Prevalence and factors associated with generational transition of female genital mutilation in The Gambia: Evidence from the 2019–2020 demographic and health survey

Background

Female genital mutilation (FGM) presents a dual challenge in The Gambia, constituting a human rights abuse and a major public health concern. Despite legislative efforts and global advocacy, the magnitude of FGM among women of reproductive age remains high. This study examined the prevalence and factors associated with the generational transition of FGM in The Gambia.

Methods

The study analysed data from the 2019–2020 Gambia Demographic and Health Survey (GDHS). We included a final sample of 5272 mother–daughter pairs. We defined generational transition of FGM as ‘women of reproductive age (15–49 years) who were circumcised and had at least one daughter circumcised’. Sample characteristics and prevalence of generational transition FGM among women and their daughters were summarised using frequencies and percentages. Bivariate and multilevel logistic regression analyses were used to examine the factors associated with the generational transition of FGM in The Gambia.

Results

The prevalence of generational transition FGM in The Gambia was 69.7% (95% CI: 66.9, 72.5). The prevalence was highest among women aged 35–49 years, 72.3% (95% CI: 68.5–75.9), those with no formal education, 74.5% (95% CI: 70.9–77.8), and those in union 71.6% (95% CI: 68.6, 74.5). The prevalence was fairly distributed across the wealth index quintile. Factors associated with increased odds of generational transition FGM included women aged 35–49 years (adjusted odds ratios [aOR]: 3.88, 95% CI: 2.93–5.52), being in a marital union (aOR: 1.96, 95% CI: 1.45–2.64), and living in clusters with high FGM support (aOR: 1.89, 95% CI: 1.31, 2.73). Conversely, secondary and higher education levels (aOR = 0.71, 95% CI: 0.57–0.89) and the richest wealth index (aOR = 0.42, 95% CI: 0.28–0.64) were protective factors against transitional FGM.

Conclusion

FGM persists in The Gambia due to a complex interplay of maternal characteristics, cultural expectations and community norms. Targeted multilevel interventions, particularly those that expand access to education, engage male partners and challenge collective attitudes, are essential to disrupt this generational transmission. Future studies should qualitatively explore the reasons behind the generational transition to inform the design of targeted interventions that can interrupt the FGM cascade.