Female Genital Mutilation in the Middle East and North Africa Female genital mutilation in the global development agenda SDG 5 Female genital mutilation (FGM) is Achieve gender equality and a violation of human rights. Every empower all girl and woman has the right to be women and girls protected from this harmful practice, a manifestation of entrenched gender inequality with devastating TARGET 5.3 INDICATOR 5.3.2 Eliminate all harmful practices, Proportion of girls and women consequences. FGM is now firmly on such as child, early and forced aged 15 to 49 years who have the global development agenda, most marriage and female genital undergone female genital mutilation mutilation prominently through its inclusion in Sustainable Development Goal (SDG) target 5.3, which aims to eliminate the practice by 2030. 02 | Female Genital Mutilation in the Middle East and North Africa KEY FACTS about FGM Almost 50 million girls and women have undergone female genital mutilation in five practising countries in the Middle East The prevalence of FGM varies from and North Africa, accounting for one quarter of the global total 94 per cent in Djibouti to 7 per cent in Iraq Age at cutting varies across countries in the region; in FGM is highly medicalized in Egypt and Sudan Yemen it most often occurs Less than half where almost 8 in 10 girls are cut in the first week of life, of women support the by medical personnel, whereas traditional while in Egypt it is most likely to continuation of FGM in most practitioners are responsible for most cutting in occur in adolescence countries in the region Djibouti, Iraq and Yemen Countries in the Middle East and North Africa have made great To reach the SDG target of eliminating FGM by 2030, strides in reducing FGM in the past generation, but the average the rate of progress in the region would need to be prevalence remains among the highest in the world 15 times faster Female Genital Mutilation in the Middle East and North Africa | 03 CURRENT LEVELS OF FGM Almost 50 million girls and women have undergone FGM in five countries in the Middle East and North Africa, accounting Egypt, 31 million for one quarter of the global total Middle East and FIG. 1 Number of girls and women of all ages who have North Africa undergone FGM 49 million Sudan, 14 million Other countries, 44 million Yemen, 2 million Iraq, 1 million Djibouti, 400,000 Nigeria, 17 million Other regions 152 million Ethiopia, 25 million Indonesia, 65 million Notes: Due to rounding, displayed values may not add up to the total. Countries included in the analysis are those with nationally representative prevalence data on FGM. 04 | Female Genital Mutilation in the Middle East and North Africa The prevalence of FGM varies in the Middle East and North Africa from 94 per cent in Djibouti to 7 per cent in Iraq FIG. 2 Percentage of girls and women aged 15 to 49 years who have undergone FGM Available data from large-scale representative surveys show that the practice of FGM is highly concentrated in a small number of countries. FGM is a human rights issue that affects girls and women worldwide however, including in additional countries in the Middle East and North Africa. Prevalence data on FGM are not available for these additional countries, but local and small- scale research studies provide an indication of the existence of the practice, including in Oman, Saudi Arabia and the United Arab Emirates. For more detail, see: Cappa, Claudia, Luk Van Baelen and Els Leye, ‘The Practice of Female Genital Mutilation Across the World: Data availability and approaches to measurement’, Global Public Health, vol. 14, no. 8, 2019, pp. 1139–1152. 94% 87% 87% 19% 7% Djibouti Egypt Sudan Yemen Iraq Female Genital Mutilation in the Middle East and North Africa | 05 In Yemen, the prevalence of FGM varies from 85 per cent in Al-Mhrah to almost zero per cent in Al-Baidha FIG. 3 Percentage of girls and women aged 15 to 49 years who have undergone FGM, by governorate 70% or more 50–69% 30–49% 10–29% 1–9% Less than 1% In Iraq, the practice is concentrated in the north-east, particularly Erbil and Sulaimaniya FIG. 4 Percentage of girls and women aged 15 to 49 years who have undergone FGM, by governorate 06 | Female Genital Mutilation in the Middle East and North Africa FGM is found more often among those living in rural areas, the poorest households and populations with less education; however, in Iraq, FGM is most common among the richest wealth quintile, and in Sudan, those with more education have a higher prevalence FIG. 5 Percentage of girls and women aged 15 to 49 years who have undergone FGM, by place of residence, wealth quintile and education Djibouti Egypt Sudan Yemen Iraq Djibouti Egypt Sudan Yemen Iraq Egypt Djibouti Sudan Yemen Iraq 100 98 97 98 97 97 94 94 93 93 92 92 87 88 85 84 80 77 77 70 60 40 26 22 22 19 20 17 14 13 11 8 7 6 1 0 Residence Wealth quintile Education Rural Urban Poorest Richest No education Secondary or higher Note: The prevalence by education in Djibouti is calculated among ever-married women only; data were not collected on the education level of never-married women. Female Genital Mutilation in the Middle East and North Africa | 07 Levels of FGM among girls under age 15 vary across countries in the region FIG. 6a Percentage of girls aged 0 to 14 years who have undergone FGM Djibouti 43% Sudan 30% Egypt 14% Information collected on FGM about girls under Iraq 1% age 15 reflects their current, but not final, FGM status. Some girls who have not been cut may still be at risk once they reach the customary age for cutting. Therefore, the data on prevalence for girls under age 15 is an underestimation of the true FIG. 6b Percentage of ever-married girls and women aged 15 to 49 extent of the practice. years with at least one living daughter who has undergone FGM Since age at cutting varies among settings, the amount of underestimation also varies. This should be kept in mind when interpreting all Yemen 16% FGM prevalence data for this age group. Note: In Egypt, data refer to girls aged 6 months to 14 years. 08 | Female Genital Mutilation in the Middle East and North Africa CIRCUMSTANCES AROUND FGM Practitioners, types of FGM and age at cutting FGM is highly medicalized in Egypt and Sudan, where almost 8 in 10 girls are cut by medical personnel, whereas traditional practitioners are responsible for most cutting in Djibouti, Iraq and Yemen FIG. 7 Percentage distribution of girls aged 0 to 14 years who have undergone FGM, by practitioner Egypt 78 21 0.3 Sudan 77 20 3 Yemen 13 85 3 Djibouti 4 92 3 Iraq 3 81 16 Practitioner: Medical personnel Traditional practitioner Other/don’t know/missing Notes: Data for Yemen refer to the percentage distribution of practitioners among ever-married girls and women with at least one living daughter who has undergone FGM. Data for Egypt refer to girls aged 6 months to 14 years. Due to rounding, individual figures may not add up to 100. Female Genital Mutilation in the Middle East and North Africa | 09 FGM is increasingly occurring at the hands of medical personnel in Egypt and Sudan FIG. 8 Percentage of cut girls and women aged 0 to 49 years who underwent FGM by a medical practitioner, by age Egypt 100 (80) 80 78 78 68 60 57 48 42 40 30 23 20 17 0 45–49 years 40–44 years 35–39 years 30–34 years 25–29 years 20–24 years 15–19 years 10–14 years 5–9 years 6 months – 4 years Sudan 100 80 80 78 76 74 68 64 59 60 60 56 51 40 20 0 45–49 years 40–44 years 35–39 years 30–34 years 25–29 years 20–24 years 15–19 years 10–14 years 5–9 years 0–4 years Notes: Values presented here are based on at least 25 unweighted cases. Those based on 25 to 49 unweighted cases are shown in parentheses. Information collected on FGM about girls aged 0 to 14 years reflects their current, but not final, FGM status, since some girls who have not been cut may still be at risk of experiencing the practice once they reach the customary age for cutting. Therefore, the results among girls under age 15 should not be read as a complete assessment of the degree of medicalization among this age group. 10 | Female Genital Mutilation in the Middle East and North Africa Among cut girls, 9 in 10 Iraq experienced flesh removal 89% Cut, flesh removed in Iraq and Yemen Cut, no flesh removed/nicked FIG. 9 Percentage distribution of girls 9% aged 0 to 14 years who have undergone FGM, by type of FGM 1% Sewn closed 1% Don’t know Yemen FIG. 10 Percentage distribution of 88% Cut, flesh removed ever-married girls and women aged 15 to 49 years with at least one living daughter who has undergone FGM, 11% Cut, no flesh removed by type of FGM 1% Don’t know/missing Note: Data on type of FGM among girls under age 15 were not available in the most recent surveys for the other countries in the region. Female Genital Mutilation in the Middle East and North Africa | 11 Age at cutting varies across countries in the region; FGM occurs earliest in Yemen, while in Egypt it is most likely to occur in adolescence FIG.