, although it is arguable, society’s lack of confidence in women’s capacity to make decisions is noted.

The study found that while some respondents believed that there is a space for women to make decisions for themselves and their children, a larger number believed that the power to decide whether a child should be touched or not (essentially, what happens to the child) is exercised by men.

It is noted that a non-compliant man will suffer, among other things, disrespect from his wife, children and the community and disharmony in the home, and endure an unfaithful wife.

Not much information was gathered on the nature of spousal communication and how it affects decisions around FGM. However, as indicated above, joint decisionmaking by men and women is precarious, as it rests on conditions that, if not met, result in the relegation of a woman’s right to participate in decision-making.

4.4.2 Gender role beliefs

To inform understanding of the realities of gender roles across communities and their influence on FGM, a gender box exercise was conducted in FGDs for all categories of respondents at the community level. The categories included adolescent girls (aged 10–19 years), male youths and caregivers (fathers and mothers). The exercise sought to elicit each group’s views on gender roles, the consequences of not conforming and the applicability of these roles to FGM.

In the gender box exercise, the role of the man in the household was variously described by respondents as follows: ‘provider and breadwinner’, ‘head of home’, ‘providing for family’, ‘paying school fees’, ‘paying hospital bills’, ‘doing farm work’, ‘building house’, ‘buying car’ and ‘taking care of wife and children’. In some instances, the social behaviours linked to the man’s role, presented from a moral perspective, were described as ‘be responsible’, ‘be controlling’, ‘lead’, ‘be respectable and disciplined’ and, from a biological perspective as ‘impregnating the woman’. The role of the woman was considered to be that of a caregiver, described with phrases such as ‘carer’, ‘cook’, ‘train the children’, ‘feed the children’, ‘wash clothes,’ ‘clean house’, and so on, being employed. From a behavioural and moral perspective, some described the woman’s role as ‘respecting the husband’, ‘being chaste’, ‘dressing decently’ and ‘not being promiscuous’.

In line with the stated roles, the consequences of non-compliance for both men and women were elicited from the respondents. It is noted that a non-compliant man will suffer, among other things, disrespect from his wife, children and the community, disharmony in the home and endure an unfaithful wife. A non-compliant woman will struggle to be or remain married; she will lack the love and respect of her husband, family and community; and she will lack a peaceful home.

Existence of social sanctions and benefits

Sanctions are used as a tool to deter the practice of FGM. Essentially, they are employed to aid modification of choices and decisions. In this study, an effort was made to explore whether communities had existing social sanctions to deter community members from practising FGM. From the analysis of the data, it has largely been determined that there were no social sanctions associated with continuing FGM. In Ebonyi and Osun states, for example, in the 2×2 table exercise, all the respondents (22 in Ebonyi and 25 in Osun) reported that there were no social sanctions attached to continuing FGM. The majority of the respondents in Oyo, Imo and Ekiti also indicated a lack of social sanctions. In Ekiti State, while 14

of the 22 respondents indicated that social sanctions did not exist, 8 respondents highlighted the existence of legal sanctions, such as a prison term of 20 years for practising FGM.

The analysis also showed that there were no social benefits or rewards for parents of a girl, or for the girl, that would serve as a motivation to undergo FGM. In the 2×2 table exercise, caregivers were asked about the social benefits attached to continuing FGM. All 71 respondents in Osun, Imo and Ebonyi states indicated that there were no social benefits. In Oyo State, 19 of the 22 respondents indicated there were no social benefits, while the remaining 3 respondents highlighted freedom from promiscuity as a benefit. In Ekiti State, 13 of the 22 respondents indicated that there were no social benefits, while 4 indicated that the benefits were tied to the value of cultural preservation.

Through the IDIs, diverse categories of respondents were asked what negative social effects – such as sanctions and punishments – would parents of a girl, or the child herself, face if they did not pursue FGM. Further probing focused on understanding what people in communities (such as immediate and extended family members, peers, neighbours and other community members) would do if mothers and fathers decided not to arrange for their daughters to undergo FGM. Findings from these engagements with respondents across the five states show that there were no social sanctions for people or families that did not engage in FGM. Respondents confidently communicated that they had no fear of attack, punishment or discrimination for standing up against their neighbours. Similarly, there was no perceived interest in discriminating against others who had not undergone FGM. This finding was further supported by young male respondents who said that they did not find a woman’s FGM status an important criterion for choosing a wife.

Support structures for abandoning FGM

An emerging trend regarding sanctions is that community members are no longer being punished for not participating in FGM; rather, they are being punished for participating in it. There is an awareness in communities of anti-FGM laws that discourage the practice. It was learned that these laws are positioned as sanctions or, in other words, as community-based edicts pronounced by traditional rulers. These sanctions proclaim FGM an unlawful practice and prescribe fines for violators. The fines include cash, livestock and other valuables as prescribed, as well as restrictions on the use of communal resources. The specifics of these sanctions differed across communities in the five study states.

For my own dear community, there is a law that the king and his cabinet made to guide the community. Any time they see you circumcise the girl, a female child of yours, the community will seize your land and you know living in the village [when] your land is seized.

CBO representative, Ekiti State

An emerging trend regarding sanctions is that community members are no longer being punished for not participating in FGM; rather, they are being punished for participating in it.

While laws exist in most communities with punitive measures to encourage compliance, the implementation and assessment of their effectiveness in serving as a deterrent to community members could not be determined.

In a community in Osun State they only believe that, if you are caught, you may be asked to cut grass, you will settle them with a keg of palm oil or you will pay a fine. Let me share an experience … There was a year we went to the local government to hold review meetings. One of the communities … gave us a report that the community caught a local circumciser that comes from [a] neighbouring state every third Sunday of the month to cut male and female children. In the process he was caught and after that, using their penalty, they collected a keg of palm oil and money from him and let him go.

State focal person, Osun State

According to respondents, the provision of community laws, where they exist, stipulate that both the parents of the child who was taken for circumcision and the person who conducted the circumcision would be sanctioned.

Compliance structures

While laws exist in most communities with punitive measures to encourage compliance, the implementation and assessment of their effectiveness in serving as a deterrent to community members could not be determined. In some communities, structures are being put in place for a team of people to monitor compliance and report on it.

As we were creating the awareness, … people [were prepared] to be monitoring to see if there are … culprit[s], and it is [these] people that … report [to the community] when they discover … culprits ….

CBO representative, Ikwo, Ebonyi State

Nowadays, the government has been making jingles, that anyone caught circumcising a girl child will receive punishment. Primary health staff in the local government are visiting local birth attendant[s] – the people that sell herbs and the olola [the circumciser]. For example, in this community, they know those who perform circumcisions. So, people from the community are investigating to see those who will go for circumcision.

FGM focal person, Iseyin, Oyo State

Besides the team in the community, the health workers also form a part of a team that monitors newborn babies and infants in the course of their antenatal visits to ensure that they are not mutilated. Despite the existence of these measures, their effectiveness could not be confirmed because none of the respondents could confirm experiencing or witnessing the implementation of a sanction.

I saw the signboard where they chained a woman that was doing the female genital circumcision to a girl child. So they’ve said it – when you do it, if they catch you, you will be jailed. Well, to tell you the truth, I can’t tell you that I have seen anyone punished for that.

FGM focal person, Ohaozara, Ebonyi State

The punishment is that they will seize their land, they will kill goat, cook food that … the cabinet [will] eat. I have never seen anyone punished, but I was there the day they read the law to the public.

Health worker, Ikwo, Ebonyi State

4.5 Objective 5: Track individual and social change over time

This section, which was adapted from the ACT Framework, was designed to register changes that have occurred in the practice of FGM across the study states. It is positioned to document changes relating to engagement with activities of the FGM abandonment programme. It is also meant to keep track of changes in the reach of programme messages and to assess their relationship to the abandonment of FGM across the programme states. However, as there are no baseline values against which current realities can be compared, the tracking of individual and social change over time is limited, particularly with respect to respondents’ opinions. Hence, the focus of this section is on anti-FGM activities, including public community declarations, disseminating FGM abandonment messages, and so on.

Findings of this study indicate that numerous anti-FGM programmes are being implemented across communities in all the project states. Across the states, the government, in collaboration with various organizations, is implementing different initiatives to drive FGM abandonment. At the federal level, the National Technical Committee, co-chaired by the Federal Ministry of Health and the Federal Ministry of Women Affairs, oversees the activities of partners working on FGM abandonment. It is noted that at state level, steering committees and gender desks have been set up with the respective health ministries to manage state-level activities focused on FGM. These activities target various groups and communities in the states and are strategically designed to address FGM.

We do advocacy. We do community dialogue, consensus-building and capacity-building for health workers. We train community champions. We establish surveillance systems in implementing community and local government.

FGM focal person, Osun State

For example, in Ekiti State, primary school teachers were targeted and sensitized on FGM on a weekly basis. This was coupled with interventions for in-school youth, focusing on FGM. Under the UNJP-supported programmes, religious centres, schools, marketplaces, transport unions and artisans’ groups, among others, are reached. In Ebonyi State, women were targeted across communities and on specialized platforms such as the August meeting, which is an annual congress held by Igbo women. As part of this event, Igbo women in the diaspora and the cities travel back to their matrimonial villages to meet with their local

Across the states, the government, in collaboration with various organizations, is implementing different initiatives to drive FGM abandonment.

The media has served as a reliable stakeholder in advancing the FGM abandonment programme.

counterparts to discuss community development, conflict management, human development and other socioeconomic and cultural matters (Odoemene, 2010). Media talks, call-in programmes and walk rallies are some of the ways that FGM abandonment messaging and education is disseminated. Diverse strategies are employed, including the adoption of symbolic community ceremonies, where community stakeholders publicly declare their commitment to the abandonment of FGM.

They brought their local calabash, [and] gathered in the community with their traditional rulers and some political stakeholders saying that anybody [who] does [FGM], the community will come heavily with severe punishment against the person and that, as from that day, [FGM] is unlawful and unacceptable. Thereafter, they break the calabash in symbolic declaration.

KII media practitioner, Ebonyi State

The media has served as a reliable stakeholder in advancing the FGM abandonment programme. Information, educational and communication materials have been created, and radio, print media and voice have been used to disseminate the message of FGM abandonment – from state level to community level. Most respondents from Oyo State indicated that media initiatives, such as radio jingles, were the source of their awareness of FGM, anti-FGM legislation and available punitive measures.

The decline in FGM prevalence, as reported in the 2018 NDHS (NPC and ICF, 2019), can be attributed to these activities and interventions. Analysis of the data from this study indicates that, overall, respondents have had a moderate level of exposure to FGM abandonment programmes. Participants in the KIIs indicated their participation at different levels in FGM abandonment programmes. The results of the IDIs presented an opportunity for further statistical assessment. Out of 60 respondents in the IDIs, only 34 indicated exposure to the FGM abandonment campaign, while only 12 out of the 60 respondents indicated that they had physically participated in abandonment programmes. According to the U-Report, only 23 per cent of 10,748 male (26 per cent) and female (19 per cent) respondents reported attending any community dialogue or public event on FGM prior to the restrictions placed on public gatherings as a result of the COVID-19 pandemic (UNICEF, n.d.). Nevertheless, the use of the media and public outreach systems in the FGM abandonment campaign means that even when people are not physically present at campaign activities, they can still be reached by other means. While it is beyond the remit of this study to provide comprehensive comparative statistics, analysis shows that respondents, to varying degrees, have been engaged in FGM abandonment activities in their communities, serving as observers, participants, facilitators or organizers.

Through this study, different study tools were used to assess respondents’ opinions on the effectiveness of the FGM abandonment programmes in their communities. Through the IDIs, respondents were asked if they thought FGM abandonment

programmes have been successful in reducing the practice in their communities. An aggregated response of all 60 IDI respondents across the five states shows that 43 of the respondents felt that the programme had brought about a reduction in FGM. The remaining 17 respondents indicated that they had neither been exposed to nor participated in the programmes, or had no opinion on the matter. To measure programme effectiveness further, participants in the IDIs were asked if they thought that the opinions of people in their communities regarding the practice of FGM had changed over the past 12 months. Of the 60 respondents, 53 indicated that they thought opinions on FGM had shifted, with some highlighting that this change in community opinion may have started happening prior to the last 12 months. Furthermore, 49 of the 60 respondents felt that people in their respective communities were also less supportive of FGM practices. Respondents largely viewed the various FGM abandonment programmes as effective and had observed changes occurring in their communities.

There is further evidence that out of 116 respondents in the FGD exercises, 92 indicated that they did not think that other people in their respective communities expected them to continue practising FGM. The programme and capacity-building activities are thus noted to have created a great deal of awareness and knowledge and shifted community values.

As I am, I was circumcised, because all this fight against FGM was not there then. Back then, if you didn’t circumcise your child, they will say that you have done a bad thing but during the tenure of the former governor’s wife – Elechi Elechi – she gathered all the … widows and she explained the consequences of female genital mutilation and that made us stop it. I didn’t circumcise any of my daughters because of that.

TBA, Ebonyi State

The FGM abandonment campaign has leveraged the law on FGM to create awareness of the practice, drive its abandonment and engineer behaviour change. The VAPP Act is recognized as an enabler of campaign effectiveness and a factor that can support achieving an FGM-free society. Respondents in this study acknowledged the positive effect that incorporating information about the legislation in campaign messages can have in creating a level of awareness, especially in places where it did not previously exist.

There is a big difference to how people take this law presently compared to then because it has been instilled in the mind of the people that the government would sanction and punish those that go against the law of FGM because the campaign against it [FGM] was massive.

FGM champion, Osun State

Besides their observation of community-level behavioural shifts, respondents participated in self-assessments of their own behaviours and actions in relation to ongoing FGM abandonment initiatives. In the IDIs, 53 out of 60 participants

The FGM abandonment campaign has leveraged laws on FGM to create awareness of the practice, drive its abandonment and engineer behaviour change.

The level of awareness created and evidenced among respondents in this study makes a case for the effectiveness of awareness programmes across target communities and age groups.

indicated their willingness to support the FGM campaign; this same group of people also indicated that they are very confident to show their support for FGM abandonment, even in the face of family opposition, and they are not afraid of being attacked, punished or discriminated against for publicly standing up against FGM in their communities. Furthermore, 52 out of the 60 participants in the IDIs shared that they would publicly support someone who has decided to refuse to subject their daughters or other female family members to FGM. In summary, data from the FGDs show that out of 116 respondents across the five study states, 91 indicated that they do not support the continuation of FGM practices.

Despite this, there is also evidence that the anti-FGM approach and strategies may be less effective than originally thought. Some respondents drew attention to the reality of the continued practice of FGM in places and sometimes even among individuals that have been exposed to anti-FGM messages, programmes and interventions.

There has been a series of meetings with community leaders, market women, who are major stakeholders and very close to the people. However, as much as they are trying to do all of this, it is unfortunate that the practice is still going on. When people gather like that, and you show them videos, they will all agree not to do FGM again. But they leave, they still go back to practise FGM. Media practitioner, Ekiti State

Aligned with this thinking is the experience of some respondents in this study. For example, out of 116 respondents in the FGDs’ 2×2 table exercise, 25 indicated their support for FGM. Further analysis of these 25 respondents shows that 11 of the 25 were from Ekiti State. These respondents comprised six caregiver mothers – all from Ilupeju, a non-UNJP community – while the remaining five were caregiver fathers who came from the Irepodun community, also a non-UNJP community. It is possible that the lack of behaviour change can be associated with the lack of FGM abandonment interventions in the communities from which the FGM supporters hail. It is also plausible that the FGM campaign messaging had not sufficiently resonated with these individuals or penetrated the areas where they live.

The larger gains, however, cannot be underestimated. The level of awareness created and evidenced among respondents in this study makes a case for the effectiveness of awareness programmes across target communities and age groups. Many respondents were of the opinion that the prevalence of FGM was decreasing significantly, as it was no longer being practised in their communities. An important observation made in the course of this study is that most respondents reported their experiences of FGM or knowledge of how it is done in language that reflected a distant past. For example, participants in the KIIs used language such as ‘that was in the olden days’, ‘when I was young’, ‘in the past’, ‘some years ago’, and so on. Narrating the experience of FGM in her community, for example, a respondent noted: “When I was young, they [did]

it when you are married and pregnant. They call[ed] you to come back to your home and do it.”

Through this study, many stories of behaviour change – individual and social – were shared. The details about how these interventions built knowledge, informed individuals’ decision-making and exerted a positive influence are noteworthy. A respondent in Oyo State emphasized her point about the increase in the level of awareness and knowledge of FGM abandonment by sharing her personal experiences:

When I gave birth to my daughter, my mother-in-law asked if I have circumcised her because she heard people are no longer circumcising female children. And I told her, the child is mine and I will do what is best for her.

My mother’s elder sister once reported her daughter-in-law to me that she does not want to circumcise a girl child, and I told her the lady has done the right thing. And I also educated her more on the reason why the baby should not be circumcised, and she was convinced. That is why I said earlier that most people in the community are already aware and well educated, including the elderly ones in the community.

FGM focal person, Afijio, Oyo State

More examples were given by respondents to highlight social change over time, with the focus on how the FGM abandonment programme has changed their society. In Osun State, for example, years ago, it was not uncommon to see circumcisers advertise their services in prominent places such as billboards. Following intense campaigns, this form of advertisement is no longer found in public spaces.

There [were] many of them before that time. You could even see people advertising themselves via signboards as a circumciser and, at times, you [would] see them going from house to house to do that. We embark on home searching; wherever we see such signboards, we uproot and break them. We go to the circumciser, and we tell him that they can only do for the boys … and not the females, because it is now a law that you cannot circumcise a female child.

CBO representative, Osun State

To further validate this, respondents highlighted the changes in behaviour that are manifesting through conscious choices, such as circumcisers now making alternative livelihood choices. Similarly, some hard-core FGM supporters have publicly declared their commitment to end FGM. Such examples indicate that the changes that are occurring at the individual and societal levels are attributable to the strategic programming employed across the states.

At the national level, more advances have been made in developing comprehensive frameworks and guidelines that help in addressing gaps in anti-FGM programming.

It is worth noting that there is evidence of progress made through the implementation of the UNJP activities over the years.

We have seen some olola renounce the job because it [was] actually a job for them; they renounced it and then they look for alternative source of income. We have some women and even grandmothers who pledged to stop mutilating girls, and we have more anti-FGM agents at the community level who pledge to continue sensitization even when the organization leaves the community.

Focal person, Osun State

At the national level, more advances have been made in developing comprehensive frameworks and guidelines that help in addressing gaps in anti-FGM programming, for example, the National Policy and Plan of Action for the Elimination of FGM in Nigeria (2021–2025), developed through collaboration between the Federal Ministry of Health and the Federal Ministry of Women Affairs. Similarly, the development of the National Protocol on the Management of Complications from FGM in Nigeria is also an important mark of progress for FGM programming in the country.

It is worth noting that there is evidence of progress made through the implementation of UNJP activities over the years. An assessment of FGM prevalence from the time of the launch of UNJP in 2014 until 2018, when the latest NDHS study was published (NPC and ICF, 2019), shows that the national prevalence of FGM among women aged 15–49 years has declined from 25 per cent in 2013 to 20 per cent in 2018. Specifically, the study states (which are also the UNJP states, selected based on their significantly high FGM prevalence rates) have made remarkable progress. In Ebonyi, Ekiti, Imo, Osun and Oyo states, a significant decrease in FGM was noted during the period that the UNJP has been implemented. All of these examples account for collective measurable progress.

4.5.1 Key success factors of the FGM abandonment campaign

It was important to understand from participants what they perceived to be the key success factors of the FGM abandonment campaign in their areas. From their responses, it became apparent that the collaborative approach of the campaign made participation easier. According to them, the role of the government as the chief actor in campaign programming across the states and communities gave it weight. Engaging community leaders and those at the grassroots was found to be a critical factor for the success of the programmes. For respondents, the role of their community leader was a critical factor in the decline of FGM practice. According to one respondent from Ebonyi: “It’s no longer practised because our king took it as a burden.” A male respondent from Nkwo Orodo community in Imo State shared that his confidence in supporting FGM abandonment was strengthened by the position of his community leader who serves as his role model: “My confidence is much

because if I’m looking at my village head; it gives me satisfaction because I look up to him in everything that I do.”

The engagement of men as a target group in the campaign has also been highlighted as a critical factor in successfully changing behaviours. In the context of FGM, the UNJP representative said that the campaign had been able to engage a significant number of networks of men who have become FGM champions. These men are also active in community surveillance to reinforce FGM abandonment messages. These are very important support systems for women. One of the main findings of this study is that men are significant actors and decision makers in FGM practice and in driving desired change. In the Afikpo South community (Ebonyi State), for example, a generational shift is noted, with most men in the community no longer finding circumcision of their daughters valuable.

Even the men don’t allow their girl child to be mutilated. Before, during the olden days, it was the men that initiated the circumcision because they [didn’t] want their girl child to be promiscuous. But now they have realized that whether a girl is being circumcised or not, it doesn’t guarantee that the child won’t be promiscuous.

FGM champion, Afikpo South, Ebonyi State

4.5.2 Challenges of the FGM abandonment campaign

Also important to this study was identifying the challenges in implementing FGM abandonment programmes across the states. Engagement with actors at the community level allowed these challenges to be identified. Representatives of CBOs stated that the challenges were related to poor mobilization (financial) of projects and community actors responsible for taking the campaign to the grass roots. Also noted was the low frequency of FGM campaign activities. Long intervals between events impede the reinforcement of messages. This is exacerbated by delays in annual resource allocation and release of funds for FGM abandonment activities. An example was given by a CBO representative in Osun State who detailed the ongoing FGM abandonment programme activities in local communities prior to 2021, which have since come to an abrupt end, with no prospect of their revival.

We established an anti-FGM club that gives school youth the opportunity to its members [to understand] why they need to abandon FGM. Also, we have what we called the focus group discussion that we had with male partners, women groups and out-of-school children within the community. Just like we have anti-FGM clubs in schools, we also have [clubs] in communities where the out-of-school youths are involved and form cohort groups within themselves where they do roadshows. Sometimes, there was community sensitization, where we give flyers and all that; then there is the television

Also important to this study was identifying the challenges in implementing FGM abandonment programmes across the states.

The ability to produce campaign messages in local languages was highlighted as a challenge for programme implementation.

programme … we used to have television programmes where people can call in, then we feature[d] different kinds of people on the programme. Religious leaders, traditional leaders, medical workers and the like were on the programme. By December 2021, that was when it ended, because of funding.

CBO representative, Osun State

Regarding the lack of funding, the responsibility for funding these programmes is often outsourced to organizations that are known to sponsor similar programmes and is not necessarily taken on by the government. This highlights the significant reliance, for both technical and financial support, on UNJP and other organizations that are currently working in the different states. Nevertheless, it is the responsibility of the government to fund programmes that are beneficial to its people. The need for state governments to prioritize FGM in their annual budgets and allocations is noted. Where annual budgets include line items for FGM and an effort is made to ensure that resources are released timeously, it becomes possible for activities to be implemented and monitored in a timely fashion.

FGM is about behavioural change communication, so when you do just [a] one-off engagement, or two engagements, with a particular community, [it] is not enough to change the community. That is not enough to change the community in terms of changing behaviour.

National KII respondent

Communication challenges were also noted among respondents. The ability to produce campaign messages in local languages was highlighted as a challenge for programme implementation. This is a considerable issue, given the diversity of languages and dialects in Nigeria. As an example, even in the same state, FGM is referred to using several different terms. In Ekiti, in earlier times, it was referred to as ‘ kiko Ila fun omo’. It is also known as ‘ dida abe fun omo’ obinrin’, as validated by respondents. In Oyo State, a circumciser is called an ‘olola’ or ‘adabe’. Tailoring communication and reviewing it constantly to ensure that it properly addresses each target group are challenges that must be addressed.

In this study, some communities were identified as being hard to reach; implementing activities in such areas poses a challenge. Respondents noted that in a state like Ekiti, each local government has hard-to-reach communities. This is owing to a lack of infrastructure and resources to reach them, i.e., transportation, security and so on. In Oyo State, CBO representatives noted that the geographical size of the state makes it difficult to reach the farthest communities: “We have a very wide and large state, so getting to every community in Oyo State is a challenge; we can only do it little by little, one at a time, based on the availability of funds that are mostly provided by partners.” This also implies that mothers and newborns in some of these remote areas are not reached with services and that progress is not

monitored. Security concerns continue to limit the spread and reach of the FGM messages, especially in the south-eastern states.

Poor cooperation among implementing organizations was noted as another challenge. Respondents drew attention to the loss of time and resources as a result of efforts and structures being duplicated to satisfy each funding partner’s particular requirements.

There is a constrain[t] in multiple partners that are interested in ending FGM. Most of them are not ready to leverage the existing structures; they always want to come and set up [their] own structure … which always results in duplication of efforts, while we have many communities that have not been covered.

KII respondent, Oyo State

As with any other culturally sensitive issue, there will be polarization of opinion, as not all members of the community will be in agreement at the same time. In the case of FGM, some staunch adherents of FGM still exist. The emergence of these dissenting voices poses a great challenge for the effectiveness of key messages of the FGM abandonment campaign. For communities that associate FGM with the preservation of their culture, the FGM abandonment messages are perceived to be part of a western agenda aimed at ensuring the extinction of a long-standing cultural practice. While this is expected in parts of the country, and more so in the process of engineering social change, the resistance to change may involve hostility, which poses a risk for CBOs.

Across communities, there are challenges to implementing anti-FGM laws that have been publicized. The punitive measures that are included in the laws can only be applied when cases of violation are reported. Compliance aimed at community members holding each other accountable to ensure that justice is pursued is almost non-existent. According to respondents, this is largely due to fear of the stigma that will result from reporting a neighbour or brother. For many, the priority is the need for self-preservation. Some respondents argued that there are different levels of difficulty for anyone reporting a neighbour. First is the difficulty of catching someone in an act that is mostly done in secret and second is the reality that the people who ought to inform the appropriate authorities are scared of those they should be reporting. This is further complicated by issues of tribalism and a lack of awareness of who to report the case to.

In faraway villages and hamlets, let’s say for instance a Benue man lives in a Yoruba community and he sees a Yoruba man doing FGM, he would not be able to report because the Yoruba community would threaten to send him out of their village.

CBO representative, Osun State

Across communities, there are challenges in implementing anti-FGM laws that have been publicized.

The lack of documentation of success stories across communities makes it difficult to measure change empirically.

You will discover that as [a] community-based agent, there is an adage they say that, “We don’t go to court and come back to make friends.” Most times when we go for [a] court case, or report somebody to be prosecuted, all of you live within the community. Your children go to the same school together, your families are intertwined, so there will always [be] a stigma associated with the person who makes cases.

CBO representative, Ekiti State

There are people who do not want to report family members practising FGM, so they don’t betray their family and they don’t want them to face the consequence. That’s it, nobody is coming out to say the truth. There has not been total abandonment. The few people that call us on radio and we cannot see them in person, it means if they have any baby girl in their house then they are still going to do it.

Media practitioner, Osun State

Respondents said that proper monitoring, documentation and evaluation were not being done. For them, poor documentation of outcomes and impacts becomes a challenge in measuring programme success. The lack of collective action in monitoring and reporting incidents of FGM means that there is a loss of measurable information.

When the health facilities are submitting their report, I don’t know if they submit the cases of FGM recorded. If they know that at the end of the month they need to record the number of FGM cases at state level – just like they provide the number of immunizations, number of births, number of deaths. If you go to the health centres you will see those charts. If they are also charting the number of girls born within a particular month and you confirm how many of them were never mutilated, that indicator … to regularly to check, rather than just talking.

CBO representative, Ekiti State

The lack of documentation of success stories across communities makes it difficult to measure change empirically. An approach to documentation that involves collective action by key actors, such as hospitals, health-care providers, CBOs and other relevant community groups, can help to address this.

Chapter 5: Cultural analysis

Culture is understood as a way of life that is peculiar to a group, people or period, representing behaviour, ideas and values that are communicated or transmitted from one generation or set of contemporaries to another. Having both universal and distinctive elements, culture is learned and is associated with the social group that upholds it. FGM is an element of culture, framed around culture and practised in a bid to protect the values and beliefs a group of people uphold.

A critical part of this study was to understand the influence that elements of culture have on the elimination of FGM in Nigeria. While it may be difficult to look at the collective culture of communities engaged in this study across states, cultural elements such as behaviour, beliefs and practices offer good scope for the analysis. Through this study, it is evident that culture is critical for defining and understanding FGM, and also for programming of FGM eradication.

Across the study states, an important enquiry was if respondents associated the practice of FGM with identity, religion, health or other factors. An analysis of the interaction between these elements suggests that, while very few respondents immediately selected religion as a factor that drives FGM or identified how FGM is associated with identity, a significantly large number of study respondents identified FGM as a product of culture.

I am not sure [what] FGM has to do with religion. In Osun and Oyo states, I have not heard them say it is because of their religion that make them practise it, most of them see it as traditional practice. These traditional practices are not based on religion. I don’t believe Islam supports women circumcision … also Christianity does not have anything to do with female genital mutilation. What the Bible prescribed is the male circumcision and I think that was where the word circumcision came from. This particular practice is purely traditional. KII respondent, Oyo State

Some of these Muslims that practise FGM believe one Hadith in their Quran supports it, while some Muslims don’t buy the idea. Like the awareness we did last month, which is July, we had a Baale [community leader], a cleric and an analyst of an NGO on the programme. And this Muslim brother was telling the Muslims out there that the Hadith in the Quran they are using to buttress this idea is very wrong and that Allah did not teach them that. Yet some were still arguing with him.

CBO representative, Osun State

The belief that women who have not undergone FGM will be promiscuous is prevalent in all cultures.

Associated with this belief, as expressed by communities, are the values of chastity and marriage.

It suffices to say that even where other factors – religion, health, identity, power and so on – were given as reasons for FGM, they all influence and are influenced by culture, as defined in this chapter. This makes culture the most critical factor in understanding and addressing FGM.

Within the different cultural spaces in the study states, certain similarities, although nuanced in some instances, have driven the practice of FGM. For example, while the five study states are geographically distinct – divided as they are into two geopolitical zones: South West and South East – they also differ in culture and ethnicity. Two major ethnic groups, the Igbo and the Yoruba, occupy these regions, and within each group there are diverse subethnic groups, communities and villages, all of which subscribe to various cultural practices. Nevertheless, while there are cultural differences between these groups, there are also major similarities. Values such as chastity, marriage, fertility, inclusion, beauty, preservation of culture and respect for leadership and family life have been consistently noted as present in all cultures in the study states. These values manifest in beliefs that drive the practice of FGM.

The belief that women who have not undergone FGM will be promiscuous is prevalent in all cultures. Associated with this belief, as expressed by communities, are the values of chastity and marriage. In many of these cultures, FGM is performed as part of the process of social integration of women from one phase of life to another, which is associated with inclusion, another value upheld by many of these cultures. Regardless of their culture, for most women, achieving recognition and socioeconomic security is tied to marriage and childbearing, indicating significant social linkage to FGM. The value of beauty further drives the need to alter female genitalia which, in their natural state, are perceived to be ugly and unsightly and thus need to be enhanced for beauty and cleanliness.

The cultural position of traditional circumcisers who specialize in the circumcision of both male and female genitals in communities is relatively important; they are protected as custodians of cultural practices. Consequently, the drive to eliminate FGM presents a threat, and this informs the notion that a threat to the circumcisers is a threat to cultural preservation.

While there are some consistencies in the meaning and value of FGM, the ways in which FGM is conducted – the rituals, the implements, the location and timing of the act – differ according to communities and their cultural contexts. An underlying feature of all the values and beliefs that have been identified within the cultural context is patriarchy. Though not consciously apparent to many respondents in this study, at the core of their understood purpose of FGM is the need to control women’s sexuality, thereby giving men power over women as a group. Nigeria’s adherence to a patriarchal culture shapes these beliefs (Ogbu, 2018). It can be argued that patriarchal values enable the cultural milieu that allows the continued practice of FGM.

Having recognized the cultural meanings of FGM, to address it implies that cultural perceptions should be modified, along with social norms and beliefs. More importantly, taking the culture of a people into account and harnessing culture for social change is critical to achieving the abandonment and eventual elimination of FGM. This is most relevant in programming for the abandonment of FGM. Presently, organizations recognize that they need to respect culture to be able to change culture. This is evident in the partnerships and collaborations being established with traditional leaders across the communities surveyed in this study.

We have worked in a lot of communities with the traditional heads. When we are talking of female genital mutilation, the belief and culture, you know traditional rulers are the custodians of this culture. You know when we are talking of culture, there is no way Ooni of Ife 8 will be left out. In 2018, a visit was made to Ooni of Ife, courtesy of UNICEF; we were there together. We visited Ooni of Ife, where Ooni of Ife made an affirmative statement (I think it was [made] online and so we can access it all over the world). And in Oyo State, they went to meet Alaafin of Oyo 9 for his own statement. So … with that, and coming back to the community, the same thing happened with the traditional heads, chiefs and the kings.

FGM focal person, Osun State

The inclusion of traditional leaders and the use of existing cultural structures in communities have proven to be an effective strategy for advancing the FGM abandonment campaign. Traditional and community leaders are positioned to mediate between the people, organizations and the state, while offering enabling conditions for change. To advance the sense of ownership of the FGM abandonment programme, which appears to be lacking among respondents in this study, the inclusion of prevailing cultural beliefs, values and practices is recommended to drive change.

Taking the culture of a people into account and harnessing culture for social change is critical to achieving the abandonment and eventual elimination of FGM.

8 Ooni is the traditional ruler of a Yoruba tribe or city or town, in this case, of Ife, which is in Osun State.

9 Alaafin is the traditional ruler of a Yoruba tribe or city or town, in this case, of Oyo, which is in Oyo State.

Chapter 6: Recommendations

A number of recommendations have been identified through this study. These highlight key actions to enhance the effectiveness of efforts being made to encourage the abandonment and eventual elimination of FGM in Nigeria.

Create effective monitoring and evaluation structures

The lack of platforms for establishing rigorous evidence on the practice of FGM and evaluating responses to anti-FGM messaging in Nigeria is noted. A structure that enables information to be gathered from communities, LGAs and the state on FGM practices and programmes will provide a comprehensive source of information on the incidence of FGM, which could be used to aid FGM abandonment efforts by UNJP and other actors.

Establish reporting mechanisms

To encourage communities to report and help track FGM incidence, reporting mechanisms that are easy for community members to adopt should be established. Where a help-seeking or reporting pathway exists – such as a toll-free reporting line for domestic violence – efforts should be made to integrate FGM messaging into it. Such reporting pathways (whether newly established or adapted) should be communicated to communities to encourage robust reporting.

Encourage states to create awareness of and implement the gazetted VAPP Act

Advocate for the implementation of the VAPP Act where it has been domesticated. This would make the law more accessible to the public and promote awareness and understanding of its provisions.

Strengthen the capacity of community actors to implement FGM laws and edicts and to monitor the implementation of their provisions

A true measure of the law is tied to efficacy in convicting violators and achieving justice. Technical and material support should be provided to CBOs, focal persons, FGM champions and other critical actors by developing standard operating procedures to assist them in identifying and processing violators of FGM laws

in their communities. This will facilitate the documentation of convictions and prosecutions in communities and states.

Scale up FGM interventions in hard-to-reach places

There are places in some states that are hard to reach due to limited resources and poor infrastructure. To ensure that no woman or girl is left behind and that no community suffers exclusion from the drive to abandon FGM, tailored programmes should be strategically designed and implemented and effective outreach enabled through collaboration with CBOs and state governments.

Ensure continual anti-FGM engagement

Continual programming of actions and messaging will increase awareness of and reinforce FGM abandonment efforts in communities. It will also contribute to eliminating change in places where opposition to FGM abandonment still exists.

Build alliances with men and boys

Men and boys can be encouraged to act as agents of change by positioning themselves as advocates, amplifiers, sponsors or champions of gender equality. Activities targeted at empowering men and boys with the requisite knowledge and skills to support social and behaviour change regarding FGM in their respective homes and communities should be designed, implemented and/or strengthened. Such activities should integrate reflective practices that enable men and boys to consider their power and privileges and suggest ways to address gender inequality while also committing to the agenda to end FGM.

Empower women and girls

Equipping women and girls with economically valuable skills and education can enhance their participation in decision-making at the household and community levels. Women should be empowered with life skills that can be employed to raise income for them and their households and will help them to exercise their agency. Girls should gain skills that can improve their understanding of their right to bodily autonomy, along with the ability to assertively defend themselves. Furthermore, women’s leadership can be encouraged by empowering women and girls with key leadership skills, thereby incentivizing them to take on leadership roles in their communities.

Strengthen collaboration across sectors

This study identified health-care workers as critical actors in the programme to abandon FGM in states. In particular, increased strategic collaboration should be

Men and boys can be encouraged to act as agents of change by positioning themselves as advocates, amplifiers, sponsors or champions of gender equality.

Insufficient scale of anti-FGM interventions in Nigeria makes it difficult to address those social norms that continue to drive FGM practice.

pursued with the health sector to monitor trends and prevalence of FGM practice. Similarly, stronger partnerships with the justice system would enable its active participation in implementing the VAPP Act across states.

Continually challenge and address social and cultural norms

Insufficient scale of anti-FGM interventions in Nigeria makes it difficult to address those social norms that continue to drive FGM practice. Similarly, long gaps between campaigns hamper the reinforcement of messages. To ensure reinforcement of FGM campaign messages, current efforts should be scaled up in states and communities. Community partners should be supported to steadily implement campaigns and regular social mobilization activities to share information, raise awareness and build knowledge of FGM.

Focus on emerging trends

The shift to Type IV FGM was noted. Attention should be given to understanding this shift, as well as the emerging dynamics of the practice. Conducting studies to gain an adequate understanding of the shift and FGM practice dynamics will enable tailored interventions and programming to address these aspects.

Encourage community ownership of FGM abandonment

A greater sense of responsibility and engagement should be fostered at state and community levels through the direct involvement of individuals in the FGM abandonment programme. It is important that a long-term vision of the programme that aligns with a community’s needs and aspirations is shared to encourage commitment and a sense of ownership.

Support the enforcement of laws and policies

Legal frameworks on FGM at state and community levels are critical to driving a normative shift and promoting more equitable attitudes and behaviours and for penalizing abusers and protecting victims of FGM. State governments and regulatory bodies should be supported to devise more effective ways of ensuring that existing policies and laws on FGM are implemented to the fullest extent.

Chapter 7: Conclusion

This country-level study was designed to elicit information for measuring social norms around FGM practice, prevalence and trends, particularly in the five UNJP implementation states of Ekiti, Ebonyi, Imo, Osun and Oyo with communities with the highest rates of FGM prevalence in girls aged 0–14 years (NPC and ICF, 2019). Five specific objectives were set to guide the study, which saw the adoption and adaptation of the ACT Framework.

The first objective was to assess what people know and feel about FGM by determining their knowledge of and attitudes towards it. The study finds that while awareness of FGM was high, knowledge of FGM, which was measured in different aspects, was lower. Knowledge of the types of FGM was low, as respondents’ knowledge was limited to what is practised in their context or in a framework that included Types I, II and IV only. Knowledge of methods of practice was relatively high, as demonstrated in discussions on the dynamics of traditional and medical methods pertaining to the practice of FGM. Respondents shared their knowledge of the risks associated with FGM from both experiential and learned perspectives. The exposure of respondents to FGM programmes was moderate and their participation in these programmes was assessed as low. While awareness of laws governing FGM was noted (mostly among participants who actively participate in FGM abandonment activities), knowledge of the provisions of anti-FGM laws was low in all the states.

The second objective was to explore the prevalence of FGM and assessed behaviours relating to it. In ascertaining the perceived prevalence rate, study respondents across the states estimated that, on average, fewer than 5 out of 10 girls aged 0–4 years still undergo FGM. Popular opinion indicates a decline in the practice of FGM; however, the realities of its covert continued practise in small pockets was noted. The increasing adoption of Type IV FGM was observed in the south-eastern states, particularly in Imo. Nevertheless, support from respondents to abandon FGM was high and was not threatened by pressure from influential social networks.

The third objective was to ascertain normative factors by identifying perceived social benefits and consequences of practising (or not practising) FGM and perceptions around prevalence. Through a social network mapping exercise, people whose opinion mattered regarding FGM and those who were directly involved in the decision for a girl to undergo FGM were identified as the child’s parents, her grandmother and community leaders. Given that these were the groups of people that were most mentioned in this exercise, it is evident that the decision architecture

Considering its purpose, this study successfully delivered on the set objectives.

that determines a girl-child’s FGM status is influenced by her parents and the leadership of the community in which they live. Respondents noted their support for the discontinuation of FGM practice and indicated their support for social networks that no longer find FGM socially or personally beneficial. No social benefits or rewards were identified to encourage the continuation of FGM in the communities studied; rather, the well-being of women and girls is prioritized.

The fourth objective was to consider social contexts, particularly gender and power, to describe the decision-making process and social contexts in families with regard to supporting FGM or not. Female agency, decision-making power and gender role beliefs, including spousal communication and social support regarding FGM practice, were considered. Respondents defined gender roles in their traditional and socially prescribed forms where men are breadwinners and providers and women are caregivers. Behavioural roles that had men being controlling and in charge of decision-making and women submissive and respectful were noted by respondents. While a spouse was considered to be one of the people most critical to decisionmaking on FGM, not much information was gathered on the dynamics of spousal communication around FGM. Nevertheless, even though men were noted to play an important role in decision-making on FGM, women were not seen as being denied agency and space to make decisions. Sanctions pertaining to FGM, which are given potency by the power of community leaders, are critical in influencing decisionmaking. While such sanctions may have previously been a source of pressure to make parents conform to the practice of FGM, changes in society have created the conditions for sanctions to be largely anti-FGM.

The last objective was to focus on documenting what changes, if any, have taken place with regard to the practice of FGM, including engagement in programme activities, reach of programme messages and encouragement to abandon FGM. The study is cross-sectional and hence does not have a baseline value for comparison. Therefore, opinions from respondents were sought on changes in the practice of FGM as a result of various FGM abandonment activities. Respondents indicated the execution of numerous anti-FGM programmes employing diverse strategies in communities in all the project states. Perceived changes in prevalence can be attributed to these activities and interventions, as community members at different levels participated or were exposed to them. Leveraging existing legislation against FGM and creating awareness of the relevant laws have supported social and behaviour change among the members of society who have expressed commitment towards FGM abandonment. Key success factors and challenges of the FGM abandonment campaign were identified. In line with the findings of this study, some general recommendations have been made.

Considering its purpose, this study successfully delivered on the set objectives. Through this achievement, it establishes standard evidence-based information to support effective FGM programming and decision-making for a strategic and targeted approach that will achieve the desired outcomes for children, particularly girls at risk of FGM.

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Annexes

Annex 1: Sample size

Table A1.1: Number and variety of study areas in the five states

Table A1.2: Number of FGDs and in-depth and key informant interviews held with stakeholder groups at the various levels of the study

Annex 2: Work plan

Table A2.1: Work plan of activities and deliverables and tentative timeline

and deliverables

Phase I: Desk review and inception

Kick-off session with UNICEF and programme team to determine contours of inception phase (including inception report)

Initial desk-review and secondary data analysis

Draft inception report (literature review, study methodology, study matrix, implementation plan and indicative timelines for the deliverables, etc.)

Nov – 12 Dec 2022

2023 Submission for and obtaining of ethical approval

2023

from UNICEF on the inception report

Feb 2023 Revised inception report shared by Ipsos

Second feedback from UNICEF on inception report

Share developed data collection tools by Ipsos

Feedback from UNICEF on tools

Meeting with NTC and other relevant

Mar 2023

Mar 2023

Mar 2023

Mar 2023

July 2023  Qualitative data collection (interviews and FGDs)

Phase III: Data analysis and report writing

Data translation and transcription

In-depth analysis using various analytical tools

Draft study report with recommendations

Feedback from UNICEF and NTC to be incorporated in the report

Presentation of findings

Deliverable: Final study report

Jul – 28 Aug 2023

Aug 2023

Aug – 3 Sept 2023

Sep 2023

Sep 2023

Sep 2023

Oct 2023