A Profile of Female Genital Mutilation in Ethiopia

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A Profile of Female Genital Mutilation in Ethiopia Female genital mutilation in the national and global development agenda SDG 5 Every girl and woman has the right Achieve gender equality and to be protected from female genital empower all mutilation (FGM), a manifestation of women and girls entrenched gender inequality with devastating consequences. FGM is a violation of human rights and has been TARGET 5.3 INDICATOR 5.3.2 Eliminate all harmful practices, Proportion of girls and women prohibited in Ethiopia’s criminal code such as child, early and forced aged 15 to 49 years who have since 2004. FGM is now firmly on marriage and female genital undergone female genital mutilation mutilation the global development agenda, most prominently through its inclusion in Sustainable Development Goal (SDG) target 5.3, which aims to eliminate the practice by 2030.

02 | A Profile of Female Genital Mutilation in Ethiopia KEY FACTS

about FGM

Overall, 65 per cent of girls and women aged 15 to 49 years In Ethiopia, 25 million girls and women have undergone FGM, have been subjected to FGM. Among adolescent girls aged 15 the largest absolute number in Eastern and Southern Africa to 19 years, 47 per cent have undergone the practice

FGM is less common today than in The risk of FGM depends on certain Most people in Ethiopia think previous generations, now affecting background characteristics. Girls FGM should stop. The 5 in 10 adolescent girls aged 15 to and women from rural areas and proportion of those opposing FGM 19 years compared to nearly 9 in 10 around those with less education are has significantly increased 1970. Since 2000, the country has seen at greater risk since 2000 faster progress in abandoning the practice

Ethiopia’s progress towards ending FGM has been faster than other high-prevalence countries in Eastern and Southern Africa. Still, eliminating FGM by 2030 will require accelerated action. Progress must be eight times faster than that observed in the past 15 years in order to reach SDG target 5.3

A Profile of Female Genital Mutilation in Ethiopia | 03 Meskerem Muleta, 16, is a Grade 7 student in SNNP region. She is well known in her neighbourhood for advocating against FGM. Meskerem uses the gender club at her school to speak about her story of avoiding FGM, and her family’s transformation into advocates against the practice. She wants to be a women’s rights activist, and hopes to find more platforms to speak against FGM and empower girls in Ethiopia. Current levels of FGM

Ethiopia is home to 25 million girls and women who have experienced FGM. More than half are in the regions of Oromia and Amhara. Overall, 65 per cent of girls and women aged 15 to 49 have undergone FGM. The highest prevalence is in the Somali (99 per cent) and Afar (91 per cent) regions

FIG. 1 Percentage of girls and women aged 15 to 49 years who have undergone FGM (map) and number of girls and women of all ages who have undergone FGM (circles)

730,000 Tigray 790,000 Across Ethiopia, 16 per cent of girls 7 million under age 15 have Afar undergone FGM. 1 million Amhara Information collected on FGM among girls 220,000 Benishangul-Gumuz 150,000 under age 15 reflects 80,000 their current but not Dire Dawa Harari final FGM status. Some Addis Ababa girls who have not been cut may still be at risk once they reach 50,000 Gambela Oromia the customary age for Somali cutting. Therefore, the SNNPR data on prevalence for this age group are an underestimation of the true extent of the 4 million 90 per cent or more 2 million practice. Since age at cutting varies among 70 to 89 per cent settings, the amount of 50 to 69 per cent underestimation also 9 million varies (see Figure 5). 30 to 49 per cent

Less than 30 per cent

Notes: The boundaries, names and designations used on the map do not imply official endorsement or acceptance by the United Nations. SNNPR stands for Southern Nations, Nationalities, and People’s Region. Due to rounding, individual figures may not add up to total.

A Profile of Female Genital Mutilation in Ethiopia | 05 Ethiopia does not rank among the countries with the highest levels of FGM in Eastern and Southern Africa, but it is home to the largest absolute number of girls and women who have undergone the practice in the region FIG. 2 Percentage of girls and women aged 15 to 49 years (bars) and number of girls and women of all ages (dots) who have undergone FGM in countries in Eastern and Southern Africa

100 98 94

87 83 80

25 M 21 20 14 M 10 6 M 4 M 1 M 2 M 0.4 M 0.3 0 0.2 M

Somalia Djibouti Sudan Eritrea Ethiopia Kenya United Republic Uganda of Tanzania

Notes: M stands for million. The chart includes all countries in Eastern and Southern Africa with available data on the prevalence of FGM. See technical notes for details.

06 | A Profile of Female Genital Mutilation in Ethiopia Girls and women from rural areas, with less education or who identify as Muslim are more likely to have undergone FGM FIG. 3 Percentage of girls and women aged 15 to 49 years who have undergone FGM, by residence, wealth quintile, education and religion

Residence Wealth quintile Education Religion

100

82 80 73 71 68 70 66 65 66 62

60 57 (58) 54 (55) 54 50 51

(10)

0 Rural Other Urban Fourth Higher Middle Richest Second Muslim Poorest Primary Catholic Orthodox Protestant Traditional Secondary No education

Notes: Values presented here are based on at least 25 unweighted cases. Those based on 25 to 49 unweighted cases are shown in parentheses.

A Profile of Female Genital Mutilation in Ethiopia | 07 Circumstances around FGM Practitioners, types of FGM, and age at cutting

Nearly all FGM in Ethiopia is performed by traditional practitioners (89 per cent), while medical personnel rarely perform the practice (2 per cent)

SNNPR is the only region in which there is some involvement of medical personnel: 1 in 10 women who underwent FGM there were cut by a doctor, nurse, midwife or other health professional

Note: Values on this page refer to the percentage of cut women aged 20 to 24 years who were cut by specific types of practitioners.

08 | A Profile of Female Genital Mutilation in Ethiopia Removing flesh is the most common form of FGM in Ethiopia. The most severe form of FGM, in which the vaginal opening is sewn closed, is common in the Somali and Afar regions, but rare elsewhere FIG. 4 Percentage distribution of women aged 20 to 24 years who have undergone FGM by type of FGM performed, by region and religion

Type of FGM: Sewn closed Cut, flesh removed Cut, no flesh removed/nicked Don’t know/not determined

2 3 4 1 6 7 11 6 2 14 14 17 2 4 28 27 28 1 2 3 36 21 35

3 5 4

91 86 71 88 80 73 85

65 69 68 67 62 56

13 7 6 5 5 5 2 1 3 3

Afar Somali SNNPR Harari Amhara Dire Dawa Benishangul- Addis Ababa Oromia Muslim Protestant Orthodox Gumuz Ethiopia Region Religion

How to read this figure:Among young women in Ethiopia who have been cut, 7 per cent were sewn closed, 73 per cent were cut with flesh removed, 3 per cent were nicked, or cut with no flesh removed, and for the remaining 17 per cent the type of cutting was not determined.

Notes: Values presented here are based on at least 25 unweighted cases. Data for some regions and religious groups are suppressed due to insufficient numbers of cases to perform the analysis. Due to rounding, individual figures may not add up to 100.

A Profile of Female Genital Mutilation in Ethiopia | 09 Nearly half of cut women underwent FGM when they were younger than 5 years old, whereas nearly 3 in 10 were cut after age 10; age at cutting varies substantially by region and religion

FIG. 5 Percentage distribution of women aged 20 to 24 years who have undergone FGM by age at cutting, by region and religion

Age at cutting: Before 5 years 5 to 9 years 10 to 14 years At or after 15 years Don’t know/missing

3 3 3 3 2 4 5 1 7 6 5 6 2 10 9 9 1 3 4 12 4 13 11 6 14 7 8 4 24

18 13

18 21 36 30 31 26 27

96 54 84 83 27 26 31 25 33 75 65 45

29 28 27 25 22 21 10

Amhara Afar Benishangul- Addis Ababa Dire Dawa Oromia SNNPR Somali Harari Orthodox Muslim Protestant Gumuz Ethiopia Region Religion

How to read this figure:Among young women in Ethiopia who have been cut, 44 per cent were cut before age 5 years, 22 per cent were cut between ages 5 and 9 years, 18 per cent were cut between ages 10 and 14 years, 11 per cent were cut at age 15 years or older, and for the remaining 5 per cent the age at cutting was unknown.

10 | A Profile of Female Genital Mutilation in Ethiopia Alemnesh Bekele, gender club leader, with club members during a discussion on ending harmful practices affecting girls at Gesa Primary School, Hula Woreda, SNNP region.

A Profile of Female Genital Mutilation in Ethiopia | 11 Opinions on FGM

The majority of Ethiopians think FGM should stop FIG. 6 Percentage of girls and women and boys and men aged 15 to 49 years who have heard of FGM and think the practice should stop, by age

Girls and women Boys and men

85% 87% 15 to 19 years 15 to 19 years

One in four girls and women and one in six boys and men believe FGM is a religious requirement. This belief is most likely among older women, and in the Afar and Somali regions. It 71% 83% is more common 45 to 49 years 45 to 49 years among Muslims than Christians.

79% 87% 15 to 49 years 15 to 49 years

Note: Data on opinions by age cohort should not be interpreted as trends, since they represent opinions at the moment of the survey that are subject to change through a respondent’s lifetime.

12 | A Profile of Female Genital Mutilation in Ethiopia Rural Higher 96 99 76 85 Urban 91 Opposition to FGM is 94 common across population Secondary groups, though those in urban 93 94 areas, in richer households and with more education are most likely to oppose it

62 87 Re Poorest sid en FIG. 7 Percentage of girls and women c n e io and boys and men aged 15 to 49 years t a Primary c who have heard of FGM and think the u

practice should stop, by residence,

wealth quintile and education

78 alth We 74 Girls and women Boys and men

No education

83 Second

79 93

84 91 Richest 82 89 Middle

Fourth

A Profile of Female Genital Mutilation in Ethiopia | 13 While only 3 in 10 girls and women opposed FGM in 2000, 8 in 10 girls and women in 2016 reported the practice should stop

FIG. 8 Percentage of girls and women aged 15 to 49 years who have heard of FGM and think the practice should stop, by age

15 to 49 years 15 to 19 years 45 to 49 years

100

80 79

72 71

60 54

40 36

23 20

0 2000 2005 2016 2000 2005 2016 2000 2005 2016

14 | A Profile of Female Genital Mutilation in Ethiopia Hasna Ahmed, 16, Lek’o Ali, 19, and Fatuma Ali, 15, attend an adolescent gender club in Afar, discussing harmful practices. Lek’o says, “I want to teach the public. FGM has to end in my community.”

A Profile of Female Genital Mutilation in Ethiopia | 15 Generational trends in reducing FGM

The prevalence of FGM among adolescent girls aged 15 to 19 has dropped from nearly 9 in 10 to fewer than 5 in 10 since the 1970s, with an acceleration after 2000

FIG. 9 Percentage of adolescent girls aged 15 to 19 years who have undergone FGM

100

87 As shown in Figure 5, 83 about 11 per cent of 83 82 cutting occurs after 80 77 77 age 15. 74 Thus the percentage of 65 adolescent girls aged 15 to 19 years who 59 have undergone FGM 60 is unlikely to reflect the complete prevalence of 47 the practice among this cohort, as some girls are still at risk of FGM. 40

0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

Note: See technical notes for details.

16 | A Profile of Female Genital Mutilation in Ethiopia Ethiopia’s progress towards ending FGM in the past three decades has been faster than other high-prevalence countries in Eastern and Southern Africa

FIG. 10 Average annual rate of reduction and current prevalence of FGM, i.e. the percentage of girls and women aged 15 to 49 who have undergone FGM

Country Average annual rate of reduction of FGM (%) Current prevalence of FGM (%)

Uganda 4.6 0.3

United Republic of Tanzania 4.6 10

Kenya 4.3 21

Ethiopia 1.7 65

Eritrea 1.0 83

Sudan 0.4 87

Djibouti 0.4 94

Somalia 0.1 98

Notes: This figure includes all countries in Eastern and Southern Africa with nationally representative data on the prevalence of FGM. Countries are ranked from highest to lowest according to the 30-year average annual rate of reduction.

A Profile of Female Genital Mutilation in Ethiopia | 17 The greatest reduction in the prevalence of FGM has been in Oromia and Addis Ababa; levels have not changed significantly in Afar, Somali, SNNPR and Gambela FIG. 11 Percentage of adolescent girls aged 15 to 19 years who have undergone FGM, by region

(100) (100) 100 95 95 (92) 1991 2016 88

80 (78) 76 (75)

63 61 60

50 50 46 43 42 (40) 40 39

20 19

0 Afar Somali Oromia Dire Dawa Benishangul- Amhara Addis Ababa SNNPR Tigray Gambela Gumuz

Notes: Values presented here are based on at least 25 unweighted cases. Those based on 25 to 49 unweighted cases are shown in parentheses. Those with fewer than 25 unweighted cases at one or both points in time are suppressed. Regions identified in the title as having no significant change have values for the two points in time that are not significantly different from one another.

18 | A Profile of Female Genital Mutilation in Ethiopia Looking ahead towards elimination

If progress in the past 15 years continues, the prevalence of FGM could fall to beneath 30 per cent by 2030 How to read the projections FIG. 12 Observed and projected percentage of adolescent girls aged 15 to 19 years who have undergone FGM Figures 12 to 14 show how the prevalence of FGM has changed since around 1970, as well as scenarios that could occur in 100 the future. Figure 12 highlights how the Percentage of adolescent percentage of girls and women who have girls aged 15 to 19 years undergone FGM has changed and could who have undergone FGM continue to change through 2050. Figures 87 13 and 14 show progress in observed rates 82 of reduction and rates required to meet 80 elimination targets. 74 In Figure 12, the projections build on existing trends to show expected values if progress from the past 30 years continues (in light blue), or if progress from the past 15 years continues (in purple). The slower 60 progress in the past 30 years makes this the less ambitious of the two scenarios. A more Percentage of adolescent girls ambitious scenario (in dark blue) projects an 47 aged 15 to 19 years who are acceleration at twice the rate of progress expected to undergo FGM if: observed over the past 15 years. In Figures 13 and 14, the observed average 40 36 Progress in the past annual rates of reduction quantify the rate 30 years continues of progress over each period. A higher rate 29 indicates faster progress. Required rates Progress in the past are calculated to illustrate what would be 26 15 years continues necessary to eliminate the practice by 2025 – the Government of Ethiopia’s target 20 18 – or by 2030, target 5.3 of the SDGs. In Progress is accelerated 15 each case, the rate required to eliminate the practice by 2025 is higher than the corresponding rate for 2030, since a faster 5 rate would be needed to reach the same level in a shorter period. 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Note: See technical notes for details.

A Profile of Female Genital Mutilation in Ethiopia | 19 Compared to the rate of decline in the last 15 years, progress would need to be eight times faster to eliminate the practice by 2030, and 13 times faster to eliminate the practice by 2025 FIG. 13 Average annual rate of reduction (per cent) in the percentage of adolescent girls aged 15 to 19 years who have undergone FGM, observed and required for elimination

30 years 1.7

Observed in the past:

15 years 3.3

2025 42.8

Required for elimination by:

2030 27.5

0 10 20 30 40 50 60

20 | A Profile of Female Genital Mutilation in Ethiopia Ending FGM by 2030 calls for accelerating progress in all regions; however, the least acceleration will be needed in Tigray, Gambela and Addis Ababa, and the most acceleration will be needed in Somali, Afar and Dire Dawa

FIG. 14 Average annual rate of reduction (per cent) in the percentage of adolescent girls aged 15 to 19 years who have undergone FGM, observed and required for elimination, by region

Observed in the past 30 years Observed in the past 15 years Required for elimination by 2025 Required for elimination by 2030

49.8 50.6 50 45.5 45.7 42.6 43.4 43.4 40.7 41.9 40 35.5 32.8 32.0 32.5 29.3 29.4 30 27.4 27.9 27.9 26.1 26.9 22.8 21.1 20

10 4.8 2.63.4 3.6 3.2 3.0 1.6 2.2 1.9 2.4 2.1 1.8 2.8 0.8 1.4 1.2 1.4 1.6 0.4 0.3 0.2 0.3 0 Acceleration of Tigray Gambela Addis Benishangul- Oromia SNNPR Amhara Harari Dire Dawa Afar Somali progress needed Ababa Gumuz to eliminate FGM by 2030, compared to progress in the 6 6 8 9 6 13 15 11 19 93 101 past 15 years

How to read this figure:In Amhara, for example, progress would need to be 15 times faster than the rate observed over the past 15 years in order to eliminate FGM by 2030.

Even though their prevalence levels are not among the highest in the country, some populous regions are home to large numbers of affected girls and women (Figure 1). They will need urgently to address FGM for Ethiopia to reduce the total number of affected girls and women.

A Profile of Female Genital Mutilation in Ethiopia | 21 Ethiopia’s programme to end FGM

Ethiopia’s programme to end FGM contributes to the national commitment to end child marriage and FGM by 2025, and to achieve SDG target 5.3 by 2030. The programme is led by the Ministry of Women, Children and Youth as well as the National Alliance to End FGM and Child Marriage, which engages other ministries, civil society, non-governmental organizations and UN entities. Building on the country’s Constitution and strong legal framework to promote and protect girls’ and women’s rights, a National Costed Roadmap to End Child Marriage and Female Genital Mutilation/Cutting (2020-2024) was developed. It has five evidence-based strategies:

1. Empowering adolescent girls to express and exercise their choices, psychosocial support and referral linkages for survivors. Mothers, especially and their families to protect their children from FGM. Through adolescent mothers, should be engaged and supported to access learning clubs and platforms for girls in and out of school, adolescent girls are opportunities. The capacity of service providers to respond to cases of supported to improve their legal literacy, knowledge and life skills, and FGM and to act as advocates against FGM is also strengthened. aquire information on the harmful social and health impacts of FGM. This will help ensure that they have support networks and role models who 4. Creating and strengthening an enabling environment that protects the increase their confidence, voice and agency to resist harmful practices. rights of girls and supports national efforts to end FGM. Law enforcement is reinforced with efforts to raise legal awareness and prosecute those who violate 2. Strengthening community engagement (including faith and traditional the law. These measures are supported by effective multi-sectoral coordination leaders) for increased social action to support girls and generate shifts in and accountability mechanisms at all levels (from federal to kebele), including social expectations relating to the elimination of FGM. This is done through through platforms such as Anti-Harmful and Traditional Practices committees, interpersonal and community-level communication, mass media outreach on the community surveillance mechanisms and women’s development groups, adverse health and social impacts of FGM, and approaches that address the root which contribute to following newborn girls to ensure that they remain uncut, causes of gender inequality and advance the rights of girls. Community elders and to report cases. At the federal level, this includes the National Alliance and religious leaders, institutions, the social service workforce, health extension to End FGM and Child Marriage. Increased budget allocations and enhanced workers, teachers, women’s groups and community-based organizations are expenditure tracking systems are also promoted. Given the cross-border mobilized to reach families and caregivers. Boys and men are specifically engaged dimensions of FGM, engagement with neighbouring countries is important. on positive masculinities and healthy relationships. Eventually these efforts should be reflected in communities’ readiness to abandon harmful practices as assessed 5. Increasing data and evidence generation and use for advocacy, by the Ministry. Such gender and social norms change within communities is programming, learning and tracking progress to end FGM. This includes critical to prevent the practice from going underground given its criminalization. implementing a comprehensive monitoring and evaluation framework encompassing administrative data collection, the Ethiopian Demographic 3. Enhancing systems, accountability and services across sectors that and Health Surveys, and the development and application of measurement are responsive to the needs of girls at risk of or affected by FGM. This tools to monitor social norms change at the community level. Partnerships includes access to adolescent-friendly health and sexual and reproductive with research entities and basic and applied research are supported for health and rights information and services, and to services including legal, documentation, publication and dissemination of good practices.

22 | A Profile of Female Genital Mutilation in Ethiopia Technical Notes Data Sources To assess the prevalence of FGM, this analysis used SDG indicator FGM data are from the Demographic and Health Surveys in 2000, 2005, 2011 and 2016. 5.3.2 – the proportion of girls and women aged 15 to 49 years who Demographic data are from the United Nations, Department of Economic and Social have undergone the practice. Affairs, Population Division, World Population Prospects 2019, Online Edition, 2019, and the Federal Democratic Republic of Ethiopia Population Census Commission, Report of the The number of girls and women who have undergone FGM 2007 Population and Housing Census: Population Size by Age and Sex. is calculated based on the population in 2018. Data presented according to religion are based on self-reported religious identities of respondents, including those who identify their religion as ‘traditional’. Acknowledgements Confidence intervals are not shown in this publication. Caution is therefore warranted in interpreting the results since apparent This data brief was prepared by the Data and Analytics Section of UNICEF (Claudia Cappa, differences among groups may not be significant. Key message titles Colleen Murray and Hyunju Park) with inputs from the Ethiopia Country Office, the Ministry for figures were developed in light of the confidence intervals for of Women, Children and Youth, and members of the National Alliance to End FGM and ECM. all values. Where the title indicates that there is a difference among groups, it has been confirmed as statistically significant.

Data on the circumstances around FGM in Ethiopia are presented here as measured among women aged 20 to 24 years. Yet cutting can occur well into adolescence, so any estimates among girls or women under age 20 would exclude populations that tend to perform FGM FDRE Ministry of Women, when girls are older. Children and Youth

Data on attitudes towards FGM from DHS 2000 and 2005 have been recalculated to exclude the opinions of women who have never heard Suggested Citation of the practice, thus results may differ from those presented in the DHS reports. United Nations Children’s Fund, A Profile of Female Genital Mutilation in Ethiopia, UNICEF, New York, 2020. Trends in the national prevalence of FGM in Figures 10 and 13 were calculated with data from the Ethiopia Demographic and Health Surveys in 2000, 2005, 2011 and 2016. Calculations of the average annual rate of reduction over the last 30 years and the last 15 years in Photo Credits Figures 14 and 15 relied on an age-cohort analysis based on data from Cover: © UNICEF/UN0140827/Mersha the latest available Demographic and Health Survey in 2016. Aisha Ousman,14 years old, is from Erubti Woreda in Afar. Aisha has been cut and Projected values based on a continuation of observed progress apply infibulated. She is the oldest girl in her family, and among her sisters, it is only Aisha who the average annual rate of reduction in the prevalence of FGM, or the was cut. After Aisha suffered severe medical complications, her parents decided not to percentage of girls aged 15 to 19 years who have undergone FGM, subject her sisters to FGM. over the past 30 years and over the past 15 years. The acceleration Page 4: © UNICEF Ethiopia/2019/Tadesse scenario assumes a doubling of the observed annual rate of reduction Page 8: © UNICEF/UN0140859/Mersha over the past 15 years. For statistical purposes, ‘elimination’ is defined Page 11: © UNICEF Ethiopia/2019/Tadesse as a prevalence of less than 1 per cent. Page 14: © UNICEF Ethiopia/2019/Tadesse

A Profile of Female Genital Mutilation in Ethiopia | 23 For information on the data in this brochure: For information on FGM in Ethiopia:

UNICEF Ministry of Women, Children and Youth UNICEF Ethiopia Data and Analytics Section National Alliance to End FGM and ECM P.O. Box 1169 Division of Data, Analytics, Planning and Monitoring P.O. Box 1293 Addis Ababa, Ethiopia 3 United Nations Plaza Addis Ababa, Ethiopia Telephone: +251 11 5184000 New York, NY 10017, USA Telephone: +251 11 8591421 or +251 11 8269293 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Website: unicef.org/Ethiopia Website: data.unicef.org Facebook: https://www.facebook.com/Ministry-of- Women-and-Children-Affairs-1574468536107434/